Diagnostic imaging is common to most clinical pathways and consists of three key components: the referral (and justification of), the image acquisition and the evaluation or report (UK Health Security Agency, 2022). This last stage may include initial evaluation by the referral team and a definitive report by the imaging department, depending on the modality and examination (Care Quality Commission (CQC), 2018; NHS England, 2023).
Image reporting by diagnostic radiographers, alongside their medical counterpart (radiologists), is well-established across the UK NHS (CQC, 2018; Halliday et al, 2020) and has underpinned many service changes, positively impacting patient care pathways (Snaith and Hardy, 2013; Bajre et al, 2017; Woznitza et al, 2018; Culpan et al, 2019). As with many skill mix opportunities, the developments have often been reactive, established in response to local service demand, resulting in inconsistent implementation and utilisation of such roles (Halliday et al, 2020; Snaith and Beardmore, 2021).
While radiographers in their reporting roles have seemingly been perceived to operate at an advanced level of practice, several studies have highlighted challenges in evidencing their delivery and impact beyond clinical practice (Milner and Snaith, 2017; Woznitza et al, 2021a; Murphy et al, 2022a). This, when reviewed in the context of the educational preparation of these radiographers, has led some to question whether these roles exist solely in the enhanced practice sphere (Snaith and Beardmore, 2021; Woznitza et al, 2021a). Enhanced-level practice acknowledges that there exists a proportion of the healthcare workforce that develops to and practices at a level between practitioner and advanced practitioner (Leary, 2019; 2022). This level may represent either a career pinnacle or a step on the journey to advanced practice.
Enhanced practitioners are expected to show development beyond the clinical pillar, embracing leadership, educational and research skills (College of Radiographers, 2022a), usually through postgraduate qualifications. Academic programmes to support UK radiographer development in image reporting are long-established (Culpan et al, 2019; Murphy et al, 2022b); although these are at postgraduate level, most individuals never achieve a full master's degree (Milner and Snaith, 2017; Woznitza et al, 2021a).
Given the evolving understanding of enhanced practice and increasing clarity concerning the advanced practice level (Leary, 2022; Snaith and Beardmore, 2022), it is important to ascertain whether radiography professionals have an understanding of the levels of practice. In particular, it is critical that they can articulate and evidence the level they are currently working at and that to which they aspire.
This article outlines one aspect of a larger-scale project undertaken in 2021, evaluating the radiographer role in projection radiography (X-ray) image reporting across a regional NHS integrated care system (ICS) in England. Integrated care systems are established in England, bringing partner organisations together to deliver joined-up care across local geographical areas and aiming to improve patient outcomes and tackle inequalities (The King's Fund, 2022). A previous publication (House et al, 2023) considered established radiographer reporting roles and expectations and aspirations of the employers within the appraised ICS. For convenience, the term ‘reporting radiographer’ is used throughout this article, so as not to ascribe a particular level of practice.
Aim
The aim of this work package was to explore the perspectives and aspirations of individual practitioners working and/or training within image reporting roles across a single region, in terms of role, utilisation and development. In relation to this article, the objectives were to:
Method
Design
Focus groups were deemed most appropriate for the exploration of reporting radiographer perceptions and lived experiences. Allowing the opportunity for individuals to discuss their roles with peers has the potential to highlight differences or commonality in experiences. Due to the COVID-19 pandemic and social distancing guidance in the UK, focus groups were conducted online using Zoom.
Ethical approval
Higher education institution ethical approval (EC26728) was gained as the project formed part of an academic award, and approval by the main author's NHS trust employer (SE0931) was granted prior to project commencement. The project was also proposed to the ICS heads of service, with permission given for the study to proceed across the network.
Recruitment
One ICS in the north of England formed the setting for the study. The ICS serves a population of approximately 1.5 million people and includes five acute NHS hospital trusts within the network. The trusts include two large teaching organisations, two district general hospitals and a specialist children's centre. At the time of data collection in 2021, there were 30 trainee and qualified plain film reporting radiographers employed across the five trusts. Radiographers were approached through the regional training academy lead, and a participant poster was disseminated to all sites to invite trainee and qualified reporting radiographers working within projection radiography. A participant information sheet was included, outlining the scope and purpose of the project and providing assurance of confidentiality and data protection. Participants completed a consent form to affirm their involvement, with the form confirming the voluntary nature of the project.
