1. RADIOLOGY—LETTER TO THE EDITOR
Is radiographer commenting the answer?
Dear Editor,
Re: Article in Journal of Medical Imaging and Radiation
Oncology, Volume 56, 2012, p. 510–513, by Brown and
Leschke, Evaluating the true clinical utility of the red dot
system in radiograph interpretation.
The authors have referenced a document written by
United Kingdom’s College of Radiographers.1
In doing so
they gave the impression that non-radiologists providing
written reports on plain radiographs were initiated due to
the success of the ‘red dot’ system. That document
essentially identifies current practices in radiography in
the United Kingdom.
The authors appear to be confusing the ‘red dot’ system
as a basic version of plain radiographic reporting. They
infer from their research results that due to the ‘red dot’
systems’ inability to reliably detect undisplaced fractures
that role extension into plain radiographic reporting by
non-radiologists has the potential to yield a less accurate
interpretation. The ‘red dot’ and reporting of plain radio-
graphs are two very different concepts and should be
treated as such. A ‘red dot’ or equivalent abnormality
detection system is a voluntary initiative in the emer-
gency setting that requires no formally recognised addi-
tional training. Such a system involves a radiographer
highlighting an acute abnormality to the referring emer-
gency clinician by placing a ‘red dot’ or equivalent (e.g.
asterisk) on the digital image. On the other hand, the
development of formalised radiographer reporting in the
1990s in the United Kingdom requires a radiographer to
complete an accredited postgraduate university program
in image interpretation. I would encourage the authors to
acknowledge the many differences between a ‘red dot’
and a formalised diagnostic report, especially the fact that
no additional training is required for radiographers to
participate in a ‘red dot’ system.
What the authors have failed to discuss is the recent
development of a radiographic comment. A radiographic
comment is where an educated and accredited radiog-
rapher not only highlights trauma pathology at the point
of care but provides a brief description. A radiographic
comment does not replace a radiologist’s report. It pro-
vides a brief, educated interpretation of a radiograph in
a clinically useful time frame, further enhancing patient
safety in the emergency health care setting. Recent
literature has acknowledged the benefits of a radiogra-
pher commenting system over the ‘red dot’ system.2,3
The authors suggest that improvements are required
to existing models to achieve the reporting of plain
radiographs in a clinically useful time frame without an
increase in cost. They have not acknowledged recently
published documents calling attention to not only the
delay in radiology reports4
but the rising concern of the
number of unreported radiographs within Australia,5
ulti-
mately leading to an increase in patient risk. With the
recent implementation of the National Emergency
Admission Targets requiring that patients are discharged
from an emergency department within 4 hours, now is
the best time to consider innovative models of care to
improve service delivery and enhance patient care,
rather than devaluing a current successful patient safety
mechanism such as ‘red dot’.
Kind regards,
MICHAEL J. NEEP
A/Team Leader Radiographer, Emergency Department, Princess
Alexandra Hospital, Brisbane, Queensland, Australia
doi: 10.1111/1754-9485.12053
References
1. College of Radiographers. Radiography role developed
revisited: the research evidence 2003. 2003. [Cited 9
Nov 2012.] Available from URL: http://www.
improvement.nhs.uk/documents/18weeks/
Role-development-revisited.pdf
2. Hardy M, Culpan G. Accident and emergency
radiography: a comparison of radiographer
commenting and ‘red dotting’. Radiography 2007; 13:
65–71.
3. McConnell JR, Webster AJ. Improving radiographer
highlighting of trauma films in the Accident and
Emergency department with a short course of study –
an evaluation. Br J Radiol 2000; 73: 608–12.
4. Queensland Government. Queensland Health Radiology
Services Profile 2009–2010. 2010; 5: 24.
5. Patty A. Reviews needed on mountain of backlogged
X-rays, says professor. Sydney Morning Herald; 16
May 2012.
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Journal of Medical Imaging and Radiation Oncology 57 (2013) 206
© 2013 The Author
Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists206