After recently participating in an online discussion board forum on the topic, I thought I would post the topic here to gain some additional perspective. Here's my question:
Do you believe that general radiographic exams should be performed by unlicensed/unregistered individuals?
In other words, people who may have medical backgrounds like Medical Assistants or Chiropractic Assistants who may have been trained on the job, but have no formalized education as an X-Ray Technician other than what someone else has shown them in the field.
Some states do not have any restrictions on who can or cannot perform radiographic examinations, and there are other states that have extreme restrictions. I know there are going to be several variances of what happens in your own state, which I would love to hear about as well, regarding qualifications. There are also some limited licensure programs that provide certification in chest, extremities, etc. that are formally structured. Having lived in states on either side of the spectrum, I have my own opinions on the topic which I will refrain from stating at this time, but I am interested in yours. I plan on posting a poll on this blog, and I also invite comments to this post explaining your reasons for your opinion.
If the responses here are as mixed as they were on my recent discussion board experience, it will prove to be very interesting.
Do you believe that general radiographic exams should be performed by unlicensed/unregistered individuals?
In other words, people who may have medical backgrounds like Medical Assistants or Chiropractic Assistants who may have been trained on the job, but have no formalized education as an X-Ray Technician other than what someone else has shown them in the field.
Some states do not have any restrictions on who can or cannot perform radiographic examinations, and there are other states that have extreme restrictions. I know there are going to be several variances of what happens in your own state, which I would love to hear about as well, regarding qualifications. There are also some limited licensure programs that provide certification in chest, extremities, etc. that are formally structured. Having lived in states on either side of the spectrum, I have my own opinions on the topic which I will refrain from stating at this time, but I am interested in yours. I plan on posting a poll on this blog, and I also invite comments to this post explaining your reasons for your opinion.
If the responses here are as mixed as they were on my recent discussion board experience, it will prove to be very interesting.
I have only worked in Canada where radiological technologists must be registered to practice. In the province I was trained and work in, a Bachelor's degree is the only option for education. While individuals with backgrounds in other medical fields will likely have knowledge of some dimensions of our practice, they probably don't have education in subjects like radiation biology, radiation physics, or imaging equipment. While unregistered individuals may be able to go through the motions of acquiring a radiograph, I wonder how competently they do this. For example, do they understand the effects of filters, the anode-heel effect, collimation, etc.? Do they know how to adequately protect the patient, others, and themselves? Do their patients know that they are not registered/licensed? How does the quality of their work really compare to someone who is registered?
ReplyDeleteI'm very much looking forward to hearing others' opinions on this.
Thanks for bringing up such an interesting topic!
I have only worked in Canada where radiological technologists must be registered to practice. In the province I was trained and work in, a Bachelor's degree is the only option for education. While individuals with backgrounds in other medical fields will likely have knowledge of some dimensions of our practice, they probably don't have education in subjects like radiation biology, radiation physics, or imaging equipment. While unregistered individuals may be able to go through the motions of acquiring a radiograph, I wonder how competently they do this. For example, do they understand the effects of filters, the anode-heel effect, collimation, etc.? Do they know how to adequately protect the patient, others, and themselves? Do their patients know that they are not registered/licensed? How does the quality of their work really compare to someone who is registered?
ReplyDeleteI'm very much looking forward to hearing others' opinions on this.
Thanks for bringing up such an interesting topic!
It's interesting to hear about the Canadian regulations... thank you for your input!
ReplyDeleteNo. As Elise pointed out there are some finer points to considered which others may not be aware of. I Australia you MUST have a license to take an x-ray.
ReplyDeleteHaving said that however, when I recently work at a hospital I was told there was surgeon that would take the image himself occasionally if you took your time to get up there. I'm ok with that because he has much more medical training than I do, and presumably knows what radiation is all about.
No. As Elise pointed out there are some finer points to considered which others may not be aware of. I Australia you MUST have a license to take an x-ray.
ReplyDeleteHaving said that however, when I recently work at a hospital I was told there was surgeon that would take the image himself occasionally if you took your time to get up there. I'm ok with that because he has much more medical training than I do, and presumably knows what radiation is all about.
I'm a first year student studying in London, UK. In the UK, Radiographers are regulated by the Health Professions Council (HPC).
ReplyDeleteBefore we can practice radiography, we have to have completed a HPC justified course. This is now a 3-year BSc (Hons) in Diagnostic Radiography (or BSc Hons in Diagnostic Imaging).
Once you have completed your degree, you register for your licence from the HPC and once you have received this, you can practice radiography.
No-one else (bar radiologists I believe) are authorised to take X-rays. However, we do have Assistant Practitioners (APs) who attend university, but study away and work at the hospital from Day 1, gaining on the job training.
However, unlike a Radiographer, APs can not justify a exposure and therefore have to get it cleared by a registered Radiographer before they can complete the examination(just like us students do).
This is due to the fact that they have not had the same level of physics training as we have and have only learn basic radiation protection issues and positioning techniques on the job.
