The technological advancements of Artificial Intelligence (AI) in medical imaging and oncology, have put radiography (diagnostic and therapeutic) at the forefront of AI development and applications in healthcare. An AI roadmap published by Unity Insights and Health Education England (HEE) in 2022, found that 240 AI technologies were being deployed in the NHS; of these 240 technologies, 34% were being deployed in diagnostics, of which 49% were being deployed as imaging solutions. This roadmap also found radiographers and radiologists occupy two of the top 5 workgroups to directly use AI out of 155 healthcare workforce groups.
AI isn’t solely being used for image interpretation and diagnosis; it is deployed in imaging and radiotherapy departments, affecting all aspects of radiographers’ roles and professional identities. AI is being used to enhance radiographer workflows, optimise image acquisition techniques, improve image storage, image processing, treatment planning and diagnostics. This is impacting the radiography profession in many ways, including the competencies and knowledge required by radiographers who use AI. Many radiographers are embracing the use of AI but Rainey et al (2021) have noted that some, particularly radiographers who identify as female, appear less confident. There is also increased pressure on radiology departments to engage in AI research, designed to develop and validate AI algorithms, as the hospitals are the gatekeepers of large datasets, that hold the potential to create unique solutions to healthcare problems and improve workflows and patient outcomes.
Technology aside, what about trustworthiness and putting the patients at the heart of this innovation? AI governance frameworks provide guidelines to ensure AI deployed in healthcare is both responsible and ethical. Guidelines that apply to the deployment and use of AI clinically, hold local healthcare providers responsible in many aspects of AI governance; but as highlighted by Walsh (2023) governance can be complex and will also involve practitioners.
Radiographers as leaders in the AI ecosystem
In the UK, diagnostic radiographers and therapeutic radiographers are autonomous health professionals. Diagnostic radiographers employ various imaging techniques and equipment to produce images of an injury or disease. Diagnostic radiographers will take the images and often report on them so that the correct treatment can be given. The role of the therapeutic radiographer involves managing the treatment pathway, providing the technical expertise and support while delivering accurate radiotherapy treatment. Both “Diagnostic Radiographer” and “Therapeutic Radiographer” are protected titles, and the Health and Care Professions Council maintains a list of the 43,000 registered persons holding these titles across the UK.
The duality of the radiographers’ role, with a robust technical skill-set and strong patient-centred care ethos, could make radiographers the ideal candidates for AI leadership and governance roles both locally and nationally within healthcare, as a professional group who bridge innovation and have the communication skills to link technology and clinical practice. One could argue that the need to develop AI leaders within radiographers is vital to sustain the high-quality clinical services offered to patients. However, radiographers need support to build their confidence using AI, increasing their knowledge of AI models and applications, and giving them a clear career pathway into AI leadership.
Leadership is required to guide service changes and challenges, allowing for successful healthcare development. In 2020, Professor Sir Mike Richards published a report reviewing diagnostic services for NHS England. Within this report, it is recommended that clinical and managerial leadership should be put in place for all diagnostic disciplines at a national, regional, and local network level to support implementation and drive change. Many radiographers fulfil formal leadership roles at both local and national levels in clinical practice, education, research, and policy making. These roles include radiographers working in advanced practice, modality leads (CT, MRI, therapy for example), departmental managers and those leading and representing the allied health professionals (AHPs) as a combined workforce. Their responsibilities often include ensuring service quality and improvement, alongside workforce development. The Developing allied health professional leaders – an interactive guide for clinicians and trust boards (2019) offers a roadmap for radiography leaders ensuring they possess the behaviours required for strong healthcare leadership.
However, AI in healthcare remains an emerging area of service development, that requires robust management and inspiring leadership to thrive. Consequently, radiographer leadership skills need to be further tailored to the world of AI, enhanced by proportionate and relevant AI knowledge, enabling them to lead in a digital environment and support AI implementation. Radiographers’ patient care skills and experience will ensure patient safety and care is at the forefront of AI deployment, alongside technological innovation within healthcare.
What next?
