Assessment Of The Knowledge And Attitude Of Radiographers Towards The Adoption Of ‘red Dot’ System Practice In Accident And Emergency Radiological Cases. (a Case Study Of The Three Tertiary Hospitals In Enugu)

This study sought to determine radiographers’ knowledge of red dot system in Nigeria; to determine if there is any factor (s) that militates against the adoption of the red dot system practice in Nigeria and to find out the attitude of Nigerian radiographers towards the adoption of the red dot system practice. The survey study involved 46 radiographers working in the three tertiary hospitals in Enugu, Enugu state. Data was collected using a structured questionnaire which in addition to demographic data collected information on the availability of radiologists and radiographers’ knowledge and attitude on red dot system. The data was analyzed using descriptive statistics of frequency distributions, percentages, pie and bar charts. The result revealed that 54% of the radiographers in the three tertiary hospitals in Enugu already know about the practice of red dot system. There has never been any interest shown by radiographers across these hospitals towards the adoption of this practice in Nigerian radiological services. The prospects of adoption of the ‘red dot’ system practice in developing countries like Nigeria still seems farfetched. Greater percentage (37) of radiographers believes that they do not have a good number of academically qualified professionals that can comfortably take up this role. Radiographers in Nigeria do not share the same attitude with Australian radiographers who do not want this practice because of its associated legal and ethical considerations. The only peculiar factor of Nigerian radiographers is that at present, they do not have a good number of academically qualified professionals that will take up the role but they believe that with time and increased effort in education, they will adopt not only the ‘red dot’ system practice but film interpretation itself.

Table 1 Highest level of education attained

Table 2 Distribution of qualified radiologists

Table 3 Dedicated radiologists for only Accident and Emergency film reporting

Table 4 Radiographers knowledge of ‘red dot’ system

Table 5 The necessity for radiographers to take up the role of red dotting

Table 6 Interest shown by RRBN

Table 7 Reasons why RRBN has no shown any interest in this practice

Figure 1 Gender distribution

Figure 2 Distribution of place of work of respondents

Figure 3 Distribution of the number of years of practice of radiographers

Figure 4 Availability of radiologists to report accident and emergency films

Figure 5 Distribution of how A&E films are reported in the absence of a radiologist

Figure 6 Distribution of how respondents got to know about the red dot system practice

Figure 7 Distribution of whether radiographers can perform satisfactorily if given this role

Figure 8 Distribution of respondents opinion about red dot system practice

Title page………………………………………………………….i

Approval page……………………………………………………ii

Certification……………………………………………………...iii

Dedication………………………………………………………..iv

Acknowledgement……………………………………………….v

List of tables and figures………………………………………..vi

Abstract………………………………………………………….vii

Table of content…………………………………………………ix

Chapter 1

1.1  Background of the study………………………………….1

1.2  Statement of the problems……………………………….

1.3  Objectives of the study……………………………………..

1.4  Significance of the study………………………………….

1.5  Scope of the study………………………………………………

 Chapter 2

2.1 Theoretical background……………………………………

2.2  Literature review……………………………………………...

Chapter 3

3.0  Research design…………………………………………………………

3.1  Target population……………………………………………………….

3.2  Subject selection criteria………………………………………………

3.2.1  Inclusion criteria..…………………………………………………….

3.2.2 Exclusion criteria……………………………………………………...

3.2.2  Exclusion criteria

3.3  Sample size……………………………………………………………...

3.4  Sources of data ………………………………………………………...

3.6  Instrument for data collection…………………………………………

3.61  Procedure for data collection…………………………………………

3.7  Data analysis……………………………………………………………

Chapter 4

4.1  Data presentation ……………………………………………..

4.2 Discussion …………………………………………………………...

Chapter 5

5.1 Summary of findings…………………………………………...

5.2 Recommendations……………………………………………….

5.3 Area of further research studies………………………

5.4 Conclusion………………………………………………………….

References……………………………………………………………….

The ‘red dot’ system is the most familiar scheme introduced in the United Kingdom by the Radiographer Abnormality Detection Scheme (RADS) in 1980’s to assist emergency radiological department staff in the correct interpretation of radiographic images1. In the practice of ‘red dot’ system, the radiographer examines the images acquired for a particular patient, at the request of the referring medical practitioner, and if an abnormality exists, they place a red dot prominently on the image to draw the medical practitioner’s attention to the likelihood of an abnormality. Prior to this, radiographers were precluded from expressing an opinion on a radiograph, largely as a result of medical and later radiological interventions2,3. However, following publication of the first reported use of red dot, the practice became widely adopted. Indeed, the role extension survey undertaken by Paterson in 1995 identified that over half of UK radiology departments had a red dot scheme in place4. It has been demonstrated by Price and Le Masurier in 2004 that this number has increased to 81% of hospital trusts demonstrating that the radiography profession had truly embraced this role development and studies to assess radiographer performance have shown the ‘red dot’ system to be a useful means to communicate abnormal findings to referring doctors in the absence of a report5. 

