The Radiographer Image Interpretation Training Gap: A Systematic Review of Diagnostic Competency with Global Comparison and Implications for Workforce Extension in Nigeria

Introduction: Nigeria has fewer than 700 radiologists for more than 200 million people. The shortage is about 30% and may reach 40% by 2028 (Royal College of Radiologists, 2023). X-ray reports are significantly delayed. Nigeria has about 5,000 radiographers who take most X-rays, but they do not routinely report them. Radiographers are trained, in some countries to read and report images. We wanted to learn from global experience and see what could work in Nigeria. Methods: We followed PRISMA 2020, SWiM and registered our protocol PROSPERO CRD420261456144. Five databases (PubMed, Scopus, Embase, Web of Science, CINAHL) plus reference lists and citation tracking were searched. We found 1,207 records and included 23 studies after screening of the studies. We used TIDieR to describe training. Quality of included studies was checked using RoB2, ROBINS-I and QUADAS-2. Narrative synthesis (SWiM) was used to synthesize result because the tests were too different for meta-analysis. We used GRADE to rate certainty.

Results: Baseline skill without training was moderate. We found that 19 training studies showed improvement in the same direction and 15 were statistically significant. Risk of bias was 7 Low, 10 Moderate/Some concerns, 4 Serious and 2 High.

Conclusion: Baseline competency is moderate but short low-cost training improves it significantly and ongoing audit helps to keep skills. The Zambian WhatsApp model with data allowances appears most suitable for Nigerian district hospitals.

Implications for practice: We propose a phased model for Nigeria which include Phase 1, Phase 2, and Phase 3 which integrate Redot, Preliminary reporting and formal reporting practices. Regulation and budget for data and supervision are needed with regular audit for improvement.

Keywords: radiographer reporting; image interpretation; preliminary image evaluation; workforce extension; Nigeria; systematic review.