It is imperative that radiographers have the support and resources readily available to them, to grow their confidence as leaders, increase their AI knowledge and harness their valuable and unique skill set to allow them to guide, influence and maintain the safe and ethical deployment of AI in healthcare. NHS England Workforce, Training and Education (formerly HEE) and the NHS digital academy have released policies and educational resources to develop healthcare workers’ confidence in AI, and consider their educational needs to adopt AI into clinical practice via the NHS AI lab and the NHS Digital Academy.
Unfortunately, due to workforce shortages and clinical pressures, radiographers have little time to participate in self-guided continuous professional development (CPD) in their own time. What radiographers need is a clear career pathway into AI leadership, that is both nationally recognised, and can be supported by radiology management, giving them the time and opportunity to develop themselves. Leadership support and AI education needs to be specific to radiographers.
Research is currently underway, exploring radiographer opinions on the required resources and support to become strong AI leaders. Locally, there is potential to be responsible for the safe implementation of AI in imaging departments, keeping AI records and quality assurance checks and be responsible for dissemination of their AI knowledge to fellow radiography and other clinical colleagues. At trust wide level, they could aid the deployment of AI within other specialities, help procure safe AI and help influence local AI governance policies. Nationally radiographers are well suited to help build national AI safety and governance frameworks and influence the evaluation of AI tools when procuring AI for the NHS and other services.
It is essential the resources required to develop digital radiographers becomes readily available. The era of AI is upon us, and we need radiographers leading in this area to ensure AI deployed in healthcare remains safe, efficient, clinically relevant but perhaps most importantly patient centred.
Authors
Gemma Walsh MSc
Gemma is a registered diagnostic radiographer within the UK, specialising in magnetic resonance imaging (MRI). Having completed her MSc at City, University of London, Gemma is an aspiring researcher and prospective PhD student. Gemma’s clinical experience and previous role as an NHS research radiographer, has made her passionate about radiographer workforce development, including the development of ‘Digital Radiographers’ as AI leaders.
Gemma is currently a research assistant at City, University of London working on a project investigating radiographer perspectives of their changing roles, responsibilities and professional identity in the era of AI.
Gemma is a EuSoMII Young Club Committee member 2023-2024.
Twitter: @GemWalsh
Dr. Christina Malamateniou
Christina is the Director of the postgraduate programme of radiography at City, University of London and a Visiting Professor of Radiography at HESAV University in Switzerland (2022-2023). She is a widely published researcher in medical imaging 9h-index 19, 63 publications, 6 standards, 6 scientific reports), with more than £3.25 million in research grants in her name as PI and Co-I and an enthusiastic educator.
Her area of research revolves around AI adoption and education in radiography, person centred care and supporting the workforce in its recovery after the Covid19 pandemic.
Christina is also the chair of the AI advisory group of the SCoR and the new Chair of research for the EFRS from April 2023-2025. She works as NIHR imaging science working group member and is an elected member of the EuSomII Board.
She is an associate editor with JMIRS and a regular reviewer for Radiography.
Christina believes in leading from the heart and in the power (and fun) of collaborative work.
Twitter: @CMalamateniou
Dr. Janice St. John-Matthews
Janice works as the Head of Allied Health Professions at the Office of the Chief AHP Officer (CAHPO) at NHS England and is a registered Diagnostic Radiographer. In England AHPs are the third largest clinical workforce after doctors and nurses with over 200,000 registrants. Janice’s role includes workstreams in AHP leadership, social justice, and equality, diversity, inclusion and belonging (EDIB). Prior to this Janice was the Clinical Fellow to the Chief AHP Officer in England, Professor Suzanne Rastrick OBE. Janice is a Fellow of the Institute of Leadership and an Associate Editor at the BMJ Leader.
In 2022, Janice was awarded a Doctorate in Professional Studies from Swansea University Medical School. Her research looked at the use of a digital tool, crowdsourcing, to capture patient, and public voice in pre-registration healthcare curriculum design processes.
Twitter: @jstjohnmatthews
Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none