1. RADIOLOGY—ORIGINAL ARTICLE
Radiographer commenting of trauma radiographs: A survey of
the benefits, barriers and enablers to participation in an
Australian healthcare setting
Michael J Neep,1,2,3
Tom Steffens,1
Rebecca Owen4,5
and Steven M McPhail2,3
2
Centre for Functioning and Health Research, Metro South Health, and 1
Department of Medical Imaging, and 4
Radiation Oncology Mater Centre,
Princess Alexandra Hospital, 3
School of Public Health & Social Work and Institute of Health and Biomedical Innovation, and 5
Faculty of Health,
Queensland University of Technology, Brisbane, Queensland, Australia
MJ Neep MSci, BAppSci (Med Rad Tech);
T Steffens BAppSci (Med Rad Tech) Grad Dip
Rad Image Interp; R Owen PhD, BAppSci (Med
Rad Tech) FIR; SM McPhail PhD, BPhty.
Correspondence
Michael J Neep, Department of Medical
Imaging, Princess Alexandra Hospital, Ipswich
Road, Woolloongabba, Qld 4102, Australia.
Email: Michael_neep@health.qld.gov.au
Conflict of interest: There is no conflict of
interest from the authors or authors’
institutions.
Submitted 24 February 2014; accepted 13
March 2014.
doi:10.1111/1754-9485.12181
Abstract
Introduction: Radiographer abnormality detection systems that highlight
abnormalities on trauma radiographs (‘red dot’ system) have been operating
for more than 30 years. Recently, a number of pitfalls have been identified.
These limitations initiated the evolution of a radiographer commenting
system, whereby a radiographer provides a brief description of abnormalities
identified in emergency healthcare settings. This study investigated radiog-
raphers’ participation in abnormality detection systems, their perceptions of
benefits, barriers and enablers to radiographer commenting, and percep-
tions of potential radiographer image interpretation services for emergency
settings.
Methods: A cross-sectional survey was implemented. Participants included
radiographers from four metropolitan hospitals in Queensland, Australia.
Conventional descriptive statistics, histograms and thematic analysis were
undertaken.
Results: Seventy-three surveys were completed and included in the analysis
(68% response rate); 30 (41%) of respondents reported participating in
abnormality detection in 20% or less of examinations, and 26(36%) reported
participating in 80% or more of examinations. Five overarching perceived
benefits of radiographer commenting were identified: assisting multidiscipli-
nary teams, patient care, radiographer ability, professional benefits and
quality of imaging. Frequently reported perceived barriers included ‘difficulty
accessing image interpretation education’, ‘lack of time’ and ‘low confidence
in interpreting radiographs’. Perceived enablers included ‘access to image
interpretation education’ and ‘support from radiologist colleagues’.
Conclusions: A range of factors are likely to contribute to the successful
implementation of radiographer commenting in addition to abnormality detec-
tion in emergency settings. Effective image interpretation education ame-
nable to completion by radiographers would likely prove valuable in preparing
radiographers for participation in abnormality detection and commenting
systems in emergency settings.
Key words: education; healthcare; image interpretation; radiographer.
Introduction
Radiographers in some emergency settings began par-
ticipating in an abnormality detection system in the early
1980s.1
An abnormality detection system (commonly
known as ‘red dot’) was first introduced in the United
Kingdom to alert the referring emergency clinician to the
possible presence of a traumatic abnormality. This
system involved the radiographer simply marking the
radiograph with a small red sticker when the radiogra-
bs_bs_banner
Journal of Medical Imaging and Radiation Oncology 58 (2014) 431–438
© 2014 The Royal Australian and New Zealand College of Radiologists 431

2. pher detected a possible abnormality.1
Numerous studies
have since demonstrated the effectiveness of this
system.2,3
However, the simplicity of the ‘red dot’ system
is not without pitfalls.4,5
The ‘red dot’ system is voluntary
and only distinguishes between normal and abnormal
pathology. It offers no opportunity to indicate the loca-
tion or severity of the abnormality, presence of a normal
variant or the number of abnormalities present.
