An Analysis of Radiographers' False Preliminary Image Evaluation Comments in One New Zealand District

Preliminary image evaluation (PIE) is an abnormality detection system that enables radiographers to assist emergency department (ED) clinicians in their treatment decisions by minimising radiographic interpretation errors. For a PIE to be successful, radiographers need to provide accurate comments on images. Given the limited number of studies that evaluate radiographers' false PIE comments, the aim of this study was to determine common false negative (FN) and false positive (FP) comments in one district in New Zealand (NZ).

Six months of PIE comments performed in the Taranaki district in NZ were collected and scored into four categories: true positive, true negative, FP or FN. The FN and FP comments were then evaluated to determine common errors and compared with international research.

A total of 844 PIE comments were collected, with 21 (2.5%) scored as FN, and 27 (3.2%) scored as FP. The common FN themes included subtle or avulsion fractures, predominantly in fingers, hands, and wrists. The common FP themes were normal variants in the foot and ankle that were mistaken for fractures.

Several recommendations are made from this study to help improve radiographer PIE accuracy. These include the addition of an unsure or equivocal category when scoring PIE comments to account for PIE comments with ambiguous language. Other recommendations include ongoing targeted training of common errors and a higher resolution monitor (generally used for image reporting by radiologists) for radiographers when performing PIE.