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3.0 Radiographers and preliminary clinical evaluation

For at least twenty five years, radiographers have been involved in abnormality detection, often referred to as the ‘red dot’ system.19 Usually, the system operates in accident and emergency imaging with radiographers signalling the presence of suspected or identified abnormalities by the addition of a red dot (or similar) to the relevant images to support emergency staff managing the patient. In 2008, a UK wide survey of emergency departments and minor injuries units found that 284 (92.8%) of responding departments operated a radiographer abnormality detection system. Of these, 221 operated a ‘red dot’ signalling system and 61 operated a radiographer comment system, often in conjunction with the signalling system. Two further sites provided radiographer abnormality detection but by systems other than ‘red dot’ signalling or comments.19

This aligns with the College’s view expressed in 20062 that making informed clinical comments on examinations / image interpretation (now referred to as preliminary clinical evaluation) and clinical reporting should become core competences of the profession. At that time, the College set out the expectation that radiography education providers include the principles of image assessment and reporting in pre-qualifying education programmes and ensure that at qualification radiographers are competent to provide written preliminary comments on imaging examinations.

Newly qualified radiographers at the point of registration with the Health and Care Professions Council now have the underpinning education and training to begin to participate in preliminary clinical evaluation, although it is essential that this be further developed and assessed during their preceptorship periods.

The majority of experienced radiographers have participated in abnormality detection systems and some in written preliminary clinical evaluation systems. These skills may need further development and assessment and should be a major focus of their continuing professional development. It was for this purpose that the College of Radiographers and the Department of Health through e-Learning for Healthcare (eLfH) have produced the e-learning resource known as ‘Interpretation of Radiological Images’ (IRI), often shortened to ‘Image Interpretation’ (II) .20

Current evidence demonstrates the achievement of appropriate standards and effectiveness of appropriately trained radiographers engaged in initial image interpretation.9 It has also been shown that where radiographers are involved in written commenting systems, overall error rates are reduced leading to a reduction in mismanagement and patient recalls.21 The College’s requirement that ‘red dot’ signalling systems be replaced by written preliminary clinical evaluation systems is therefore appropriate, and will improve yet further radiographers’ contributions to the effective management of patients following imaging.

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