Journal of Medical Imaging
and Radiation Sciences
Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203
Review Article
Exploring the Benefits of Magnetic Resonance Imaging Reporting by
Radiographers: A UK Perspective
Paul Lockwood, MSc, FHEA, PGCL&T(HE), BSc(Hons), BA(Hons)*
Allied Health Department, Canterbury Christ Church University, Medway Campus, Chatham Maritime, UK
ABSTRACT
Background: The United Kingdom (UK) National Health Service
(NHS) Imaging and Radiodiagnostic activity 2013/14 report esti-
mates the year-on-year increase of magnetic resonance imaging
(MRI) examinations to be 12.3%, with the designated radiologist
workforce disproportionate to the increase in demand.
Objective: To review the economics, risk, and feasibility of MRI re-
porting by radiographers.
Design: A PICO (the four major components of a clinical or
research question: patient [population], intervention, comparison,
and outcome) framework using example patient demand from
audit data of noncomplex MRI examination attendance (n ¼
3,525) over 12 months was used to review costs, potential outcome
risks (diagnostic thresholds), and feasibility (workforce capacity) of
both interventions.
Conclusions: The benefits of introducing a skills mix reporting ser-
vice model to the benefit of service delivery in the UK has shown a
potential £145,230–£60,524 per annum cost saving using a generic
acute workload model. Research into recorded discrepancy/error
audit data for potential detrimental risk to patient outcomes identi-
fied a paucity of evidence and recommends that further research is
needed.
Keywords: Magnetic resonance imaging; reporting radiographer; role extension; advanced practice; economic evaluation
Introduction
The National Health Service (NHS) England released the Five
Year Forward View [1] in 2014 to consider possible changes
that could be implemented to improve patient outcomes and
The author has no financial disclosures or conflicts of interest to declare.
* Corresponding author: Paul Lockwood, MSc, FHEA, PGCL&T(HE),
BSc(Hons), BA(Hons), Allied Health Department, Canterbury Christ Church
University, Medway Campus, Rowan Williams Building, 30 Pembr. Chatham
Maritime, ME4 4UF, UK.
E-mail address: paul.lockwood@canterbury.ac.uk
1939-8654/$ - see front matter Ó 2016 Canadian Association of Medical Radiation Technologists. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jmir.2015.12.083
Journal de l’imagerie médicale
et des sciences de la radiation
www.elsevier.com/locate/jmir
RESUME

