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Appendix 1

Standards for preliminary clinical evaluation systems by radiographers 

The standards outline the College of Radiographers’ view of best practice in implementing and maintaining a consistent, reliable and well governed preliminary clinical evaluation system. 

A1.0 Education and professional development

Radiographers must have undertaken defined training or development, either through an appropriately structured pre-registration programme followed by a period of preceptorship, or through documented professional development that may include formal learning.

  • Newly qualified radiographers, in relation to  standard radiographic images, must:
    • have demonstrated competence in the assessment of image appearances to identify abnormalities, and describe them in written form 
    • be competent in identifying normal image appearances, including normal anomalies
    • be able to advise on further radiographic projections based on their clinical findings.
  • Experienced radiographers must demonstrate competence in undertaking and producing written preliminary clinical evaluations.

A2.0 Preceptorship

Newly qualified radiographers should, within the context of a structured preceptorship programme, receive developmental support over an extended period on initial employment to enable them to demonstrate competence in undertaking and producing written preliminary clinical evaluations.

A3.0 Clinical governance

Preliminary clinical evaluation systems need to be set within a proper clinical governance framework and deliver consistent, high quality outcomes.  Clinical governance processes should include:

  • a clearly defined clinical supervision framework;
  • agreed schemes of work and protocols that guide the anticipated range of circumstances;
  • a continuing education and development plan;
  • regular audits and review of audit outcomes at multi-disciplinary team meetings and/or discrepancy review meetings in which a constructive ‘no blame’ culture exists;
  • periodic review of outcome standards (eg true and false positives and negatives, accuracy of written evaluations, satisfaction of referrers, satisfaction of patients) and subsequent revision of schemes of work and protocols, and ongoing education and training plans;
  • clear lines of responsibility and accountability for delivering the service effectively.

A4.0 Procedures

Preliminary clinical evaluation must have recorded reports. A proforma system is recommended, either electronic or paper-based or both, and should be developed in accordance with identified clinical need locally. 

It is expected that locally developed proformas should facilitate communication of one of the following:

  • the imaging appearances are normal / normal for age or known condition/ normal with an anatomical variant at ....;
  • an abnormality is evident at .... (the nature and location of the abnormality using standard anatomical, physiological and pathological terminology);
  • the imaging appearances are complex and require a consultant radiologist’s (or, where appropriate, consultant radiographer’s) opinion. If this option is used, it is expected that the examination be fast tracked for a full clinical report, and to indicate this on the proforma;
  • a preliminary evaluation has not been provided. This option is necessary to avoid ambiguity but its use is best avoided as it is unhelpful to both referrers and patients.  

In addition, proformas should state:

  • the initial projections undertaken, and any additional projections carried out when clinically indicated; 
  • artefacts evident on any images;
  • relevant clinical details;
  • patient identification details; 
  • the name and status of the person providing the preliminary clinical evaluation;
  • the date and time at which the evaluation was completed.

Informal and verbal systems of communication are best avoided but, if used, carry the same status as written comments, in terms of radiographers’ personal and professional responsibilities. 

A5.0 Individual choice

The College of Radiographers is unequivocal in its view that individual decisions to ‘opt out’ of a preliminary clinical evaluation system are unacceptable. Where a clinical imaging service provides such a system, participation in it should be determined at local level and be mandatory for those providing the service. 

The College recognises that there may be occasions where the participating radiographer may find it impossible to provide a preliminary clinical evaluation (eg in such a situation where a considered judgement cannot be made. There may also be times when staff and skills shortages mean that there are no radiographers available with preliminary clinical evaluation skills and competences, or that the radiographer available has not yet acquired such skills for a particular examination or range of examinations. A well designed proforma (see 4.0 above) should enable these situations to be dealt with effectively, with appropriate communication to the referrer.

A6.0 Knowledge, skills and scope of practice

Radiographers participating in preliminary clinical evaluation systems must:

  • be able to provide written evaluations of standard plain imaging and contrast agent examinations; 
  • have in-depth knowledge of anatomy, physiology and pathology and use this to distinguish trauma or pathology from normal and anomalous appearances on standard imaging and contrast agent examinations;  
  • have some understanding of common mechanisms of injury and origins of pathology;
  • understand fully the effects on image appearances of radiographic projections, and be able to convey this to referrers to assist them in understanding imaging appearances;
  • undertake further radiographic projections or recommend other imaging procedures as indicated by the imaging appearances and in accordance with the Royal College of Radiologists referral guidelines, I-Refer;
  • know and comply with the scope of the scheme and its governance arrangements;
  • recognise the extent and limits of their personal competence and scope of practice, taking appropriate action when necessary to deliver a safe service at all times.

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