Although ‘red dot’ remains the most widely used radiographer abnormality

detection system, the College of Radiographers (CoR) has stated that its

aspiration is for all radiographers to be able to make an initial interpretation on

a trauma radiograph by 20106. Such development of the radiographers’ role is

also supported by the regulatory body7, the Health Professions Council7 and

the Quality Assurance Agency8 (the organization responsible for setting

academic benchmarks). Importantly, the CoR’s aspiration statement does not

indicate that all radiographers should be able to provide definitive image

reports, instead, it appears to promote radiographer role development into the

middle ground between ‘red dot’ and definitive reporting by encouraging the

introduction of radiographer comments, or preliminary opinion. In this way, the

radiographer can take a more proactive role in the diagnostic process by

indicating verbally, or in writing, the nature of the abnormality identified rather than just highlighting the radiograph9,10,11.

There are different forms of the system in use, however, in one study by Sonnex, Tasker and Coulden in Cambridge, the number of cases where pathological changes were not identified by the radiographer was 1% 12. In another study, emergency department doctors were found to be only slightly better than radiographers in their image interpretation and the identification of pathologi¬cal changes. In their study, Berman, de Lacey and Twomey et al. describe the importance of the role radiographers can play in reducing the possibility of pathology being missed by emergency doctors1. Indeed they went further, suggesting that image screening by radiographers should be utilized as a standard practice. 

The main bio-ethical principle related to the Red-dot system is that of beneficence. The principle of beneficence holds that medi¬cal practitioners (including radiographers) act in accordance with the interests of the patient, mainly to preserve life. Beneficence can also relate to the provision of a label by the radiographer highlighting an abnormal result and drawing the referring doctor’s attention to it. Clearly, if a radiographer prevents the misinterpretation of just one patient’s images by the placement of a red label on a film, thus they have assisted both that patient and the community in general, satisfying most bio-ethics and most patients. Though the radiologist’s report still remains the gold standard in most imaging diagnoses, so it fits that, wherever possible, attempts to gain a for¬mal report on images should be the first priority. However, there are many circumstances, for instance in the Australian health system where a radiologist is not available and the ‘next best’ qualified interpreter could well be the radiographer or referring doctor. Of course, a combination of these two people has been proven to offer the patient the closest thing to a radiologist’s report, though some radiographers are hesitant in taking up this role because of its associated ethical and legal considerations1. 

The principle of non-malfeasance, or not causing harm through one’s practice, is also central to this discussion13. Interpretations of harm are wide and varied; however, this principle can be used to argue the clinical relevance of radiographic examinations and the avoidance of unnecessary examinations or the inappropriate discharge of patients with pathology requiring further care. Also, the misleading interpretation of radiographs by radiographers becomes unethical. For this reason, among others, radiographers applying red-dot principles to the daily practice should endeavour to maintain adequate skill levels. The importance of continuing professional development and maintenance of a professional standard for radiographers cannot be understated. It is clearly the responsibility of all radiographers to contribute to the upholding of good professional practice con¬sistent with that of an independent profession. At the same time, radiologists should be seeing themselves as a resource for assisting radiographers and referring doctors to maintain sufficient skill and knowledge in radiographic image interpretation14.

The Commonwealth Government is also pondering this issue, with specific reference to past improvements in the medical world as a result of doctors releasing skills to other health professionals where that profession is adequately skilled to undertake that task14. 

The underlying principles to the provision of healthcare are the patient’s right to good quality care and maximizing the benefit for the patient. For this reason the use of the Red-dot system should be considered best radiographic practice15.

Managers of radiology departments not currently employing a Red-dot system are encouraged to establish a means by which radiographers can easily communicate abnormal findings to referring doctors in the absence of a radiologist’s report. Pressure should also be applied to the developers of computed radiography systems for the development of means by which radiographers can flag images for the referring doctor prior to the radiologist’s report being issued.

All radiographers should take it upon themselves to contemplate the ethical, legal and human rights perspectives behind this process1, and evaluate their stance and preparedness to participate in a program aimed at improving general health of the international community.