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2. Exploring the Diagnostic Radiography Workforce

2.1 Introduction

This chapter reports data on the diagnostic radiography workforce across the United Kingdom. An online questionnaire was used to seek information on roles and developments in the workforce. Information was sought on the different roles undertaken within clinical practice.


2.2 Methodology
 

2.2.1 Questionnaire design

The research tool was an online questionnaire via Survey Monkey. A copy of the questionnaire can be found in the appendices.

2.2.2 Participants

Emails invitations containing a link to the online questionnaire were sent to 1278 diagnostic imaging managers / superintendent radiographers / consultant radiographers throughout the UK in March 2012. Email addresses were sourced from the SCoR membership database. The survey was targeted at the total population as this would ensure that the samples were representative and not biased.

Responses were received from 143 departments which is an 11% response rate. This compares to 108 managers responding to the equivalent 2008 survey. In this survey none of the questions were mandatory so different questions may have different response rates. Where more than one response was received from a department the later response has been disregarded.

The results are not directly comparable to the 2008 survey as this survey targeted individual departments whereas the 2008 survey was directed at overall hospital-wide imaging managers. So in the 2012 survey we have responses from ultrasound department managers for example where we might expect the answers to be different to those provided by the overall imaging manager for the site / hospital. The 2008 survey also looked only at NHS acute hospitals whereas the 2012 survey covered all types of departments including those in a community or private setting.


2.3 Results

2.3.1 Demographic data

The region and type of hospital for those responding are shown in table 2.1. The highest response was 22 from Scotland with none from Northern Ireland being the lowest. Five respondents identified themselves as being in the private / independent sector.
 

Table 2.1 Region and type of hospital

Region Foundation Non-teaching Teaching Other / unknown Grand Total
Northern Ireland 0 0 0 0 0
Scotland 0 3 9 4 16
Wales 1 6 4 0 11
East Midlands 2 0 3 0 5
East of England 3 4 2 2 11
London 8 4 5 5 22
North East 8 0 0 1 9
North West 5 1 1 1 8
South Central 1 2 1 0 4
South East Coast 3 1 1 1 6
South West 9 0 6 0 15
West Midlands 4 1 1 0 6
Yorkshire and Humber 3 2 2 0 7
Unknown 0 0 1 22 23
Grand Total 47 24 36 36 143

The department type of those responding is shown in table 2.2 by UK country / region.

 

Table 2.2 Region and type of department

Region Radiology / x-ray / Imaging CT and / or MRI Ultrasound Breast imaging Unknown / Other Grand Total
Northern Ireland 0 0 0 0 0 0
Scotland 12 2 1 0 1 16
Wales 5 2 1 0 3 11
East Midlands 4 0 1 0 0 5
East of England 4 0 2 2 3 11
London 11 2 1 1 7 22
North East 8 0 0 1 0 9
North West 7 1 0 0 0 8
South Central 3 0 0 0 1 4
South East Coast 5 0 0 0 1 6
South West 9 1 1 1 3 15
West Midlands 4 0 0 0 2 6
Yorkshire and Humber 6 1 0 0 0 7
Unknown 6 5 2 2 8 23
Grand Total 84 14 9 7 29 143

 

2.3.2 Reporting roles

Table 2.3 shows the responses to questions about reporting roles. Where an equivalent question was asked in the 2008 survey the equivalent percentage is shown for comparison.

Table 2.3 Reporting roles frequencies

Role Number of departments with role Total number of respondents to question %        % (2008 survey)
‘Red dot’ scheme 78 137 57% 84%
Radiographer-led ‘hot-reporting’ service in A&E 29 135 22% 18%
‘Written preliminary comment’ scheme 20 137 15% N/A

The percentage of departments with a ‘Red dot’ scheme increases to 71% when only responses from radiology / x-ray / imaging departments are considered. Furthermore, 73% of radiology / x-ray / imaging departments have a ‘Red dot’ scheme and/or a ‘Written preliminary comment’ scheme.

 

2.3.3 Advanced trauma life support team roles

Table 2.4 shows the response to the question about radiographers forming part of advanced trauma life support teams.

 

Table 2.4 Advanced trauma life support team roles frequencies

Role Number of departments with role Total number of respondents to question % % (2008 survey)
Radiographers form part of advanced trauma life support team 10 134 8% N/A

 

2.3.4 Imaging request roles

Table 2.5 shows the responses to questions about imaging request roles.

Table 2.5 Imaging request roles frequencies

Role Number of departments with role Total number of respondents to question %      % (2008 survey)
Requests for imaging 73 137 53% N/A
Justification under IR(ME)R 120 137 88% N/A

 

2.3.5 Audit and research roles

Table 2.6 shows the number of departments with radiographers undertaking audit and the number of departments with radiographers with a substantive role (0.2 whole time equivalent and above) in research.

