Image interpretation system for diagnostic radiography: a collaborative approach

Abstract

In healthcare, medical imaging is essential to patient management, but rising demand and dependence on imaging services have led to radiologists focusing primarily on high-end modalities, resulting in a gap in image interpretation of routine radiographic imaging procedures. As a result, image interpretation of radiographs may be delayed or absent, potentially compromising patient management and healthcare quality. This is the case in many countries in Africa, where the number of radiologists is consistently low and insufficient. Radiographers are qualified health professionals whose responsibilities have expanded, in countries across the world, to include image interpretation in response to the radiologist shortage. Radiographers can provide image interpretation services via three recognised pathways: the red-dot system, preliminary clinical evaluation (PCE), and clinical reporting. The primary function of a radiology department is to provide medical images with accurate and efficient image interpretation reports for patient diagnosis and management. The radiographic service in Namibia’s state hospitals provides for the production of medical images upon request. However, the image interpretation system in Namibia seems to be underperforming, resulting in a significant number of plain images being left unreported. Additionally, the roles of radiographers in Namibia related to image interpretation are not well defined, and their preparedness for such roles has not been investigated. An evaluation of the image interpretation system was therefore proposed to assess the system's capacity and effectiveness and to explore ways to improve performance, including determining possible roles for radiographers to enhance the quality of image interpretation services. The purpose of this study was to examine the radiology image interpretation system and explore possibilities for improvement by actively involving radiographers in a collaborative approach, using one example of an under-resourced environment as a case study. A multiphase mixed method design was used to collect data from radiographers, radiologists, referring doctors from three hospitals and lecturers at one higher education institution in Namibia. Purposive sampling was used, aiming for maximum variation and data saturation in the qualitative strands and maximum recruitment in the quantitative strands. Data were collected using a combination of instruments, including questionnaires, checklists, and semi-structured, one-on-one interviews, and analysed using quantitative and qualitative methods as appropriate. Ethical approval for the study was sought and granted by all relevant bodies. The research process consistently upheld principles of respect for persons, beneficence, and justice, with participants providing informed and voluntary consent to participate in the study. The findings of the study provided evidence of a severe shortage of radiologists, with no reporting of plain images and a significant backlog on CT reporting. All the surveyed departments followed a doctor-driven structure with no specified roles for radiographers in image interpretation. The referring medical doctors indicated that image interpretation services were poor and characterised by delays that compromise patient diagnosis and treatment. They also indicated that comments from the radiographers would assist them in image interpretation in the absence of a radiologist's report. The participating radiographers demonstrated an adequate level of knowledge regarding plain image abnormalities. However, in practical assessments, the radiographers showed a high level of accuracy and sensitivity in detecting abnormalities in the images. The participating lecturers and graduates from the higher education institution indicated that the teaching and learning processes were not optimised to develop the necessary competencies for radiographers in image interpretation. This was compounded by a theory-to-practice paradox that hindered the acquisition of skills. Based on the study results and existing literature, a modified image interpretation system was developed using systems theory. The system included the practice of a Radiographer Abnormality Detection System (RADS) and Preliminary Clinical Evaluation (PCE) by radiographers as a means to tackle the shortage of radiologists. System modifications were introduced across four primary stakeholder groups to enhance the involvement of radiographers. These groups include radiographers and radiologists, medical doctors, the higher education institution, and the Allied Health Professions Council of Namibia. Implementation of the modified system would ensure that most plain radiography images receive an interpretation to inform referring healthcare professionals and enhance patient management. Furthermore, an implementation plan was developed based on the diffusion of innovation theory to guide the adoption and implementation of the modified system. The implementation plan consisted of four successive phases, based on the four stakeholder groups identified during the system modification process, and to facilitate system adjustments through feed-forward and feedback mechanisms. The study has contributed valuable information, regarding image interpretation in under-resourced settings. These findings will also have relevance to well-resourced environments through the proposed approach for modifying and implementing systems to incorporate radiographers in image interpretation. The study also emphasises the importance of aligning training and regulatory provisions with industry demands through periodic evaluations. Additional research on image interpretation is recommended to gather more empirical evidence to support and enhance the incorporation of radiographers into the image interpretation system.