An evolution of a detection-only system has been the
development of radiographer commenting systems.
Radiographer commenting systems not only indicate the
possible presence of a traumatic pathology but also
provide the radiographer with an opportunity to include
a brief comment on the nature and location of possible
abnormalities present.
Radiographer abnormality detection and commenting
is not intended to replace radiologist reports but assist
multidisciplinary clinical teams and radiologists when
viewing and interpreting radiographs. Benefits of front-
line image interpretation integrated within radiographer
services have been reported.4–11
Previous research has
indicated radiographer commenting systems that high-
light and describe acute abnormalities at the point of
care can expedite service delivery and improve the accu-
racy of diagnoses to enhance patient outcomes in emer-
gency settings.4,5,11,12
Similarly, previous research has
suggested that nurse practitioners may also be able to
contribute towards improving the service in the emer-
gency department by interpreting radiographs.13
A lit-
erature review conducted by Australian researchers
acknowledged that further research is necessary to
establish the clinical utility of nurses to interpret
radiographs.14
Contemporary healthcare standards indicate that non-
urgent radiological studies must have a report provided
to the referring doctor within 24 hours of imaging in
order to influence patient management.15
This may be
problematic in public healthcare settings with high
demand and limited resourcing. For example, the
2011–12 Radiology Services Profile for public hospitals in
Queensland highlighted that only 56% of all radiologist
diagnostic reports were available within 24 hours.16
In emergency departments, a delay in availability of
radiologist reports can mean that decisions regarding
clinical management or discharge may be made by
the referring clinical team without consideration of the
radiologist report. The absence of a radiologist report
or radiographer comment within clinically relevant
timeframes is a potential risk to patients accessing
healthcare services through increased likelihood of
missed or incorrect diagnosis.17,18
This represents a
major shortcoming in the contemporary clinical model
that is dependent on junior medical officers for immedi-
ate interpretation of medical images without a radiologist
report. International evidence acknowledges that
medical school curriculum often incorporates little radi-
ology, and many emergency departments do not have a
structured image interpretation education programme
for junior doctors.19,20
Furthermore, junior doctors with
little experience in interpreting radiographs often work
demanding shifts in emergency departments, and errors
do occur.20–24
Similar to junior doctors, radiographers
also make incorrect interpretations of trauma radio-
graphs. A study in Brisbane in 2012 indicated that errors
made by radiographers when interpreting radiographs
are different to those made by junior doctors.25
This
study acknowledged that when an emergency doctor and
radiographer’s interpretation of a radiograph is com-
bined, the overall diagnostic accuracy is enhanced com-
pared with the accuracy of emergency doctors alone.25
Despite the development of radiographer commenting
systems in the UK National Health Service, there is a
scarcity of peer-reviewed research in this field conducted
outside the United Kingdom. Several preliminary studies
have trialled radiographer image interpretation in Aus-
tralian settings, all yielding encouraging results.5,6,8,9,25–27
The purpose of this study was to investigate radiogra-
phers’ current participation in abnormality detection
systems and their perceptions of the benefits of radiog-
rapher commenting; the barriers and enablers to radi-
ographer commenting; and the level of radiographer
image interpretation service that they consider appro-
priate for public hospital emergency settings.
Methods
Design
A cross-sectional web-based survey was implemented.
Ethics
The Human Research Ethics Committees of the Metro-
politan South Hospital and Health Service District and
the Queensland University of Technology approved this
investigation. Potential participants were provided with a
study information sheet as part of the email invitation;
choosing to complete the survey was taken as consent to
participate. Participation was voluntary.
No personal identifying information was attached to
the survey responses.
