Radiographers Provide "Gateway to Diagnosis"

Radiation has been a tool in medicine since the first x-rays were developed late in the 19th century. Now, the administration of radiation to patients is generally in the hands of radiographers, who use a variety of techniques and many types of equipment to produce diagnostic images or apply the radiation itself as a form of treatment.

As the field of radiography grows to keep pace with advances in technology and the expanding medical use of different forms of radiation, making sure that radiographers are properly trained and certified is of particular importance to Sandra Lemiesz Helinski, MBA, RT(R), QM, MRI, a registered radiographer at Froedtert Hospital. Helinski is Legislative Liaison for the Wisconsin Society of Radiologic Technologists (WSRT) and serves on US Representative Paul Ryan's health care advisory committee.

"Many people still use the term 'x-ray technologist' instead of radiographer, and they often confuse us with nurses because we wear uniforms that look similar to theirs," said Helinski. "However, our jobs are very different. A radiographer is also called a radiologic technologist. A radiographer, in essence, is the person who usually provides the gateway to diagnosis for most medical problems. For instance, if you go to see your doctor and you're not feeling well, often the doctor will order a diagnostic exam that will most likely include medical imaging."

"These include x-rays, CT scanning, ultrasound, MRI, fluoroscopy, mammography, and all of the newest computerized imaging techniques," Helinski continues. "We encompass the whole 'schoolbook' of medical imaging exams. Conducting those exams is what a radiographer is specifically trained to do. Radiographers also assist radiologists, who are physicians, in many of the interventional studies like angiographic studies and in some other procedures that used to be done in the operating room."

Not All Radiographers are Registered
Congress passed the Consumer-Patient Radiation Health and Safety Act in 1981 to establish minimum standards for state licensure of personnel who administer ionizing radiation in medical and dental radiologic procedures. The goal was to minimize unnecessary exposure to potentially hazardous radiation and the law stated that those who administer radiologic procedures should be required to demonstrate competence.

However, the law left it up to the individual states to adopt the licensing minimums it suggested, with no penalties for not doing so. According to the American Society of Radiologic Technologists (ASRT), to date only 37 states fully or partially license, regulate or register radiographers; 29 states license radiation therapists (who apply radiation in treatment regimens for cancer patients, for example); and 23 states license nuclear medicine technologists. Thirteen states don't license at all, and the laws for states that do vary widely in standards and enforcement.

Helinski is a registered radiographer and is working to establish at least minimum standards at the federal level by advocating for passage of the Consumer Assurance of Radiologic Excellence (CARE) bill now sitting in a House of Representatives committee. CARE would not require that all radiographers be registered, but it would amend the 1981 law and require states to adopt minimum standards for the education and credentials needed for anyone who delivers radiation therapy treatments and performs every type of medical imaging examination except sonography.

Froedtert Hospital employs only registered radiographers, Helinski said, but there is no requirement for individual hospitals and clinics to do so. Many facilities use radiographers who have not passed the national examination.

"To be 'registered' means that we have passed the American Registry of Radiologic Technologists national certification exam," Helinski said. "Much like registered nurses have a registry, we now have our own registry. We have passed a comprehensive examination on all the training we've received, and are certified in our field. It is the gold standard of those who perform medical imaging."

"When a person comes out of what has traditionally been a two-year technical program, you don't automatically know how to run a CT scanner, for instance. You don't know all the science behind magnetic resonance imaging. To do those types of jobs, people take post-primary exams that take a lot of self-study, and you also have to demonstrate competency. That's the key - when you pass the American Registry exam, it has been documented that you know what you're doing in a whole breadth of procedures."

Problems, Practices Vary
Even without calling for all radiographers to be registered, Helinski said, CARE would help eliminate a hodgepodge of real and potential problems in states that don't do any licensing, and in other states where some medical facilities may be understaffed in terms of highly trained radiographers. "We actually had a case in Wisconsin where the person in charge of custodial duties was 'trained' to take chest x-rays at a clinic," Helinski said. "That is unconscionable, because what is involved is radiation exposure, and that you can never take away from a patient."

"In some respects, this is legal. But is it ethical? No. In Wisconsin, the WSRT prepared a physician statement when they were updating the Health and Family Services department's nuclear regulation code. As a result, here in Wisconsin those who do CT scanning and radiation therapists have to be registered technologists. We're very proud of that, because most states don't say the word 'registered,' and that is law here. For CT scanners and radiation therapists, that's one protection that we have."

"Also, because of federal law, a woman is protected when she has her mammogram. Many years ago, the wife of a member of Congress was misdiagnosed from a misperformed mammogram, because they did not see the tumor, and she died of breast cancer. Ultimately, in 1992, that event resulted in the Mammographic Quality Standards Act that flew through Congress, a whole body of regulations related to quality assurance standards as to how mammograms are processed."

Helinski noted that in Wisconsin, while better than many states in terms of licensing some radiographers, the law still doesn't cover many radiologic imaging exams. "People daily can be misdiagnosed by improper exams," she said. "They can be exposed to radiation improperly and harmfully. People who are radiation therapists, who deliver the beam that kills tumors, don't have to be trained in some states. Even in Wisconsin, we're only protected when in comes to CT scanning and radiation therapists and the woman's mammogram."

The proposed federal law would allow states to exempt physicians and nurses from the minimum standards to cover circumstances when they administer radiation to patients themselves.

"We do recognize that there are areas where people aren't going to have access to gold standard hospitals like Froedtert," Helinski said. "The ASRT has a curriculum of instruction that they would like to promote to work in concert with the government to give people the proper knowledge so that they don't improperly expose patients for the basic exams. We want to start somewhere. CARE is a steppingstone. Overall, it's a piece of cost-effective patient protection legislation."

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.