Table 2.6 Audit and research roles frequencies

Role Number of departments with role Total number of respondents to question %      % (2008 survey)
Radiographers undertaking audit 135 137 99% 94%
Research radiographers 23 135 17% 5%

Six departments have research radiographers at Agenda for Change (AfC) band 6, fourteen at AfC band 7, six at AfC band 8a and two at AfC band 8b, c or d.

 

2.3.6 Clinical education

Table 2.7 shows the number of departments with radiographers with a substantive role (0.2 whole time equivalent and above) in clinical education.

Table 2.7 Clinical education roles frequencies
 

Role Number of departments with role Total number of respondents to questions %       % (2008 survey)
Clinical education radiographers 45 137 33% 42%

 

2.3.7 Injection and interventional roles

Table 2.8 shows the responses to questions about injection and interventional roles.

Table 2.8 Injection and interventional roles frequencies

Role Number of departments with role Total number of respondents to questions %       % (2008 survey)
IV / cannulation 101 137 74% 94%
Image guided intervention 35 135 26% N/A
Peripherally inserted central catheters (PICCs) 7 135 5% N/A
Supplementary prescribing 17 131 13% 12%

The percentage of departments with radiographers performing intravenous injection / cannulation increases to 82% when only responses from radiology / x-ray / imaging departments are considered.

It is claimed that supplementary prescribing was undertaken in 17 (13%) of the sample sites. However, this figure is higher than expected. It may be that the question was misinterpreted and included those administering a healthcare product or medicine under a patient group direction or a patient specific direction.

 

2.3.8 Radiographer-led investigation roles

Table 2.9 shows the responses to questions about injection and interventional roles.

 

Table 2.9 Radiographer-led investigation roles frequencies

Role Number of departments with role Total number of respondents to questions %      % (2008 survey)
Angiographic procedures 4 129 3% N/A
IVUs 23 129 18% 35%
Radiographer-led CT examinations 43 129 33% 34%
Radiographer-led MRI examinations 30 127 24% 19%
Dacro-cystograms 3 127 2% N/A
Sialograms 5 128 4% N/A
Cardiac and/or physiological measurement 7 128 6% 6%
Pharmacological stressing in RNI 10 122 8% 12%
Exercise stressing in RNI 11 124 9% 8%

 

2.3.9 Gastrointestinal and gynaecological imaging roles

Table 2.10 shows the responses to questions about gastrointestinal and gynaecological roles.

Table 2.10 GI and gynae roles frequencies

Role Number of departments with role Total number of respondents to questions %      % (2008 survey)
Barium studies 63 129 49% N/A
Endoscopic gastro-intestinal procedures 8 128 6% N/A
Computed tomography colonography (CTC) imaging 58 127 46% N/A
Hysterosalpingography 22 127 17% N/A
Hycosys (hysterosalpingo-contrast-sonography) 9 129 7% N/A

 

2.3.10 Diagnostic ultrasound

Managers were asked to indicate against a predetermined list whether sonographers (or radiographers, where relevant) offered a service in the areas shown in Table 2.11.

Table 2.11 Diagnostic ultrasound roles frequencies

Role Number of departments with role Total number of respondents to questions %     % (2008 survey)
Early pregnancy 60 92 65% 77%
Obstetrics 64 92 70% 79%
Nuchal thickness 57 92 62% 48%
Neonatal head 32 92 35% 42%
Gynaecology 74 92 80% 85%
Abdominal 78 92 85% 94%
Transrectal 16 92 17% 19%
Thyroid 38 92 41% N/A
Testes 64 92 70% N/A
Other small parts 47 92 51% N/A
Deep vein thrombosis identification 61 92 66% N/A

Role

Number of departments with role Total number of respondents to questions %     % (2008 survey)
Other vascular 45 92 49% N/A
Musculoskeletal 43 92 47% 39%
Ultrasound guided joint injection 9 92 10% N/A
Cardiac 7 92 8% 7%
Breast 23 92 25% 20%
Hycosys 7 92 8% N/A
Other contrast examinations 7 92 8% N/A
Nerve blocks 3 92 3% 0.0

Some respondents also gave other ultrasound areas not included in the above list: paediatric hip (2 departments); transrectal biopsies (2 departments); trans cranial doppler (1 department); breast vacuum biopsy (1 department); and fine needle aspiration (1 department).

 

2.3.11 Ultrasound reporting practice

Excluding obstetric reporting, managers were asked to identify which phrase best fitted their departmental reporting practice in ultrasound. The options presented were:

  1. A pro-forma or tick chart is completed by the sonographer, but verified by another person (e.g. a radiologist).
  2. A pro-forma or tick chart is completed and verified by the sonographer.
  3. An independent (free text) report is produced by the sonographer but verified by another person.
  4. An independent report is produced and verified by the sonographer.

