The role of the radiographer in a Computed Tomography Colonography service: to look at service provision and the reporting of intra-luminal pathology

Abstract

Phase 1 - Accuracy of radiographer primary clinical evaluation of intraluminal pathology at computed tomography colonography. Objective; Computed Tomography Colonography plays a vital role in the diagnostic pathway for colorectal cancer and colonic polyp management. As demands for the service grows and imaging departments are encouraged to move away from offering the barium enema and towards a CT service radiographer skills need to develop to support this. There is potential for radiographers to be trained to provide a clinical evaluation of the bowel lumen and this study looks at radiographer accuracy for this task as demonstrated in the clinical setting over a four year period. An audit was completed to determine the accuracy of a radiographer primary clinical evaluation of intraluminal pathology identified at computed tomography colonography. Design; A retrospective audit following development and validation of a suitable audit tool was undertaken on a database of radiographer preliminary clinical evaluations to measure the accuracy of the radiographer opinion against radiology reports, endoscopy and pathology findings. Method; A database was designed to capture radiographer and radiologist report data. The radiographer’s preliminary clinical evaluation of intraluminal pathology was given a score (the PDS score) by the reporting radiologist based on the pathology present, the discrepancy between the preliminary clinical evaluation and the final report and the significance of that discrepancy on the clinical management of the patient. A one-way analysis of variance was undertaken to assess for consistency in use of the audit tool by the radiologists. Agreement for the radiographer primary clinical evaluation was assessed using percentage agreement and kappa scores. Significant discrepancies between findings were compared against endoscopy and pathology reports. Results; There was direct or near agreement between the radiographer primary evaluation and the final radiology report for 95.6 %( 98.4% adjusted) of cases. There was a significant discrepancy between findings in 2.7 %( 2.8%adjusted) of cases and a major discrepancy recorded for 0.3 %( 0.2% adjusted) of cases. 1.4% of cases did not have a radiographer preliminary clinical evaluation prior to reporting by a radiologist. Conclusion; With suitable training radiographer preliminary clinical evaluation of intraluminal pathology at Computed Tomography Colonography is accurate enough to provide a valuable contribution to decision making during the procedure and to support a double read reporting service. Thought should be given to independent radiographer reporting of intraluminal pathology for Computed Tomography Colonography.

Phase 2 - Survey of current clinical practice of radiographers performing Computed Tomography Colonography. Objective; To benchmark current accepted practice for UK radiographers in all areas of providing a Computed Tomography Colonography service. Design; An online survey was conducted and promoted by various sources including the College and Society of Radiographers. Method; UK radiographers were invited to take part in a survey investigating provision of a Computed Tomography Colonography service including managing referrals, prescription and administration of drugs, patient care, decision making during the procedure and image evaluation. In addition it collected data on the competencies, grades and qualifications of staff and basic demographic information on the hospital. Results; Radiographers were involved in all aspects of the Computed Tomography Colonography service but roles varied greatly between sites and individuals although they seemed appropriate for the employed grade and qualifications of staff. Most respondents demonstrated effective use of radiographer skills in a few key areas but few provided a radiographer led service, no hospital provided a Computed Tomography Colonography service without radiologist support and no respondent offered independent radiographer reporting. Opinions on training varied; those with the most autonomy of practice felt appropriately trained and qualified whilst those in a more supporting role on lower grade desired more training. Gastrointestinal radiographers seemed to receive more training opportunities and were employed at higher grades when compared with their cross-sectional imaging colleagues undertaking similar tasks. Conclusion; There is potential for advanced radiographer roles to be developed through use of protocols, sharing of best practice and effective use of referral pathways and patient group directives to provide enhanced services. There is a need for the definition of roles and responsibilities within grades for radiographers in order to achieve parity in practice across specialties and between hospital sites. These developments requires support through education by the provision of formal accredited post graduate courses to underpin advanced practice at this level, support research and encourage peer review as practice evolves.