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Introduction
Preliminary image evaluation (PIE) is a mechanism whereby radiographers provide a preliminary evaluation of whether pathology is present in their radiographs, typically acquired within the emergency department (ED). PIE provides referrers with a timely communication of pathology prior to the availability of a radiology report. The purp...
Citations
... 4 A recent study by Alexander-Bates et al. further investigated the common FN PIE errors in the hopes to lead more content-focused education for radiographers. 5 The study discovered that phalanges of the hand and feet accounted for the most interpretive errors from radiographers. More recently, Petts et al. 6 compared and combined the accuracy of radiographer's X-ray interpretation with emergency clinicians. ...
... The most common regions that produced FP errors were the foot, ankle, and chest. Like Alexander-Bates, 5 the lower extremities were the most common area of misinterpretation. Although the study discussed FN errors, difficulty in interpreting X-rays in extremities can be attributed to the fact that these are anatomically dense areas with smaller structures. ...
Introduction
Diagnostic errors in the emergency departments can have major implications on patient outcomes. Preliminary Image Evaluation (PIE) is a brief comment written by a radiographer describing an acute or traumatic pathology on a radiograph and can be used to complement referrer's image interpretation in the absence of the radiologist report. Currently, no studies exist that focus their analysis on false‐positive (FP) errors in PIE. The purpose of this study was to investigate the regions of the body that cause the most FP errors and recognise other areas in image interpretation that may need additional attention.
Methods
A longitudinal retrospective clinical audit was conducted to determine the accuracy of radiographer PIE's over 5 years from January 2016 to December 2020. PIE's were compared to the radiologist report to assess for diagnostic accuracy. FP and unsure errors were further categorised by anatomical region and age.
Results
Over this period, a sample size of 11,090 PIE audits were included in the study demonstrating an overall PIE accuracy of 87.7%. Foot, ankle and chest regions caused the most FP errors, while ankle, shoulder and elbow caused the most unsure cases. 76% of the unsure cases were negative for any pathology when compared to the radiologist report. The paediatric population accounted for 21.3% of FP cases and 33.6% of unsure cases.
Conclusion
Findings in this study should be used to tailor education specific to radiographer image interpretation. Improving radiography image interpretation skills can assist in improving referrer diagnostic accuracy, thus improving patient outcomes.
... 10,11 To date, there have been no studies specifically assessing the possibility of extending the scope of the PCE service to include other body parts that often present with traumatic mechanisms of injury, such as the chest. Recent research has indicated the inclusion of the chest X-ray (CXR) in a PCE system in at least one institution 6,12 though there has been no published assessment of performance showing how, or if, training can improve radiographers' abnormality detection and/or commenting accuracy. ...
... However, chest examinations account for the biggest proportion of non-participation in a PCE system, accounting for 53% of all instances. 12 Interestingly, the study by Alexander-Bates et al. 6 also indicated that traumatic chest examinations had the highest percentage of participants who were unsure or never provided a comment for a CXR examination, possibly due to reduced confidence, knowledge and/or understanding. ...
... Additionally, for those who did provide a comment on the CXR examinations, the overall sensitivity and specificity scores were 71% and 99%, respectively, showing excellent ability to recognise normal appearances but with room for improvement regarding describing CXR abnormalities. The study by Alexander-Bates et al. 6 used a correct comment as the determinant of accuracy, whereas our study used a correct localisation; however, the sensitivity and specificity scores in our study, of 79% and 90%, respectively, were comparable. This suggests that there might be a need for additional training in CXR abnormality detection for radiographers participating in a PCE system, in which CXR examinations are within the scope of practice. ...
Introduction
The chest X-ray (CXR) is the most frequently performed radiographic examination. This study evaluates radiographers’ ability to localise traumatic CXR pathology and provide a preliminary clinical evaluation (PCE) for these cases.
Methods
This observer study was performed in a district general hospital in the United Kingdom (UK). A 58-case image bank was used with 20 positive cases. Participants were awarded a maximum of three points, based on abnormality recognition and descriptive accuracy. Localisation data were recorded with ROCView. Training was delivered via short online recorded tutorials covering an introduction of a systematic search strategy for CXR, how to recognise the common abnormalities covered in the tests, how to structure a PCE and multiple practice cases to review at participants’ own pace. Pre- and post-training data was recorded.
Results
Nine participants completed the study. Overall, pooled sensitivity remained consistent (78.9%–78.8%) following training, specificity and accuracy showed improvement of 79.0%–89.9% and 78.9%–86.0% respectively. An increase in the number of correct localisations and PCE scores were also evident. Participants performed better at correctly identifying a pneumothorax compared to skeletal abnormalities.
Conclusion
Improvements in performance were evident for most participants’ abnormality localisations and PCE scores, following the training intervention. The study highlighted areas of CXR PCE that may require further training, such as detecting superimposed or subtle abnormalities.
