Radiologist Assistants (RAs) and RPAs: Questions and Answers

I’ve had some questions from radiography students, about RA ( radiologist’s assistant’s).

Below are some questions and answers from the American College of Radiology I’ve collected, and a link to a white paper about radiology assistant’s. Comments welcomed.

Question: What is a radiologist assistant?

Answer: As envisioned by a working group of the ACR and ASRT, a Radiologist Assistant (RA) is an advanced-level radiologic technologist who works under the supervision of a radiologist to enhance patient care by assisting the radiologist in the diagnostic imaging environment. The radiologist assistant would be an ARRT-certified radiographer who has successfully completed an advanced academic program encompassing a nationally recognized radiologist assistant curriculum and a radiologist-directed clinical preceptorship. Under radiologist supervision, the radiologist assistant would perform patient assessment, patient management and selected exams. The radiologist assistant will not perform interpretations (preliminary, final or otherwise) of any radiological examinations, nor will he or she transmit observations other than to the supervising physician.

The term was developed during a series of meetings between the American Society of Radiologic Technologists (ASRT) and the ACR during the spring and summer of 2002. The two groups have been meeting to consider the development of an advanced-level radiologic technologist to address workforce shortages among radiologic technologists and radiologists.

Question: What is an RPA?

Answer: The term RPA refers to a Radiology Practitioner Assistant. The term was coined through a program developed at Weber State University. According to a recent study, among some of the common procedures performed by RPAs are GI barium studies, fistulograms, genitourinary studies, arthrograms, thorocentesis, paracentesis, ultrasound and CT-guided biopsies and drainages, peripherally inserted central venous catheter line placement, angiography, and venography, Dobhoff tube placement, lumbar punctures and myelograms. Among the preliminary image evaluation reports being generated to the supervising radiologist are reports of the chest, abdomen, pelvis, othopedics, spine and skull, as well as barium and interventional studies, CT, MRI, ultrasound, nuclear medicine, vascular/cardiac procedures, and mammograms.1

Question: Does the ACR recognize RAs or RPAs?

Answer: At present, the ACR only recognizes Radiologist Assistants under the terms and conditions contained in the 2003 ACR/ASRT Joint Statement on the Roles and Responsibilities of the Radiologist Assistant.

Question: Why did the ACR considering recognize RAs?

Answer: The profession of radiology is experiencing workforce shortages among diagnostic radiologists and radiologic technologists. Indeed, many groups have begun hiring nurse practitioners and physician assistants to fill efficiency gaps in their practices. Many academic institutions are in the process of considering programs to initiate advanced-practice status for radiologic technologists. In addition, several state legislatures are currently considering laws that would provide extended scope of practice for radiologist extenders. The ACR and ASRT sought to establish a balanced approach that recognizes the human resource shortages, the current environment for hiring physician extenders, the status of academic programs and the uncertainty that exists from the evolving state legislative and regulatory environment. In addition, the ACR and ASRT were looking to provide a professionally satisfying career pathway for radiologic technologists. The RA is an outgrowth of those discussions.

Question: Does acceptance of the RA pose a future risk to the practice of radiology?

Answer: The profession of radiology is ever-evolving. The ACR is concerned about the potential effect of this position on the future of our members. However, the only thing that seems certain at this point is change. By considering this issue, the ACR chose to promote the development of the RA. We are aware of the acrimonious scope-of-practice battles that have occurred between other physician and ancillary provider groups. By developing the RA roles and responsibilities document, the ASRT and the ACR sought to improve patient care while addressing some of the human resource shortfalls that were occurring in the radiologic technologist field at the time.

Question: Should states enact legislation or regulations instituting an RA or RPA designation?

Answer: The ACR supports state legislation or regulation that embraces the development of the RA consistent with the roles and responsibilities developed by the ACR Council. The ACR will work with its chapters and the ASRT to ensure that state scope of practice does not exceed that envisioned by the two groups. The ACR does not recognize either the scope of practice or designation of an RPA. For more information on RA state legislative and regulatory issues, please contact Ariel Gonzalez at 800-227-5463 ext. 4488 or at agonzalez@acr.org or visit the ACR State Legislative Web site at.

1Burton, Samuel Scott, “Radiology Practitioner Assistant: Utilizing this New Role in Imaging Could Help Win Turf War,” ADVANCE for Imaging and Radiation Therapy Professionals, November 4, 2002, pages 20-21.

And the link to ARC’s white paper:

White Paper on the Radiologist Assistant

I hope this helps anyone looking for this information.

Dave

Comment on Pediatric Radiation Safety from Diagnostic Imaging Magazine

Image Gently alliance seeks to reduce pediatric CT radiation dose

by H. A. Abella

Diagnostic Imaging Magazine

The Alliance for Radiation Safety in Pediatric Imaging, a group representing about a half-million medical professionals, has launched today the Image Gently campaign with the motto “Be wise. Adjust for size.” The alliance aims to raise awareness on the need to child-size radiation doses from pediatric CT scans to reduce the possible harmful effects of cumulative radiation exposure over time.

