It's very important to understand what can reasonably be expected from an interpreting radiographer, and what's outside the limits of the job.
Here are the tasks at their simplest:
It seems obvious to expect that you will produce a good image. That's what you do, right?
But one of the course participants in Fiji told me that learning about interpretation, and being the person who was also going to do the interpretation, had made her think much more about how she took the images.
An unexpected but very good side-effect!
'Interpret the findings' also seems pretty obvious. Learn a bit, see all the abnormalities, put it all together. But it's more complex than that, as you will see.
Your interpretation will produce one of three possible results:
'Normal' is a diagnosis that you should be reasonably happy to make.
Your confidence will be based on a good search system, and a knowledge of common normal variations that can cause strange or suspicious appearances, but don't matter.
A normal result is not a failure of diagnosis, it's a very useful result and of course usually good news for the patient.
Just don't forget to look everywhere you should, before signing off.
That's easy to say, but it can be hard to do especially if you are busy! But it's vital - many more mistakes are made by people not seeing abnormalities than by people misinterpreting them.
The next group is where the X-ray is definitely abnormal and there are findings that fit with the clinical story for a common diagnosis in your part of the world.
Here is a list of 9 common diseases or findings, and 2 normals that you will be able to suggest with reasonable confidence using imaging with X-ray:
Normal X-ray
Common normal variants
Airspace disease
Pneumothorax
Pleural effusion
Heart failure
Tuberculosis
Infection in the skeleton
Fractures
Bowel obstruction
Free gas in the abdomen
There will be others - for example you might live in an area where there is a lot of schistosmiasis, so you'll get good at recognising that.
And then there's all the rest.
You have to be able to say, "I don't know". And you must expect to say it many times a day.
Seeing an abnormality - perhaps one that others would miss because they don't have a search system - is a very important service to provide to the patient and the caregiver.
But deciding what the abnormality means will not always be possible no matter how much experience you have, and it's not helpful to the patient if you go outside your area of expertise and make a diagnosis that is wrong.
As a senior radiologist, I still say "I don't know" a lot. And that's because many times the answer just isn't there on an X-ray.
But I'm lucky enough to be interpreting for hospitals that have CT and MRI readily available, so it's easy for me to suggest the next test that is likely to give a better answer.
You may not have that luxury. But never forget that "I don't know" will often be the best answer you can give. And then the caregiver will have to decide what to do next, based on all the other results they have and the services that are available elsewhere in your part of the world.
You can still suggest a diagnosis but if it's something uncommon, or something you have never seen before, or the X-ray findings don't fit with the symptoms of one of the common conditions on the list, then you have to let the carer know that you are not sure.
And always remember that if you say "I don't know", the patient is not worse off - they are just in the same position as they were before you looked at the image.
PS: There is far more in this website than you need to know in order to be an interpreting radiographer as described above. But a deeper background than the absolute minimum is essential. Sometimes (and I have done this) you can look at an abnormality and because you don't know what it is, you may ignore it. Bad idea!
Being aware of a lot of possible abnormalities, even though you are not going to decide what they are, will give you more confidence to say that there is an abnormality present.