Background: The College of Radiographers' vision was that diagnostic radiographers in the UK would be writing preliminary clinical evaluations (PCE) on images. Their 2013 policy supporting the use of PCE has not been updated in a decade and it might be suggested PCE practices in the UK have not really moved on, though elsewhere it appears to have gained traction. The aim of this scoping review was to establish the current global status of the use of PCE. Method: The Arksey and O'Malley scoping review framework and PRISMA-ScR guidelines were used to develop a protocol to identify studies between January 2013 to January 2024 using six databases. Collated literature was analysed using content analysis to identify themes. Results: 52 relevant studies were identified for inclusion. Studies focused predominantly on evaluating accuracy, education, perceptions, and new initiatives. Themes identified a developing role in the use of PCE internationally, perhaps more than in the UK, and in a range of modalities and clinical settings though projectional radiography remains the mainstay. Barriers and drivers to the use of PCE were identified in addition to some quality mechanisms used to support PCE implementation, though impact of implementation was not well explored. Conclusion: Considering PCE has been an aspiration for more than a decade, it remains relatively infrequently researched. There is growing scope internationally, particularly in Australia, yet there is no real evaluation of the impact and role that PCE may have. Implications for practice: Until further research into the potential impact of PCE and barriers to its implementation, it is likely practices may not evolve with the risk AI technologies may supersede necessity for the practice.

Introduction: The chest x-ray (CXR) is the most commonly performed x-ray examination in England, UK. Reporting radiographers provide a cost-effective and safe solution for managing CXR backlogs, but not all Trusts support this service development. This study aimed to establish the service enablers and challenges associated with training and employing radiographers to report CXR images in acute hospital sites in England, UK. Methods: Approval for this electronic survey was granted in 84 of 146 (58%) Trusts approached. The survey was open for 10 weeks during August to October 2020, comprising of qualitative and quantitative questions. Data was exported in to an Excel spreadsheet where manual thematic analysis was performed. Descriptive statistics were also generated. Results: Sample size was 75 (89% response rate). Thirty-three departments (44%) had at least one trainee. Most departments (n = 53, 71%) employ at least one CXR reporting radiographer. A total of 121/160 (76%) radiographers report CXRs. Number of reporting sessions shows progression. Factors enabling training and employment arise from service improvements, financial pressures, and developing the workforce. The main challenges relate to staffing issues with a number of associated sub-themes. A small faction indicated lack of radiographer interest to report CXRs due to litigation worries; possibly uncovering a new and emerging issue. Conclusion: Enablers and challenges associated with radiographers reporting CXRs are similar to previous studies. The growth of CXR reporting radiographers and reporting sessions indicates a continuing reliance on radiographers to contributing to managing CXR backlogs. Implications for practice: It is recommended that potential trainees are explicitly informed of the legal protection that will be provided, to prevent accountability concerns impacting on the continuing progression in this area of advanced practice.

Introduction: Current UK guidelines state that suspicious thyroid nodules <10 mm do not require FNA. These are often followed up with serial ultrasound scans. Ultrasound Strain Elastography (USE) could provide a more accurate alternative and preclude the need for follow-up. Can USE identify nodules at greater risk of malignancy and streamline patient management? Methods: Systematic review methodology used. Inclusion criteria are: - Population: patients with suspicious thyroid nodules <10 mm.- Intervention: USE.- Comparator: Ultrasound features of nodules.- Outcome measure: FNA or surgical removal of nodules. Searches performed on 6 commercial databases, along with grey literature anddissertation databases. The QUADAS-2 diagnostic study checklist used for quality assessment. Results: 8 studies included and a narrative analysis performed due to heterogeneity of results. The mean USE sensitivity is 74.3%, mean specificity 80.5%. Mean overall ultrasound sensitivity is 80.4%, specificity 71.0%. Results suggest that USE is not superior to ultrasound for detecting malignancy. Some study limitations, particularly the heterogeneity of reporting the ultrasound features preclude meaningful conclusion from being drawn. Conclusion: USE is more accurate at identifying benign nodules than ultrasound. Nodules appearing benign on USE could be excluded from serial ultrasound follow-up. No significant difference was found between USE and ultrasound at identifying malignant nodules. Implications for practice: As FNA is not recommended for suspicious thyroid nodules <10 mm, these are often followed up with multiple scans and clinician reviews. This increases pressure on healthcare systems and uncertainty for the patient. This review shows that USE is more accurate at identifying benign nodules than ultrasound alone, meaning that these nodules could potentially be excluded from serial follow up. This would streamline patient management, freeing-up vital resources in ENT and ultrasound departments.