Participants and setting
A total of 108 radiographers were identified as eligible
for participation and were invited to complete the
survey. Participants included radiographers from four
metropolitan hospitals in Queensland where radiogra-
pher participation in abnormality detection systems is
currently voluntary. Radiographers were considered
eligible for inclusion if they had at least 12 months
clinical experience immediately following completion of a
48-week period of supervised practice and had worked in
an emergency setting. This volunteer sampling approach
MJ Neep et al.
© 2014 The Royal Australian and New Zealand College of Radiologists432

3. was undertaken to ensure the sample adequately repre-
sented radiographers who have some understanding of
the implementation of a radiographer abnormality detec-
tion system in a public hospital emergency setting. The
current radiographer abnormality detection systems
that operate in the four participating facilities encourage
(but do not mandate) radiographers to flag abnormalities
on trauma radiographs. Within the participating set-
tings, radiographers are encouraged to highlight trauma
abnormalities of the appendicular and axial musculoskel-
etal system as well as a suspected pneumothorax.
Survey content and procedure
The custom-designed questionnaire consisted of five
sections. The first contained questions about demo-
graphic information including years of clinical experience
and gender, whereas the second asked respondents
whether they participate in an abnormality detection
system (yes or no) and the estimated proportion of cases
in which they participate. Respondents were then asked
to identify benefits of a radiographer commenting
system in their own words. The fourth section asked
respondents to describe perceived barriers and enablers
to implementing a front line image interpretation service
again using open-ended responses. The questionnaire
concluded by asking respondents to nominate the level
of a radiographer image interpretation service they con-
sidered appropriate for implementation in public hospital
emergency settings on a Likert scale. The questionnaire
was piloted among radiographers with experience using
abnormality detection systems that were not from the
participating hospitals. During the piloting of the survey
instrument, cognitive pre-testing methods were used to
ensure the questions were easy to understand, were
interpreted as intended and that response options were
clearly understood.28
This resulted in an amendment of
one of the original questions due to potentially mislead-
ing terminology.
Eligible radiographers from the four facilities were
invited to participate via an email containing a hyperlink
to the web-based survey platform. This allowed respond-
ents to complete the questionnaire at their convenience
and submit it online. A reminder email was sent 1 week
before the closure of the 4-week data collection period to
maximise the response rate. The time required to com-
plete the questionnaire was approximately 15 minutes.
Analysis
Conventional descriptive statistics (number, percentage;
median, interquartile range (IQR) and range) were used
to describe participants’ demographic information and
participation in an abnormality detection system. Open-
ended responses were independently coded by two
researchers who then consulted with each other to
derive a set of agreed data categories. These similar
categories were then considered as an overarching
theme. The number of responses coded into each cat-
egory were recorded and expressed as a percentage of
total responses. Response frequency was also used to
determine the primary emerging categories for per-
ceived barriers and enablers.
Results
A total of 73 (68% response rate) completed the survey.
The median (interquartile range) years of radiographer
experience was 5 (2–10). The range of experience was
from 1 to 36 years. Forty-nine (67%) respondents were
women. Sixty (82%) respondents reported that they
currently participate in an abnormality detection system.
The proportion of cases that radiographers reported par-
ticipating in an abnormality detection system is dis-
played in Figure 1. The pattern of responses indicated a
bi-modal distribution with two focal maxima at either end
of the participation range with 30 (41%) respondents
reporting levels of participation in the 0–20% range and
26 (36%) respondents reporting participating in an
abnormality detection system for 80–100% of cases.
Radiographers reported a variety of perceived benefits
from potential participation in a radiographer comment-
ing system (Table 1). Some of most frequent responses
referred to ‘assisting junior medical staff in identifying
traumatic pathologies’ (Participant 28) as they ‘are not
well trained (or experienced) in X-ray interpretation’
(Participant 12), enhancing ‘communication and team-
work within the emergency department’ (Participant
19) leading to ‘improved patient care’ (Participant 73)
and promoting ‘an efficient and streamlined patient
treatment/diagnosis’ (Participant 66).
