REVIEW SYSTEM:A NUMBER of hospitals across the State do not ensure all patient X-rays are reported on by consultant radiologists, it has emerged.
Several radiologists have told The Irish Timesthat a shortage of radiologists for an ever-increasing workload has resulted in them having to prioritise work, leaving certain categories of film going unreported.
In the main these would include X-rays on patients attending fracture clinics or other films taken on orthopaedic patients which orthopaedic surgeons would feel competent to read themselves.
There is no national protocol on what films should and should not be reported by radiologists, but one is to be developed by a new group which has just been established by the HSE.
This group is being led by Dr Risteárd Ó Laoide, dean of the faculty of radiologists at the Royal College of Surgeons in Ireland.
It is understood most of the 57,000-plus X-rays which were not reported on by consultant radiologists at Tallaght Hospital between 2005 and 2009 related to orthopaedic work.
However, in a review of 34,752 of these unreported X-rays to date two patient chest X-rays were found among them which had gone unreported.
In both cases the patients they related to had a delayed diagnosis as a result. One of these, an elderly patient, has died. The other is being treated for cancer.
Dr Ó Laoide said the faculty of radiologists was aware there were different practices in relation to orthopaedic film reporting in different hospitals.
“In some departments, due to significant workload pressures, a pragmatic decision is made to prioritise the imaging workload or the reporting workload and in this situation follow-up orthopaedic films are not reported unless requested by the referring orthopaedic surgeon. This is not universal and many departments report all X-rays.
“In the largest orthopaedic department in Northern Ireland orthopaedic films are not routinely reported under a protocol agreed between the radiologists and the hospital trust.”
Dr Ó Laoide pointed out that radiology workload has increased significantly in recent years, both in quantity and complexity.
In addition, radiologists have to attend multidisciplinary team meetings in the cancer arena. “The general increase in workload has led to discussion on prioritisation of reporting,” he said.
Concern around the non-reporting by radiologists of thousands of X-rays at Tallaght Hospital has followed the issuing of a statement by the hospital’s chief executive, Prof Kevin Conlon, on Tuesday evening when he said it was “totally unacceptable” that 57,921 adult X-rays had not been reported officially by a consultant radiologist even though the majority of them would have been reviewed by a non-radiologist.
A senior radiologist working in a large hospital outside Dublin said some radiologists believe all X-rays should be reported by radiologists and some do not.
In his experience “it would be unusual for all X-rays in all hospitals to be reported by radiologists because the volume of work is high and the number of consultant radiologists is low”.
Generally the workload radiologists have in the Republic “would be one-and-a-half to twice” that of their colleagues internationally, he added.
Dr Ó Laoide confirmed Ireland certainly has a smaller number of radiologists for its population than the UK.
The Irish Hospital Consultants Association said Tallaght Hospital had just seven consultant radiologists, which it said was far fewer than any of the other teaching hospitals.
Its assistant general secretary, Donal Duffy, said a radiologist should report about 11,000 films a year, which would mean Tallaght, for its workload, would need 18 radiologists.
Meanwhile, the HSE last night could not say what the scale of unreported X-rays by its hospitals is, but is attempting to ascertain this.
Anne Carrigy, director of the HSE’s serious incident management team, yesterday wrote to all hospitals asking them to confirm by return email “that all X-rays in your institution have been reported by a radiologist or other suitably-trained doctor in line with your local protocols, and further confirm that there are no current backlogs in reporting”.
She also asked them to confirm that any reviews of radiology services which were ongoing in their hospitals had been notified to the HSE.