. 2016 Apr 14;89(1062):20151066. doi: 10.1259/bjr.20151066

Table 4.

Study characteristics

Study	Country of origin	Advanced practice activity/focus	Study aim and overview	Research question addressed (service quality dimension)	Mean quality assessment grading
Brown and Desai, 2002³⁸	UK	Radiographer-led barium enema examination	A single-site prospective study to determine the cost effectiveness of radiographer-performed barium enemas compared with those undertaken by a consultant radiologist	Reduction in service costs (efficient)	Low (26.2%)
Brealey et al, 2005³²	UK	Radiographer reporting of appendicular skeletal radiographs	To determine the effect on patient management and costs of introducing radiographer appendicular reporting for patients with trauma at a single hospital site. A retrospective review of trauma cases 2 years before and after intervention	Reduction in patient morbidity (effective; safe) Reduction in service costs (efficient)	Moderate (61.9%)
Jones and Robinson, 2008³⁹	UK	Consultant radiographer	Reflective case study to illustrate the value of the four domains of non-medical consultant practice with respect to improving patient care and service delivery; specifically, examined a local (single site) intervention to reduce the volume of chest radiography referrals for NG tube position confirmation by replacing litmus paper with pH paper on wards and introducing radio-opaque NG tubes as standard across hospital. Costs of intervention determined relative to standard practice	Reduction in service costs (efficient)	Low (29.8%)
		Leadership
		Service change
Ludwig and Ferrara, 2008⁴⁰	USA	RA role	A retrospective audit of clinical activity of RAs in training to associate a monetary value to their activity as an impact estimate for private practices mentoring advanced practice radiographers (RAs). Data included all procedures undertaken by an RA that could potentially be reimbursed by Medicare/Medicaid insurance	Reduction in service costs (efficient)	Low (27.4%)
McIlroy et al, 2008³⁶	UK	Radiographer-/nurse-led treatment review clinic	A single-site prospective survey to determine the effectiveness of non-medical review during adjuvant radiotherapy for breast cancer	Patient satisfaction (acceptable)	Moderate (35.7%)
Hardy et al, 2013³³	UK	Radiographer-led immediate reporting service for patients with musculoskeletal trauma	Pragmatic multicentre randomized controlled trial to determine if a radiographer-led immediate reporting service for patients with emergency musculoskeletal trauma is a cost-effective service improvement initiative. Individual variations in health outcomes between arms were calculated using EuroQol EQ-5D^™ (EuroQol, Rotterdam, Netherlands) survey tool	Reduction in patient morbidity (effective; safe) Reduction in service costs (efficient) Reduction in time to treatment (accessible)	High (71.5%)
Hardy et al, 2013³⁴	UK	Radiographer-led immediate reporting service for patients with musculoskeletal trauma	Pragmatic multicentre randomized controlled trial to determine if a radiographer-led immediate reporting service for patients with emergency musculoskeletal trauma reduces emergency department image interpretation errors and positively impacts on patient referral and treatment pathways	Reduction in patient morbidity (effective; safe) Reduction in time to treatment (accessible)	High (71.5%)
Rozanec et al, 2014³⁷	Canada	CSRT clinical review service	A prospective patient survey to determine patient satisfaction with a CSRT-led communication, review and support service for palliative patients at a single regional cancer centre	Patient satisfaction (acceptable)	Low (22.7%)
Lockwood, 2016³⁵	UK	Radiographer CT head reporting	A retrospective analysis of audit data to determine the cost, risk and feasibility of introducing a skills mix approach to CT head reporting in clinical practice	Reduction in service costs (efficient)	Moderate (52.4%)

CSRT, clinical specialist radiation therapist; NG, nasogastric; RA, radiologist assistant.