1 Radiographer Reporting – A Happy Ending?Professor Nigel Thomas Consultant Radiologist

2 Radiographer Reporting – A Happy EndingProfessor Nigel Thomas Consultant Radiologist

3 Outline The past The present The future

4 The Past

5 Anon, B.M.J., 1903 “There is no reason for professional prejudices against the practice of radiology by lay men, so long as they confine themselves to the mere mechanical act of producing a picture, and abstain from assuming scientific knowledge of the bearing of their radiographs on diagnosis or prognosis”

6 J.H.E., B.M.J., 1917 “I would suggest that the practice of radiography by laymen be made a penal offence, and that laws be passed which will render it impossible for the practice of radiography to be carried out by other than skilled and trained medical experts”

7 F. Hernaman-Johnson, 1919 “To organize and educate the various classes of lay helpers” “To see that their status, remuneration and prospects are such as to make them contented” “To educate the public as to why such people are at one and the same invaluable as helpers, and extraordinarily dangerous when they seek to practice independently”

8 F. Hernaman-Johnson, 1919 “We should welcome lay assistance and seek to organize and guide it.” “It is too late in the day to make a mystery of taking plates, but the interpretation is ours for ever”

9 Society of Radiographers, 1924“The membership of the Society of Radiographers does not imply that the member is in possession of the necessary medical knowledge or training for the giving of diagnostic reports, and that the responsibility for the diagnosis must rest with the medical man in charge of the case”

10 C.W.Furby, Radiography, 1944 “The primary function of the radiographer is to be of the utmost service to the radiologist” “The function of the radiologist is the interpretation of the radiograph”

11 Historical PerspectiveSwinburne, Lancet 1971, suggested that the task of distinguishing between normal and abnormal films could be undertaken by radiographers in view of “the chronic shortage of radiologists, and the fact that radiographers seem to function below their full potential”

12 Historical PerspectiveSaxton, Clinical Radiology 1992, reiterated the view that radiographers might report effectively on selected groups of examinations, provided that “they were given proper training and supervision”

13 Further Progress Berman L, de Lacey G, Twomey E, Twomey B, Welch, T and Eban, R. ‘Reducing errors in the accident department: a simple method using radiographers’, British Medical Journal 1985; 290: 421-2 Loughran,C.F., Reporting of fracture radiographs by radiographers: the impact of a training programme. Br.J.Radiol.,1994 The Extended Role of the Radiographer Project (Leeds),1995 – trauma films, chest and abdomen

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15 The Present

16 A few thoughts about the Present…Reported images are not actually reported The Gold Standard is not the Gold Standard You’re part of the furniture now Clinical Medicine is not dead, but it’s a bit off colour Some people still don’t like us

17 The Future

18 The best preparation for tomorrow is to do today’s work superbly wellSir William Osler ( )

19 Doing today’s work superbly well…Audit and Governance Support Career Structure and working outside the NHS.

20 Audit

21 Audit Resistance because “doctors don’t do it”Who is the gold standard?

22 Audit Audit is like a bicycle helmet

23 Audit Audit is like a bicycle helmetIt doesn’t stop you having accidents, but , when you do, it can save your life

24 Audit Audit is like a bicycle helmetIt doesn’t stop you having accidents, but , when you do, it can save your life Some people choose to cycle without a safety helmet…

25 Audit Audit is like a bicycle helmetIt doesn’t stop you having accidents, but , when you do, it can save your life Some people choose to cycle without a safety helmet… Audit might make you a better cyclist…

26 Discrepancy Meetings Very useful as a learning processTraditionally a “Doctors Only” approach Still some resistance, but Radiographers need to become actively involved

27 Support

28 Support Radiographic Colleagues Radiologists University DepartmentsInterest groups

29 Career Structure

30 Working outside the NHS

31 Working outside the NHSAudit Numbers (burn out) and accuracy rate Indemnity (learn lessons from the NHS) Inland Revenue – self employed status / sources of income

32 The Future as I see it… An increasing number of increasingly experienced and knowledgeable reporting radiographers who will become the mainstay of plain film reporting in the NHS, who will have a major role to play in the reporting of other modalities, and, through the use of practical skills, will contribute to patient management. What used to separate Radiologists and Radiographers was breadth of knowledge and skills, now it’s the depth of skills and knowledge – Radiologists in the 20th Century will be fully occupied with Intervention, complex ultrasound examinations, and increasingly demanding cross-sectional imaging (CT, MR, PET-CT/MR) Reporting Radiographers and Radiologists will be complementary not competitive

33 A Happy Ending? We should be proud of what has been achieved, but not complacent We should also recognise that, despite the fact that some still oppose the process, and we have come a long way, we’ve not yet reached the end

34 Maslow’s Hierarchy of Needs“To see that their status, remuneration and prospects are such as to make them contented”

35 A Happy Ending...

36 A Happy Ending...To Be Continued…