Contexte : Le Rapport sur les activites d’imagerie et de radiodiagnos-
tic 2013-2014 du National Health Service (NHS) du Royaume-Uni
estime que l’augmentation annuelle des examens d’imagerie par
resonance magnetique (IRM) a ete de 12,3 %, avec une dispropor-
tion entre le nombre de radiologistes designes et l’augmentation de
la demande en rapports d’imagerie.
Objectif : Examiner l’aspect economique, le risque et la faisabilite de
faire preparer les rapports d’IRM par les radiographes.
Conception : Un cadre PICR (les quatre elements d’une question
clinique ou d’une recherche: patient (population), intervention, com-
paraison et resultat) utilisant la demande des patients tiree des
donnees de verification de presence
a un examen d’IRM non com-
plexe (n ¼ 3 525) sur une periode de 12 mois, avec un examen
des co^uts, des risques potentiels pour les resultats (seuil de diagnostic)
et de la faisabilite (capacite des effectifs) pour les deux interventions.
Conclusions : Les avantages lies
a l’introduction d’un service de rapport
en competences mixtes pour la prestation des services au Royaume-Uni
montrent des economies annuelles potentielles de l’ordre de £145 230 -
£60 524 par annee avec l’utilisation d’un mod
ele generique de charge de
travail aigu€e. Les recherches sur les donnees de verifications des ecarts ou
erreurs enregistrees afin d’etablir le risque potentiel pour les patients ont
permis de constater en manque de donnees probantes, et il est re-
commande de poursuivre les recherches sur cet aspect.
satisfaction, and decrease service delays, with an emphasis on
investment for local service changes. The English Cancer
Strategy 2015–20 [2] followed in 2015 and embraced the
Five Year Forward View’s [1] three main aims of better preven-
tion, swifter diagnosis, and better treatment. The Royal College
of Radiologists [3] (RCR) endorsed the strategy but insisted the
plan to improve access to scans and reports requires a change in
diagnostic capacity and an increase in radiology staffing.
The Kings Fund Better Value in the NHS 2015 [4] report
called on NHS staff to engage in delivering better outcomes
by improving value rather than reducing the costs, in the wake
of the Five Year Forward View [1] that proposed £22 billion
of efficiency savings. The report findings emphasised the need
to create an environment for change and highlighted major
service areas where restructuring diagnostic pathways could
deliver cost-effective service improvements, increase the speed
of delivery, reduce length of stay in hospital, and fast-track
treatment and management for preventable illness.
Two specific driving factors for change in radiology have
been a flexible response to workforce shortages [5–10], and
demand for imaging that outstrips capacity [11–13]. The
NHS Imaging and Radiodiagnostic activity 2013/14 report
[11] assessed the number of magnetic resonance imaging
(MRI) examinations from April 2013 to March 2014 to be
2.7 million, with a 12.3% increase in examinations from
the previous year [11], 71.7% over 5 years [14], and 220%
growth over a 10-year period [11], which is a substantial in-
crease in the pattern and trend of imaging demand. Both
the RCR [13] and the Society and College of Radiographers
[13] (SCoR) observe that demand in imaging is expected to
intensify. The Centre for Workforce Intelligence (CfWI)
[12] predicts the demand for imaging will escalate due to
multiple factors, including growing and/or aging populations,
rise in cancer diagnosis and chronic illness, screening pro-
grammes, introduction of 24/7 working hours, and future im-
aging techniques introduced into clinical practice. The CfWI
and the RCR have estimated the total imaging workload
could potentially rise from 39 million tests in 2011 to 51
million by 2025 (an increase of all imaging by 76%, with
MRI alone raising 87%) [12].
The RCR [15] recommend a formal report for diagnostic
examinations within 2 days, but acknowledge that due to
workforce shortages, this is not occurring [14]. This causes de-
lays in cancer and serious illness diagnosis, hospital stay, and
the subsequent increased listing of radiology departments to
NHS risk registers [15]. In October 2014, an RCR survey
[16] highlighted a month delay in results (1,697 examina-
tions) in the 25% of NHS trusts surveyed. The survey was
repeated in February 2015 [15] with 71% of surveyed trusts
having delays of more than a month, with over 3,277 unre-
ported MRI scans (estimated for all trusts in England to be
up to 4,268 [15]).
Methodology
To define the perspective of the review and the key drivers of
cost-effectiveness (capacity and demand, benefits, and risks) a
PICO framework [17] was adopted. A PICO has four major
components, in this case consisting of P for the patient sample
group defined by the MRI imaging pathway; I for the intervention
of radiographers reporting MRI examinations; C for the compar-
ison to existing intervention of radiologists reporting MRI
examinations; and O for the outcome comparison of current
and alternative service provision through costs, savings, and risk.
This review received university research ethical and gover-
nance approval to calculate a deterministic, scenario-based
evaluation of costs for the current and new intervention.
P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203
The study used data from a retrospective audit of MRI exam-
ination attendance at an acute NHS district general hospital
(DGH). A defined time horizon of 12 months (August
2014–July 2015; Tables 1 and 2) was used to identify the
key resource demand for MRI examinations (n ¼ 12,958).
Using decision tree modelling to illustrate the process
mapping of the current intervention (Table 3) allowed evalu-
ation of costs and outcomes from each intervention for inter-
nal validity. Using the audit data allowed external validation
of the model as an example of expected workflow demand
in a generic DGH. A decision tree was chosen over conven-
tional Markov models because data for chronic returning pa-
tients were not available to consider all feasible transitions of
patient’s health states or cohorts of particular disease categor-
ised patients.
Patient Group
The sample size from the data collection identified n ¼
3,525 noncomplex MRI scans (Table 2). The inclusion
criteria included knee, lumbar, internal auditory meatus
(IAMs), scaphoid, and breast. The noncomplex examination
criteria limitations were due to the restricted literature evi-
dence available on reported diagnostic thresholds of reporting
radiographers and radiologists in MRI reporting.
The Current Intervention
The NHS currently employs radiologists to report MRI
examinations, but drivers for change include the low work-
force numbers of UK registered radiologists [14]. The fifth
RCR workforce report 2012 [14] recorded the number of
UK registered radiologists as 2,997 (4.7 radiologists per
100,000 population); with a current deficit of 421 vacant
posts [3]. To reach comparable radiologist levels with the
rest of the European Union countries, the RCR estimated it
would require an 82% increase of radiologists [12].
The CfWI report on Clinical Radiology [12] commis-
sioned by the Department of Health (DoH) with multiple
stakeholders, including the RCR and SCoR, reviewed the
RCR 2012 [13] report for the Medical Programme Board
and the Joint Working Group on Speciality Training
Numbers. Recommendations included a proposed, but not
implemented, increase of 60 trainee radiology registrars per
year, with the use of radiographers to effectively support the
future expansion of radiology.
Unit Costs and Discounting
To ascertain an average hourly price for radiologists, Net-
ten et al’s Ready Reckoner for staff costs in the NHS [18] and
the Personal Social Services Research Unit (PSSRU) Unit
Costs of Health and Social Care 2014 [19] were adopted
for the basis of the calculations. The salary was based on a
full time equivalent (FTE) mean of NHS medical consultant
wages [19]. An additional 33.5% was added for overtime,
shift work and geographic allowances [19], National Insur-
ance contributions (NI) [20], and employer’s contribution
to superannuation [21]. The costs for education and training
195
Table 1
Audit Results of MRI Demand at an Average-Sized Generic DGH (2014–2015)