Implications for practice
This study provides additional support for the development of PCE systems in additional areas of imaging practice.
... This issue of the Journal of Medical Radiation Sciences (JMRS) features two interesting articles which performed retrospective quality improvement studies on digital radiography in an Australian metropolitan emergency department (ED). The first study (Alexander-Bates et al.) 1 involved the investigation of a radiographer preliminary image evaluation (PIE) system, highlighting the most common false-negative interpretations by crosscorrelation of the radiographer's evaluation of any suspected pathology on x-ray with the radiologist's report. Their study used a clinical audit to assess the quality improvement on PIE accuracy within their ED and identified that most of the false-negative radiographer PIEs were within upper and lower distal extremities. ...
... 4 As addressed by the authors, projection-specific reject and multiple reject analysis is important for QI to reduce patient radiation exposure. 2 Alexander-Bates' et al. 1 study is also recognised as a long-term QA study due to their large monthly sample size (n = 100) deemed adequate for a local clinical audit according to the Royal College of Radiologists. 5 Both studies examined two important aspects of medical imaging -PIE and reject analysis, which are critical for improving the quality of everyday services and patient care. ...
... There is an assumption that the audit will improve practice in the longer term, but this can only be demonstrated by follow-up research using the advice to educate and monitor changes from the respective authors of these two studies. 1,2 Alexander-Bates et al. 1 and Stephenson et al. 2 are both QA studies which focus on human error that seek to identify and reduce outliers or poor performance as a method. QA is an activity that is part of QI, which is required to establish an advanced confidence that performance is maintained at a high standard. ...
This editorial discusses the importance of quality improvement and quality assurance in the provision of medical imaging services, by exploring two studies which aim to improve the quality of practice in emergency departments (ED). The quality of work by ED radiographers are continually planned, measured, assessed, and improved to enhance patient care outcomes – from the accurate diagnosis of patients, maintaining the consistency of diagnostic images, and to minimising radiation exposure to patients.
Introduction: The timely communication of clinically significant image appearances to Emergency Department (ED) referrers is necessary for optimum patient care. Australian reliance on verbal communication only is time-limited, open to misinterpretation and lacks transparency. A combined radiographer alert and comment model was designed to reliably communicate image abnormalities to ED referrers in real-time. Methods: A multidisciplinary steering group designed the model for all ED general imaging. Protocols were developed to document radiographer comments (critical, urgent and clinically significant) in pa-tients' medical records. Critical findings were communicated directly to ED. Five NSW hospitals varying in size, complexity and population demographics piloted the model between three to twelve months during 2021e2022. Site auditors compared comments with the radiology report and designated each as True Positive (TP), False Positive (FP), indeterminate and clinically significant. Indeterminate cases were analysed by an external radiologist. Inter-observer consensus was obtained for all classifications via two independent auditors. The Positive Predictive Value (PPV), or precision of the comment, was calculated for each site. Results: Radiographers (n ¼ 69) provided comments for 1102 cases. The pooled average PPV for TP was 0.96; (0.947e0.971; 95% CI). The weighted mean error (FP comments) was 3.9%; (2.9%-5.3%.; 95% CI). Conclusion: The Radiographer Comment model provided consistent levels of commenting precision and reproducibility across a range of sites with a pooled average PPV (0.96). The False Positive rate or weighted mean error (FP) of 3.9% (2.9%-5.3%.; 95% CI) was low. Implications for future practice: A strategic, interprofessional approach in the implementation of an image alert combined with a Radiographer Comment can be adapted across a variety of hospital settings for ED and other departments.
Objective:
The purpose of the present study was to compare and combine the radiographic interpretation accuracy of emergency clinicians and radiographers in clinical practice.
Methods:
A total of 838 radiographic examinations were included for analysis from 1 August to 24 August 2020. The range of examinations reviewed included the appendicular and axial skeleton, chest and abdomen. Both paediatric and adult examinations were reviewed. The emergency clinician's and radiographer's interpretations for each examination were compared to the radiologist's report. This allowed mean sensitivity, specificity and diagnostic accuracy to be calculated.
Results:
The radiographer's interpretation demonstrated a mean sensitivity, specificity and accuracy of 80%, 98% and 92%, respectively. The emergency clinician's interpretation demonstrated a mean sensitivity, specificity and accuracy of 82%, 95% and 89%, respectively. When the radiographer's and emergency clinician's interpretations were combined, it yielded a mean sensitivity, specificity and accuracy of 90%, 93% and 92%, respectively.
Conclusions:
This is the first study to directly compare and combine the accuracy of an emergency clinician's radiographic interpretation with a radiographer's interpretation within clinical practice. The present study demonstrated that with the addition of a radiographer's interpretation, an emergency clinician's interpretation can be more accurate than the emergency clinician's interpretation in isolation. This highlights the value of a radiographer's interpretation that can complement an emergency clinician's interpretation when a radiologist's report is unavailable.
