Adult chest radiograph reporting by radiographers: Preliminary data from an in-house audit programme

Aim
To examine the adult chest radiograph (CXR) reporting performance of a reporting radiographer in clinical practice using different audit systems; single radiologist and two radiologists, with clinical review of discordant cases.

Materials and methods
100 chest radiographs (CXRs) were drawn randomly from a consecutive series of 4800 CXRs which had been reported during a nine month period at a district general hospital by a radiographer after two years of training. Diagnostic outcomes were normal or abnormal, and agreement with the reporting radiographer or not. There was 50% duplication of CXRs reported between three radiologists. Concordance rates were determined for the radiographer-radiologist and inter-radiologist interpretations. Independent clinical review of discordant cases was performed to establish the final diagnosis.

Results
Ninety-nine cases were reviewed, with 40 cases deemed abnormal by at least one radiologist. Consensus was found with the radiographers report in 59 normal and 33 abnormal CXRs reviewed by two radiologists (96.7% and 86.8% respectively). Seven CXR reports were discrepant with clinical review: mediastinal lymphadenopathy was missed by both radiologist and radiographer; linear atelectasis was reported by two radiologists but not the radiographer. Three cases were over-interpreted and on two occasions at least one radiologist agreed with the radiographer. There was very high concordance between the radiographer and each radiologist, 96%, 96% and 92% respectively.

Conclusions
This study suggested that regular audit, which incorporates case note review and discrepant reporting within a multidisciplinary setting, should contribute to safe practice.