This paper reports an investigation into the accuracy and effectiveness of two (2) senior Australian radiographers in the reporting of appendicular musculo‐skeletal radiographs in the adult trauma situation. and discusses the international debate on radiographer role extension into plain film reporting. The study of 540 patients referred to a large metropolitan emergency imaging department demonstrated high rates of diagnostic accuracy (sensitivity = 98.00% specificity = 99.11%) in the assessment of appendicular musculo‐skeletal radiographs. 294 out of 300 positive examinations were identified correctly (FPR=0.88%) as were 225 out of 227 negative or normal examinations (FNR=2.00%). A discussion on relevant statistical measures and their definitions is outlined. In the study radiologist reports are used as the comparative gold standard. The findings demonstrate an ability of clinically experienced radiographers to accurately and effectively provide diagnostic opinions on musculoskeletal radiographs. A formalised approach to radiographer reporting can be justified and a formal program to train appropriately experienced radiographers is recommended.

IntroductionX‐ray Operator (XO) supervision in Queensland is performed by radiographers in a site removed from the XO site. This has historically been performed by telephone when the XO requires immediate help, as well as post‐examination through radiographer review and the provision of written feedback on images produced. This project aimed to improve image quality through the provision of real‐time support of XOs by the introduction of video conference (VC) supervision.MethodsA 6‐month pilot project compared image quality with and without VC supervision. VC equipment was installed in the X‐ray room at two rural sites, as well as at the radiographer site, to enable visual and oral supervision. The VC unit enabled visualisation of the X‐ray examination technique as it was being undertaken, as well as the images produced prior to transmission to the Picture Archiving and Communication System (PACS).ResultsStatistically significant improvement in image quality criteria measures were seen for patient positioning (P = 0.008), image quality (P < 0.001) and diagnostic value (P < 0.001) of images taken during this project. No statistically significant differences were seen during case level assessment in the inclusion of only appropriate imaging (P = 0.06), and the inclusion of unacceptable imaging (P = 0.06), however improvements were seen in both of these criteria. The survey revealed 24.6% of examinations performed would normally have involved the XO contacting the radiographer for assistance, although, assistance was actually provided in 88.3% of examinations.ConclusionThis project has demonstrated that significant improvement in image quality is achievable with VC supervision. A larger study with a control arm that did not receive direct supervision should be used to validate the findings of this study.

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