Data collection
Individuals responding to the invitation were sent a link to a short online survey (Jisc, Bristol, UK), which enabled the collection of anonymous demographic data, such as employing NHS trust site and relevant postgraduate qualification(s), including any currently studying. Qualified reporting radiographers were asked additional questions concerning the scope of reporting practice (including restrictions), job planning and leadership duties.
A focus group topic guide was developed based on the literature and author experiences to semi-structure the conversation and ensure consistency. Additionally, as the focus groups would be performed and chaired by the principal investigator (who is employed as a reporting radiographer within the ICS and a peer of some participants), the topic guide aimed to reduce the risk of bias. The areas for discussion included: advanced practice and the four pillars; perceptions of current utilisation; and future aspirations. Participants were also encouraged to introduce points that they considered to be relevant to the discussion. A pilot focus group took place with two reporting radiographers employed outside of the target population, which enabled testing of the technology and refinement of the topic guide.
Three online focus groups took place between July–September 2021 with individuals at differing career stages: trainee, undertaking further education and/or experienced. With permission from the participants, the Zoom focus groups were recorded and subsequently transcribed verbatim by the main author. In addition to being able to accurately transcribe focus group verbal discussion, the Zoom recording also enabled observation and documentation of body language and gestures in transcripts, thus capturing potential subtle nuances in conversation.
Data analysis
The demographic survey data were downloaded into Microsoft Excel® 2018 for descriptive analysis. A copy of the relevant transcript was emailed to each participant to assess its accuracy. Participants confirmed accuracy, and no changes to focus group transcripts were required. In final transcript edits, each participant was provided with a pseudonym, together with their employing trust (A–E), to ensure anonymity. Transcripts were analysed individually and then coded and categorised into themes. The transcripts were then compared, to identify common or conflicting themes and viewpoints between the focus groups.
Results
Nine reporting radiographers were recruited, with representation from each of the five acute trusts. The participants included trainee (n=3), qualified (n=2) and those undertaking further study to extend their current clinical scope (n=3) or complete an MSc (n=1). Of those already independently reporting in practice (n=6), one was seconded into a Band 8a clinical specialist leadership role, with the remainder all paid at Band 7 under the NHS Agenda for Change (AfC). Qualified participants had varying scopes of reporting practice, with different restrictions depending upon the employing trust, with only one site consistently reporting primary care referrals. Differing leadership responsibilities were described, although no one had a formal job plan in place.
Four main themes of discussion were common across all focus groups, with several subthemes identified within the transcripts, including role scope, utilisation, aspirations and barriers.
Understanding of scope of reporting roles and advanced practice
All participants were able to articulate how developing competency in image reporting constitutes role extension/enhancement, but does not in itself fulfil advanced level practice:
‘Reporting…is a part of the role as an advanced practitioner, but there's a clear difference between an advanced practitioner and the reporter.’
‘Sort of an extended role, the task of reporting, and then the other stuff combined is what you eventually become an advanced practitioner.’
Several participants described how attaining the reporting qualification forms part of a professional journey towards advanced practice, and the additional development of experience, within the domains of leadership, education and research, is required to fulfil a higher level of practice and justify the advanced practitioner role title:
‘I perceive reporting radiographer as on the step to being an advanced practitioner. I think you gain your reporting competency and over time then you add to your role with undertaking more education and research and improving leadership qualities and then you can call yourself an advanced practitioner.’
‘I think the main difference [between reporting radiographer and advanced practitioner] is knowledge about what the other elements of advanced practice are and being given the time to do those bits.’
Some of the participants, however, alluded to their understanding and expectation of the reporting role and advanced practice being at odds with the perceptions of radiographer colleagues who attained reporting competency years previously:
‘Quite interestingly … we've got quite a lot of reporting radiographers in management roles that no longer report, and I think, because they've gone through the reporting radiographer process before the advanced practitioner process was sort of envisaged, in a way I think we may struggle even more to get them to understand the process now.’
‘At our trust [the role] is historically a reporter, who's qualified to report MSK [musculoskeletal X-rays] and does it ad-hoc and it was never a clearly defined.’