Introduction: The chest X-ray (CXR) is the most frequently performed radiographic examination. This study evaluates radiographers' ability to localise traumatic CXR pathology and provide a preliminary clinical evaluation (PCE) for these cases. Methods: This observer study was performed in a district general hospital in the United Kingdom (UK). A 58-case image bank was used with 20 positive cases. Participants were awarded a maximum of three points, based on abnormality recognition and descriptive accuracy. Localisation data were recorded with ROCView. Training was delivered via short online recorded tutorials covering an introduction of a systematic search strategy for CXR, how to recognise the common abnormalities covered in the tests, how to structure a PCE and multiple practice cases to review at participants' own pace. Pre- and post-training data was recorded. Results: Nine participants completed the study. Overall, pooled sensitivity remained consistent (78.9%-78.8%) following training, specificity and accuracy showed improvement of 79.0%-89.9% and 78.9%-86.0% respectively. An increase in the number of correct localisations and PCE scores were also evident. Participants performed better at correctly identifying a pneumothorax compared to skeletal abnormalities. Conclusion: Improvements in performance were evident for most participants' abnormality localisations and PCE scores, following the training intervention. The study highlighted areas of CXR PCE that may require further training, such as detecting superimposed or subtle abnormalities. Implications for practice: This study provides additional support for the development of PCE systems in additional areas of imaging practice.

Introduction: Radiographer abnormality flagging systems have been in use in the UK for over 30 years, with the guidance of the Society and College of Radiographers indicated that the preliminary clinical evaluation (PCE), or comment, be the preferred system of choice. This study aimed to provide an updated assessment of current practice based upon a previous 2008 study. Methods: A cross-sectional online survey was disseminated via Twitter and aimed at departmental and reporting leads. It requested information on the types of flagging and reporting systems operated, scope of the systems employed, required education of participants, and the role of audit. Results: Responses were received from 31 Trusts within the UK. Red dot systems were employed in 90% (n = 28) of sites, with 26% (n = 8) undertaking PCE. Skeletal radiographs were most commonly reviewed (90%; n = 28) followed by chest (58%; n = 18) and abdomen (32%; n = 10). Only 13% (n = 4) sites indicated if the image was normal but 71% (n = 22) allowed the radiographer to indicate if they were unsure. There was marked variation in the educational requirements and use of audit. Conclusion: Compared to 2008 there appears to be quite minimal change in practices in the UK. There does appear to be some increase in the use of flagging systems generally and a higher proportion of PCE systems in comparison to red dot but the use of education and audit does not necessarily show much development in the past 15 years. Implications for practice: Significant conclusions cannot be drawn due to limited sample size, however, it may support further study and consideration in relation to implementation and potentially standardisation of abnormality detection systems may be justified.

Introduction: The preliminary clinical evaluation (PCE) system involves the radiographer providing an immediate comment highlighting an abnormality on the x-ray image. This can be a valuable service development though it must be recognised that the structure of the PCE may impede its usefulness. This study aimed to assess radiographers' ability to form a concise description of radiographic abnormalities by evaluating their structure and brevity. Method: A convenience sampling approach was used and the study was open to all radiographers (n = 48) in a United Kingdom (UK) hospital. Participants provided a PCE for 35 abnormal appendicular cases, which were assessed for the number of words used, lexical density and Gunning-Fog index; comparisons were made with a gold standard. PCE accuracy was evaluated with a scoring system and statistical analysis was completed with SPSS. Results: 21 participants took part. The mean (SD,range) words used was greater than the gold standard (9.5 (3.89,14.9) vs 5.6 (1.46,7)). The mean (SD,range) lexical density was lower than the gold standard (73.8 (4.02,20.1) vs 100 (0,0)), and the mean Gunning-Fog index was also lower (15.1 (3.79,18.3) vs 20.7 (6.82,22.6)). The mean (SD,range) PCE score was 2.8 (0.34,1.17), compared to 5 (0,0) for the gold standard, and this was a statistically significant difference (t (21) = -29,p = .001). Conclusion: Participants used too many words in their PCE comments with reduced descriptive content that did not match the reading level of the gold standard. Areas for suggested improvement in practice include introduction of a comment-forming model with additional education. These findings provide an interesting addition to the growing PCE knowledge base. Implications for practice: Dedicated training prior to implementation and participation, to standardise comment structure, could improve the effectiveness of the PCE system.