Radiography (Lond). 2026 Apr 22;32(4):103416. doi: 10.1016/j.radi.2026.103416. Online ahead of print.
ABSTRACT
INTRODUCTION: Missed fractures in the Emergency Department (ED) can lead to delayed treatment and patient harm. Radiographer preliminary clinical evaluation (PCE) aims to support referrers when interpreting radiographs in the absence of a definitive clinical report. This pre-implementation study evaluated radiographer participation and diagnostic accuracy in a department without an existing radiographer abnormality detection system.
METHODS: A prospective service evaluation study was conducted in a general hospital. Radiographers were asked to provide PCE for consecutive ED musculoskeletal trauma radiographs. Participation was recorded. PCEs were compared with the clinical report, and sensitivity, specificity and accuracy were calculated with 95% confidence intervals. Accuracy was evaluated against a fixed performance standard using a non-inferiority test. Differences in proportions between the first and second halves of the study period, in participation and accuracy, were assessed using z-tests.
RESULTS: Of 937 eligible examinations, 412 contained a PCE comment (44.0% participation), increasing significantly from 39.3% (182/463) in the first half of the study period to 48.5% (230/474) in the second half (p = 0.0045). After exclusions, 369 PCEs were analysed. Sensitivity, specificity and accuracy were 80.2%, 94.2% and 89.3%, respectively. The lower bound of the accuracy confidence interval (85.7%) exceeded the non-inferiority margin (82% accuracy), confirming PCE accuracy was statistically non-inferior to the 92% benchmark. Median time from examination attendance to PCE entry was 12 min.
CONCLUSION: Radiographers provided timely, accurate PCEs, achieving performance comparable with published standards, demonstrating the feasibility of implementing a PCE service.
IMPLICATIONS FOR PRACTICE: This study contributes to the evidence supporting PCE in departments without a 24-h hot-reporting service. Even without a dedicated training package, radiographers performed well, but this study emphasises that sensitivity remains a key area for further improvement.
PMID:42026441 | DOI:10.1016/j.radi.2026.103416
