Guidance

Guidance on reporting breast images from home

Published 5 October 2020

This guidance is to support breast screening providers and NHS England and NHS Improvement (NHSEI) when considering implementation of home reporting within the NHS Breast Screening Programme (NHS BSP). It highlights the minimum criteria that need to be in place before implementation.

Reporting images from home may be a helpful method of increasing image reporting capacity in exceptional circumstances, when services lack manpower physically located at the screening service. This could be due to a variety of reasons. The screening programme is currently facing a shortage of radiologists and radiographers. The ability of individuals to report images from home potentially presents one solution. Home reporting also offers an alternative to outsourced teleradiology for backlog reporting. It could be a preferred option for staff who are:

• nearing retirement
• wanting to return to practice following retirement
• involved with caring responsibilities
• wanting additional out-of-hours reporting in a more convenient location
• unable to work in a hospital setting

Services must be aware that there are real challenges to successfully implementing home reporting, including:

• IT connections between remote sites slowing down the transfer of images – this may be of greater concern if tomosynthesis images need to be read on a regular basis
• a lack of functionality with image manipulation
• the lack of experienced radiologists physically in a service may impact detrimentally on training and mentoring opportunities for more junior staff
• the expense of breast imaging reporting monitors and workstations
• the extra resources required from medical physics to test monitors and IT services to set up the system
• an increased risk of information governance issues

1. Requirements for reporting breast images from home

Screening providers are responsible for ensuring the safety and quality of their service delivery which should be in line with the NHS BSP standards. Screening providers will be aware that there are specific standards and requirements for breast screening which are more stringent than for symptomatic breast work. They will need to work with their trust information governance team and local physics service to make sure these requirements are met.

2. IT requirements

Confirmation of secure and reliable virtual private network (VPN) IT connections for both picture archiving and communication system (PACS) and the national breast screening system (NBSS) is required to ensure that data is kept secure in transit. Full NBSS and PACS desktop integration is also necessary. The bandwidth must be adequate to ensure there is no lag in desktop integration. This is organised by and the responsibility of the local IT department within the trust or organisation.

3. Information governance and approvals

There must be written approval by the trust for this way of working. This must be supported by a risk assessment which has been formally signed off by the trust. In addition:

• there should be consideration of insurance cover for equipment and staff working from home
• home reporting standard operating procedures (SOPs) must be in place for medical physics and for remote readers
• the image reading process should be paperless and appropriate information governance should be in place to audit and risk assess the process prior to implementation – this should be approved by the screening quality assurance service (SQAS)
• SQAS must have confirmation that the right results pathway has been updated to include home reporting and this should be audited annually by the service
• hanging protocols must be set up so that the whole breast is displayed at full acquisition resolution
• robust systems of communication with the screening office should be established to ensure any issues with digital images, any anomalies noted in the audit trail or patient details, and any other issues normally directly dealt with by the office continue to be handled in a timely fashion

4. Workforce

Image reporting must be undertaken as safely as possible. Image readers must meet the skills, competency and continuing professional development (CPD) requirements of the NHS BSP as specified in the quality assurance radiology standards guidance.

Regular audit of image reading numbers should monitor that all readers in a service continue to meet the minimum 5,000 reads per annum. Home reading should not compromise this.

Services should ensure there are always senior staff (radiologists, consultant practitioners and/or breast clinicians) on site to support more junior staff or trainees. Home working should not compromise shared learning which is part of normal service delivery.

5. Equipment

Diagnostic images need to be high quality and conditions in the home need to be optimal to maximise detection of breast abnormalities. The requirements are that:

• reporting monitors must be at least 5 megapixel and the make and model of reporting device must be in use in the NHS BSP
• reporting monitors need to be used with a dedicated workstation with suitable graphics cards and the workstation must have the full reporting software installed
• quality control checks on the monitors must be carried out by the user in accordance with current NHS BSP guidelines – the local medical physics team will provide a written QA test protocol and may perform routine audits to review the quality assurance (QA) data
• image display devices are subject to an initial assessment and annual review by medical physics services
• daily monitor checks must be undertaken as per local medical physics ‘home reporting’ SOPs – this must include a daily visual check (or whenever the monitor is used) which should be recorded and reported with other daily or monthly quality control checks
• where home reading is performed, lighting should be ambient to make sure that image display is optimal to aid detection of breast abnormalities (medical physics may perform a survey of the ambient lighting and advise on reporting conditions where necessary, in accordance with QA guidelines on medical physics)
• users should follow the health and safety guidance and display screen equipment (DSE) guidance supplied by the trust – this should include performing an ergonomic assessment of the proposed workspace when initially setting up the workstation (research on ergonomics of digital imaging is available)

To help alleviate the problem of slow image upload, folders may be set up to identify clinics for home reporting.