Introduction Innovations are necessary to accommodate the increasing demands on emergency departments whilst maintaining a high level of patient care and safety. Radiographer Preliminary Image Evaluation (PIE) is one such innovation. The purpose of this study was to determine the accuracy of radiographer PIE in clinical practice within an emergency department over 12 months. Methods A total of 6290 radiographic examinations were reviewed from 15 January 2016 to 15 January 2017. The range of adult and paediatric examinations incorporated in the review included the appendicular and axial skeleton including the chest and abdomen. Each examination was compared to the radiologist's report this allowed calculated mean sensitivity and specificity values to indicate if the radiographer's PIE was of a true negative/positive or false negative/positive value. Cases of no PIE participation or series’ marked as unsure for pathology by the radiographer were also recorded. This allowed mean sensitivity, specificity and diagnostic accuracy to be calculated. Results The study reported a mean ± 95% confidence level (standard deviation) for sensitivity, specificity, accuracy, no participation and unsure of 71.1% ± 2.4% (6.1), 98.4% ± 0.04% (0.9), 92.0% ± 0.68% (1.9), 5.1% (1.6) and 3.6% (0.14) respectively. Conclusions This study has demonstrated that the participating radiographers provided a consistent PIE service while maintaining a reasonably high diagnostic accuracy. This form of image interpretation can complement an emergency referrer's diagnosis when a radiologist's report is unavailable at the time of patient treatment. PIE promotes a reliable enhancement of the radiographer's role with the multi‐disciplinary team.