Surprisingly, at one trust, this apparent inconsistency in understanding had resulted in reporting radiographers utilising varying job titles. The ‘advanced practitioner’ term is used inconsistently, and perhaps inappropriately, by radiographers who have reporting competency but limited wider experience. Role titling is seemingly influenced by the length of time an individual has been in post, as opposed to their competency or capability, with a resultant lack of consensus across the team and confusion of role purpose:
‘We have quite a mixed bag of job titles within the reporting team: we've got reporting radiographers; reporting radiographer advanced practitioners; just advanced practitioners. They all seem to have a bit of a different job title. So, the people who have been in post for longest are advanced practitioners reporting radiographers … It's also interesting that the people that have the advanced practice title are part-retired and they don't do any advanced practice.’
All participants articulated what the four pillars of advanced practice are and reflected positively upon the value of diagnostic radiographers developing capability beyond clinical practice and taking a leading role in driving change and contributing to service improvement:
‘I want to develop my own practice but then also others.’
‘We're all obviously committed to the service and improving ourselves and the department.’
Participants highlighted how radiographers with image reporting qualification have a breadth of clinical experience and are, therefore, well-placed to educate staff within multidisciplinary teams, especially in image interpretation:
‘We have [to support] the first-year medical students; the radiologists used to do it but now we do it. We'll have ENPs [emergency nurse practitioners] and ANPs [advanced nurse practitioners] in the reporting room or over [Microsoft] Teams…and we've had paramedics, physios and all sorts of other professions who want to extend their practice in with us as well.’
‘Education is one of the most important ones [pillars] because I think it…does the full circle, and kind of allows you to move on and do other things by educating people.’
Providing such education was, in particular, felt likely to have a positive impact upon working relationships and communication between professional groups:
‘It's not just our team we can help educate—you know, the radiology team. We've got GPs [general practitioners], junior doctors on the wards. If we can support them with education, there would be less enquiries and a lot more confidence in looking at the images.’
‘We can understand what they want from us [pause] from different clinical areas for outpatients, A&Es [accident and emergency] or GPs. We can tailor it [the report] relevant to who the reader is.’
Participants highlighted how leadership in the immediate clinical area is an inherent aspect of a reporting role, by nature of the extensive clinical experience held by this staff group. Reporting radiographers are a visible and accessible point of contact for staff and provide support to management teams in the daily coordinating and functioning of departments:
‘As just strictly an AP [advanced practitioner], we do, like, all the appraisals for staff; we support the superintendent team and do morning safety huddles, so we cover them. We kind of just do anything to help the superintendent team.’
‘We are there for points of contact reference, for pretty much everything: the weird and wonderful, as well as the stuff that you are trained to do.’
Several participants, however, were clear in articulating their understanding that leadership is not the same as management. They highlighted that there can be confusion in defining leadership in reporting roles, and potential misperception that performing managerial duties would fulfil the leadership aspect of advanced practice:
‘Management is one thing, but leadership is another, we are very much leaders in the department.’
‘I think it's difficult to not let it [leadership] get involved in with management, it's really difficult and I think you've got to be quite strict with what you are willing to do.’
Perceptions of current role utilisation and level of practice
Reflection upon their utilisation within the role highlighted disparity in the level of practice participants perceived themselves to be operating at, and varying opinions were expressed about scope for future development of capability across the four advanced practice domains. Participants in one NHS trust perceived their roles to fulfil advanced practice, with sufficient opportunity and autonomy to develop and evidence wider capability beyond image reporting:
‘I think we definitely do [have scope to practice across the four pillars], and there is opportunity if you want to, and time; we get a lot of AP [advanced practice] time do things.’
‘We're very much left to plan our own time in that sense. And we cover our hot reporting service and the cold reporting service around it, and then all the other bits fill in, and if we've got gaps it's for us to decide what to do with that time, as long as the wider service is coping okay.’
Conversely, others felt that their experience beyond clinical practice was more limited, and they would not deem their roles to currently be operating at an advanced level:
‘I don't see myself as an advanced practitioner. I don't think I possess the skills at the moment to call myself an advanced practitioner and I definitely don't partake in any of the [pause] as much as I could, you know, education, evidence-based practice.’
‘I'm not sure I could call myself an advanced practitioner completely looking at the framework, but I think, with some of the things I get involved with, I feel like I do have a level of education and leadership involved in what I do.’
Interestingly, one participant described how a recent return to university had offered insight into the breadth of advanced practice and the four pillars. While they had previously believed that attaining a reporting qualification constituted advanced practice, upon reflection, their knowledge and viewpoint had shifted, and they would not perceive their practice and role to be developed to this level:
‘I think before, when I qualified as [reporting radiographer] for the appendicular [reporting], I kind of did think we were advanced practitioners, but then looking more into it and the role, beyond just reporting, I'm not fulfilling that part of it, so I'm not an advanced practitioner as yet.’
