A mixed-methods service evaluation of point-of-care imaging by non-radiographers in a remote UK island setting: evaluating the acceptability and impact of PIXAR

Introduction: The Isles of Scilly are a remote island cluster off the coast of Cornwall in the United Kingdom. They face persistent challenges in accessing timely diagnostic imaging. With X-ray availability only one day per week, Islanders experience diagnosis delays, unnecessary medical evacuations, and reduced continuity of care.  A new, author-developed PIXAR model (Point-of-Care Imaging for X-ray Access using Remote Operators) was proposed. This decentralised, system-embedded approach empowers trusted, on-island registered professionals, specifically GPs, nurses, and allied health professionals, to perform protocol-driven planar imaging of the limbs, chest, and pelvis. This is conducted under secure remote radiographer oversight and governed by the radiology profession in compliance with IR(ME)R regulations. Our study aimed to evaluate the operational and experiential impact of implementing the PIXAR model using non-radiographic practitioners in a remote setting.

Methods: Prior patient and public involvement work informed the study design. A mixed-methods service evaluation was conducted using an explanatory sequential and exploratory design. Quantitative operational data were triangulated with qualitative findings from semi-structured interviews across six stakeholder groups that were thematically analysed. The study received ethical approval.

Results: Quantitative analysis revealed a median imaging wait time of six days, with extreme outliers of up to 90 days highlighting unacceptable diagnostic delays. Qualitative inquiry reframed these delays not as isolated incidents but as symptoms of structural fragility, driven by geographical isolation and transport constraints. Stakeholders reported that prolonged waits led to significant service inequity and negatively impacted both patient and clinician experiences. This resulted in moral injury, care avoidance, and unnecessary transfers. In response, the PIXAR model emerged as an essential innovation for local imaging, offering a clinically safe, ethically justified, and operationally feasible solution. Stakeholders advocated for empowering non-radiographers to perform planar film imaging under robust governance in line with IR(ME)R regulations, supported by competency-based training, interprofessional collaboration, and enhanced workforce development pathways. Mobile radiography was considered indispensable for island healthcare, particularly for frail or immobile patients who face the greatest barriers to timely diagnosis.

Conclusion: The PIXAR model represents a scalable, ethical, and patient-centred approach to address diagnostic inequities in remote settings. Grounded in existing workforce and regulatory frameworks, it supports NHS strategies for community-based care, digital innovation, and workforce sustainability. 

Keywords: decentralised community diagnostics, diagnostic imaging, health equity, interprofessional workforce development, point-of-care imaging, rural health care.