Role of Radiography in Modern Imaging Service. The Interventional Radiology; Guidance for Service Delivery (2010) aims to guide local service development of interventional radiology through summarising clinical evidence and by illustrating

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Role of Radiography in Modern Imaging Service


The Department of Health (2010) defines interventional radiology as a minimally invasive alternative to open surgery or medical interventions achieved by using radiological imaging guidance.  The need to improve equity of interventional radiology is recognised by the Department of Health in their publications; ‘Interventional Radiology: Guidance for Service Delivery’ (2010) and ‘Interventional Radiology: Improving Quality Outcomes for Patients (2009).  It is also recognised within the Department of Health White Paper Equity and Excellence; Liberating the NHS (2010).

The National Confidential Enquiry (2005-2009) into patient outcomes and deaths clearly illustrates inequalities in provision.  It reported, over a four year period, poor and inconsistent provision, throughout the country of both diagnostic and interventional radiological services. However there are many factors, or arguably constraints, such a geographical, financial, workforce and workload that currently impede equity in service provision.  

The ‘Interventional Radiology; Guidance for Service Delivery’ (2010) aims to guide local service development of interventional radiology through summarising clinical evidence and by illustrating how successful imaging services have been set up in such a way that enables good quality, equitable care  by skilled multidisciplinary teams.  

The document informs both organisational and practitioner requirements for service delivery improvement and is reflective of national Department of Health strategy; The Quality, Innovation, Productivity and Prevention programme which ultimately aims to improve the quality and delivery of care at the same time reduce efficiency costs that could then be reinvested in front line services.

The document offers a comprehensive and varied evidence base for change, supported by key clinical data, providing details of how quality interventional radiology services can be achieved in a variety of settings.  It explores different models of service from different perspectives as well as acknowledging constraints to delivery; thus implicitly acknowledging and avoiding bias.   Case Study illustrations make explicit reference to the benefits of good interventional radiology services.  

Despite the different models of service delivery posed the potential impact on radiology departments are likely to be similar.  The Royal College of Radiologists (date) report the need to overcome various barriers to improving interventional radiological departmental services.  These include:

  • Equipment availability
  • National shortage of radiologists, radiographers and interventional radiology nurses
  • Current radiology departmental opening times
  • NHS IT strategy

Recent data (see figure 1; appendix 1) illustrates huge percentage increases in imaging examinations and hence workload over the last three years; and whilst there has been a significant improvement in the availability of equipment, according to the Organisation for Economic Co-operation and Development (OECD), the UK lags behind other European countries in terms of radiology equipment provision (European Society of Radiology 2011).  Therefore the patient’s needs, in terms of rapid diagnosis, may be impeded by the lack of equipment compared to patients from other European countries.

Arguably it may not only be the provision of equipment that is far from ideal but the location of equipment, confined to radiology departments, or type of equipment used that may impede workflow efficiency and patient needs.  

“As Interventional Radiology has developed within diagnostic imaging departments, many units have utilised existing X-ray rooms which were adapted for the purpose. IR requires dedicated facilities, which should conform to the infection control standards of operating theatres” (NIB 2009).

In the event of Trauma cases, “The emergency department should have its own CT capability to guarantee efficient workflow and to prevent the time-wasting and dangerous transfers of critically ill patients” (Reekers 2011)  

The Academic Medical Centre, Amsterdam showcases an example of an efficient interventional radiology workflow system.  The innovative set-up provides a sliding CT gantry serving two emergency rooms that performs imaging, feet first, so IV-lines and monitors do not need repositioning (Reekers 2011).  The impact of such a set up potentially results in the radiology ‘department’ becoming more dispersed.  This could hence result in a fragmented ‘departmental’ workforce, placing a higher importance on effective multi-disciplinary team working and effective communication.

Even if the provision of equipment currently meets demand, the potential increase in use, as departmental operating times are increased, is likely to result in increased wear and tear on equipment resulting in the need for service interval time reduction.  Ultimately this is likely to result in increased servicing, running and replacement costs within the radiology department.

Given that equipment maintenance is the second largest budgetary expense in large radiology departments (Strauss 2006) managers will be under pressure to contain costs.  The impact of this could result in the need for consultant radiographers and senior managers to consider different options for equipment maintenance such as in-house engineering, agreed contracts with equipment manufacturers and independent service organisations; thus potentially placing a higher, costly administrative demand on skilled professionals. This cost however would be more than recouped through rising demand for less expensive more outpatient based procedures (Medimaging staff writers 2011).

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The suggestion that “local services will develop according to the skills of local workforce and service need” (DOH 2010) poses a potential challenge for radiology departments where there is a skills gap in their workforce which differs vastly from high demand service need.    The challenge to overcome the lack of appropriately trained radiologists, radiographers and nurses is a major constraint to developing interventional radiology services within a department.  

The Royal College of Radiologists (2009) reported a rise in the number of trainee radiologists and although numbers in practice appear to have risen (30 radiologists per million population) since ...

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An introduction outlining what would be covered would be useful to help the reader get a sense of what will be presented. It is also useful for the writer in terms of using it to check that what is in the main body matches what is written in the introduction. Nevertheless, this is a well-written piece of work examining the role of radiography in the modern imaging service. Good references to relevant documents such as policy and White Papers are made. A few minor amendments could be made, such as ensuring that diagrams are explained adequately, but other than that, this is a good piece of work. 4/5