Mounting evidence suggests the increased utilization in recent years of medical imaging, particularly CT, has heightened patients’ exposure to ionizing radiation. Radiation protection experts have repeatedly warned physicians, who are responsible for pediatric radiography, that children are more sensitive to radiation than adults because of its cumulative effects.

To date, however, no comprehensive effort regarding pediatric radiation safety has involved all the specialists who participate in pediatric imaging, said Dr. Marilyn Goske, alliance chair.

About a year and a half ago, Goske, as chair of the board of directors of the Society for Pediatric Radiology, contacted representatives of the American College of Radiology, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine. In July 2007, the four founding groups agreed upon their key message.

They later earned an education grant from GE Healthcare, put together the Image Gently website, and prepared to launch the campaign.

The first phase will target radiologists, radiologic technologists, and medical physicists, according to Goske. These providers will be encouraged to

reduce significantly the amount of radiation used in pediatric CT
scan when necessary, do it once, and scan only the indicated region
work together to optimize and monitor pediatric CT scanning

“We hope to change practice,” Goske said. “We know that these healthcare providers want to do the right thing. But they primarily do imaging for adults. We hope to give them straightforward information and resources so they know what they need to do to take care of children in the best way possible.”

The number of pediatric CT scans has tripled in the last five years, according to the alliance. About four million pediatric CT scans were performed in 2007.

The Alliance’s long-term goal is to ensure that medical protocols for pediatric imaging keep pace with advancing technologies. Its ultimate goal is to establish kid-size radiation doses as the standard of care in the U.S., Goske said.

Image Gently is not intended to be a scare campaign or a move to humiliate or punish physicians, said Dr. Donald P. Frush, chief of pediatric radiology at Duke University and chair of the ACR Pediatric Commission.

“We want this to be a cooperative effort on a positive note that gives people helpful information to do things better,” Frush said.

The Image Gently campaign will focus initially on CT. Future phases will include other ionizing radiation imaging modalities, and it will eventually address the utilization of alternative nonionizing medical imaging modalities such as MRI and ultrasound, Frush said.

The four charter members of the Alliance represent more than 160,000 physicians, radiologic technologists, and medical physicists. Nine affiliate organizations have joined the effort: the American Academy of Pediatrics, American Osteopathic College of Radiology, American Registry of Radiologic Technologists, American Roentgen Ray Society, Association of University Radiologists, Conference of Radiation Control Program Directors, National Council on Radiation Protection and Measurements, RSNA, and Society of Computed Body Tomography and Magnetic Resonance.

Alliance officials estimate the Image Gently campaign could reach more than 500,000 medical professionals.

For more information from the Diagnostic Imaging archives:

Pediatric CT dose reduction strategies get global focus

Radiation spotlight shows jump in pregnancy imaging

NEJM article blames CT-related radiation for up to 2% of cancers in U.S.

Dose-saving strategies play catch up to greater CT use

An email from the ASRT

Just received this email from the ASRT today and I’m very excited about this new website promoting radiation dose to pediatric patients. I’ve been passionate about this subject since I started CT 18 years ago, and I think its fantastic that we are finally unrecognizing the issue.

Please consider joining this campaign. Dave !!

Here’s the email and the web address:

Dear David,

ASRT members like you who work in CT are among the 400,000 health care professionals across the country receiving advance notice about a special effort to lower radiation dose when performing CT scans on children.

Today marks the launch of the Image Gently campaign, an initiative to lower pediatric radiation dose sponsored by the Alliance for Radiation Safety in Pediatric Imaging. The ASRT proudly supports the Image Gently campaign and is one of the four founding members of the Alliance. The other founding members are the Society for Pediatric Radiology, the American College of Radiology and the American Association of Physicists in Medicine.

I encourage you to join the Image Gently campaign. It’s easy. Visit the Image Gently Web site (www.imagegently.org) for the latest research and educational materials to assist you in determining appropriate radiation techniques to use. Take the pledge to image gently and encourage your coworkers to join in the effort.

The February issue of the ASRT Scanner features helpful advice on pediatric CT imaging and a free Image Gently poster. Display the poster in a visible area as a reminder to keep pediatric imaging child-sized.

Technologists are at the front line, working directly with patients to create the images physicians use to determine their diagnoses. We have an ethical obligation to produce the best images in the safest manner possible for the patient. Children are not simply smaller adults. Their bodies are different and require a different approach to imaging. When you perform imaging exams on children, please image gently.

Sincerely,
Connie Mitchell, M.A., R.T.(R)(CT)
ASRT President

Let’s image gently when we care for kids! Be Wise. Adjust For Size.

Welcome to Radiology Portals

I plan for this blog to become a resource for all modalities in Radiology, and a spin off of my website Dave’s Places in Radiology. I plan to post more personal comments about the field, and hopefully spur comments from my fellow technologist’s in the radiology community. This is just a “work in progress” right now so bear with my while I develop this blog.

Dave Woeber RT(R)(CT)