Nature of the Work:
Perhaps the most familiar use of the X-ray is the diagnosis of broken bones. Although this remains a major use, medical uses of radiation go far beyond that. Today, radiation is used not only to produce images of the interior of the body, but to treat disease as well. At the same time, the rapidly growing use of imaging techniques that do not involve X-rays is transforming the field, and the term diagnostic imaging embraces procedures such as ultrasound and magnetic resonance scans as well as the familiar X-ray.
With the application of computer technology to radiology, the field has been revolutionized. Computer-enhanced equipment produces amazingly clear and sharp images. Thanks in part to the speed with which computerized scanners can read and organize the millions of messages involved in a single test, it is now possible to view soft tissues and organs such as the heart and brain, parts of the body that until quite recently could only be examined through invasive techniques such as exploratory surgery.
Remarkable strides have occurred in the development of imaging equipment that does not involve the use of radiation, thereby reducing the risks of adverse side effects. Examples include ultrasound machines (which use sound waves), magnetic resonance scanners (radio waves), and positron emission scanners (electrons). Although discovered many years ago, some of these imaging techniques have become clinically practical only during the last decade, as a result of improvements in electronic circuitry that enable computers to handle the vast amount of data involved.
No hard and fast rules about job titles exist in this field. However, operators of radiologic equipment should not be confused with radiologists, physicians who specialize in the interpretation of radiographs.
Radiologic personnel may be called radiologic technologists in one hospital, radiographers in another and X-ray technicians in yet a third. The size of the facility, amount of specialization, and organizational policy are among the factors that determine which job titles are used. Another reason for inconsistency in job titles is the rapidity with which new medical technologies have emerged and practice patterns have changed. When new equipment is introduced, existing staff are taught to operate it, and it may be some time before job titles are changed.
Radiographers take X-ray films (radiographs) of all parts of the human body for use in diagnosing medical problems. They prepare patients for radiologic examinations, assuring that they remove any articles, such as belt buckles or jewelry, through which X-rays cannot pass. Then they position the patients, who either lie on a table, sit, or stand, so that the correct parts of the body can be radio-graphed, always taking care not to aggravate injuries or make the patients uncomfortable. To prevent unnecessary radiation exposure, the technologist surrounds the exposed area with radiation protection devices, such as lead shields, or in some way limits the size of the X-ray beam.
After the necessary preparations, the technologist positions the radiation equipment at the correct angle and height over the appropriate area of a patient's body. Using instruments similar to a measuring tape, the technologist measures the thickness of the section to be radio-graphed and then sets the controls on the machine to produce radiographs of the appropriate density, detail, and contrast The technologist then places a properly identified X-ray film of the correct size under the part of the patient's body to be examined, and makes the exposure. Afterward, the technologist removes the film and develops it. Throughout the procedure, the technologist is careful to use only as much radiation as is necessary to obtain a good diagnostic examination.
Before a radiologist examines a patient by fluoroscopy, watching a patient's internal organs on a monitor or screen, the radiologic technologist may prepare a solution of contrast medium for the patient to drink. As this solution passes through the patient's digestive tract, the radiologist looks for diseases, injuries, or defects in the patient's digestive system. When fluoroscopic examinations are performed, whether on the digestive tract or on other parts of the body such as chest, heart, or blood vessels, the technologist assists the physician by preparing and positioning the patient, adjusting the machine, applying the correct exposure, and making any necessary follow up radiographs.
With the successful use of radiation as a cancer treatment, radiation therapy technology has developed into a separate specialty. Radiation therapy technologists prepare cancer patients for treatment and administer prescribed doses of ionizing radiation to specific body parts. Technologists operate many kinds of equipment, including high-energy linear accelerators with electron capabilities. They must position patients under the equipment with absolute accuracy in order to expose affected body parts to treatment while protecting the rest of the body from radiation.
Radiation therapy may produce side effects such as nausea and vomiting. Hair loss and redness of skin can occur in treated areas, so the technologist must observe the patients reactions and keep the physician informed. A sympathetic and understanding manner is essential, for technologists need to give clear instructions and explanations to patients who are likely to be very ill and may be dying. Radiation therapy technologists have the opportunity to develop a close and compassionate relationship with patients and their families, for, in contrast to other areas in radiology, these technologists are likely to see the same patient repeatedly.
Other responsibilities include quality assurance duties such as maintaining the proper operation of accessory devices and radiation equipment, observing departmental safety measures, keeping patient records, and assisting in the preparation and handling of radioactive materials.
