A health watchdog has raised concerns over how some diagnostic services are run after finding that tens of thousands of patients were caught up in backlogs.
Backlogs in radiology services meant some test results at one trust were not assessed for eight months, the Care Quality Commission (CQC) found.
The CQC launched a national review into radiology services after it found a significant backlog at another trust last year.
The watchdog said that patients had come to "significant harm" at Queen Alexandra Hospital in Portsmouth where junior doctors were left to interpret chest x-rays, including those for suspected cancer.
It found that more than 20,000 x-rays had not been reviewed by a radiologist or an appropriately trained clinician at the hospital.
Problems had also been identified at Worcester Royal Hospital and Kettering General Hospital prior to the CQC review.
The national review found that there is significant variation in the timescales for reporting on radiology examinations across NHS trusts.
Trusts also have a wide range of arrangements to deal with backlogs of images which have not been analysed, CQC found.
It raised concerns that this could mean a delay to patients' x-ray results being shared with the doctor responsible for their care, or x-rays being examined by clinicians without specialist training in this area.
The watchdog called for nationally agreed standards for turn around times for radiology reporting and improved guidance for trusts to monitor their performance.
During its review, CQC requested data from all acute trusts in England about the timeliness and governance of their radiology reporting.
Timescales set for reporting radiological examinations referred from emergency departments vary widely - from an hour at one trust, to two working days at another.
For outpatients the timescales varied from five to 21 days.
It found that four trusts had significant backlogs, but have all since cleared or significantly reduced their backlogs since they were discovered last year.
- Chelsea and Westminster Hospital NHS Foundation Trust had a backlog of just over 15,000 unreported images at one site, and just over 6,800 unreported images at the other site.
- East Kent Hospitals University NHS Foundation Trust had a backlog of just under 8,300.
- King's College Hospital NHS Foundation Trust had a backlog of 33,400 unreported images - the oldest images had been waiting to be reported for eight months.
- Lewisham Greenwich NHS Trust's Queen Elizabeth site had a backlog of 8,700 examinations.
The watchdog said that a shortage in radiologists is a contributing factor to backlogs.
Professor Ted Baker, CQC's chief inspector of hospitals, said: "While our review found some examples of good practice it also revealed a major disparity in timescales for interpreting and reporting on examinations, meaning that some patients are waiting far longer than others for their results.
"We are calling for agreed national standards to ensure consistent, timely reporting of radiological examinations. This will allow trusts to monitor and benchmark their own performance - and ensure that, for example, patients are not put at risk by delays in their x-ray results being reported to the clinician responsible for their care."
Plain film x-rays make up the majority of activity carried out in radiology departments, but they also conduct more complex types, such as CT and MRI scans.
Commenting on the review, Dr Nicola Strickland, president of the Royal College of Radiologists, said: "The premise of national standards for the turnaround of imaging reports is laudable - patients deserve a uniformly safe, high quality standardised service across the country, and hospitals need to be able to monitor and benchmark performance.
"Whether high quality national standards can be maintained in practice is another question. Creating standards that balance the realities of struggling imaging teams with the best turnaround for patients will not be easy.
"The underlying problem remains - without more radiologists to provide imaging expertise in our hospitals, backlogs will continue and patients will suffer."
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