June’s blog was written by Andrew Murphy. Andrew is a radiographer based in Brisbane, Australia. He creates radiographic image interpretation pathways for a wide audience of health care professionals and is currently a managing editor of Radiopaedia.
Over the years, the dialogue around image interpretation by Australian radiographers has become a debate of semantics. It’s a discussion that with each iteration seems to be gaining nothing but circular momentum. In Australia, the question is often asked: ‘should we introduce radiographer image interpretation into this workplace?’, but really, the more pressing questions we should be asking ourselves are, ‘what are the regulatory implications of our staff not working to the expectation of the Medical Radiation Practice Board of Australia? 1’, and ‘what are the implications to both our patients and our department for ignoring significant findings because a functioning system was not in place?’. Sadly, the discussion often doesn’t move past the initial question of whether or not a radiographer image interpretation system should be implemented.
Medical Radiation Practice Board of Australia Professional capabilities for medical radiation practice Domain 1, Key Capability 7
To be clear, this blog post is not about reporting. This is about day-to-day image interpretation, whereby a radiographer notices an abnormality, flags that abnormality, and communicates their findings to relevant parties in the form of a written and/or verbal comment. This is known in Australia as a preliminary image evaluation (PIE), or as I like to think of it, ‘if you see something, say something’.
There are radiographers in Australia who believe this is not part of their job, and it seems that no amount of evidence or regulatory policy will convince them otherwise. I personally believe this is because we tend to approach this topic from an overly academic point of view. So rather than listing and synthesizing the evidence to support radiographers participating in PIE (I have done this. It is 15 pages long and a riveting read. If you are interested, it can be found here 2), I want to reflect on what this should really be about, and that is, adding value.
‘Image interpretation is not my job’
Sure, providing a diagnostic report is not your job, but examining your images for abnormalities for patient safety? That is 100% your job.
Imagine this scenario: It’s 10pm. You’re working alone. The radiologist has gone home, there isn’t a doctor in sight. There may be one upstairs…if you call around enough. You perform this head scan:
Case courtesy of Dr David Cuete. Radiopaedia ID: 22907
Now, do you:
a) complete your scan and call for your next patient?
b) call the most relevant person to this patient and let them know immediately that this scan needs their attention?
This is an obvious case, but it paints a picture: you recognize the severity of these findings and you feel an obligation to your patient to ensure they are cared for in a timely matter.
The same goes for a case like this:
Case courtesy of Dr Ian Bickle. Radiopaedia ID: 50351
Or this:
Case courtesy of Dr Gagandeep Singh. Radiopaedia ID: 7226
Now picture yourself in a busy emergency department. You have performed this shoulder radiograph:
Case courtesy of Assoc Prof Craig Hacking. Radiopaedia ID: 39440
You notice all three abnormalities on the radiograph (can you find them?). You ensure that the appropriate parties are informed, in the form of a comment on your PACS (or however you convey information in your department). Why? Because you feel an obligation to your patient and to your ED team that when a patient come to your department, they not only get their scapular fracture attended to, they also have their AC joint injury and broken ribs noted as well, because when a patient come to your department, they get the best care: the type of care you’d want for your family. And overall, this is what image interpretation is about. It is about adding value: to your patient’s care, to your doctor’s request.
Should your department (in Australia) have a working image interpretation protocol to support you? Yes. If you see something, but there is not a protocol in place, are you expected to say something and write it down? Absolutely. Do you need anyone’s permission to do this in Australia? No, you don’t, because it is your job. It may mean you feel a little vulnerable, but overall you’re doing what is best for your patient.
But where do you draw the line? Great question! If a radiographer were to observe a chest CT and comment ‘There is a mass extending outside the vessel wall into adjacent lung parenchyma. This is a pulmonary angiosarcoma.’, then yes, we can all agree this is not simple recordkeeping; this is an attempted diagnosis. We must be clear that PIE is a comment, an observation, a point worth mentioning, and it is not, nor will it ever be, a diagnostic report.
This has been a bit of a whirlwind blog post about the role of the radiographer in Australia (beware there are regulatory differences across international borders). At the end of the day, if I could leave you with one thing it would be, ‘If you see something, say something’, because that is what I would want if my mother, father, friend, any member of the human race, or even my pet were a patient.
References:
- “Professional capabilities for medical radiation practice (the professional capabilities)”. The Medical Radiation Practice Board of Australia, 2020. [Link].
- Andrew Murphy, Ernest Ekpo, Thomas Steffens, Michael J. Neep. Radiographic image interpretation by Australian radiographers: a systematic review. (2019) Journal of Medical Radiation Sciences. 66 (4): 269 org/10.1002/jmrs.356
