INTRODUCTION: the aim of this study is to take a longitudinal approach to assess the value of an in-house program developed in a Singapore hospital over a two year period. METHODS: Radiographers (n = 48) consented to take part in the study. The control group (CG: n = 40) continued with normal working practice whilst the remaining 'additional training group' (ATG: n = 8) participated in the hospital's in-house image interpretation program. Upon completion, all participants were assessed using a RadBench® test bank. All participants then continued to work in their normal clinical practice; however the ATG received regular peer support to reinforce learning and aid further development. One year later, the same populations were invited to sit another RadBench® assessment. RESULTS: the mean accuracy of both groups was very similar at phase one (70v71%). The ATG demonstrated higher mean sensitivity (83v72%) but the CG higher mean specificity (68v56%). One year later, with continued mentor support, the ATG demonstrated a marked improvement in mean accuracy over CG (86v70%) largely driven by a marked increase in mean specificity from 56 to 87%. 43% of the ATG could deliver exceptional standards for accuracy, sensitivity and specificity, ready and able to provide reliable preliminary clinical evaluation, versus none of the CG. CONCLUSION: In-house programmes could be a cost effective approach to skills development and ideally suited to preceptorship and new employee orientation in order to assess, develop and monitor image interpretation performance.

Lower limb ischemia is common in peripheral artery disease and diabetes. This study explores the use of Infra-Red (IR) Thermal imaging to assess upper to lower leg temperature in healthy volunteers (n=4) to consider a normal point of reference.
A FLIR T650 IR thermal imaging camera was used in a temperature controlled environment. BMI was calculated from height and weight. Phase 1; 12 single shot standing images acquired over several hours. Phase 2; 16 images with added thigh marker and foot positioner two days later. Reviewers measured the temperature in both legs from thigh to ankle. Assessments were made of intra and inter operator reliability using the root mean square standard deviation (RMSSD) and the root mean square coefficient of variation (RMSCV%).
Both legs are the same temperature in healthy volunteers (+/-0.05 degrees), typically with a negative gradient from thigh to ankle and a warm ‘spike’ around the knee. Intra-operator RMSCV% (RMSSD) for Phase 1: 18.65% (0.74); Phase 2: 3.84% (0.28). Inter-operator RMSCV% (RMSSD) for Phase 1: 9.31% (0.38); Phase 2: 3.70% (0.24). A moderate correlation is noted between temperature gradient and BMI (r=0.45).
IR Thermal imaging of the lower limbs is a non-invasive technique that is relatively easy to perform, with positioning technique closely related to projection imaging, and ideally suited to the extended radiographer role. Use of the thermo-sensitive thigh maker combined with development and application of a foot template to aid positioning reduced measurement error and deliver increased reliability.

Aim: the SCoR (2013) policy expects radiographers to be able to make reliable decisions on the images they produce. Image interpretation has been integrated into all undergraduate degree programmes. Therefore this project aimed to benchmark and compare PCE competencies of undergraduate diagnostic radiography students from different universities.
Methods: all 21 Universities in England & Wales delivering diagnostic radiography education were invited to participate; 9 agreed. Final year students (n=87) at the point of graduation participated. The test contained 30 blind double reported MSK images with equal prevalence of normal and abnormal.
Results: Accuracy ranged from 56 to 87%; mean 73.4, SD 8.01. Sensitivity ranged from 47 to 100%; mean 79.6, SD 10.78. Specificity ranged from 20 to 100%; mean 67.1, SD 16.42. A weak correlation in accuracy by university was demonstrated (r2=0.266) highlighting the wide range of graduate performance. One-way ANOVA (with PostHoc Tukey) highlighted a statistically significant difference in Specificity (F (8, 78) = 3.40, p = 0.002) at University a (CI: -47.4/-4.5).
Conclusion: This project is the first to benchmark and compare PCE competencies of radiography students from multiple universities. Whilst image interpretation is now a routine part of undergraduate degree education, the capability of graduates varies and few appear to be able to meet a 'reliable' standard, highlighting the need for further training prior to participation in abnormality signalling systems. A follow-up study is recommended to increase reliability.

'Red dot' is the most common form of abnormality detection system in clinical practice. The SCoR 2013 policy recommends replacement with preliminary clinical evaluation (PCE) however this requires a different skill set and radiographers are arguably not yet ready for this change. Radiographers (n=39) at a busy NHS hospital were required to make a decision on every patient examined for three weeks. 'Red' = Abnormal, 'Green' = Normal, 'Amber' = Unsure; and provide a preliminary clinical evaluation (PCE). Quantitative analysis of responses enabled assessment of accuracy, sensitivity and specificity. Qualitative analysis of the PCE’s enabled assessment of written description versus the actual report.
The total number of examinations undertaken in the accident and emergency department was 1411. 39 radiographers took part in the study although 14 effectively disengaged by simply applying an amber dot to all cases and made no attempt at PCE. 34% (n=484) of cases received a red or green response. Analysis of the red (n=133) decisions reveals an overall sensitivity performance range from 50 to 100% with a mean of 88.2%, green (n=355) reveals a specificity performance range from 67 to 100% with a mean of 96.1%. Overall accuracy ranged from 60 to 100% with a mean of 93.4%. 66% (n=927) received an amber response.
Analysis reveals the most problematic body parts.
The traffic light system requires a response to every image taken, providing a clear indication to the referring clinician; a major advantage over red dot. Further development of some radiographers may be necessary for them to reliably partake in ‘traffic light’. Establishing an individual image interpretation benchmark performance by radiographer is recommended before participating in any form of abnormality signalling system.