is radiographer commenting the answer?

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    Is radiographer commenting the answer?

    Dear Editor,Re: Article in Journal of Medical Imaging and RadiationOncology, Volume 56, 2012, p. 510513, by Brown andLeschke, Evaluating the true clinical utility of the red dotsystem in radiograph interpretation.

    The authors have referenced a document written byUnited Kingdoms College of Radiographers.1 In doing sothey gave the impression that non-radiologists providingwritten reports on plain radiographs were initiated due tothe success of the red dot system. That documentessentially identifies current practices in radiography inthe United Kingdom.

    The authors appear to be confusing the red dot systemas a basic version of plain radiographic reporting. Theyinfer from their research results that due to the red dotsystems inability to reliably detect undisplaced fracturesthat role extension into plain radiographic reporting bynon-radiologists has the potential to yield a less accurateinterpretation. The red dot and reporting of plain radio-graphs are two very different concepts and should betreated as such. A red dot or equivalent abnormalitydetection system is a voluntary initiative in the emer-gency setting that requires no formally recognised addi-tional training. Such a system involves a radiographerhighlighting an acute abnormality to the referring emer-gency clinician by placing a red dot or equivalent (e.g.asterisk) on the digital image. On the other hand, thedevelopment of formalised radiographer reporting in the1990s in the United Kingdom requires a radiographer tocomplete an accredited postgraduate university programin image interpretation. I would encourage the authors toacknowledge the many differences between a red dotand a formalised diagnostic report, especially the fact thatno additional training is required for radiographers toparticipate in a red dot system.

    What the authors have failed to discuss is the recentdevelopment of a radiographic comment. A radiographiccomment is where an educated and accredited radiog-rapher not only highlights trauma pathology at the pointof care but provides a brief description. A radiographiccomment does not replace a radiologists report. It pro-vides a brief, educated interpretation of a radiograph ina clinically useful time frame, further enhancing patientsafety in the emergency health care setting. Recent

    literature has acknowledged the benefits of a radiogra-pher commenting system over the red dot system.2,3

    The authors suggest that improvements are requiredto existing models to achieve the reporting of plainradiographs in a clinically useful time frame without anincrease in cost. They have not acknowledged recentlypublished documents calling attention to not only thedelay in radiology reports4 but the rising concern of thenumber of unreported radiographs within Australia,5 ulti-mately leading to an increase in patient risk. With therecent implementation of the National EmergencyAdmission Targets requiring that patients are dischargedfrom an emergency department within 4 hours, now isthe best time to consider innovative models of care toimprove service delivery and enhance patient care,rather than devaluing a current successful patient safetymechanism such as red dot.

    Kind regards,

    MICHAEL J. NEEPA/Team Leader Radiographer, Emergency Department, Princess

    Alexandra Hospital, Brisbane, Queensland, Australia

    doi: 10.1111/1754-9485.12053


    1. College of Radiographers. Radiography role developedrevisited: the research evidence 2003. 2003. [Cited 9Nov 2012.] Available from URL:

    2. Hardy M, Culpan G. Accident and emergencyradiography: a comparison of radiographercommenting and red dotting. Radiography 2007; 13:6571.

    3. McConnell JR, Webster AJ. Improving radiographerhighlighting of trauma films in the Accident andEmergency department with a short course of study an evaluation. Br J Radiol 2000; 73: 60812.

    4. Queensland Government. Queensland Health RadiologyServices Profile 20092010. 2010; 5: 24.

    5. Patty A. Reviews needed on mountain of backloggedX-rays, says professor. Sydney Morning Herald; 16May 2012.


    Journal of Medical Imaging and Radiation Oncology 57 (2013) 206

    2013 The AuthorJournal of Medical Imaging and Radiation Oncology 2013 The Royal Australian and New Zealand College of Radiologists206