Across all focus group, research was highlighted as being the advanced practice pillar in which participants had the least confidence and experience. There was an evident lack of knowledge as to whom staff could approach for support with developing research capability, and exposure to research activity was limited:
‘As a reporting radiographer we're not even involved in protocols, imaging protocols. We're not even asked about them. We don't do any research or evidence-based practice.’
‘I don't know a lot about research and I don't know who would ever teach me about it.’
‘We're quite secure in the audit and service improvement side, but in terms of actual research, primary research, publication, that's the area that we're not as informed about and we don't have clear routes of knowing sort of where to go with it.’
One participant, however, highlighted optimism that undertaking the MSc final stage project would provide an opportunity to develop research knowledge and strengthen weaknesses:
‘I think the MSc project will help a lot, to learn more about research methodology and techniques, so that might help to overcome some of my own limitations in understanding research.’
Future aspirations
It was encouraging to hear that the aspiration of all participants was for roles to operate at an advanced level and encompass activity across the four pillars, with support and opportunity for development of experience and capability beyond image acquisition and reporting. For the six participants who did not already hold a full master's degree, the goal was to continue with postgraduate education and attain the full MSc award:
‘I'd like to do my MSc, get my chest and abdomen reporting, full MSK reporting and actually be able to say, “Look, I am an advanced practitioner because I am able to do the education and do research.”’
‘I want to do my MSc, which is going to be a couple of years yet. And then, I think, long-term, personally my goal is to look at a consultant role eventually.’
‘We can explore the things that we're passionate about, but also that are relevant to the department. So that's, for me, the area that I see my focus staying with. And whether that is explored in the context of radiography or whether that can go down other routes, I don't know yet.’
Nevertheless, despite all participants understanding the breadth of advanced practice and having ambition to develop to and work at this higher level, there was scepticism from the majority of them about the feasibility of roles formally encompassing activity beyond clinical practice. Time and staffing pressures and lack of autonomy were highlighted as longstanding and ongoing barriers to development, and support mechanisms/networks were described as requiring improvement and clarification:
‘We've got some really experienced reporting radiographers that don't get to teach, don't get to [pause] do an audit, even! They just don't have the time to do anything like that, and I just can't imagine convincing anyone to give me the time to do it when none of the others have.’
‘The benefits [of advanced practice] are clear and our role in that. It's just deciding how we do it and releasing our time. And ensuring everybody's expectations are clear and they're not currently clear from above and below, and from ourselves. To a certain extent, they don't match.’
‘I think we're considered highly autonomous practitioners, but what we're actually allowed to do is limited.’
Perceived barriers to role utilisation and development
Challenges in the clinical environment were perceived to be creating barriers to the development of roles and services, and the fulfilment of advanced practice. These included insufficient department staffing levels and increasing workloads, disparity in understanding and expectation of reporting roles across staff groups, inadequate support mechanisms and varying levels of radiologist support.
Participants from two sites described a reliance upon reporting radiographers to plug gaps in clinical teams and regular interruption or forfeiture of reporting sessions due to insufficient staffing levels:
‘We have structured [reporting] time, which is set out and is [pause] supposed to be protected. Currently it's not protected at all.’
‘I think we all find that we're obviously constrained significantly by the lack of staffing. There's not enough radiographers to do the X-rays and, therefore, in radiography, everyone then pulls down a level to do things that, maybe—not that they shouldn't be doing, but there should definitely be other people to fill the gaps.’
There was a perception that image acquisition was prioritised by management, with the focus on patient throughput and with limited outward consideration of the resultant impact upon reporting workloads:
‘It's just not balanced. You do one X-ray on one patient and that patient hasn't waited more than half an hour, but then the reporting time has increased by hours at the end, which [means] patients can't be treated effectively because they've waited a lot longer.’
‘There seems to be a misunderstanding that you've completed the examination without the report.’
There was a described resultant two-fold pressure on reporting radiographers: to provide support to image acquisition teams and meet incoming imaging demand, while maintaining reporting capacity and preventing backlogs forming:
‘I do feel a bit of empathy with them [staff] on the frontline because I can understand the reason why I'm being pulled is because it's short [staffed]. I do feel a bit uncertain sometimes, as well, to know, like, if there's a significant amount of [reporting] time I've lost, am I supposed to ask for that back?’