The summary of radiographers’ perceived barriers to
the implementation of successful radiographer com-
menting systems is presented in Table 2. Responses
were coded into 13 categories of barriers. The most
051015
Frequency
0 20 40 60 80 100
Percentage of cases radiographers participate in an Abnormality Detection System
Fig. 1. Histogram representing the proportion of cases (out of 100) that radi-
ographers participate in an abnormality detection system.
Radiographer commenting: emergency settings
© 2014 The Royal Australian and New Zealand College of Radiologists 433

4. frequent potential barriers to implementing a radiogra-
pher commenting system included access to targeted
image interpretation education (n = 32, 43%), lack
of time to review radiographs (n = 30, 41%) and
radiographers’ low confidence to interpret radiographs
(n = 24, 33%).
The potential enablers for the implementation of suc-
cessful radiographer commenting systems are presented
in Table 3. A total of 14 perceived enablers were iden-
tified. Access to image interpretation education (n = 65,
89) was identified as an enabler five times more fre-
quently than the next most common response. The two
next most frequently identified enablers were support
from radiologists (n = 13, 18%) and junior doctors being
aware that the system was in place in order to utilise
the radiographer comments in their clinical practice
(n = 13, 18%).
Radiographers’ ratings on a five-point Likert scale of
agreement (1 = strongly disagree, 5 = strongly agree)
with six statements about radiographers’ involvement in
an integrated image interpretation service are presented
in Figure 2. The pattern of responses varied across the
six statements. Strong disagreement with the statement
that ‘radiographers should never provide an image inter-
pretation opinion’ was evident (Fig. 2a). This matched
the strong agreement with the statement that radiogra-
phers should participate in an abnormality detection
system (Fig. 2d). Radiographers had differing opinions
on whether a written description (radiographer
comment) should be provided for each case (Fig. 2e),
but most disagreed or strongly disagreed that a com-
plete diagnostic report should be provided by the radi-
ographer (Fig. 2f).
Discussion
This has been the first study to report the perceptions of
Australian radiographers’ with respect to participation in
Table 1. Radiographers’ perceived benefits of a radiographer commenting system divided into categories within five themes
Radiographer ability Patient care Assisting multidiscipline teams Quality of imaging Profession
Benefits relating to the skills and
knowledge of radiographers
Benefits associated with
improved care and patient
outcomes
Benefits that assists the team in
their clinical roles
Benefits to the profession (and
individuals working within the
profession)
Benefits to the profession (and
individuals working within the
profession)
Knowledge of abnormal and
normal pathology
Less abnormalities missed Support junior medical officers Enhanced understanding of
required image quality
Improve job satisfaction
n = 22 (30%)
n = 25 (34%) n = 36 (49%)
n = 24 (33%)
n = 20 (27%)
Skill in detecting and describing
pathology
Expedited service delivery Enhanced communication Improve awareness of the
radiographer profession
n = 9 (12%)
n = 24 (33%) n = 20 (27%)
n = 7 (9%)
Confidence in their ability to
detect and describe
pathology
Opportunity for career
advancement
n = 12 (16%)
n = 6 (8%)
Table 2. Perceived barriers that radiographers believe inhibit the
implementation of a successful radiographer commenting system
Perceived barriers N (%)
Access to targeted image interpretation education 32 (43)
Lack of time to review radiographs 30 (41)
Radiographers’ low confidence to interpret radiographs 24 (33)
Inconsistency in use and absence of guidelines 17 (23)
Resistance to participate by radiographers 11 (15)
Radiologists’ resistance to change 10 (14)
Radiographers fear that they could be wrong 9 (12)
Junior medical officers’ awareness of such a system 8 (11)
Emergency departments lack of trust in the system 5 (6)
Medico legal issues 4 (5)
Resistance from other professions 3 (4)
Scope of practice concerns 2 (3)
Deficient emergency department communication 2 (3)
Table 3. Perceived enablers that would assist the successful implementation
of a radiographer commenting system
Perceived enablers N (%)
Access to image interpretation education 65 (89)
Support from radiologists 13 (18)
Awareness of radiographer commenting system by junior medical
officers
13 (18)
Improved communication with emergency department 10 (14)
Clear guidelines (radiographer commenting role clearly defined) 8 (11)
Consistent rostering of competent radiographers 6 (8)
Support from radiography management 5 (7)
Allowing time to review radiographs 5 (7)
Continuous audit on quality of the radiographer comment 5 (7)
Support from national governing body 4 (5)
Evidence that such a system works 4 (5)
Willing participation from radiographers 4 (5)
Implementation of a standardised radiographer comment worksheet 2 (2)
Medico legal cover 1 (1)
MJ Neep et al.
