Status In progress
Technology type Diagnostic
Decision Selected
Reason for decision Anticipate the topic will be of importance to patients, carers, professionals, commissioners and the health of the public to ensure clinical benefit is realised, inequalities in use addressed, and help them make the best use of NHS resources
Further information This topic area has been identified by the Royal College of Radiologists as a clinical area of importance. This has been informed by extensive engagement with senior clinical experts across the NHS. For people presenting to the emergency department with a suspected fracture, an x-ray is undertaken followed by, if available, an interpretation of the image by a reporting radiographer or radiologist. Radiologists may not have time to formally report on x-rays for suspected fractures in the ED before a diagnosis is made, leaving diagnoses to be made based only on interpretation by a less-specialised/skilled ED clinician. This contributes to an issue of missed fractures, whereby patients are given an incorrect diagnosis of having no fracture present or missing multiple fractures. The downstream effects of missed fractures include reductions to patient HRQoL, risk of life-changing or life-ending events, and the NHS paying out for damages, litigation costs, and additional treatment costs due to complications. The emergency care system is under significant pressure, especially A&E. Vacancy rates are 12.5% for radiologists and 15% for radiographers. Yet, the number of patients referred for diagnostic tests has risen by over 25% over the last five years. It is reported that in 2018/19, there were 1,147,822 Emergency Department (ED) attendances where the primary diagnosis was classified as dislocation/fracture/joint injury/ amputation, accounting for 5.1% of all ED attendances. It is possible that the occurrence of missed fractures could be reduced by improving the human element of radiology departments, but workforce pressures limit this. Even if the human element were to be improved, some fractures may still be missed by even the most skilled and experienced radiologists. A potential solution to these issues is AI technology which can detect fractures and support clinician interpretation of x-rays and diagnosis in the ED. The clinical decision support technology is not intended to be used in isolation to make a diagnosis, but instead to support interpretation by a trained professional. The technology could increase the accuracy of x-ray diagnoses in the emergency department, leading to better outcomes for patients by reducing unnecessary treatment and ensuring those who require treatment receive this in a timely manner. AI technology could also provide efficiency gains by freeing up radiologist time for dealing with more complex issues where they can add most value, and reducing the number of patient recalls.
Process EVA

Provisional Schedule

Committee meeting: 1 18 September 2024
Diagnostics consultation 17 October 2024 - 31 October 2024
Expected publication 17 December 2024

Email enquiries

External Assessment Group Peninsula Technology Assessment Group (PenTAG), University of Exeter


Key events during the development of the guidance:

Date Update
22 April 2024 Launch
22 April 2024 In progress. Updated from DG to EVA
07 February 2024 Awaiting development. Status change linked to Topic Selection Decision being set to Selected

For further information on our processes and methods, please see our early value assessment interim statement.