Radiologists' perceptions regarding the establishment of reporting radiographers in Zambia: Implications for radiology workforce development.

INTRODUCTION: Medical imaging is central to diagnosis and patient management. However, rising demand and a shortage of radiologists have led to reporting delays across many healthcare systems. In Zambia, the shortage is particularly severe, with limited radiologist coverage and reliance on non-specialists for image interpretation. Reporting radiographers have been introduced in several countries as a strategy to improve reporting capacity, yet little is known about radiologists' perceptions of this role in Zambia. This study explored radiologists' perceptions regarding the establishment of reporting radiographers in Zambia. METHODS: After ethical approval, an exploratory-descriptive qualitative study was conducted with seven radiologists of the 23 radiologists serving the Zambian population of 21 million. Participants were recruited through purposive and snowball sampling. Data were collected through unstructured, in-depth, face-to-face interviews conducted between August and December 2025. Interviews were audio-recorded, manually transcribed verbatim, and analyzed using inductive thematic analysis guided by Patricia Leavy's five-phase framework. Data collection continued until saturation was achieved. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability strategies. RESULTS: Four themes emerged in this study: perceived traditional roles of radiographers, impact of radiologist shortages, professional role boundaries, training and competency requirements. Radiographers were mainly viewed as responsible for image acquisition, equipment management, and patient care. Participants acknowledged significant reporting delays but expressed concern that introducing reporting radiographers could compromise diagnostic accuracy. Most radiologists opposed role extension due to perceived inadequate training and risks to professional boundaries and accountability. A sizable minority supported limited reporting of plain radiographs, provided structured postgraduate training is implemented. CONCLUSION: Radiologists who participated in this study largely hold cautious or negative perceptions toward establishing reporting radiographers, primarily due to concerns about competence, safety, and role overlap. However, conditional support exists for limited role expansion in plain radiography, provided robust postgraduate training and regulatory frameworks are in place. Addressing workforce shortages will require stakeholder engagement, clear policy direction, and the establishment of postgraduate education and training programmes in image interpretation and clinical reporting for radiographers. PLAIN LANGUAGE SUMMARY: Medical imaging plays an important role in diagnosis, but shortages of radiologists can delay the reporting of scan results. This study interviewed radiologists in Zambia to explore their views on allowing radiographers to take on some image reporting responsibilities. This study found that most radiologists were concerned about training, patient safety, and professional roles, although some supported limited reporting of simple Xrays if appropriate postgraduate training and regulation were in place. This matters because understanding these views can help guide policies, education, and workforce planning to improve access to imaging services while maintaining patient safety.