© 2014 The Royal Australian and New Zealand College of Radiologists434

5. voluntary abnormality detection systems, their per-
ceived benefits, barriers and enablers to the successful
implementation of a radiographer commenting system in
emergency care settings. A large proportion of radiog-
raphers reported participating in abnormality detection
systems. However, the level of participation was not
consistent with some radiographers taking part in abnor-
mality detection for almost all examinations, while
others rarely contributed to abnormality detection. This
inconsistent participation may be attributed to several
0
10
20
30
40
50
60
1 2 3 4 5
(a)
Respondents(n=73)
0
10
20
30
40
50
60
1 2 3 4 5
Respondents(n=73)
(b)
0
10
20
30
40
50
60
1 2 3 4 5
Respondents(n=73)
(c)
0
10
20
30
40
50
60
1 2 3 4 5
Respondents(n=73)
(d)
0
10
20
30
40
50
60
1 2 3 4 5
Respondents(n=73)
(e)
0
10
20
30
40
50
60
1 2 3 4 5
Respondents(n=73)
(f)
Fig. 2. Histogram representing radiographers’ level of agreement (1 = strongly disagree, 5 = strongly agree) with six statements (a) Radiographers should never
provide an image interpretation opinion, (b) Radiographers should provide a verbal opinion when an abnormality is detected, (c) Radiographers should provide a
verbal opinion only when requested by a medical officer, (d) Radiographers should participate in an abnormality detection system (e.g. red dot), (e) Radiographers
should complete a written description for each radiographer examination, (f) Radiographers should provide a full diagnostic report for each radiographic exami-
nation) about potential involvement in an image interpretation service.
Radiographer commenting: emergency settings
© 2014 The Royal Australian and New Zealand College of Radiologists 435

6. factors including the voluntary nature of participation,
mixed confidence levels in interpreting radiographs,
inconsistent implementation of abnormality detection
systems or variable time availability (to review each
radiograph) across emergency care settings.
The Medical Radiation Practice Board of Australia’s
statement on professional capabilities for medical radia-
tion practice29
recommends that radiographers are to
communicate results of diagnostic tests to referring
doctors when they identify significant abnormal findings.
This investigation has demonstrated some radiographers
in Australian emergency settings may not be following
this recommendation. Perhaps this should be a point
of concern among radiographers, managers of medical
imaging departments or to the Medical Radiation Practice
Board of Australia.
Despite the evidence of benefit, some resistance to
radiographer image interpretation has been reported.8,30
Research evidence questioning the benefit of radiogra-
pher participation in a frontline image interpretation
service is generally lacking. However, one study has
recently questioned the benefit of the ‘red dot’ radiog-
rapher abnormality detection system in tertiary hospi-
tals.31
This study set out to investigate the accuracy
(sensitivity and specificity) of the ‘red dot’ system utilis-
ing a retrospective review of radiographic examinations
at a single facility. Due to their retrospective study
design and the voluntary nature of participation in the
‘red dot’ system, this did not allow the investigators to
distinguish between ‘no abnormality detected’ (no red
dot) and ‘radiographer did not participate in the red dot
system for this radiograph’ (also no red dot). Findings
from the current study highlighted that a substantial
proportion of radiographers choose to participate in vol-
untary ‘red dot’ systems less than 20% of the time. It
is likely that a large proportion of the ‘false negative’
cases in this previous study was a result of radiographer
non-participation.