used PSSRU [19] standard estimation approaches for the
components of training, tuition fees, clinical placement costs,
infrastructure (books, journals, and computers), and lost pro-
duction costs of staff training days.
The costs incorporated the discounting system used by
PSSRU [19] and Her Majesty’s Treasury [22] to transfer all
costs and benefits to ‘‘present values’’ to compare, using a
3.5% discount rate. This allowed a net present value of the
intervention to be calculated, which is the primary indicator
used by the UK government to justify action. Furthermore,
this is the approved system in use by the National Institute
for Health and Care Excellence (NICE) [23] for all DoH
[24] assessment and appraisals of health technologies, tech-
niques, and screening programmes. The hourly unit cost of
a radiologist (2014–2015) was calculated at £156 (Table 4).
The New Intervention
The RCR and the SCoR have jointly published guidance
[26] to endorse the collaborative skills mix of radiographers
and radiologists working in complementary reporting roles
(not substitution or replacement of roles) to sustain service de-
livery. The SCoR scope of practice [27,28] legally entitles UK
radiographers with accredited training and competence to
report MRI examinations. The CfWI [29] have predicted
an increase of 17% (to 19,830) of radiographers from 2012
to 2016. Currently, the Health and Care Professions Council
(HCPC) [30] have 29,711 radiographers registered (3,100 are
therapeutic radiographers [31]), which is above the projected
increase of workforce by the CfWI [29]. In addition, Health
Education England (HEE) [32] has increased educational
commissioning of places for 2014/2015.
The 2014 UK radiographer unfilled vacancy rate was 5.1%
at Band 7 reporting level [31]; the SCoR [31] estimate 3,662
radiographers were in advance practice and 86 in consultant
roles, with a further 1,288 in postgraduate training [31]. The
master’s degree pathway in clinical reporting in our university
currently offers a wide range of options for MRI reporting
modulesdincluding head and neck, IAM, spine, breast,

Table 2
Audit Results of MRI Demand at an Average-Sized Generic DGH (2014–2015)
Area Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Total
Knee 166 110 122 127 125 152 102 150 106 105 116 120 1,501
Lumbar 127 102 115 93 149 103 122 109 88 106 102 104 1,320
IAM 33 39 39 41 34 41 47 47 45 33 38 25 462
Scaphoid 17 11 15 17 14 10 7 7 21 16 13 13 161
Breast 2 9 5 8 5 7 5 6 9 4 11 10 81
All MRI 1,189 1,093 1,136 1,057 1,051 1,109 1,064 1,180 1,016 971 1,035 1,057 12,958
DGH, district general hospital; IAM, internal auditory meatus; MRI, magnetic resonance imaging.

