Professional advancement of the CT workforce: A UK modified e-Delphi study of competency and capability requirements...

The United Kingdom (UK) has a well-established career framework for the radiography profession, but evidence of advanced modality-specific technical and clinical responsibilities are limited in comparison to some other countries. This study aims to achieve agreement on essential practice capabilities for the UK Computed Tomography (CT) workforce at competent (enhanced), proficient (advanced), and expert practice levels, discussing these in the context of international CT credentials.

A modified e-Delphi study was conducted combining a bespoke workshop with CT service leads for idea generation with two survey questionnaire rounds. Through targeted invitations and snowballing approach, the intended audience was those with expertise and direct involvement in developing, delivering, or managing CT services, and those conversant in the education and training of CT staff. Survey respondents reviewed 214 capability statements and applied a rating of essential, desirable or not needed for three radiography practice levels. Controlled feedback (frequency and percentage agreement for each statement) was provided between survey questionnaires to inform revised scoring considering the group response. A content validity approach was applied to define a critical level of agreement for capability statement inclusion.

Collective agreement on 70 essential radiography competencies applicable to the CT context and 51 cumulative CT-specific capability statements was achieved by 34 respondents. Although the response rate is unknown, 68% of participants completed both e-Delphi survey rounds. Essential capability statements for the competent radiographer working at career framework Level 6 (n = 33) comprised those related to the CT examination including patient care and the optimised acquisition and visualisation of CT images applying a range of applications, techniques and injection protocols within defined governance frameworks. The proficient, career framework Level 7 (n = 12) radiographer develops the procedures within which the competent workforce practice, manages the equipment and risk portfolio, and assumes responsibility for the education of others on the optimal use of CT. Six additional expert capabilities were identified characterised by vision for CT innovation and future direction and an understanding of the role of CT and self in care pathways and service transformation.

This consensus study of CT capabilities demonstrates for the first time expectations and opportunities for modality-specific practice at higher levels of UK employment despite ambiguity in the transitions between practice levels beyond threshold competency. All roles are underpinned by progressively complex knowledge of CT principles and technical prowess, but clinical intuition and professional judgement, independence and leadership shift over time. There is consistency with international clinical CT practices at competent and proficient levels but the capability requirements for expert roles are limited for comparison.

Although the knowledge and skill statements generated in this study have been agreed through the e-Delphi process, further research is required to validate the first iteration of CT capabilities to ensure that they are widely applicable across geographical locations, healthcare sectors and imaging providers. The scope of any definitive CT competency and capability framework needs to be defined by the profession alongside a roadmap to realisation with stakeholder consultation from professional and regulatory bodies, higher education institutions and clinical representatives before recommendations for adoption can be made.

CT scans use X-rays to create clear pictures of the body and are used in many health services. This study explored what skills people who provide CT scans in the United Kingdom need as they move from competent to advanced and expert roles by asking experienced service leaders to review possible duties. This study found clear agreement on a set of core skills at each level, with higher levels involving more decision making, teaching, and leadership. This matters because shared expectations can support safer care, better training, and clearer career pathways for the people who receive and deliver CT imaging.