Leveraging the full expertise of radiographers for improved healthcare delivery

The role of radiographers in healthcare has evolved significantly. Traditionally viewed as technicians responsible for operating imaging equipment, radiographers are increasingly recognised for their role in patient care and diagnosis. This shift is driven by several factors, including advances in radiographer lead research, changes in healthcare delivery models, and a growing emphasis on multidisciplinary teamwork.

In Australia, a key area where radiographers are making an important difference is in image interpretation. While the final diagnostic report is the responsibility of the radiologist, a radiographer is the first healthcare professional to view imaging studies. Their ability to identify and communicate significant findings has a direct effect on patient outcomes.^1–4 Many radiographers are not empowered to make this difference, placing the patient in danger from time delays and potentially leading to poor outcomes, death and increased costs.

Preliminary image evaluation

Radiographers interpret images as part of their daily workflow, a process known as a preliminary image evaluation (PIE), where a radiographer ensures that important findings are not overlooked. PIE can lead to faster diagnosis and treatment for patients, particularly in urgent or emergency situations. In fact, radiographers can provide a consistent PIE service while maintaining a reasonably high diagnostic accuracy.³ This form of image interpretation can complement an emergency referrer’s diagnosis when a radiologist’s report is unavailable at the time of patient treatment. Consider a scenario where a radiographer, working alone at 2 am, identifies a nasogastric tube in the incorrect location. What should the radiographer do? The answer is clear: communicate the findings immediately to the referring treating team to ensure timely care for the patient. Not only is this morally the correct thing to do, but it is also expected, by the Medical Radiation Practice Board of Australia that a radiographer takes ownership of their patient and ‘exercise professional judgement. If critical information emerges or there is a risk to patient care, timely communication of this information to clinicians involved in the care of the patient/client is essential’.⁵

Similarly, a radiographer who is working in a clinic notices a patient’s chest pain is due to a saddle pulmonary embolism. Do they send the patient home and advise them to ‘wait for the report’? No, they call the radiologist and ensure it is dealt with immediately. This is the essence of a radiographer’s role; they ensure significant abnormalities are noted and take action to ensure their patient is safe.

Would an artificial intelligence algorithm detect these abnormalities? Eventually yes, but not as fast as a radiographer at the bedside saying, ‘Don’t use that feeding tube; it’s going into the patient’s lung’.

These expectations align with the Australian National Safety and Quality Health Service Standards, particularly Standard 6 – Communicating for safety, which emphasises the importance of clear and effective communication in healthcare settings to ensure patient safety.⁶

Is PIE utilised Australia-wide, in every hospital setting? No. Despite the Medical Radiation Practice Board of Australia stating, quite clearly, it should be,⁵ the reality is underwhelming.⁷ Why is this? Radiographers feel a lack of empowerment in the local setting to act on their expertise. Radiographers image thousands of patients a year, have impeccable pattern recognition and yet, some feel unsupported to pick up the phone and let a referrer know they have concerns for the patient. Radiographers are imaging experts with a solid grasp of anatomy, pathology, and radiographic appearances. Collaborative efforts between radiographers and other healthcare professionals enhance the accuracy of image interpretation and ensure safe, timely patient care.^1–4

Underutilisation of the radiographer workforce

Radiography is a workforce resource that remains largely untapped due to systemic underutilisation. The evidence is clear: radiographers are vital assets in the healthcare system, capable of enhancing patient care through preliminary image evaluation. Yet a lot of the focus tends to be around professional boundaries and scope which, for all intents and purposes, has been clarified by the profession’s governing body. Opposition to this practice has been fraught with misconceptions around the purpose of PIE and overall, a scare campaign to deceptively depict PIE as ‘scope creep’ when in reality it means a radiographer does not send a patient away with a significant finding without letting someone know.

It is imperative that healthcare institutions recognise and leverage the expertise of radiographers. We must advocate for policy changes that empower radiographers to practice to their full scope of practice and integrate PIE into standard workflows across all healthcare settings.

By doing so, we not only enhance the quality and efficiency of patient care but also foster a more collaborative and responsive healthcare environment.

The ironic aspect of this piece is the call to action; it is not a call to expand scope, nor to re-invent scope – rather a call to use radiographers to their full capability and capacity. Radiography is a 4-year degree in Australia, with a minimum entry score similar to medicine:⁸ let us capitalise on this workforce and further integrate radiographers into the multidisciplinary healthcare team, ensuring they can contribute their invaluable expertise to improve patient safety and quality of patient care.

Ethics

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