Radiology Assistant: A New Career Pathway for Radiologic Technologists

Jeff Killion, PhD, RT(R)(QM), and James Johnston, PhD, RT(R)(CV)

    ^*Assistant Professor, Department of Radiologic Science, Midwestern State University, Wichita Falls, Texas.
    ^†Assistant Professor, Department of Radiologic Science, Midwestern State University, Wichita Falls, Texas.
   Address correspondence to: Jeff Killion, PhD, RT(R)(QM), Assistant Professor, Department of Radiologic Science, Midwestern State University, 3410 Taft Blvd, Wichita Falls, TX 76308. E-mail: jeff.killion@mwsu.edu.

History and Background

The concept of a physician extender in radiology is not new. The idea was first introduced in the 1970s by the University of Kentucky and Duke University.¹ However, it did not make enough of an impression to survive the loss of federal funding.¹ In the mid 1990s the concept was reintroduced when the Department of Defense approached Weber State University, requesting that it develop a radiology assistant program for the military. Federal budget cuts again halted the program's launch, but that did not stop the university from introducing the program 2 years later.²  

In 2002 the American Society of Radiologic Technologists (ASRT), American College of Radiology (ACR), and the American Registry of Radiologic Technologists (ARRT), in response to a national shortage of radiologists and growing demand for imaging services, began developing the radiologist assistant position.^3-5 This effort was initiated and nurtured by the ASRT. It convened a panel that included representatives of the ACR, ASRT, ARRT, state licensing agencies, National Society of Radiology Practitioner Assistants, educators, and industry.⁴ This panel became the Advanced Practice Advisory Committee, which developed the curriculum and education requirements, title, definition, roles and responsibilities, and levels of supervision, in addition to addressing regulatory issues.⁴ The ARRT then established an advisory committee representing the communities of interest to develop certification standards. The ARRT also conducted a survey to develop the role delineation document.⁴ The resulting document includes 42 clinical activities; each activity and procedure is assigned a level of radiologist supervision.⁴ The role delineation document and required supervision levels can be viewed on the ARRT Web site.⁶ In 2003 the ACR council passed a resolution to support the radiologist assistant concept, including certification of the registered radiologist assistant (RRA) by the ARRT.^4,5

Requirements

To become an RRA, an individual must first be a registered radiographer with the ARRT. Additionally, the individual must have a minimum of 1 year of experience as a radiologic technologist (RT) to enter a program. He must have a minimum of a bachelor's degree upon completion of an ARRT-recognized RRA program. Finally, he must complete all of the didactic and clinical requirements outlined in the ASRT curriculum and recognized by the ARRT.^3,4 The clinical component must be supervised by a radiologist mentor/preceptor, who oversees the clinical portion of the RRA's education. Throughout the program, the individual must maintain a clinical portfolio documenting all competencies and experiences.⁴

Once these requirements are met, the graduate will be eligible to take the ARRT RRA exam. This 5-hour exam covers 6 major subject areas: (1) patient communication, assessment, and management; (2) drugs and contrast materials; (3) anatomy, physiology, and pathophysiology; (4) radiologic procedures; (5) radiation safety, radiation biology, and fluoroscopic operation; and (6) medical/legal, professional, and governmental standards.⁵ The exam includes a variety of multiple-choice formats, in addition to case studies that require essay-type responses.⁷

Job Duties and Responsibilities

The RRA is an advanced level of practice for the RT. These individuals will perform a variety of patient care and procedural tasks. Job responsibilities will range from assessing patients, reviewing medical records to facilitate care, performing a variety of procedures that once required a radiologist, and performing preprocedural and postprocedural evaluations.

The Appeal

Before the introduction of this career track, an RT's only possibilities for upward mobility included specializing in imaging modalities such as computed tomography or magnetic resonance imaging, or going into special procedures, management, or teaching. A true advanced level of clinical practice was missing. For many, the special imaging modalities, management, and teaching options were not attractive. RTs may have enjoyed general clinical practice, but they had no upward mobility. This lack of options may have resulted in some leaving the field for similar challenges in different professions such as nursing or becoming a physician assistant.

With the development of the RRA position, those who truly enjoy general clinical practice now have an opportunity to practice at an advanced level. This provides individuals with new challenges while simultaneously addressing the radiology shortage and problems with quality patient care. RRA programs will attract those who want new challenges in clinical practice but were not interested in going back to school for the previous options for career advancement.

Overall Impact on the Profession

It is anticipated that RRAs will address 3 areas within radiologic technology: (1) the shortage of radiologists; (2) the improvement of patient care in radiology; and (3) the attraction and retention of professionals in radiology.

The number of radiology exams and services continues to increase every year while the number of radiologists continues to decline.⁸ This shortage hinders the workflow in the radiology department, in addition to limiting the time and attention that each patient can be given. It could also be speculated that with increased workload per radiologist, the risk of missed pathology increases.

It is expected that the role of the RRA in the patient care arena will relieve the radiologist of certain patient-care duties, allowing him to focus on image interpretation. This would then improve workflow and quality of patient care. Finally, because of the new challenges presented to the technologist with this career option, it is anticipated that more RTs will stay in the profession to meet these challenges rather than looking elsewhere.

Current State of Affairs

There are currently 6 programs with radiologist assistant students enrolled: Loma Linda University, Loma Linda, Calif; Midwestern State University, Wichita Falls, Tex; Virginia Commonwealth University, Richmond, Va; University of Medicine and Dentistry of New Jersey, Newark, NJ; University of Arkansas for Medical Science, Little Rock, Ark; and University of North Carolina at Chapel Hill, Chapel Hill, NC. Two new programs are also in development: Bloomsburg University of Pennsylvania, Bloomsburg, Pa; and the State University of New York Upstate Medical University, Syracuse, NY.⁴

It is too early to accurately quantify the impact of the RRA position on the radiology profession. There are still challenges to overcome, such as licensure/recognition, reimbursement/billing, and supervision levels. These questions and challenges are being examined as the first graduate pioneers enter the workforce. Anecdotally, having just graduated our first class of radiologist assistants at Midwestern State University last spring, RRAs are being well received and welcomed as they blaze the trail for future RTs.

References

1. Strickland G. Physician extenders: which one is right for you? Appl Radiol. 2005 ;34:23-28.

2. American Academy of Physician Assistants. Physician assistants and radiology practitioner assistants: the distinctions. Available at: http://www.aapa.org/gandp/rpas.html. Accessed February 7, 2007.

3. ASRT radiologist assistant resource page. American Society of Radiologic Technologists Web site. Available at: http://www.asrt.org/Content/RTs/SpecialtySpecific/RadiologistAssistant/Radiologist_Assistant.aspx. Accessed January 20, 2007.

4. ARRT radiologist assistant resource page. American Registry of Radiologic Technologists Web site. Available at: http://arrt.org/index.html?content=radasst/raintro.htm. Accessed January 20, 2007.

5. ACR radiologist assistant resource page. American College of Radiology Web site. Available at: http://www.acr.org/s_acr/sec.asp?CID=969&DID=14714. Accessed January 23, 2007.

6. American Registry of Radiologic Technologists. Registered radiologist role delineation. Available at: http://www.arrt.org/radasst/finalraroledelineation.pdf. Accessed February 7, 2007.

7. ARRT radiologist assistant resource page. American Registry of Radiologic Technologists Web site. Available at: http://www.arrt.org/examinations/contentspecs/RA_CS_2005.pdf. Accessed January 20, 2007.

8. Bennett SE. Advantages of hiring a radiologist assistant. Radiol Technol. 2006;78;9-10.