An evaluation of a radiographer-led barium enema service in the diagnosis of colorectal cancer

Abstract 

Purpose

This study was undertaken to assess the sensitivity and efficacy of a radiographer-led double contrast barium enema (DCBE) service in the diagnosis of colorectal cancer (CRC).

Methods

All patients on the CRC database from its inception in 1997 until the end of 2004 were cross-referenced with the radiology database. Details were recorded of any patient who had undergone a DCBE examination at any time prior to histological confirmation of colorectal cancer. All the DCBE in this review were performed and reported by radiographers as part of a protocol of double reporting with a consultant radiologist. The radiographers and radiologists reports were reviewed for each patient. Notes and X-rays were also reviewed when necessary. Reporting sensitivity was compared with the Royal College of Radiologists (RCR) barium enema examination targets for the diagnosis of colorectal carcinoma.

Results

362 of the 1005 patients on the CRC database had undergone a DCBE. Combined radiographer and radiologist reporting demonstrated a diagnostic sensitivity of 98% for CRC and were cancer specific in 93% of cases. These results compared favourably with the referenced RCR sensitivity targets for colorectal cancer. Reporting discord only occurred with the terminology of reporting 13 equivocal polyps. None of these polyps were neoplastic and thus did not affect CRC sensitivity.

Conclusion

Radiographer reporting compares favourably with published CRC sensitivity data of more expensive techniques such as CT colonography. A protocol of radiographer/radiographer double reporting is now used at this hospital with radiological second opinion being acquired for more complex abnormal DCBE examination appearances. This service is a safe, cost-effective option that should not be overlooked with the increasing demand for CRC screening.

Keywords: Radiographer, Colorectal, Cancer, Barium enema, Reporting, Sensitivity