Many of the new, extremely powerful forms of diagnostic imaging do not involve the use of radiologic equipment at all. The ability to see inside the human body without exposing patients or technologists to radiation hazards is one reason the new procedures have taken hold so quickly.
Monographers, also known as ultrasound technologists, use non-ionizing equipment to transmit sound waves at high frequencies into the patient's body, then collect reflected echoes to form an image. The image, which results from the bounce-back of sound from the areas being scanned, is viewed on a screen and may be automatically recorded on a printout strip or photographed from the screen for permanent records and for use in interpretation and diagnosis by physicians.
Magnetic resonance imaging works in much the same way but uses magnetic fields in place of sound waves. Ultrasound and magnetic resonance images can be displayed as moving pictures, an important feature for cardiovascular and prenatal studies. In the area of obstetrics and gynecology, the use of ultrasound is widespread, and it is coming into use in other clinical areas as well.
Sonographers select equipment appropriate for use in ultrasound tests ordered by physicians. They also check the patient's other diagnostic studies for information. Sonographers explain the procedure, record any additional medical history considered necessary, and then position the patient for testing. Viewing the screen as the scan takes place, the sonographer must be able to recognize subtle differences between healthy and pathological areas; to check for factors such as position, obstruction, or change of shape; and to judge if the images are satisfactory for diagnostic purposes. A high degree of technical skill and knowledge of anatomy and physiology are essential to recognize the significance of all body structures present in the ultrasound image.
Technologists carry out doctors' orders. Before a radiologic technologist can perform any examination or procedure on a patient, a physician must issue a requisition for the study or treatment. Similar to prescriptions for drugs, these requisitions assure that technologists examine or treat only people certified by physicians as needing such studies or treatment. At all times, technologists must follow precisely not only physicians' instructions but also regulations concerning use of radiation to insure that they, patients, and co-workers are protected from its dangers.
Since technologists may work with patients who cannot help themselves, good health, moderate strength, and stamina are important. The possibilities always exist that patients will have breathing difficulties or go into shock or cardiac arrest; should this happen, the technologist must be ready to assist until other medical personnel can be called in.
In addition to the duties involved in preparing patients and operating equipment, technologists may have administrative tasks. They may prepare work schedules, evaluate equipment, or manage their department or unit
Working Conditions:
Radiologic technologists generally work a 40-hour week that may include evening and weekend or on-call hours. Some hospitals offer extremely flexible work schedules. A technologist may choose to work 3 13-hour days a week, for example. Part-time work is widely available.
Technologists are on their feet a lot and may be required to lift or turn disabled patients. There are potential radiation hazards in this field; however, these hazards have been reduced by the use of safety devices such as instruments that measure radiation exposure, lead aprons, gloves, and other shielding. Because of the presence of radiation and radioactive materials, technologists wear special badges that measure radiation levels while they are in the radiation area, as well as the cumulative lifetime dose. The badge measurement rarely approaches or exceeds established safety levels because of safety programs and built-in safety devices.
Employment
Most of the jobs that Radiologic technologists held involved the operation of diagnostic radiologic equipment. Radiation therapy technologists and Sonographers hold a very small proportion of the jobs in this field. Two-thirds of the jobs are in hospitals. The rest are located in physicians' offices, health maintenance organizations, clinics, and diagnostic imaging centers. Many technologists work part time.
Training, Other Qualifications, and Advancement:
Preparation for this field is offered at the postsecondary school level in hospitals, medical centers, colleges and universities, trade schools, vocational-technical institutes, and the Armed Forces. Hospitals, which employ most radiologic technologists, prefer to hire individuals who have completed a formal training program.
Formal training programs are offered in radiography, radiation therapy technology, and diagnostic medical sonography (ultrasound). These programs vary in a number of respects: Length of training, prerequisites, class size, and cost. Programs range in length from 1 to 4 years and lead to a certificate, associate degree, or bachelor's degree. Two-year programs are most prevalent.
Magnetic resonance imaging (MRI) is a field in which few formal programs have been developed to prepare technologists to operate MRI scanners. Most training is provided by hospitals and equipment manufacturers. Radiologic technologists are among those most often chosen to train on the equipment.
