Radiographers, also known as Radiologic Technologists, Diagnostic Radiographers, Medical Radiation Technologists are Healthcare Professionals who specialise in the imaging of human anatomy for the diagnosis and treatment of pathology. Radiographers are infrequently, and almost always erroneously, known as X-Ray Technicians. In countries which use the title radiologic technologist they are often informally referred to as techs in the clinical environment; this phrase has emerged in popular culture such as television programmes.
Radiographers 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.
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.
History
Until around 1918 radiographers were known as skiagraphers; the term is derived from the Ancient Greek words for 'shadow' and 'writer'.
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Role in healthcare
A radiographer uses their expertise and knowledge of patient care, physics, human anatomy, physiology, pathology and radiology to assess patients, develop optimum radiological techniques and evaluate the resulting radiographic media.
This branch of healthcare is extremely varied, especially between different 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:
- Autonomy as a professional
- Accountability as a professional
- Contribute to and participate in Continuing Professional Development (CPD)
- Enforcement of Radiation Protection (There is a duty of care to patients, colleagues and any lay persons that may be irradiated)
- Justification of radiographic examinations
- Patient Care
- Production of diagnostic media
- Safe, efficient and correct use of diagnostic equipment
- Supervise students and assistants
On a basic level, Radiographers do not generally interpret diagnostic media, rather they evaluate media and make a decision about its diagnostic effectiveness. In order to make this evaluation Radiographers must have a comprehensive but not necessarily exhaustive knowledge of pathology and radiographic appearances; it is for this reason that Radiographers often do not interpret or diagnose without further training. Notwithstanding, it is now becoming more common that Radiographers have an extended and expanded clinical 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 which would have previously been undertaken by a cardiologist, urologist, radiologist or oncologist autonomously.
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
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 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. Upon qualifying it is common for Radiographers 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.
Imaging modalities
Generally, imaging modalities are all diagnostic, all have the potential to be used therapeutically in order to deliver an intervention. Modalities (or specialities) include but are not limited to:
Non-imaging modalities
Non-imaging modalities vary, and are often undertaken in addition to imaging modalities. 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 ionising radiation absorbed by anyone who comes into contact with ionising 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
Education varies worldwide due to legal limitations on scope of practice.
Federal Democratic Republic of Nepal
As a developing country, the health care sector in Federal Democratic Republic of Nepal has very limited resources meaning radiological services are rather limited. Nepal is still struggling to improve and manage conventional radiological examinations. Radiological Services in Nepal commenced in 1923 at Military Hospital by Dr. Rana and Dr Asta Bahadur Shrestha. The first health related training program began in 1933 at the Nepal Rajkiya Ayurved School; the Civil Medical School was later established in 1934. Radiological education in Nepal started in 1923 in a 64 bedded Military Hospital, Tri-ChandraElectro-Medical Institute. The post graduate (M.Sc.) program in physics at TU began in 1965 with only Nuclear Physics specialization. In 1972, the Institute of Medicine (IOM) which is affiliated with TU started the Proficiency Certificate Level (PCL) Radiography course however this has since stopped.
Radiotherapy was first introduced at Maternity Hospital in 1976 utilising radium needle treatment. CT and Nuclear Medicine was introduced in 1988 at Bir Hospital. The Radiotherapy unit with Tele Cobalt-60 machine was established at Bir Hospital in 1991.
Nepal became a member of IAEA in 2008. Since 2008 onwards diploma level radiography courses have been conducted across the country by the Council for Technical Education and Vocational Training (CTEVT) and other affiliated institutions.
In Nepal there are 125 vocational health training institutes however only 15 are conducting radiological technological education. Bachelor level radiography education is taught in two universities & one college whereas master level radiography course is taught in one where another university is in pipeline. Until recently, therapeutic radiography courses have not been taught in Nepal; radiation therapists are predominately trained abroad.
The Nepal Health Professional Council (NHPC) is the legislative body for registering, accrediting, developing & enforcing quality assurance of Health Professionals, including Radiographers, in Nepal.
Republic of Ireland
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's degree program; currently degree programs only exist at University College Dublin. 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.
The professional body representing Radiographers in the ROI is the Irish Institute of Radiography and Radiation Therapy (IIRRT).
Saudi Arabia
X-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.
United Kingdom
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. 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 of General Practitioner referred (GP) patients, outpatients, Emergency Department (ED) referred patients 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 CT and even basic experience of 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), Urologist or Cardiologist in the past. This extended practice includes various interventional procedures not excluding barium enemas, barium meals/swallows, peripheral angioplasties, nerve root injections, central line insertions and many other 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.
Expanded practice
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.
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. It is thought that in the future Radiographers in will gain independent prescribing rights, however this is currently limited by their restricted and varied scope of practice.
United States
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 organisation for Radiologic Technologists in the United States, requires that candidates for ARRT Certification Exams must have an associate degree at minimum as of January, 2015, effectively ending non-degree granting diploma programs. Accreditation is primarily through The Joint Review Committee on Education in Radiologic Technology (JRCERT), the only agency recognised 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.
Radiologic Technology students study anatomy and physiology, physics, mathematics, radiopharmacology, pathology, biology, research, nursing, medical imaging, diagnosis, radiologic instrumentation, emergency medical procedures, 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), 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. Additional requirements are set forth for technologists who specialise in mammography by the US FDA.
Expanded practice
A new and evolving career for Radiologic Technologists is that of the Registered Radiologist Assistant (R.R.A.) who is an experienced Technologist- not a Physician Assistant- who has completed additional education, training and has passed exams to function as radiologist extenders. A list of the 9 currently accredited R.R.A. programs is maintained by the ARRT and can be accessed online. 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. The role has been accepted by the American College of Radiology (ACR).
Risks
- Epidemiological studies indicate that Radiographers 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.
- Ionising radiation, used in a variety of imaging procedures, can damage cells. Lead shields are used on the patient and by the Radiographer 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.
- Radiographers who develop x-ray films are exposed to the various chemical hazards such as sulfur dioxide, glutaraldehyde, and acetic acid. These agents can cause asthma and other health issues.
- 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.
- 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.
- As with any allied health professional, exposure to infectious diseases is likely, and use of Personal Protective Equipment (PPE) and infection control precautions must be employed to reduce the risk of infection.
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