Radiologic technologist

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An X-Ray unit in use.

Radiologic Technologists, also known as Diagnostic Radiographers,[1] Medical Radiation Technologists[2] or less frequently as a X-Ray Technicians perform imaging of the human body for diagnosis and/or treatment of pathological or medical conditions. Radiologic technologists work in both public and private healthcare and can be physically located in any setting where appropriate diagnostic equipment is located, most frequently in hospitals. Their practice varies country to country and can even vary between hospitals in the same country.[3]

Radiographers are represented by a variety of organisation worldwide, the International Society of Radiographers and Radiologic Technologists (ISRRT) aims to give direction the profession as a whole through collaboration with national representative bodies.[4]

Role in Healthcare[edit]

A radiographer uses their expertise and knowledge of patient care, physics, anatomy, physiology, pathology and radiology to assess patients, develop optimum radiological techniques and evaluate resulting radiographic images.[5]

This branch of healthcare is extremely varied between countries and as a result Radiographers in one country often have a completely different role to that of Radiographers in another. However, the base responsibilities of the Radiographer are summarised below:

  • Safe, efficient and correct use of diagnostic equipment
  • Enforcement of Radiation Protection
  • Patient Care (There is a duty of care to their patients, colleagues and any lay persons that may be affected/irradiated)
  • Production of diagnostic images
  • Autonomy as a professional
  • Supervise students and assistants
  • Contribute to and participate in Continuing Professional Development (CPD)

Generally Radiographers do not interpret diagnostic media, rather they evaluate media and make a decision about it's diagnostic effectiveness. In order to make this evaluation Radiographers must have a comprehensive but not necessarily exhaustive knowledge of radiographic appearances of pathologies; it is for this reason that Radiographers often do not interpret or diagnose without further training. However, it is now becoming more common that Radiographers have an extended and expanded role. This includes a role in initial radiological diagnosis, diagnosis consultation and what subsequent investigations to conduct. It is not uncommon for Radiographers to now conduct procedures autonomously.[6]

Contrary to what could be inferred, Radiographers conduct and contribute to investigations which are not necessarily radiological in nature i.e sonography and MRI.

Radiographers often have opportunities to enter military service due to their role in Healthcare. As with most other occupations in the medical field many radiographers have rotating shifts that include night duties.

Career Pathways[edit]

Radiography is a deeply diverse profession with many different modalities and specialities. It is not uncommon for Radiographers to be specialised in more than one modality and even can have expertise of interventional procedures themselves; however this depends on the country in which they operate. As a result of this the typical career pathway for a radiographer is hard to summarise. It is common for Radiographers upon qualifying to focus solely on Plain Film Radiography before specialising in any one chosen modality. After a number of years in the profession, non-imaging based roles often become open and radiographers may then move into these positions. [3]

Imaging Modalities[edit]

Generally, imaging modalities can be either diagnostic or therapeutic, therapeutic meaning that the modality can be used to conduct an intervention or treatment. Modalities (or specialities) include but are not limited to:

A US Navy Radiographer simulates the computed tomography head scanner.
Name Technology Diagnostic? Therapeutic? Description
Angiography/Venography Image Intensification Radiography Green tick.svg Green tick.svg Imaging of the cardiovascular system, usually involves some sort of invasive procedure such as an angioplasty.
Computed Tomography (CT) CAT, CT Green tick.svg Green tick.svg Provides cross-sectional views (slices) of the body; can also reconstruct additional images from those taken to provide more information in either 2D or pseudo-3D.
Diagnostic Radiography Plain Film Radiography (PFD) Green tick.svg Red x.svg Utilizes ionizing radiation in the examination of internal organs, bones, cavities and foreign objects.
Echocardiography 2D, 3D and Doppler Sonography Green tick.svg Red x.svg Utilises 2D, 3D and Doppler Sonography to image the heart.
Fluoroscopy CINE Radiography Green tick.svg Green tick.svg Utilizes ionizing radiation and direct imaging (constant radiation) used to dynamically visualize the digestive system, monitor the administration of contrast agents to highlight vessels and organs, or to help position devices within the body (such as pacemakers, guidewires, stents, etc.).
Mammography Plain Film Radiography Green tick.svg Red x.svg Uses low dose ionizing radiation systems to produce images for the diagnosis of breast disease.
Neuroradiography Magnetic Resonance Imaging (MRI) Green tick.svg Green tick.svg Uses magnetic imaging to image the complete human anatomy. Frequently called the 'gold standard' in medical imaging.[7]
Nuclear Medicine (NM) or Radionuclide Imaging (RNI) SPECT with Radioactive Tracers Green tick.svg Green tick.svg Uses radioactive tracers which can be administered to examine how the body and organs function, for example the kidneys or heart. Certain radioisotopes can also be administered to treat certain cancers, such as thyroid cancer.
Sonography (Ultrasonography) 2D, 3D and Doppler Sonography Green tick.svg Green tick.svg Images pathology using ultrasound waves.
Surgical or Theatre Radiography Image Intensification, varies Green tick.svg Green tick.svg Images anatomy and related pathology during surgical procedures.

