MRI Service Development: Evolution and Governance of MRI Reporting Radiographers and the Establishment of Novel MRI Care Processes. A Diffusion of Innovations Approach to Understanding Adoption Challenges

Abstract

MRI services within the NHS are challenged, the demand on imaging is increasing year on year, with an increase in requests for MRI examinations of 48.0% between 2012 and 2019 (NHSE, 2025a). Issues with both radiographer and radiologist staffing have been found to affect scan waits and reporting times for all imaging examinations (NHSE, 2025a). Over 4.5 million MRI examinations were completed in 2024 within England alone with MRI having the longest average number of days between ‘date of test’ and ‘date of report issued’ of all the modalities (NHSE, 2025a). This portfolio offered a means of critically evaluating three projects from my recent professional practice as a consultant and reporting radiographer working in MRI. The first two projects relate to the provision of MRI reporting radiographer practice and the surrounding governance. Two surveys were completed, providing previously unknown evidence of the population and scope of practice of MRI reporting radiographers in the UK and associated barriers and facilitators. The second project describes the development of a governance framework to support the implementation of reporting radiographer services. The third project describes an analytical framework for the development of the national Clinical Imaging Board Cauda Equina guidelines and a local pathway for patients presenting with bilateral papilloedema. Both emergency conditions that have an impact on patient outcomes if timely imaging intervention is not provided. The successful adoption of new ideas, practices or technologies in healthcare is rarely straightforward. These projects involve the introduction of new practices that challenge existing norms in MRI service provision and are therefore examined through the lens of Rogers’ Diffusion of Innovation theory. The thesis demonstrates that consideration of innovation and adopter characteristics, the role of the social system (such as radiologists, radiographers and referrers), opinion leaders and change agents, and the acknowledgment of the potential for reinvention will improve adoption and diffusion. This thesis presents a structured three phase model for the translation of innovative MRI service processes into routine clinical practice.