Initial image interpretation of appendicular skeletal radiographs: A comparison between nurses and radiographers

Abstract 

Purpose

To examine the effect of a short training programme on nurses and radiographers, exploring differences between their performance before and after training.

Method

Twenty-two nurses and 18 radiographers interpreted 20 trauma radiographs of the appendicular skeleton before and after training. Normal and abnormal cases of a discriminatory nature were included. Total score, sensitivity and specificity values were calculated for each participant by comparison with an agreed expected answer. The area under the curve (AUC) was analysed using alternate free-response receiver operating characteristic (AFROC) methodology.

Results

Significant differences were demonstrated between the total scores achieved by the two groups (pre-training: p=0.007, post-training: p=0.04). After training, the mean score increased significantly for both groups (p<0.001). No significant difference was found between the radiographers mean pre-training scores and the nurses mean post-training scores (p=0.66).

Sensitivity for both groups increased following training, significantly so for the nurses (nurses: p<0.001, radiographers: p=0.06). Specificity reduced significantly after training for the nurses (p<0.001), and increased for the radiographers but not significantly (p=0.085). After training, there was no significant difference between the two groups in terms of sensitivity (p=0.09) but specificity was significantly higher for the radiographers (p<0.001).

The radiographers achieved higher pre-training AUC values than the nurses (p=0.04), although a difference remained after training this did not achieve statistical significance (p=0.15). The AUC values increased significantly after training for both groups (nurses: p=0.012, radiographers: p=0.004) and again there was no significant difference between the radiographers pre-training performance and the nurses post-training performance (p=0.62).

Conclusion

Improvement after training was seen in both groups, although differences in performance between the two groups remained, with the radiographer group achieving a better overall performance than the nurse group. As patients in MIUs and A/E receive treatment based on the initial interpretation of their imaging investigations by either nurses or radiographers, the improvement after training is encouraging but the difference in the overall performance is less so. More work is required to evaluate the performance of radiographers and nurses undertaking initial image interpretation as part of their normal practice.

Keywords: Image interpretation, Appendicular skeleton, AFROC, Training, Radiographer, Nurse