Non-Imaging Modalities[edit]

Non-imaging modalities vary however they commonly include:

  • Academia - Education role.
  • Clinical Management - Clinical managerial role which can be varied; may include managing audits, rotas, department budgets, etc.
  • Clinical Research - Research role.
  • Medical Physics - Multidisciplinary role ensuring the correct calibration of and most efficient use of diagnostic equipment.
  • PACS Management - Managerial role concerned with maintaining and supervising appropriate and correct use of the RIS and PACS systems.
  • Radiation Protection - A managerial role concerned with monitoring the level of ionizing radiation absorbed by anyone who comes into contact with ionizing radiation at their site.
  • Reporting Radiography - A clinical role involved with interpretation of radiographs and various other radiological media for diagnosis.

Education and Role Variation[edit]

Education varies worldwide due to legal limitations on scope of practice.

Republic of Ireland[edit]

Radiographers in the Republic of Ireland (ROI) must be registered with CORU before they can practice in the Republic of Ireland. Student radiographers training in the ROI will typically study for 4 years on an approved bachelor degree program; currently degree programs only exist at University College Dublin.[8][9] Applicants must have either an approved qualification, a schedule 3 qualification, an appropriate letter of recommendation/accreditation or another qualification which is deemed 'suitably relevant' by registration board in order to successfully fulfil the vocational education requirements to become a Radiographer in the ROI. Applications for registration with qualifications outside of this are considered on an individual basis; typically this includes most international applicants.[10]

The professional body representing Radiographers in the ROI is the Irish Institute of Radiography and Radiation Therapy (IIRRT).[11]

Saudi Arabia[edit]

Ray Technicians in Saudi Arabia must successfully undertake a degree level program at a recognised higher level education institution in Nursing before undertaking further study in radiographic imaging at university for typically 2 to 3 years; this must include a year's experience in a hospital. Upon completion, graduates are qualified X-Ray Technicians and can commence clinical practice. [12]

United Kingdom[edit]

In the United Kingdom, there is ambiguity in the use of the term Radiographer as this does not differentiate between Therapeutic Radiographers (also known as Radiotherapists) and Diagnostic Radiographers. As a result, all of these titles are protected titles within the United Kingdom and can not be used by any persons who has not undertaken formal study and registered with the Health and Care Professions Council (HCPC). In order to practice Radiography in the United Kingdom candidates must now successfully obtain a pass in a degree level program from an accredited institution. Degrees are offered by universities across the UK and last for at least 3 years in England, Wales and Northern Ireland; and 4 years in Scotland.[13][14]

Student Diagnostic Radiographers spend a significant amount of time working at various hospitals affiliated with their university during their studies to meet the requirement for registration with the HCPC. They specialise in the acquisition of radiographs (X-rays) and work with GP patients, Outpatients, A&E referrals and inpatients. They conduct mobile X-rays on wards and in other departments where patients are too critical to be moved and work as part of the operating team in mainly orthopaedic and urology cases, offering surgeons live radiographic imaging. Once qualified, diagnostic radiographers are able to acquire X-rays without supervision and work as part of the imaging team. They will have basic head examination qualifications in Computed Tomography (CT) and even basic experience of Magnetic Resonance Imaging (MRI), Ultrasound and Nuclear Medicine.