Many are also not able to image minors (under 18 yrs) unless they have had specialist training. After their 2 year training scheme, they have to work for a number of years as an AP before they can attend uni again and do a top up course where they can then become a Radiographer and are then able to justify their own examinations.
If you don't mind, could you explain to me how the system works in the USA, as it seems very different. Thanks,
That's one of the big debates right now in the U.S. Currently, it is up to the individual state that you take x-rays in to require formal training. Most states require it, while some do not.
ReplyDeleteThere has been proposal on the national level here that, if passed, would create a minimum requirement that would require some kind of formal training for all those who are operating x-ray producing equipment.
The state where I trained, California, and the school at the time I trained, prepared me to take the national registry exam (ARRT), the state x-ray exam (CRT), and the state fluoroscopy exam (fluoro permit). At that time, if you came to California from another state, but had your national ARRT registration, you still had to study to take the CRT state exam, which was more difficult. Additionally, nurses and physicians are not allowed to operate x-ray producing equipment in the state as well. Physician can sit for the fluoroscopy exam if they want to operate equipment, but nurses are not permitted to, and must complete the same x-ray school that we do. Some of this has since changed, but it gives you an idea of the level of regulation there is in one state.
The state I live in now, North Carolina, has no regulations at all. Hospitals only need to require a national license (ARRT) if they wish to maintain national accreditation standards, but they are not required to here. I have seen many individuals with no formal training who really have no idea what they're doing taking x-rays in North Carolina. I have had good and bad personal experiences, but there is no national regulation of practicing radiographers at this time.
I hope this answered your question without imposing too much of my own opinion about it. It's interesting to hear how this works in other countries as well. Maybe the U.S. could model some ideas from others.
That's one of the big debates right now in the U.S. Currently, it is up to the individual state that you take x-rays in to require formal training. Most states require it, while some do not.
ReplyDeleteThere has been proposal on the national level here that, if passed, would create a minimum requirement that would require some kind of formal training for all those who are operating x-ray producing equipment.
The state where I trained, California, and the school at the time I trained, prepared me to take the national registry exam (ARRT), the state x-ray exam (CRT), and the state fluoroscopy exam (fluoro permit). At that time, if you came to California from another state, but had your national ARRT registration, you still had to study to take the CRT state exam, which was more difficult. Additionally, nurses and physicians are not allowed to operate x-ray producing equipment in the state as well. Physician can sit for the fluoroscopy exam if they want to operate equipment, but nurses are not permitted to, and must complete the same x-ray school that we do. Some of this has since changed, but it gives you an idea of the level of regulation there is in one state.
The state I live in now, North Carolina, has no regulations at all. Hospitals only need to require a national license (ARRT) if they wish to maintain national accreditation standards, but they are not required to here. I have seen many individuals with no formal training who really have no idea what they're doing taking x-rays in North Carolina. I have had good and bad personal experiences, but there is no national regulation of practicing radiographers at this time.
I hope this answered your question without imposing too much of my own opinion about it. It's interesting to hear how this works in other countries as well. Maybe the U.S. could model some ideas from others.
I think that if we want to advance the practice of radiological technologists, we need to regulate who practices our profession. If unqualified persons continue to practice, it deprecates our practice as professionals. Furthermore, as has been discussed here, patients receiving care from unqualified individuals are possibly and probably receiving lower standards of care. The focus here is really the patient. A person should not be caring for a patient if they are going to subject them to excessive radiation or injure them due to lack of knowledge of their medical condition.
ReplyDeleteObviously this change cannot be implemented immediately because it would create a sudden shortage of technologists in North Carolina. However, continuing to allow individuals with no formal training whatsoever to practice is unacceptable. Perhaps the most reasonable plan of action would be to stop hiring unqualified individuals and also provide formal education to those uneducated practitioners.
I think that if we want to advance the practice of radiological technologists, we need to regulate who practices our profession. If unqualified persons continue to practice, it deprecates our practice as professionals. Furthermore, as has been discussed here, patients receiving care from unqualified individuals are possibly and probably receiving lower standards of care. The focus here is really the patient. A person should not be caring for a patient if they are going to subject them to excessive radiation or injure them due to lack of knowledge of their medical condition.
ReplyDeleteObviously this change cannot be implemented immediately because it would create a sudden shortage of technologists in North Carolina. However, continuing to allow individuals with no formal training whatsoever to practice is unacceptable. Perhaps the most reasonable plan of action would be to stop hiring unqualified individuals and also provide formal education to those uneducated practitioners.
To be fair, I should mention the opposing views of the debate:
ReplyDeleteHospitals in remote locations may not have a proper supply of licensed radiographers. Does this mean that people should have to drive 50-100 miles just to have an x-ray?
Who is to say that someone trained on the job by a licensed technologist is any better or worse than someone who goes through formal training to take radiographs?
If formalized training is so great, why are there so many court cases across the country right now dealing with overexposure of patients to radiation?
These are just some of the questions raised that I have seen.