Perhaps more importantly, this highlights a key pitfall
of voluntary radiographer abnormality detection systems
for clinical care. When radiographer abnormality detec-
tion is voluntary, other members of the multidisciplinary
team may be unsure whether the radiographer did not
detect an abnormality or was not participating in the
abnormality detection system. It may also lead to radi-
ographer participation in cases where an abnormality
is overtly evident (e.g. a joint dislocation) and non-
participation in cases where abnormality detection
would require closer consideration and possibly greater
skill, confidence and time commitment to the task,
for example, an avulsion fracture of the triquetral
carpal bone.
The five themes of radiographer-perceived benefits
from the successful implementation of a radiographer
commenting system were congruent with previous
research investigating radiographer image interpretation
internationally.4–6,11,12
A number of previous reports have
highlighted that junior emergency doctors have little
experience in interpreting radiographs and that errors in
interpretation occur.19,21–24
Previous studies have shown
that between 1% and 7% of radiographs are misinter-
preted by emergency doctors.23,32
The most commonly
missed findings were fractures and pulmonary nodules.
The perceived potential benefits reported by respond-
ents in this study extended beyond those related to
improved patient care and assisting other members of
the multidisciplinary team. The respondents also indi-
cated that radiographer commenting might lead to
improved skills, career advancement opportunities and
improved job satisfaction. This finding is consistent with
research in this field from the United Kingdom.33,34
The realisation of any benefit from a radiographer
commenting system hinges on its successful implemen-
tation. Interestingly, both the most frequently identified
barrier to and enabler of the successful implementation
of a radiographer commenting system centred on the
importance of access to image interpretation education.
While some postgraduate university qualifications
(e.g. a master’s degree) involving image interpretation
coursework are available, clinical radiographers are likely
to find formal university coursework of this nature inac-
cessible. This inaccessibility may be due to large (often
inflexible) time requirements and a substantial financial
commitment. The financial cost is not limited to tuition
fees but may also include leaving current employment
(or taking extended leave) during semester to attend
coursework activities.
An alternative to regimented postgraduate university
qualifications is targeted image interpretation training
for radiographers. Targeted image interpretation training
programmes in short course formats exist in the United
Kingdom.4
However, lack of access to suitable short
course image interpretation education for diagnostic
radiographers remains a barrier to the successful imple-
mentation of a radiographer commenting system in
regions where image interpretation education is not
readily available. Initial radiographer image interpreta-
tion training seems a critical first step to radiographer
involvement in an integrated image interpretation
service in emergency settings. Initial research in this
field has indicated that short course training enhances
radiographers’ confidence and ability to interpret plain
radiographs.2,4,25,26,35–37
Another important topic that was raised as both an
enabler of and barrier to the successful implementation
of an image interpretation service was the support or
potential lack of support from radiologists in healthcare
services. It is not surprising that radiographers consider
the support of radiologists as an important facilitator to
the successful implementation of a radiographer com-
menting system. This may be due to the interrelated and
interdependent roles that radiologists and radiographers
provide in diagnostic imaging services, as well as their
longstanding history of working together for the common
MJ Neep et al.
© 2014 The Royal Australian and New Zealand College of Radiologists436

7. good of their patients receiving medical imaging ser-
vices. One potential concern that has been raised is the
potential for loss of professional demarcation between
the role of radiologists and radiographers.33,38
The data
from the current study may dampen these concerns with
radiographers clearly indicating they did not see their
role in a successful image interpretation service to
include the provision of a diagnostic report, the primary
role of their radiologist colleagues.
Strengths and limitations
This investigation has several strengths and limitations.
