Developing an Original Evidence-Based Framework for Radiographer Scope of Practice Expansion in Nigerian Secondary Healthcare: A National Delphi Study

Radiographer scope of practice in Nigeria remains narrowly defined despite evidence from comparable low-resource health systems that expanded radiographer roles, including reporting, image-guided procedures, and advanced sonography, can substantially address diagnostic service gaps without compromising quality or safety. No evidence-based framework exists to guide scope of practice expansion decisions in the Nigerian secondary healthcare context. This study develops an original evidence-based framework for radiographer scope of practice expansion at Nigerian secondary healthcare level. A three-phase design is applied: a systematic mixed-methods review synthesising evidence on radiographer role expansion outcomes from comparable healthcare systems in South Africa, India, and United Kingdom; a national Delphi consensus study engaging 80 expert radiographers, radiologists, health policymakers, NRBN officials, and patient advocates across five rounds to establish consensus on role expansion criteria, training requirements, and governance standards; and a stakeholder co-design process producing the framework document. The original Nigerian Radiographer Scope of Practice Expansion Framework specifies competency thresholds, training pathway standards, institutional governance requirements, and regulatory amendment pathways for five priority expanded roles: chest radiograph reporting, antenatal ultrasound, FAST ultrasound, CT colonography, and ultrasound-guided aspiration procedures. Available scope of practice literature from Nigerian radiography identifies regulatory conservatism and medical profession resistance as the primary structural barriers to role expansion, yet no evidence-based framework has been developed to address these specifically. The Scope of Practice Decision-Making Framework by Nancarrow and the Systems Thinking Framework by Swanwick provide the theoretical reference. Keywords: radiographer scope of practice, role expansion, secondary healthcare, Nigeria, Delphi study.