This pressure and internal conflict to meet imaging and reporting demands had left some feeling stressed, lacking morale, and confused about the purpose and priority of their roles:
‘You feel stuck in the middle. You don't know where you fit. And you get told one day to make decisions and be autonomous in your decisions, and then you don't know what the plan is elsewhere.’
Additionally, difficulty in securing dedicated and uninterrupted reporting sessions was described as having a negative impact upon productivity and confidence levels, and concern about the potential risk of making reporting errors:
‘I think it does affect decision-making to an extent if you are constantly being interrupted, because you're always second guessing yourself.’
‘I feel really anxious when I'm constantly interrupted, because I don't feel [pause] have I even looked at that? Then I worry about it and I need to go back and look at it again and it's just counterproductive because you just end up looking at the same X-ray thinking, have I made a mistake?’
Some participants alluded to there being a perceived disparity in expectation and understanding of radiographer reporting roles and advanced practice by colleagues and managers:
‘I think maybe advanced practitioners and managers locally come from different perspectives. As an advanced practitioner, we look at radiography and think, how can we improve the profession? Managers look at radiography and think, how can I run my department?’
‘I think it is just more the fact…it's just very seen as very clinical, but I think the other pillars aren't as, I don't know, not seen as, kind of, important…I know my colleagues definitely don't see, erm, the other sides of it and just think it's purely just reporting an X-ray.’
‘I think just general support from the bigger team might be a barrier.’
While all participants articulated the value of reporting radiographer roles evolving beyond clinical practice, several described limited support within workplaces for staff to develop to an advanced level. This was seemingly demonstrated by lack of allocated time for activity across all advanced practice pillars, and an expectation at two trusts that master's degree completion would be done in personal time:
‘I've been told by our manager that, basically, when we do our MSc research stuff, that will be in our own time.’
‘I think ours [trust] state that we have to do it [MSc] in our own time also.’
‘I'd like to be an advanced practitioner. I'm just concerned I probably won't have the time.’
At the time of project completion, none of the participants had a formal job plan, although some did describe an informal agreed clinical time split between image reporting and image acquisition. Some were also unaware of the existence of job descriptions for their role, or the detail of what was included:
‘We've got job descriptions, but we've not got like a defined 60/40 split or this much AP [advanced practice] time; it's not defined like that. But we have got an overall job description, but it's not specific as to what hours are spent doing.’
‘I don't even know if mine [job description] exists, or what the deal is with it, but they've [reporting radiographers] all got different ones. So, I don't know if it will just be a case of piecing together bits from other people's.’
Discussion
Previous studies exploring such roles have highlighted inconsistent and, in some cases, incorrect titling and description of reporting radiographers as advanced practitioners, and limited evidence of roles consistently encompassing activity beyond clinical practice (Milner and Snaith, 2017; Harris et al, 2021). There has, however, been limited exploration of reporting radiographer understanding and perception of role purpose and levels of practice and, importantly, what aspirations they may have for current and developing roles.
This study involving trainee and qualified reporting radiographers employed across a single NHS network demonstrated that, while there is evident understanding of levels of practice by this group and staff desire to develop capability across the four advanced practice pillars, there continues to be inconsistent utilisation and development of reporting roles in projection radiography. Echoing the conclusions of other reporting radiographer study and evaluation (Milner and Snaith, 2017; Halliday et al, 2020; Murphy et al, 2022b), challenging clinical environments, insufficient staffing levels and varying support mechanisms across the appraised ICS have resulted in limited contribution and influence beyond direct clinical care, and a perceived negative impact upon job satisfaction and staff morale.
To keep pace with increasing imaging demand and maximise image reporting capacity, previous national reviews of diagnostic services (Halliday, 2020; Richards, 2020) have recommended development of the entire radiography workforce and enablement of staff to work to their potential. It was, therefore, disappointing to hear that the capacity of radiographers across the appraised ICS was not maximised, as evidenced by limited and inconsistent scopes of reporting practice and the described difficulty in securing dedicated and uninterrupted reporting time. As acknowledged by Halliday et al (2020) and articulated by several participants in this study, it is felt to be counterproductive for radiographers to attain reporting competency and qualification if they are relied upon to support teams in meeting image acquisition demand, as opposed to reporting demand. A diagnostic imaging examination is not complete without appropriate interpretation and communication of image findings, and the patient journey from referral to diagnosis should be considered to ensure each step and process is adequate and timely. Indeed, the recent publication of diagnostic imaging reporting turnaround times guidance (NHS England, 2023) emphasises the requirement for UK imaging departments and networks to address workforce issues and improve reporting infrastructure, so as to enable reporting of all diagnostic imaging within 4 weeks.