196 P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203

Table 3
Decision Tree Populated with Risk Probabilities

gastrointestinal, knee, foot and ankledwith strong recruitment rate was applied, and the hourly unit cost of a reporting ra-
of students. diographer (2014–2015) was determined as £53 (Table 5).

Unit Costs and Discounting Comparison of Costs per Intervention

To estimate an hourly rate for a reporting radiographer,
Netten et al’s Ready Reckoner for staff costs in the NHS
[18] and PSSRU Unit Costs of Health and Social Care
2014 [19] were applied. The salary was based on a FTE
mean of band 7 (point 30) on the Agenda for Change [33]
wages for allied health professionals. A further 7.2% was
added to reflect payments for additional requirements such
as overtime, shift work, and geographic allowances [19],
with NI contributions [20] and employer’s contribution to
superannuation [21]. The costs for education and training
used PSSRU [19] standard estimation approaches to calculate
the components of preregistration and postgraduate training,
tuition fees, clinical placement costs, infrastructure, and lost
production costs of staff training days. A 3.5% discounting
By applying the unit cost per hour of both interventions,
estimations of cost per examination for both interventions
can be established. The RCR activity reporting guidelines
[36] calculate time per test for reporting, which is the measure
for appointing workload standards in radiology (applying a
maximum of 50% of time spent reporting examinations).
The RCR recognises that because attempting to identify
one method to model the costings for reporting is difficult,
and each system had limitations, the RCR elected to calculate
work output using the Gishen’s Ready Reckoner [36]. The
RCR indicative modality-based method estimates against
1 hour of uninterrupted time a range of 3–6 (noncomplex)
MRI reports were possible [36], with three variable time cal-
culations of slow, medium, and fast (20, 13.33, and

Table 4
Consultant Radiologist Hourly Unit Cost Calculation
Unit Costs and Unit Estimation 2014/2015 Value Notes
A Wages/salary (þ) £87,060 per year Medical consultant average [19]
£29,165 per year 33.5% Allowances [19] for overtime/shift work/etc
B Salary oncosts (þ) £5,012 per year National Insurance secondary threshold deduction [20]
(þ) £11,753 per year Superannuation–NHS pensions 13.5%–Tier 6 [21]
London multiplier 1.19  (AþB) and 1.39  G Allow for higher costs of living in London [19]
Non-London multiplier 0.97  (AþB) and 0.97  G Allow for lower costs of living outside London [19]
C Qualifications (þ) £72,197 per year Taken from PSSRU [19], using Netten et al [18] costs from
DoH and HEE consultants ¼ 2 foundation years, 6 speciality registrar years
D Fees (þ) £420 per year GMC [25]
E Overheads, management, Taken from PSSRU–NHS (England) [19]
Administration and estates staff (þ) £20,048 per year Management and noncare staff 19.31% of direct care salary
F Nonstaff (þ) £43,575 per year Nonstaff costs 41.97% of direct salary costs (include costs to provider–office,
travel/transport, telephone, education, training, supplies, services, utilities of
water, gas, electricity) [19]
G Capital overheads (þ) £8,411 per year Capital costs annuitised over 60 years (discount rate of 3.5%) based on
PSSRU [19]. New build and land requirements of NHS hospitals (adjusted
for both treatment and nontreatment space)
H Working time (O) 42.4 wk/y PSSRU [19] calculated unit costs of 1,589 h/y: 212
(O) 37.5 h/wk Working days (minus sickness absence and training) [19]
Unit costs 2014/2015 £156 per hour
DoH, Department of Health; GMC, General Medical Council; HEE, Health Education England; NHS, National Health Service; PSSRU, Personal Social
Services Research Unit.