The responses are shown in table 2.12. The majority of departments responded that an independent report is produced and verified by the sonographer.

Table 2.12 Ultrasound reporting practices

Role Responses Total number of respondents to questions %       % (2008 survey)
A pro-forma or tick chart is completed by the sonographer, and verified by another person (e.g. radiologist). 0 89 0% 1%
A pro-forma or tick chart is completed and verified by the sonographer. 2 89 2% 5%
An independent (free text) report is produced by the sonographer and verified by another person. 7 89 8% 3%
An independent report is produced and verified by the sonographer. 80 89 90% 82%

2.3.12 General reporting practice

Managers were asked to indicate against a predetermined list in which categories do radiographers in their department issue written reports. The results are shown in Figure 2.1.

Some respondents gave other reporting areas not given in the above list: ultrasound (6 departments); barium swallow/contrast swallow (1 department); fetal cardiography (1 department); insertion of tunnel lines (1 department); pre-lim comment on scaphoid MRI to fracture clinic for [patient] management - formal report follows (1 department); video urodynamics (1 department); Hysterosalpingography reporting (1 department); Report on the siting of nasogastric tubes (1 department).

 

2.3.13 Career progression framework roles

Managers were asked if they have the following career progression framework roles in their department: assistant practitioners; practitioners; advanced practitioners; and/or consultants.

We would expect the number of departments with practitioners to be higher than any of the other roles because all departments will have practitioners i.e. radiographers practising at Agenda for Change band 5/6 or equivalent. The responses indicate therefore that some respondents misinterpreted this response option, perhaps because the term practitioner is not widely used. There was a similar misinterpretation in the 2008 survey.

  2.3.14 Other radiographic roles

Managers were asked to describe any other roles carried out by radiographic staff in their department that had not been covered in this questionnaire.

A total of 28 additional roles were identified across the departments. Table 2.13 identifies the roles presented by managers and the number of sites where they have been adopted. Roles which have been incorporated previously in this report are not included in the table below.

Table 2.13 Other radiographic roles

Role Responses
Audit development and review 1
Quality management 2
Hospital wide ultrasound clinical governance 1
Performance manage waiting lists across modalities 1
   
People management 3
Training 3
Lecturing 2
   
IR(ME)R lead 1
   
IT 1
PACs 3
   
Forensic service for the coroner 1
   
Arthrography 2
Barbotage and high volume saline paratenon stripping 1
   
Bone marrow sampling 1
   
Breast cancer follow up service 1
   
Breast biopsies 4
   
Radiotherapy planning scanning 1
   
Cell labelling in an isolator 1
   
Contrast administration 2
Administration of diuretics 1
Administration of thyroid blocking agents 1
Pharmacy 2
Radio-iodine therapy for thyrotoxic and cancer patients 1
   
Cystograms 1
Video urodynamics 1
Glomerular filtration rate 1
Lithotripsy 1
Tubograms 1

 

2.4 Discussion

The results from this survey demonstrate that the role of the diagnostic radiographer continues to expand.

One third of responding departments have radiographer-led CT examinations and one quarter have radiographer-led MRI examinations. Nearly half of responding departments have radiographer-led barium studies and nearly half have radiographers undertaking CTC imaging. Over half the departments have radiographers making requests for imaging and nearly nine out of ten have radiographers justifying requests for images under IR(ME)R.

The proportion of departments with ‘red dot’ schemes in place has reduced since 2008 perhaps as they have been replaced by other image interpretation reporting systems. Outside ultrasound, the most common categories for radiographer written reports are appendicular skeleton, barium enema and axial skeleton. Within ultrasound, nine out of ten departments selected “An independent report is produced and verified by the sonographer” as the best description of their practice.

Three-quarters of departments have radiographers performing intravenous injection / cannulation. This is a decrease since the 2008 survey. The number of departments where radiographer-led intravenous urograms (IVUs) are undertaken has nearly halved since the 2008 survey. This reduction in IVUs may be as a result of a move towards more CT urograms and ultrasound.

The proportion of departments with research radiographers has increased threefold since 2008 which is pleasing as the 2008 report identified radiographer-led clinical research as an area for development. One third of responding departments have radiographers with a substantive role in clinical education which is a slight drop since the 2008 survey and highlights a potential area for improvement.
 

In diagnostic ultrasound fewer departments are offering a service in early pregnancy, obstetrics and abdominal and more departments are offering nuchal thickness and musculoskeletal services when compared to the 2008 survey. This may reflect an increase in service demand in the latter areas, such as the introduction of the Fetal Anomaly Screening Programme (or equivalent) first trimester ultrasound examination between 11w and 13w 6d to include nuchal translucency measurement as part of the combined test.

When asked about other radiographic roles not covered in the survey, breast biopsies, identified by 4 departments, was the most frequent response.

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