The reasons for the reported deficiencies in staffing levels were not explored and were not corroborated independently. Nevertheless, staffing shortfalls are not unique to this single region, and imaging departments across the UK face challenges in recruiting and retaining staff (Murphy et al, 2022), with a 12.7% diagnostic radiography workforce vacancy rate reported in 2021, the time at which this study was performed (College of Radiographers, 2022b). Additionally, the COVID-19 pandemic has placed significant stress upon imaging services and staff, with ongoing pressure to prioritise clinical care and tackle backlogs (College of Radiographers, 2021; College of Radiographers, 2022b). Staffing shortfalls and the apparent negative impact upon reporting radiographer utilisation and productivity was felt by some participants to be compounded by a perceived disparity between professional groups in understanding of the priority of the reporting role and the necessity of radiographers developing practice to an advanced level.
Despite facing challenges in developing roles and maximising skillsets, all participants spoke positively about future role development and reported aspirations to develop capability beyond clinical practice and as advanced practitioners. Participants across all focus groups articulated a clear understanding of the difference between enhanced and advanced-level practice in the context of radiography, describing how attaining a postgraduate image-reporting qualification forms part of a professional journey towards advanced-level practice; however, it was also acknowledged that, in itself, the task of reporting does not solely fulfil the higher level of practice. This potentially demonstrates a shift in the understanding of levels of practice since previous research was conducted (Milner and Snaith, 2017); however, as the majority of participants were, at the time of focus group discussion, nearing completion of a postgraduate education module, it is likely that such education has contributed to their knowledge and appreciation of levels of practice.
It was encouraging to hear participants acknowledge the importance of research, so as to contribute to the evidence base, ensure best practice and drive professional standards forwards. This conflicts with previous research across professions (Milner and Snaith, 2017; Evans et al, 2020; Kerr and Macaskill, 2020), which suggested that limited participation in activity across the wider domains of advanced practice may be due to a lack of personal interest or limited appreciation of the value of doing so. As highlighted by several participants, however, radiographer development beyond clinical practice may remain an aspiration without a change in understanding of role purpose by management and colleagues, clarification of expectations and improvement of support mechanisms. Job plans for reporting radiographers have been proposed as a potential tool to support utilisation, by outlining protected reporting sessions and allocating time for other expected clinical and non-clinical duties. They may also aid with appraising workforce capacity (Halliday et al, 2020; Woznitza et al, 2021b).
Limitations
It is acknowledged that this study has several limitations. Data collection took place in late 2021, and guidance to support career and workforce development has subsequently been published (College of Radiographers, 2022a). The focus groups were led by the principal investigator, an individual employed in a reporting radiographer role within the region and as a peer of some potential participants, which may have affected the decision to participate.
Conclusions
This study confirmed variation in utilisation and development of reporting radiographers in projection radiography across trusts within one imaging network in England. Radiographers with established or developing reporting competency articulate understanding of the scope of advanced practice and the value of such roles encompassing activity across the leadership, education and research pillars.
Nevertheless, for some reporting radiographers, current roles are falling short of personal and professional expectations, negatively impacting upon job satisfaction and morale. There is a perception that influence and impact of radiographers beyond immediate clinical areas is limited, and capacity is seemingly not being maximised.
Unsurprisingly, and similar to prior research, there are several common challenges to staff development and utilisation in projection radiography reporting, and support mechanisms require improvement to enable and empower radiographers to build reporting competency and wider capability beyond clinical practice, especially if this is the expectation of employers and managers. Evaluation of current role utilisation provides the opportunity to consider the purpose and priority of radiographer reporting roles, and the level of practice at which they can feasibly operate. Employers should ensure that expectations are realistic and underpinned by national workforce guidance, and consideration should be made as to how workforce planning and collaboration across imaging networks may assist in reducing variation in the implementation of radiographer reporting roles. The feasibility of harmonising roles and advanced practice development across professions and within the wider multidisciplinary team should also be explored, with the aim of reducing variation and maximising impact of staff.