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To dot or not?: The need to redesign frontline image interpretation

Dear Editor, I was interested to read the article ‘Evaluating the true clinical utility of the red dot system in radiograph interpretation’ in the October issue.1 As in previous similar studies, it indicates the need to educate radiographers in image interpretation so that they can better work with emergency department (ED) doctors and help them arrive at the most accurate, earliest possible diagnosis. This article contains no ethics statement nor is there an explanation as to why ethics clearance was deemed unnecessary. This is a serious oversight, especially as figure 1 shows a radiographic marker that identifies the radiographer who performed the examination and ‘red dotted’ the image. The figure shows a radiologically normal elbow that, apparently because of a false positive call by the radiographer, was immobilised for 4 weeks before the error was discovered. Why there was no radiologist’s report in that time? Meanwhile, several other doctors must have viewed the images and formed the same opinion as the radiographer who first saw them, that the elbow was abnormal. It has become common for ED images to go unreported for days, weeks or even months if they are reported at all. In 2006, the Brisbane Courier Mail said that Queensland hospitals had over 500 000 unreported radiology cases. In September 2008, it was found that only 39% of imaging reports were available within 24 h and at one Brisbane tertiary hospital, only 36% were reported within 72 h.2 In 2007, the Sydney Morning Herald (SMH) wrote that Liverpool Hospital had 4500 unreported radiology cases. Westmead Hospital volunteered that they had thousands more. Again, in May this year, the SMH called attention to thousands of unreported radiology cases. The authors suggest that there is no radiology workforce problem, with growth in trainee positions occurring at a rate of 76% between 2000 and 2010.1 This is misleading. The growth in the number of radiologists in the workforce during that period was only 35%,3,4 while the growth in the number of medical imaging examinations was 54%.5 Furthermore, the population is ageing, so the number of examinations per capita is increasing. Most of the growth is in examinations that require large amounts of radiologists’ time. Between 2000 and 2010, CT and ultrasound services each increased by 100% and MRI by 200%.5 The ‘red dot’ is not intended to substitute for a radiologist’s report but to flag abnormalities to ED doctors. However, what if there is no radiologist’s report? The potential value of any form of radiographer ‘opinion giving’ is to fill a gap when a radiologist’s report is not immediately available. It provides the ED doctor with another opinion, a second pair of eyes. This article discourages radiographers from giving their opinion. In fact, the practice model where radiologists are expected to report on every ED examination is unsustainable. Instead, there is a need to redesign frontline image interpretation and to re-educate radiographers to give a short, concise comment on abnormal appearances, whether or not a radiologist’s report is subsequently available.