The Red‐dot system in medical imaging: ethical, legal and human rights considerations

Abstract

The Red‐dot system, used extensively overseas, but sporadically in Australia, allows radiographers to bring abnormal images to the attention of the referring medical practitioner, prior to the issuance of a formal radiologist's report. There is much discussion in the public arena as to the increasing workload of medical practitioners, and the role other health professionals may play in easing this burden. In addition, hospital emergency departments across Australia are under pressure to minimise ambulance bypass and patient waiting times, while maintaining optimal diagnostic and treatment standards. The third component to this discussion is some radiographers' general hesitance regarding the Red‐dot system because of legal issues. In addition, there is the issue of many medical practitioners not wanting to give up aspects of their practice, citing a potential decrease in the quality of the health service. Analysis of the legal and human rights literature with respect to the provision of emergency medical services in particular, as well as detailed exploration of the various ethical issues involved with the Red‐dot system indicate to the author that such a system has a significant role to play in the provision of healthcare, particularly where a radiologist's report may be delayed. Additionally, radiographers are able to accept the challenge of contributing to healthcare without fear of legal endangerment in particular, provided they are willing to maintain a level of excellence with respect to their image interpretation skills. The Australian Institute of Radiography (AIR) is correct in listing the ability of radiographers to notify referring doctors of abnormal results and offering opinions on radiographic examinations within their expertise, when requested. It is the conclusion of this paper that use of the Red‐dot system is best practice and as such should be implemented in all radiography departments associated with emergency medicine departments.

Evaluating the true clinical utility of the red dot system in radiograph interpretation

“…Additionally, non‐metropolitan health services without immediate access to radiologist input may gain benefit from ‘red dots’ placed by experienced radiographers as happens in many rural hospitals in Australia. We also acknowledge the ethical responsibility for radiographers to alert referring clinicians of possible abnormalities 10 . However, as is recognised in these discussions, radiologist reports remain the gold standard and should be issued as a matter of priority in tertiary medical imaging departments.…”

“…We also acknowledge the ethical responsibility for radiographers to alert referring clinicians of possible abnormalities. 10 However, as is recognised in these discussions, radiologist reports remain the gold standard and should be issued as a matter of priority in tertiary medical imaging departments.…”

Multi-method laboratory user evaluation of an actionable clinical performance information system: Implications for usability and patient safety

“…Icons used in patient lists should be appropriate to the clinical context in which they are used. For example, radiological systems should avoid using red dot icons, which are also used to highlight abnormal findings on a radiological image [86] . This agrees with more general icon usability guidelines regarding [87] , though may only be recognised as problematic through user testing.…”

The ‘radiographer–referrer game’: image interpretation dynamics in rural practice

“…More than 30 years after its introduction, the red dot system is not consistently used across Australia. 17 Communication difficulties which contribute to adverse events in healthcare may arise from the hierarchy of power that exists between different health professionals. 7,8,18 It seems that historical changes to radiography have set in place a restrictive, hierarchical professional structure in which radiographers now practice.…”