Charlotte Beardmore

Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model

INTRODUCTION To assess whether an enhanced role for radiographers in reporting lung cancer chest radiographs is cost-effective. METHODS Costs and outcomes of chest radiograph reporting by reporting radiographer or by a radiologist were compared using a decision tree model. The model followed patients from an initial chest radiographs for suspected lung cancer to the provision of cancer care in positive cases. Sensitivity and specificity of reporting for radiographers and radiologists were derived from a recent trial. Treatment costs and quality adjusted life expectancy were estimated over five years for those diagnosed. Deterministic and probabilistic sensitivity analyses were used to test the robustness of inference to parameter uncertainty. RESULTS For 1000 simulated patients, radiographer reporting decreased detection costs by £8500 and detected 10.3 more cases at initial presentation. After including treatment costs and outcomes, radiographer reporting remained cheaper than radiologist reporting and resulted in 1.4 additional QALYs per 1000 screened patients. Probabilistic analysis indicated a 98% likelihood that radiographer reporting is cheaper and more effective than radiologist reporting after inclusion of treatment costs and outcomes. CONCLUSION Radiographer reporting is a cost-effective alternative to radiologist reporting in lung cancer diagnosis. Further work is needed to support the adoption of radiographers reporting pathway in diagnosis of lung cancer suspected patients.

The research agenda and the role of the therapeutic radiographer: The College of Radiographers perspective

This article reflects on the influences on current radiotherapy practice and the key role that Therapeutic Radiographers have in the management of cancer care and the delivery of treatments. In particular the Cancer Reform Strategy is discussed which clearly highlights the many challenges related to cancer. Changes in societal and scientific understanding will demand that the most appropriate and evidence-based care is provided for patients, underscoring the need for evidence through research, to underpin every aspect of daily work if patient outcomes are to continue to improve. In October 2005, the Society and College of Radiographers published: ‘Research and the Radiography Profession—A Strategy and Five Year Plan’ . This is an ambitious document, which sets out expectations for the appreciation and use of substantiated research involvement at all levels of practice. Sections of this document and the relevance to radiotherapy practice are discussed. Alongside this, the career progression model for radiography continued to be driven forward with support from the Department of Health. This model describing higher levels of practice for radiographers, at advanced and consultant levels, clearly identified research as a key requirement for the profession. The guidance document in 2006, from the Society and College of Radiographers ‘Positioning Therapeutic Radiographers within Cancer Services: Delivering Patient Centred Care’ , further articulated these expert roles, in response to the changing drivers within cancer and across the radiotherapy pathway. In conclusion, research must become a fundamental component of everyday radiotherapy practice as it will verify professional standards of care and sustain the future of the profession. To contribute to the wider cancer agenda it is imperative that all therapeutic radiographers, from practitioner to consultant level, participate in and lead research.