First, the investigation included a sample of participants
from four metropolitan hospitals. This enabled the study
to address the intended research aim. However, radiog-
raphers working in dissimilar settings or regional and
rural locations may have had different perceptions
regarding the implementation of a radiographer com-
menting system than those radiographers who partici-
pated in this investigation. Similarly, radiographers’
foundation of knowledge is shaped by their undergradu-
ate or postgraduate education. This investigation did not
capture details of participants’ educational qualifications
or location of training. A further limitation that is always
a risk when conducting voluntary survey research was
the possibility of response bias. Radiographers who
responded to the survey may have a greater interest in
radiographer commenting than non-responders.
Conclusion
This investigation has addressed the research aims and
highlighted that many radiographers do not participate
in existing abnormality detection systems for a large
proportion of their trauma cases. A leading perceived
(and modifiable) barrier to the implementation of radi-
ographer interpretation and commenting in Australian
emergency care settings is access to effective image
interpretation education for radiographers. For abnor-
mality detection and commenting by radiographers to
advance within Australian healthcare settings, it is per-
tinent that radiographers are appropriately skilled in
interpreting trauma radiographs. The evaluation of
targeted radiographer image interpretation education
programmes amenable to completion by clinical radi-
ographers is a key priority for future research in this
field.
Acknowledgements
This research was supported by Queensland Health’s
Health Practitioners Research Grant Scheme as well as a
scholarship from the Australian Centre for Health Ser-
vices Innovation. SM is supported by National Health and
Medical Research Council (of Australia) Fellowship.
References
1. Berman L, de Lacey G, Twomey E, Twomey B, Welch
T, Eban R. Reducing errors in the accident
department: a simple method using radiographers.
BMJ 1985; 290: 421–2.
2. McConnell J, Webster A. 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.
3. Brealey S, Scally A, Hahn S, Thomas N, Godfrey C,
Crane S. Accuracy of radiographers red dot or triage
of accident and emergency radiographs in clinical
practice: a systematic review. Clin Radiol 2006; 61:
604–15.
4. Hardy M, Culpan G. Accident and emergency
radiography: a comparison of radiographer
commenting and ‘red dotting. Radiography 2007;
13: 65–71.
5. Smith T, Younger C. Accident and emergency
radiological interpretation using the radiographer
opinion form (ROF). Radiographer. 2002; 49: 27–31.
6. Jane S, Hall R, Egan I. The red dot system: the
outback experience. Radiographer 1999; 46: 83–7.
7. Smith L. The Red-dot system in medical imaging:
ethical, legal and human rights considerations.
Radiographer 2006; 53: 4–6.
8. Smith T, Traise P, Cook A. The influence of a
continuing education program on the image
interpretation accuracy of rural radiographers. Rural
Remote Health 2009; 9: 1145.
9. Cook AP, Oliver T, Ramsay L. Radiographer
reporting: discussion and Australian workplace trial.
Radiographer 2004; 51: 61–6.
10. Hardy M, Barrett C. Interpretation of trauma
radiographs by radiographers and nurses in the
UK: a comparative study. Br J Radiol 2004; 77:
657–61.
11. Snaith B, Hardy M. Radiographer abnormality
detection schemes in the trauma environment – an
assessment of current practice. Radiography 2008;
14: 277–81.
12. Coleman L, Piper K. Radiographic interpretation of
the appendicular skeleton: a comparison between
casualty officers, nurse practitioners and
radiographers. Radiography 2009; 15: 196–202.
13. Summers A. Can nurses interpret X-rays safely without
formal tuition? Accid Emerg Nurs 2005; 13: 162–6.
14. Free B, Lee GA, Bystrzycki A. Literature review of
studies on the effectiveness of nurses ability to order
and interpret X-rays. Australas Emerg Nurs J 2009;
12: 8–15.
15. Australian Council on Healthcare Standards.
Australian Cinical Indicator Report 2004–2011, 13th
edn. Southern Colour, Sydney, Australia, 2012.
16. Queensland Govenment. Queensland Health radiology
services profile 2009–2010. Queensland Health, 2010.