P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203 197

Table 5
Reporting Radiographer Hourly Unit Cost Calculation
Unit Costs and Unit Estimation
A Wages/salary
B Salary oncosts
Inner London multiplier
Outer London multiplier
Fringe multiplier
C Qualifications
D Fees
F Overheads management, administration, and estates staff
G Nonstaff
H Capital overheads
I Working time
Unit costs 2014/2015
AfC, Agenda for Change; HCPC, Health and Care Professions Council; MRI, magnetic resonance imaging; NHS, National Health Service; PSSRU, Personal
Social Services Research Unit.
10 minutes per examination per report, respectively [12]).
The CfWI and DoH [12] use weighted factors of 24, 16,
and 12 minutes per examination per report. The CfWI [12]
calculated that each FTE radiologist was allocated 10.3 pro-
grammed activities (PAs); 2 PAs for nonreporting administra-
tion of paperwork, teaching, and other duties, with 8 weeks
deducted for annual leave/study. Likewise, the RCR [14] cal-
culations use 10.3 PAs (8 PAs over 44 weeks).
A limitation of this review found the SCoR have no pub-
lished costings of reporting radiographers’ unit costs per
noncomplex MRI examination to compare against, so the
RCR [12,36] and CfWI and DoH [12] systems have been
adopted for comparison. A literature search using CINAHL,
Cochrane Library, MEDLINE, PubMed, Science Direct,
and Google Scholar found no studies on the time taken for
radiographers to report MRI scans. The study reverted to
the evidence of previously published studies [3739] that
applied timed reporting of MRI examinations (same case-
loads) of radiographers and radiologists, which produced
near equivalent accuracy, agreement, sensitivity, and speci-
ficity results.
Comparison of Diagnostic Thresholds per Intervention
The risk of discordance in reporting is another important
measure to include in the evaluation of assessing interven-
tions. This will influence potential impact on patient out-
comes (mortality, morbidity, functional status, and quality
198 P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203
2014/2015 Value Notes
£35,891 per year AfC band 7 mean–point 30 [33]
£2,584 per year 7.2% Allowances [19] for overtime/shift work/etc
(þ) £4,197 per year National Insurance secondary threshold deduction [20]
(þ) £3,337 per year Superannuation–NHS pensions 9.3%–Tier 4 [21]
£4,117–£6,342 per year 20% of basic salary [31]
£3,483–£4,439 per year 15% of basic salary [31]
£951–£1,649 per year 5% of basic salary [31]
(þ) £6,120 per year BSc diagnostic radiography tuition fees, living expenses,
clinical placement [19], and Postgraduate
Clinical placement [19] and Postgraduate Certificate in
Clinical Reporting (MRI) fees [34]–expected annual cost at
3.5%
(þ) £70 per year HCPC [35]
(þ) £8,385 per year Taken from PSSRU–NHS (England) [19] Management and
noncare staff 19.31% of direct care salary
(þ) £18,225 per year Nonstaff costs 41.97% of direct salary costs (includes costs to
provider, office, travel, transport, telephone)
Education, training, supplies, services, utilities of water, gas,
electricity [19]
(þ) £8,411 per year Capital costs annuitised over 60 years (discount rate of 3.5%)
based on PSSRU [19]. New build and land requirements of
NHS hospitals (adjusted for both treatment and non–
treatment space)
(O) 42.4 wk/y PSSRU calculated unit costs of 1,589 h/y: 212 working d
(minus sickness absence and training) [19]
(O) 37.5 h/wk
£53 per hour
of life) from the change of service delivery. The DGH audit
data did not provide statistics from error and/or discrepancy
meetings to assess the potential for detrimental risk to pa-
tient outcomes through reporting. To estimate the potential
for errors in reporting that theoretically could affect the
health of patients, a literature review on the diagnostic accu-
racy of radiologists and reporting radiographers interpreting
MRI examinations was performed using Cochrane, MED-
LINE, Europe PubMed Central, CINAHL, Science Direct,
and Google Scholar. The search results were limited because
of the variation and quality of the literature methodologies
and results, and details on sample size and pathology range
were inconsistent. In addition, reference standards varied,
with certain studies only providing agreement levels, mostly
without confidence intervals, sensitivity, or specificity.
Observer variation studies on radiologist diagnostic perfor-
mance from a number of published sources comparing set
reference standards for MRI knee studies have identified radi-
ologist agreement levels ranging from 48.1% to 96%
[37,4046]. Radiologist sensitivity levels ranged from
73.5% to 88% [42,43,46,47], with specificity between
90.8% to 97% [40,43,46,47]. The introduction of reporting
radiographers to interpreting MRI knee examinations was re-
viewed by the university in an academic setting [39],
recording a mean sensitivity of 99.4% (95% CI, 97.4–99.8)
[39] and mean specificity of 95.9% (95% CI, 93.1–97.7)
[39].
 90.5 [42], 94 [46], 94 [43], 97 [47]
Radiologist lumbar spine MRI agreement ranged from
60.8% to 94.4% [37,40,4850]. Sensitivity and specificity
were unrecorded. Reporting radiographer agreement ranged
from 58.6% to 87.2% [38,40], sensitivity and specificity
levels were 99% [38].
Scaphoid reporting by radiologists mean sensitivity rate