Diagnostic Radiographers can specialise in-house or through a university course as a postgraduate in CT, MRI, Ultrasound or Nuclear Medicine with opportunities to gain an MSc or PhD in their field. Diagnostic Radiographers in the UK are also taking on roles that were typically only undertaken by the radiologist (a medical doctor who specialised in interpreting X-rays) in the past. This extended practice includes various interventional procedures not excluding Barium Enemas, Barium Meals and various other invasive/non-invasive procedures.

The professional body and workers union for radiographers in the United Kingdom is the Society and College of Radiographers (SCoR). The union has been heavily involved in extending practice of radiographers in the United Kingdom and has helped expand the role of the radiographer greatly.

SCoR is the professional body and union for UK radiographers

Expanded Practice[edit]

Radiographers are now able to write reports and diagnose pathologies and/or conditions seen on differing diagnostic media after completing a HCPC and SCOR accredited university course; completing a course in this modality allows the radiographer to become a reporting radiographer in their chosen specialty.[15]

Radiographers, often Therapeutic Radiographers, are able to become supplementary prescribers which allows them the capacity to prescribe medications in line with an agreed Patient Group Direction (PGD) or Patient Specific Direction (PSD). An accredited university course must be undertaken before this role extension is annotated onto a HCPC registrant's record.[16]

United States[edit]

In the United States, these professionals are known as Radiologic Technologists. Formal training programs in radiography range in length that leads to a certificate, an associate or a bachelor's degree. The American Registry of Radiologic Technologists (ARRT), the primary credentialing organization for Radiologic Technologists in the United States, requires that candidates for ARRT Certification Exams must have an Associate's degree at minimum as of January, 2015, effectively ending non-degree granting diploma programs.[17] Accreditation is primarily through The Joint Review Committee on Education in Radiologic Technology (JRCERT)- the only agency recognized by the United States Department of Education and the Council for Higher Education Accreditation to grant accreditation to both traditional and online programs in Radiography, Radiation Therapy, Magnetic Resonance Imaging, and Medical Dosimetry. An online page where prospective students can check the accreditation of programs is maintained by JRCERT.[18]

Radiologic Technology students receive training in human anatomy and physiology, physics, mathematics, radiopharmacology, pathology, biology, research, nursing, medical imaging, diagnosis, radiologic instrumentation, emergency radiology, medical imaging techniques, computer programming, patient care, medical ethics and general chemistry. Schooling also includes significant amounts of documented practicum supervised by Registered Technologists in various clinical settings where the classroom theory is translated to practical knowledge and real world experience. The change from Film to Digital imaging has changed training as film quality assurance and quality control is largely obsolete. The role of computer workstations to produce synthetic images for Radiologists has steadily increased the need for computer skills as has electronic medical record software.

After primary training and licensure, continuing education is required to maintain licensure and certification with the ARRT, who sets the accepted national guidelines. The ARRT requires 24 Units of accredited continuing education every two years and the laws and the regulations of most states accept this standard. Continuing formal education or the passing of an advanced practice speciality exam may also be accepted for continuing education credit. The American Society of Radiologic Technologists (ASRT),[19] a professional association for people in Medical Imaging and Therapy, offers members and others continuing education materials in various media that meet the requirements of the ARRT for continuing education.[20] Additional requirements are set forth for technologists who specialize in mammography by the US FDA.[21]

Expanded Practice[edit]

A new and evolving career for Radiologic Technologists is that of the Registered Radiologist Assistant (R.R.A.) [22] who is an experienced Technologist- not a Physician Assistant- who has completed additional education, training and has passed exams to function as radiologist extenders.[23][24] A list of the 9 currently accredited R.R.A. programs is maintained by the ARRT and can be accessed online.[25] Candidates for the R.R.A. certification must possess a Bachelor of Science Degree at minimum.

Registered Radiologist Assistant (R.R.A.), a new advanced practice Radiographer career path in the United States for experienced Technologists. R.R.A.s do not interpret films/images/studies in the manner of the Reporting Radiographer.[26] The role has been accepted by the American College of Radiology (ACR).[27]

Risks[edit]