17. Devaney C, Gordon M Radiography abnormality
description project: project completion report.
Queensland Health, 2010.
Radiographer commenting: emergency settings
© 2014 The Royal Australian and New Zealand College of Radiologists 437

8. 18. Kachalia A, Gandhi TK, Puopolo AL et al. Missed and
delayed diagnoses in the emergency department: a
study of closed malpractice claims from 4 liability
insurers. Ann Emerg Med 2007; 49: 196–205.
19. Vincent C, Driscoll P, Audley R, Grant D. Accuracy of
detection of radiographic abnormalities by junior
doctors. Arch Emerg Med 1988; 5: 101–9.
20. Gunderman RB, Siddiqui AR, Heitkamp DE, Kipfer
HD. The vital role of radiology in the medical school
curriculum. Am J Roentgenol 2003; 180: 1239–42.
21. McLauchlan C, Jones K, Guly H. Interpretation of
trauma radiographs by junior doctors in accident and
emergency departments: a cause for concern?
J Accid Emerg Med 1997; 14: 295–8.
22. Guly H. Diagnostic errors in an accident and
emergency department. Emerg Med J 2001; 18:
263–9.
23. Sprivulis P, Frazer A, Waring A. Same-day X-ray
reporting is not needed in well-supervised emergency
departments. Emerg Med 2001; 13: 194–7.
24. Willis BH, Sur SD. How good are emergency
department Senior House Officers at interpreting
X-rays following radiographers’ triage? Eur J Emerg
Med 2007; 14: 6–13.
25. McConnell J, Devaney C, Gordon M. Queensland
radiographer clinical descriptions of adult
appendicular musculo-skeletal trauma following a
condensed education programme. Radiography 2012;
19: 48–55.
26. McConnell J, Devaney C, Gordon M, Goodwin M,
Strahan R, Baird M. The impact of a pilot education
programme on Queensland radiographer abnormality
description of adult appendicular musculo-skeletal
trauma. Radiography 2012; 18: 184–90.
27. Orames C. Emergency department X-ray
diagnosis-how do radiographers compare?
Radiographer 1997; 44: 52–5.
28. Collins D. Pretesting survey instruments: an overview
of cognitive methods. Qual Life Res 2003; 12:
229–38.
29. Medical Radiation Practitioner Board of Australia.
Professional capabilities for medical radiation practice.
Melbourne, Victoria, 2013.
30. Kenny LM, Andrews MW. Addressing radiology
workforce issues. Med J Aust 2007; 186: 615–16.
31. Brown N, Leschke P. Evaluating the true clinical
utility of the red dot system in radiograph
interpretation. J Med Imaging Radiat Oncol 2012;
56: 510–13.
32. Wardrope J, Chennells P. Should all casualty
radiographs be reviewed? Br Med J (Clin Res Ed)
1985; 290: 1638–40.
33. Howard ML. An exploratory study of radiographer’s
perceptions of radiographer commenting on
musculo-skeletal trauma images in rural community
based hospitals. Radiography 2013; 19: 137–41.
34. Lancaster A, Hardy M. An investigation into the
opportunities and barriers to participation in a
radiographer comment scheme, in a multi-centre
NHS trust. Radiography 2012; 18: 105–8.
35. Loughran C. Reporting of fracture radiographs by
radiographers: the impact of a training programme.
Br J Radiol 1994; 67: 945–50.
36. Hargreaves J, Mackay S. The accuracy of the red dot
system: can it improve with training? Radiography
2003; 9: 283–9.
37. Mackay S. The impact of a short course of study on
the performance of radiographers when highlighting
fractures on trauma radiographs: ‘The Red Dot
System. Br J Radiol 2006; 79: 468–72.
38. Johansen LW, Brodersen J. Reading screening
mammograms – attitudes among radiologists and
radiographers about skill mix. Eur J Radiol 2011; 80:
325–30.
MJ Neep et al.
© 2014 The Royal Australian and New Zealand College of Radiologists438