Specificity %
ranged from 83.3% to 100% [5153], specificity 90%

% Unknown

% Unknown
100 [52,53]
to 100% [5153], and agreement of 86.65% to 100%

69.2 [56]

96.3 [54]
94 [39]

99 [38]

99 [38]

99 [38]
[5153]. Radiographers demonstrated a mean sensitivity
rate of 100% (95% CI, 82.3–95.1) [54] and specificity
96.3% (95% CI, 90.1–100) [54] and agreement of 92.2%

73.5 [42], 76 [46], 86 [47], 88 [43]

(95% CI, 89.3–95) [54].
MRI lumbar examinations agreement for radiologists have
documented agreement ranges from 60.8% to 94.4%
[37,40,48,50], but no sensitivity or specificity levels were
identified from the literature. Reporting radiographer lumbar
spine agreement ranged from 58.6% to 87.2% [38,40], with

Sensitivity %

% Unknown

% Unknown
sensitivity and specificity levels of 99% [38].

100 [52,53]
88.6 [56]
95.2 [39]

100 [54]
IAM diagnostic threshold studies have identified radiolo-

99 [38]

99 [38]

99 [38]
gist agreement levels between 56% and 100% [37,55], with
no found levels of separate sensitivity or specificity. Reporting
radiographers agreement levels for IAMs were 98.4% [38],

48.1 [40], 68 [41], 86.1 [42], 85 [46], 87 [37], 88 [43],

sensitivity 99% [38], and specificity 99% [38], respectively.
MRI breast observer agreement levels by radiologists were
85% [56], with sensitivity and specificity at 88.6% [56] and
69.2% [56] respectively. Evaluated in comparison to radiog-
raphers’ MRI breast agreement levels of 88.6% [39] and sensi-
tivity and specificity at 95.2% [39] and 94% [39], the results
were comparable. The literature review findings indicated that
radiographer’s MRI results are approaching, and similar to,

60.8 [40], 77 [48], 80 [49],

the range of results identified for radiologists (Table 6), taking
into account the possible variations present in the study 52.6 [40], 86.3 [38]

83.8 [50], 94.4 [38]

58.6 [40], 87.2 [38]
94 [44], 96 [45]

56 [55], 100 [37]

designs.
Agreement %

88.6 [39]

92.2 [54]

98.4 [38]
100 [51]
85 [56]

Outcome Results of Interventions to National Tariffs and

Reference Standards
Estimated Mean Diagnostic Thresholds of Current and New Interventions

The key findings estimating monetary value of the radiol-

Anatomic area

Lumbar spine

Lumbar spine

ogist’s hourly rate against reporting radiographer’s hourly rate

using RCR [36] unit costs per noncomplex MRI report
Scaphoid
Scaphoid

demonstrated a variance of £34.34–17.17 per patient/report.

Breast
Breast
Knee

Knee

IAM
IAM

Applying the CfWI and DoH [12] ranges to the hourly re-
porting rates estimated a cost difference of £41.20–£20.60
Radiographer–reporting

Radiographer–reporting

Radiographer–reporting

Radiographer–reporting

Radiographer–reporting

per patient/MRI report (Table 7).

Radiologist–reporting

Radiologist–reporting

Radiologist–reporting

Radiologist–reporting

Radiologist–reporting

The committed price NHS trusts and commissioners agree

to cost at is set by the sector regulator monitor [57], to reduce
Configuration

anticompetitive practice that is opposed to patient interests.