  • Epidemiological studies indicate that radiologic technologists employed before 1950 are at increased risk of leukemia and skin cancer, most likely due to the lack of use of radiation monitoring and shielding.[28]
  • Ionizing radiation, used in a variety of imaging procedures, can damage cells. Lead shields are used on the patient and by the radiologic technologist to reduce exposure by shielding areas that do not need to be imaged from the radiation source. While lead is highly toxic, the shields used in medical imaging are coated to prevent lead exposure and are regularly tested for integrity.[29]
  • Theoretically, the strong static magnetic fields of MRI scanners can cause physiological changes. After a human neural cell culture was exposed to a static magnetic field for 15 minutes, changes in cell morphology occurred along with some modifications in the physiological functions of those cells. However, these effects have not yet been independently replicated or confirmed, and this particular study was performed in vitro.[32]
  • Ultrasound imaging can deform cells in the imaging field, if those cells are in a fluid. However, this effect is not sufficient to damage the cells.[33]

References[edit]

  1. ^ AIR. AIR. Retrieved on 2012-01-27.
  2. ^ CAMRT > Home Page. Camrt.ca. Retrieved on 2012-01-27.
  3. ^ a b [1] A global overview of the changing roles of radiographers, Cynthia Cowling, International Society of Radiographers and Radiological Technologists (ISRRT), 143 Bryn Pinwydden, Pentwyn, Cardiff, Wales CF23 7DG, UK, Retrieved on 28/10/2014.
  4. ^ [2]ISRRT: Statutes word document. Retrieved on 28/10/2014.
  5. ^ [3]Diagnostic Radiographer: Job description, prospects.ac.uk. Retrieved on 29/10/2014.
  6. ^ [4]Royal College of Radiologists: Radiographer performed Hysterosalpingogram. Retrieved on 29/10/2014.
  7. ^ [5]
  8. ^ [6]UCD: Graduate studies in diagnostic imaging. Retrieved on 28/10/2014.
  9. ^ [7]NUIG: Your path to Radiography. Retrieved on 28/10/2014.
  10. ^ [8]CORU, Radiographer Guidance Notes. Retrieved on 28/10/2014.
  11. ^ [9]IIRRT: About us. Retrieved on 28/10/2014.
  12. ^ [10]CAT - Career Advisory Tool
  13. ^ [11] SCoR: Education approval and accreditation. Retrieved on 2014-10-25.
  14. ^ [12] SCoR: A Career in Radiography. Retrieved on 2014-10-25.
  15. ^ [13] SCoR: Reporting. Retrieved on 2014-10-25.
  16. ^ [14] HCPC: Medicine and Prescribing. Retrieved on 2014-10-25.
  17. ^ https://www.arrt.org/Education
  18. ^ https://portal.jrcertaccreditation.org/summary/accreditedprogramsearch.aspx
  19. ^ http://www.asrt.org/main/about-asrt
  20. ^ http://www.asrt.org/main/continuing-education/earn-ce
  21. ^ https://www.xraycert.com/rad-tech-talk/arrt-ce-credits
  22. ^ http://www.acr.org/quality-safety/resources/radiologist-assistant
  23. ^ http://www.asrt.org/main/careers/radiologist-assistant
  24. ^ https://www.arrt.org/FAQ/RRA
  25. ^ https://www.arrt.org/RRA/Educational-Programs
  26. ^ http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Radiologist%20Assistant/DevelopmentOfRA.pdf
  27. ^ http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Radiologist%20Assistant/JointPolicyStatement.pdf
  28. ^ Yoshinaga, S.; Mabuchi, K.; Sigurdson, A. J.; Doody, M. M.; Ron, E. (2004). "Cancer Risks among Radiologists and Radiologic Technologists". Radiology 233 (2): 313–21. doi:10.1148/radiol.2332031119. PMID 15375227. 
  29. ^ Lead Garments (Aprons, Gloves, etc.). Hps.org (2011-08-27). Retrieved on 2012-01-27.
  30. ^ "Metabisulphite-induced occupational asthma in a radiographer". doi:10.1183/09031936.05.00024304. 
  31. ^ Batch, James; Nowlan, Patrick (2003). "Legal Issues in Radiography: Darkroom Disease". Legal Issues in Business 5. 
  32. ^ Formica, Domenico; Silvestri, Sergio (2004). "Biological effects of exposure to magnetic resonance imaging: an overview". BioMedical Engineering OnLine 3: 11. doi:10.1186/1475-925X-3-11. PMC 419710. PMID 15104797. 
  33. ^ Zinin, Pavel; Allen, John (2009). "Deformation of biological cells in the acoustic field of an oscillating bubble". Physical Review E 79 (2). doi:10.1103/PhysRevE.79.021910.