To be fair, I should mention the opposing views of the debate:
ReplyDeleteHospitals in remote locations may not have a proper supply of licensed radiographers. Does this mean that people should have to drive 50-100 miles just to have an x-ray?
Who is to say that someone trained on the job by a licensed technologist is any better or worse than someone who goes through formal training to take radiographs?
If formalized training is so great, why are there so many court cases across the country right now dealing with overexposure of patients to radiation?
These are just some of the questions raised that I have seen.
That being said, I am curious about the varied responses in your discussion board experience. The opinion seems to be unanimous here. Are you in a position to provide us with a link to said discussion?
ReplyDeleteYou can find the original thread at auntminnie.com in the "technologist" forum. It is titled "non-rt's performing x-rays."
ReplyDeleteI have to admit, responses are getting rather childish at this point. That's why I chose to bring it up here... feel free to comment here if you don't want to partake in the madness :-)
To Elise:
ReplyDeleteI am a recent graduate of an x-ray school in NC. (Recently passed the registry as well!) I can assure you that if they cleared out all the unqualified people taking x-rays, there would be PLENTY of RT's to take their places. In this state especially it's nearly impossible to find a job. The last opening I heard of received 60 applications.
To Elise:
ReplyDeleteI am a recent graduate of an x-ray school in NC. (Recently passed the registry as well!) I can assure you that if they cleared out all the unqualified people taking x-rays, there would be PLENTY of RT's to take their places. In this state especially it's nearly impossible to find a job. The last opening I heard of received 60 applications.
A relative who's a LPN and works at an ENT clinic, which is located in Oklahoma (which doesn't mandate certification/licensing for administering ionizing radiation), operates a MiniCAT™ scanner for diagnosing ear and sinus problems. She received half a day's worth of training with no emphasis on radiation safety other than she should stand behind the portable shield while operating the scanner.
ReplyDeleteI reside in Texas, and I know of a few Level IV Trauma Centers/Critical Access hospitals that primarily staff their radiology departments with Limited Medical Radiological Technologists and/or Non-Certified Techs. Coincidentally, a lot of these same facilities normally staff their ER depts. with PAs and/or FNPs...
A relative who's a LPN and works at an ENT clinic, which is located in Oklahoma (which doesn't mandate certification/licensing for administering ionizing radiation), operates a MiniCAT™ scanner for diagnosing ear and sinus problems. She received half a day's worth of training with no emphasis on radiation safety other than she should stand behind the portable shield while operating the scanner.
ReplyDeleteI reside in Texas, and I know of a few Level IV Trauma Centers/Critical Access hospitals that primarily staff their radiology departments with Limited Medical Radiological Technologists and/or Non-Certified Techs. Coincidentally, a lot of these same facilities normally staff their ER depts. with PAs and/or FNPs...
i'm in the third world and i am shocked to hear that you in the US are allowing none radiographers to practice radiography. where i am we initially tried to have only radiographers doing xrays, but it was soon realised that this was not possible especially out in the bush/rural areas. thereafter we created posts for what we call xray operators. this move proved to be the death of the profession in this country. i can understand why poorer countries have to do this, especially due to loss of radiographers to greener pastures, but in the US i didn't realise this was also a problem. maybe you should stipulate that non-radiographers should only be allowed to take xrays when they are in departments that have advertised and failed to get radiographers/RTs.
ReplyDeletein the end if we are to preserve our profession, and even continue to call it a profession, without fooling ourselves as we do now , we must forthwith venture into reporting( right now we are not a PROFESSION but , a JOB. indeed we are just workers for radiologists no matter how much we may try to deceive ourselves. we do their dirty work and help them to get rich without doing any real work, like other types of doctors who actually have to touch,examine and deal with 'awful patients')
i think we should do something along the lines of what the dentists have done, whereby we learn only the parts of medicine relevant to ourselves. if we follow this route, then we can replace radilogists
i'm in the third world and i am shocked to hear that you in the US are allowing none radiographers to practice radiography. where i am we initially tried to have only radiographers doing xrays, but it was soon realised that this was not possible especially out in the bush/rural areas. thereafter we created posts for what we call xray operators. this move proved to be the death of the profession in this country. i can understand why poorer countries have to do this, especially due to loss of radiographers to greener pastures, but in the US i didn't realise this was also a problem. maybe you should stipulate that non-radiographers should only be allowed to take xrays when they are in departments that have advertised and failed to get radiographers/RTs.
ReplyDeletein the end if we are to preserve our profession, and even continue to call it a profession, without fooling ourselves as we do now , we must forthwith venture into reporting( right now we are not a PROFESSION but , a JOB. indeed we are just workers for radiologists no matter how much we may try to deceive ourselves. we do their dirty work and help them to get rich without doing any real work, like other types of doctors who actually have to touch,examine and deal with 'awful patients')
i think we should do something along the lines of what the dentists have done, whereby we learn only the parts of medicine relevant to ourselves. if we follow this route, then we can replace radilogists