Demand for medical imaging – X-rays, CT and MRI scans – and other investigations continue to rise, both in the UK and globally. Accurate and timely clinical reporting is a key component of effective healthcare and maximising the contribution that radiographers make to the diagnostic pathway is essential to streamlining patient care.
Here, Nick Woznitza, Senior Lecturer and Consultant Practitioner Radiographer in the School of Allied Health Professions, speaks to Inspire about the importance of radiography reporting and how his research work is contributing to early diagnosis and improving diagnostic capacity and outcomes for lung cancer patients.
Nick qualified as a diagnostic radiographer from the University of South Australia before moving to the UK and joining Christ Church in 2006 as a postgraduate student. He has been teaching at the University since 2011.
Nick currently has a joint appointment as Consultant Practitioner Radiographer at the University and London’s Homerton University Hospital. He reports a range of plain imaging examinations, including skeletal, chest and neonatal X-rays, teaches image interpretation and conducts research into the accuracy and impact of radiographer reporting.
The University has long been at the forefront of teaching and research in radiography reporting and has an excellent reputation in the field.
According to Nick: "Christ Church was actually the first university to offer an accredited programme in radiographer clinical reporting, based on the pioneering work of Dr Keith Piper as the programme lead. It’s been internationally recognised ever since.
"The programme at Christ Church was also the first to offer chest reporting and has now expanded its remit to include MRI, CT, practically the whole spectrum of image reporting. The University has spearheaded some of the research supporting radiographer reporting as well.
"The teaching and research are internationally renowned, continually developing and evolving as professional needs grow."
Radiography plays a vital role in the diagnosis of disease in patients. As Nick explains: "Radiography is essential to a large proportion of patient pathways. Most patients will undergo a form of imaging investigation during the work up to their treatment or prognosis. According to the Royal College of Radiologists, 90% of patients engaging in hospital services have some form of imaging test performed. Traditionally, it’s been a radiographer who acquires the diagnostic images. The images are then interpreted by a specialised doctor – a radiologist.
"However, in the UK in the last 25 years, radiographers have been able to undertake additional training on some aspects of this interpretation and on the reporting of the images. That is the focus of my clinical teaching and research – I look at the role of the radiographer in the whole patient pathway but, more specifically, examine image interpretation and clinical reporting by radiographers."
With the inevitable pressure on NHS resources, the enhanced role of the radiographer has become an essential part of the diagnostic process. At the same time, as Nick reveals, there has been a huge increase in the forms of imaging that are available to patients: "Imaging examinations have gone up exponentially in the last few years; it’s been a sustained rise in activity. Procedures have doubled in the last nine years, but we haven’t doubled the workforce. Radiographer reporting is one way of creating additional capacity in the system. However, the most important thing to bear in mind is that a reporting radiographer is never a replacement for a consultant radiologist – they possess a different skill set and it’s not a like-for-like replacement. But what it can do is give you the opportunity to look differently at how the patient proceeds through the pathway and offer novel intervention, as well as create additional capacity."
Nick’s own research has examined the effectiveness of radiographers assisting with image reporting. His PhD focused on chest X-ray reporting by radiographers. It compared their diagnostic performance with that of a group of consultant radiologists and found that their results were of comparable accuracy. The second part of his study looked at a group of doctors who use chest X-rays as part of their practice and analysed how the chest X-ray reports influenced diagnosis and again the findings suggest that the clinical reports produced by either reporting radiologists or radiographers are equally useful for clinicians’ diagnosis.
Building on his thesis, he has now secured funding for two more projects focused on lung cancer diagnosis and treatment:
"Lung cancer has very poor outcomes. It’s the largest cause of cancer death worldwide. Last year, there was an optimal pathway published by NHS England. The aim of the pathway is to take diagnosis time down from anywhere between 14 and 28 days, to having all the radiology completed on day one or two so that there is increased time to make treatment decisions and hopefully get everything done earlier. Therefore, I’m involved with a project, funded by Cancer Research UK, studying the impact that immediate radiographer reporting can make to the lung cancer patient diagnostic pathway. It is hoped that this will positively affect report turnaround times and cancer waiting times.
"The second project is for NHS England, which launched a diagnostic capacity fund in response to the Independent Cancer Task Force Report in 2015, highlighting diagnostic capacity as a significant barrier to outcomes for cancer. I was lead applicant on a successful bid to train 14 radiographers to report chest X-rays, based on a hub and spoke hospital model, and this training will complement the accredited postgraduate programme at Christ Church."
So, in an ever-changing healthcare landscape, what does the future hold for the radiography profession? "Hopefully, with everyone being used to their capacity and operating to the maximum of their scope of practice, we will have more assistant practitioners supporting the qualified radiographers, who in turn will support the advanced practitioners," says Nick. "The end result will be a more effective patient journey, which is both cost and resource effective while still maintaining good outcomes."
However, medical technology advances at a phenomenal rate and it is Nick’s belief that medical imaging, in particular radiography, will transform significantly over the next decade: "We might soon have machine learning and neural networks, which can also read medical imaging examinations. It’s difficult to predict the future, but one thing I’m certain of is that the profession will look very different from how it operates now."
Find out more about Radiography courses at Christ Church.