IAM, internal auditory meatus.

The monitor 2014–2015 direct access and outpatient diag-

nostic imaging services tariff (unbundled) [58] determines
the cost paid by Clinical Commissioning groups for an
MRI scan (one area, no contrast) as £138 [58] with reporting,
Current intervention

Current intervention

Current intervention

Current intervention

Current intervention

and cost of reporting alone as £22 [58]. Although there are

New intervention

New intervention

New intervention

New intervention

New intervention

regional variations of cost and local modifications [59], this

price is set in the current Healthcare Resource Groups
Table 6

(HRG4) costs currently in use by the NHS national tariff pay-

Unit

ment system (2014/15) and is enforced by the Health and

P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203 199

Table 7
Unit Costs of per Examination of Current and New Interventions Using RCR [36], CfWI, and DoH [12] Calculations
Noncomplex MRI Report Configuration Cost per Hour RCR [36] Slow Report RCR3 [2] Medium RCR [36] Fast Report
(20 min) Report (13.33 min) (10 min)

Current intervention Radiologist reporting £156 £52.00 per patient/report £34.66 per patient/report £26.00 per patient/report

Noncomplex MRI Report Configuration Cost per Hour CfWI/DoH [12] Slow CfWI/DoH [12] Medium CfWI/DoH [12] Fast
Report (24 min) Report (16 min) Report (12 min)

Current intervention Radiologist reporting £156 £62.40 per patient/report £41.60 per patient/report £31.20 per patient/report

Noncomplex MRI Report Configuration Cost per Hour RCR [36] Slow Report RCR [36] Medium RCR [36] Fast Report
(20 min) Report (13.33 min) (10 min)

New intervention Radiographer reporting £53 £17.66 per patient/report £11.77 per patient/report £8.83 per patient/report

Noncomplex MRI Report Configuration Cost per Hour CfWI/DoH [12] Slow CfWI/DoH [12] Medium CfWI/DoH [12] Fast
Report (24 min) Report (16 min) Report (12 min)

New intervention Radiographer reporting £53 £21.20 per patient/report £14.13 per patient/report £10.60 per patient/report
CfWI, Centre for Workforce Intelligence; DoH, Department of Health; MRI, magnetic resonance imaging; RCR, Royal College of Radiologists.

Social Care Act 2012 [60] for NHS trusts, NHS foundation
trusts, and private providers.
Comparison of the interventional cost of reporting ra-
diographers to report a noncomplex MRI scan against the
national tariff of £22 [58] per report demonstrates cost sav-
ings between £2.83 and £11.17 per scan, calculated against
all the proposed RCR [36] and CfWI and DoH [12] time
ranges to report an MRI scan (Table 7). Extrapolation of
the data allowed approximation over the observed range
using the data (n ¼ 3,525) from the acute DGH 12-
month audit of workload. Calculated savings between
£121,048 - £60,524 could be possible using reporting ra-
diographers against the RCR [36] workload model (fast, me-
dium, and slow reporting times). Calculating the reporting
radiographer’s unit costs against the CfWI and DoH [12] re-
porting ranges give an estimated annual cost saving of
£145,230–£72,615 (Table 8) compared with the current
intervention of radiologists.

Table 8
Potential Unit Costs of per Annum of Current and New Interventions Using DGH Audit of Workload Against the RCR [36], CfWI, and DoH [12] Calculations
Noncomplex MRI Configuration Annual DGH RCR [36] Slow RCR [36] Medium RCR3 [2] Fast Report
Report Workload Report (20 min) Report (13.33 min) (10 min)

Current intervention Radiologist reporting 3,525 MRI scans Annual cost Annual cost Annual cost
£183,300.00 £122,141.25 £91,650.00

Noncomplex MRI Configuration Annual DGH CfWI/DoH [12] Slow CfWI/DoH [12] CfWI/DoH [12] Fast
Report Workload Report (24 min) Medium Report Report (12 min)
(16 min)

Current intervention Radiologist reporting 3,525 MRI scans Annual cost Annual cost Annual cost
£219,960.00 £146,640.00 £109,980.00

