Basic chest imaging in adult trauma patients: interpretation skills of radiographers in the Copperbelt province of Zambia

Abstract

BACKGROUND: Zambia is currently faced with a shortage of radiologists, with nine qualified radiologists in public hospitals countrywide to serve a population of 18 million people. Therefore, trauma chest x-ray (CXR) images in public hospitals are assessed by trauma teams comprising medical officers (MOs) and clinical officers (COs). Trauma teams routinely lack adequate time for image interpretation. Ideally, image interpretation and subsequent reporting on the images should be performed by radiologists. However, due to the shortage of radiologists and a yearly increase in radiologists’ workload, the United Kingdom has explored delegating plain image reporting to carefully selected radiographers. One of the areas of reporting for radiographers that has been explored is CXR interpretation and reporting. In Zambia, radiographers are currently not involved in interpreting CXR images, despite the critical shortage of radiologists. Hence, this study is deemed critical, because it investigated the skills of radiographers in basic adult trauma CXR image interpretation. The findings of this study can be helpful in discussions with stakeholders regarding revising radiographers’ current scope of practice in Zambia.

PURPOSE: The study aimed to determine the basic adult trauma CXR image interpretation skills of radiographers in the Copperbelt Province of Zambia. The objectives were to (i) determine the basic adult trauma CXR image interpretation skills of radiographers in the Copperbelt Province of Zambia; (ii) to determine if there is a need to involve radiographers in basic trauma CXR image interpretation in the Copperbelt Province of Zambia and (iii) to recommend the development and implementation of a training programme to develop radiographers’ skills in adult trauma CXR image interpretation, if indicated by this inquiry.

METHODOLOGY: An experimental pre- and post-intervention study and a descriptive, quantitative study design were used. A total of eight public hospitals in the Copperbelt Province of Zambia were included, with a sample size of 27. A checklist was used to acquire the pre- and post-intervention results for a total of 28 CXR images that had been purposively selected (20 CXR images for the pre- and post-intervention phase and 8 CXR images for the post-intervention phase). The pre-intervention phase included a lecture on basic CXR image interpretation and eight weeks of online interactive adult trauma CXR image review and discussions. Additionally, questionnaires were distributed in hard copy to the 15 MOs and COs of the eight hospitals, to solicit their views on the need to involve radiographers in CXR image interpretation in the Copperbelt Province of Zambia.

RESULTS: The median overall score for pre-intervention results was 82.8% and the interquartile range (IQR) = (79.5%–87.2%). The median overall score for postintervention results was 87.2% and the IQR = (85.6%–89.2%). This positive median score difference is associated with a statistically significant p-value of <0.0001 when the two scores are compared. Years of work experience (p = 0.16) and the type of qualifications (p = 0.59) of the radiographers were not associated with their performance. However, the level of the hospital where the radiographers were employed presented a statistically significant p-value of <0.0323 concerning their performance in CXR image interpretation. Of the MOs and COs, the majority (86.7%) stated that no written reports were issued for trauma CXR images by radiology departments. Furthermore, 60% of the MOs and COs experienced challenges interpreting adult trauma CXR images. The majority (93.3%) of the MOs and COs indicated a need at their hospitals to involve radiographers in adult trauma CXR image interpretation.

CONCLUSION: The study confirms that radiographers working in public hospitals in the Copperbelt Province of Zambia possess basic adult trauma CXR image interpretation skills. The study confirms that there is a need to involve radiographers in basic CXR image interpretation of adult trauma in the Copperbelt Province of Zambia. It is, however, important to note that the involvement of radiographers in CXR image interpretation demands an extension of the scope of practice of radiographers in Zambia; hence postgraduate training is required.