South African services explore radiographer practice reporting

South Africa's diagnostic radiology services would be much improved if radiographers were trained in reporting, according to a researcher from Cape Peninsula University of Technology. Imelda Williams, a lecturer at the university's radiography division, now hopes to instigate such a program in her home country, having seen the benefits of role extension in Europe.

In South Africa, some hospitals operating medical imaging services have no trained radiologists onsite, leaving reporting in the hands of referring physicians. The staffing problem is most acute in public hospitals, where the need for trained radiologists is actually greatest, Williams said. Reporting times are lengthy, and in some cases, x-ray films are not reported at all.

Some radiographers currently assist physicians by flagging abnormalities on accident and emergency x-rays with a red dot sticker. They do not, however, receive any formal training in image interpretation and provide no written comments to accompany the dotted films.

Williams' Masters course in medical imaging at the University of Bradford, U.K., included practical reporting skills at Hull Royal Infirmary, and she would like to see similar training for radiographers in South Africa. A survey of radiologists from one of nine regional provinces indicated a significant level of support, she said.

"Of course there are concerns," she said. "Will radiographers be able to take on this initiative? Also, we are still quite traditional in South Africa. What the radiologist says goes, whereas the radiographer is basically a technician taking the x-rays. So quite a lot needs to be done."

While radiologists would need convincing to delegate some of their duties, radiographers would have to grasp the added responsibility, Williams said. Government assistance would also be required to support radiographers while they were training.

Her first aim is to start an official training course on the appropriate use of red dots. Radiographers working in the emergency room should be prepared to see a wide spectrum of diseases and trauma injuries on x-ray, including a high number of gunshot wounds, she said. Plain-film readers should also be looking for "hidden" pathology, such as a bone tumor in a patient x-rayed for a sprained ankle.

"That at least will make radiographers aware that there is much more to learn," she said. "Diagnosing an obvious bone fracture is something that everyone can do. There are many more important subtleties to be missed, so that is the place I am going to start."

The scientific program of the 2006 International Congress of Radiology, to be held in Cape Town from 12 to 16 September, is likely to address the controversial subject of radiographer reporting.