Noncomplex MRI Configuration Annual DGH RCR [36] Slow RCR [36] Medium RCR [36] Fast Report
Report Workload Report (20 min) Report (13.33 min) (10 min)

New intervention Radiographer 3,525 MRI scans Annual cost Annual cost Annual cost
reporting £62,251.50 £41,489.25 £31,125.75

Noncomplex MRI Configuration Annual DGH CfWI/DoH [12] Slow CfWI/DoH [12] CfWI/DoH [12] Fast
Report Workload Report (24 min) Medium Report Report (12 min)
(16 min)

New intervention Radiographer 3,525 MRI scans Annual cost Annual cost Annual cost
reporting £74,730.00 £49,808.25 £37,365.00
CfWI, Centre for Workforce Intelligence; DGH, district general hospital; DoH, Department of Health; MRI, magnetic resonance imaging; RCR, Royal Col-
lege of Radiologists.

200 P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203

Discussion
The RCRs [15] have explored various responses to the
capacity demands of reporting services and acknowledged re-
porting radiographers as one of several solutions (including
out-sourcing, locums, overtime catch up sessions, and review
of existing radiologist’s performance). The use of locums and
outsourcing to commercial private companies is not without a
large financial burden and may not be a sustainable policy
considering current NHS financial constraints.
The review has shown that both interventions have the
diagnostic thresholds to achieve similar reporting standards.
The societal benefit to patients from integrating the new inter-
vention could potentially improve reporting services and result
in faster diagnosis. Evidence from studies in x-ray [6164],
computed tomography [65,66], ultrasound [65], and MRI
[65] supports achievable increases in reporting turnaround
times. The influence of introducing system efficiencies in report-
ing enhances patient treatment and management [61,67,68],
which improves quality of care and patient satisfaction.
Health care economic evaluations normally review the
tradeoff in a comparison of costs, benefits, and harms to
determine if current treatment is more expensive and worse
than an alternative, or if a new treatment is better, but
more expensive or cheaper and better. There has been prece-
dence in the past from studies in x-ray [63,6871], computed
tomography [66] and fluoroscopy [72,73] establishing the
cost effectiveness of radiographer reporting. Any additional
cost between interventions could not be appropriately calcu-
lated to Quality Adjusted Life Years (QALYs) or Incremental
Cost Effectiveness Ratios (ICER), because the sample audit
data did not record the impact of the intervention on care
pathways; and treatment plans, as evidence from discrepancy
audit meetings, were unavailable.
An additional limitation of this study recognises that some
NHS teaching hospitals use registrars in training to report
MRI examinations and, as such, can be a cost-effective
approach to reporting. In justifying why registrars were not
evaluated in the data modelling, the DGH where the audit
was obtained did not commission registrars. In addition, the
use of registrars could be problematic because of the various
levels of experience and exposure in reporting; moreover,
some will require a level of double reporting at an extra
cost of time and money.
Conclusion
In summary, the literature [11–14] implies that current
practice is not conducive to future service delivery. A consid-
eration of future workforce planning to cope with capacity
and demand should include a whole-team approach to devel-
oping an effective service delivery with involvement from pro-
fessional bodies, commissioners, and stakeholders. The
current scope and boundaries of imaging professions will
need to consider sufficient overlap of roles to enable an effi-
cient service delivery.
P. Lockwood/Journal of Medical Imaging and Radiation Sciences 47 (2016) 194-203
The review of introducing an MRI skills mix reporting ser-
vice model has shown one potential option in tackling the ca-
pacity and demand issues faced by NHS imaging
departments, with a possible £145,230–£60,254 per annum
cost saving using a generic acute NHS DGH workload model.
Research into discrepancy audit data from MRI reporting by
radiographers and radiologists for potential risk to patient
outcomes identified a paucity of evidence on patient mortal-
ity/morbidity and quality of life. Further research into this
area is recommended.
Acknowledgements
The author would like to thank all the radiographers that
participated in the study.
There were no financial conflicts of interest.
Paul Lockwood is a senior lecturer on the MSc Clinical
Reporting, MSc Medical Imaging pathways, and programme
director for BSc Diagnostic Radiography at Canterbury
Christ Church University.
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