This is a repository copy of Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful?.

Background and aim: Neonatal respiratory distress syndrome is a leading cause of morbidity in preterm newborn babies (<37 weeks gestation age). The current diagnostic reference standard includes clinical testing and chest radiography with associated exposure to ionising radiation. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against the reference standard in symptomatic neonates of 42 weeks gestation age. Methods: A systematic search of literature published between 1990 and 2016 identified 803 potentially relevant studies. Six studies met the review inclusion criteria and were retrieved for analysis. Quality assessment was performed before data extraction and meta-analysis. Results: Four prospective cohort studies and two case control studies included 480 neonates. All studies were of moderate methodological quality although heterogeneity was evident across the studies. The pooled sensitivity and specificity of lung ultrasound were 97% (95% confidence interval [CI] 94-99%) and 91% (CI: 86-95%) respectively. False positive diagnoses were made in 16 cases due to pneumonia (n ¼ 8), transient tachypnoea (n ¼ 3), pneumothorax (n ¼ 1) and meconium aspiration syndrome (n ¼ 1); the diagnoses of the remaining three false positive results were not specified. False negatives diagnoses occurred in nine cases, only two were specified as air-leak syndromes. Conclusions: Lung ultrasound was highly sensitive for the detection of neonatal respiratory distress syndrome although there is potential to miss co-morbid air-leak syndromes. Further research into lung ultrasound diagnostic accuracy for neonatal air-leak syndrome and economic modelling for service integration is required before lung ultrasound can replace chest radiography as the imaging component of the reference standard.

Objectives: After a 500 ms presentation, experts can distinguish abnormal mammograms at above chance levels even when only the breast contralateral to the lesion is shown. Here, we show that this signal of abnormality is detectable 3 years before localized signs of cancer become visible. Methods: In 4 prospective studies, 59 expert observers from 3 groups viewed 116–200 bilateral mammograms for 500 ms each. Half of the images were prior exams acquired 3 years prior to onset of visible, actionable cancer and half were normal. Exp. 1D included cases having visible abnormalities. Observers rated likelihood of abnormality on a 0–100 scale and categorized breast density. Performance was measured using receiver operating characteristic analysis. Results: In all three groups, observers could detect abnormal images at above chance levels 3 years prior to visible signs of breast cancer (p < 0.001). The results were not due to specific salient cases nor to breast density. Performance was correlated with expertise quantified by the number of mammographic cases read within a year. In Exp. 1D, with cases having visible actionable pathology included, the full group of readers failed to reliably detect abnormal priors; with the exception of a subgroup of the six most experienced observers. Conclusions: Imaging specialists can detect signals of abnormality in mammograms acquired years before lesions become visible. Detection may depend on expertise acquired by reading large numbers of cases. Advances in knowledge: Global gist signal can serve as imaging risk factor with the potential to identify patients with elevated risk for developing cancer, resulting in improved early cancer diagnosis rates and improved prognosis for females with breast cancer.

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Objective: Clinical Imaging contributes to screening, diagnosis, planning and monitoring of treatment and surveillance in cancer care. This literature review summarises evidence about radiographer reporting to help imaging service providers respond to Health Education England's 2017 Cancer Workforce Plan project to expand radiographer reporting in clinical service provision. Key findings: Papers published between 1992 and 2018 were reviewed (n ¼ 148). Evidence related to dynamic examinations (fluoroscopy, ultrasound) and mammography was excluded. Content was analysed and summarised using the following headings: clinical scope of practice, responsibilities, training, assessment, impact in practice and barriers to expansion. Radiographer reporting is well established in the United Kingdom. Scope of practice varies individually and geographically. Deployment of appropriately trained reporting radiographers is helping the NHS maintain high quality clinical imaging service provision and deliver a cost-effective increase in diagnostic capacity. Conclusion: Working within multiprofessional clinical imaging teams, within a defined scope of practice and with access to medical input when required, reporting radiographers augment capacity in diagnostic pathways and release radiologist time for other complex clinical imaging responsibilities.

Breast cancer is most often diagnosed using x-ray mammography. Traditionally mammography images have been interpreted and reported by medically qualified practitioners -radiologists. Due to radiologist workforce shortages in recent years some nonmedical practitioners, radiographers, now interpret and report mammography images. The aims of this survey were to describe the characteristics and practices of radiographers who interpret and report mammography images in NHS hospitals in the UK, and in particular to establish the extent of their practice beyond low-risk asymptomatic screening cases.This service evaluation demonstrated that UK radiographers are interpreting and reporting images across the full spectrum of clinical indications for mammography including: low-risk population screening, symptomatic, annual surveillance, family history and biopsy / surgical cases. The survey revealed that radiographers are involved in a diverse range of single and double reading practices where responsibility for diagnostic decision making is shared or transferred between radiologists and / or other radiographers. Comparative analysis of subgroup data suggested that there might be differences in the characteristics and practices of radiographers who interpret only low-risk screening mammograms and those who interpret and report a wider range of cases.The findings of this survey provide a platform for further research to investigate how and why the roles and responsibilities of radiographers who interpret and report mammograms vary between organisations, between practitioners and across different examinations. Further research is also needed to explore the implications of variation in practice for patients, practitioners and service providers. Highlights UK radiographers interpret mammograms across the full spectrum of clinical indications  UK radiographers are involved in a wide range of single / double mammography reading practices  Characteristics required for screen reading may differ from those for interpreting other cases  Further research is required to explore variation in practice across organisations and individuals  Further research is required to identify patient and service consequences of variation in practice

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