Some of the 1-year certificate programs are designed for individuals from other health professions who wish to change fields - medical technologists, registered nurses, and respiratory therapists, for example. Certificate programs also attract experienced radiologic technologists who want to specialize in radiation therapy technology or sonography. A bachelor's or master's degree in one of the radiologic technologies is desirable for supervisory, administrative, or teaching positions.
Radiography programs require, at a minimum, a high school diploma or the equivalent. High school courses in mathematics, physics, chemistry, and biology are helpful. The programs provide both classroom and clinical instruction in anatomy, physiology, patient care procedures, physics and radiation protection, principles of imaging, medical terminology, positioning, medical ethics, radiobiology, and pathology.
It is difficult to generalize about prerequisites for training programs in radiation therapy and diagnostic medical sonography, but applicants with a background in science, or experience in one of the health professions, generally are preferred. Most programs consider applicants with liberal arts backgrounds, however, as well as high school graduates with substantial coursework in math and science.
Radiologic technologists and radiation therapy technologists are covered by provisions of the Consumer Patient Radiation Health and Safety Act of 1981, which aims to protect the public from the hazards of unnecessary exposure to medical and dental radiation by making sure that operators of radiologic equipment are properly trained. The act requires the Federal Government to set standards that the States, in turn, may use for accrediting training programs and certifying individuals who engage in medical or dental radiography.
Procedures for acquiring professional credentials in radiologic occupations include licensure - required by law in some States - and certification or registration, which is voluntary. Many jobs are open only to registered or registry-eligible technologists. Hospitals, for example, generally require CAHEA-accredited training plus credentials in the appropriate radiologic technology. Public health departments and private physicians are more likely to hire workers without such credentials.
Registration is offered by the American Registry of Radiologic Technologists (ARRT) in both radiography and radiation therapy technology. The American Registry of Diagnostic Medical Sonographers (ARDMS) certifies the competence of Sonographers.
With experience and additional training, staff technologists in large radiography departments may be promoted to clinical jobs that require advanced skills in special procedures including CT scanning, ultrasound, angiography, and magnetic resonance imaging. Another route to career advancement is supervisory; experienced technologists may be promoted to supervisory positions such as chief technologist, supervisor, and ultimately department administrator or manager. Some technologists progress by becoming instructors or directors in radiologic technology programs; others take jobs as sales representatives or instructors with equipment manufacturers.
Job Outlook:
Employment in the field of radiologic technology is expected to grow much faster than the average for all occupations because of the importance of these technologies in the diagnosis and treatment of disease. Radiology is a dynamic field with vast clinical potential, and current as well as new uses of imaging equipment are virtually certain to increase demand for technologists.
Technology will continue to evolve. New generations of diagnostic imaging equipment are expected to give even better information to physicians, with less risk and discomfort for the patient, than is the case today. Computed tomography, magnetic resonance imaging, arteriography, and digital vascular imaging have taken hold very quickly.
In the treatment area, radiation therapy will continue to be used, alone or in combination, with surgery or chemotherapy to treat cancer. More treatment of cancer is anticipated due to the aging of the population, educational efforts aimed at early detection, and improved ability to spot malignancies through radiologic procedures such as mammography. New procedures based on ultrasound promise to change the way some diseases are treated. Lithotripsy, which uses sound waves to pulverize kidney stones, is an example.
However, the speed with which hospitals adopt new technologies such as lithotripsy depends largely on cost and reimbursement considerations. Magnetic resonance imaging (MRI) equipment, for example, is extremely expensive to purchase and install. Although physicians are enthusiastic about the clinical benefits, it is reimbursement policy that is the willingness of third-party payers (insurers) to pay for a particular procedure that governs the decision to adopt a technology as costly as MRI. Some promising new technologies may not come into widespread use because they are too expensive, but on the whole, it appears that the benefits to physicians and patients are so great that new uses of radiologic procedures will continue to grow.
Changes in the age structure of the population should assure expansion of the field, since middle-aged and older persons, whose numbers will grow substantially, are at risk for heart disease, cancer, and other diseases in which radiologic technologies are used. The number of heart patients undergoing arteriograms has already risen dramatically, and a further increase is likely.
Although hospitals will remain the principal employer of radiologic technologists, opportunities in nonhospital settings are increasing rapidly. Many technologists will find jobs with walk-in clinics, freestanding imaging centers, medical group practices, and health maintenance organizations. Radiology groups will constitute a particularly important employer of technologists. Health facilities such as these are expected to grow very rapidly due to the strong shift toward outpatient care, encouraged by third party payers and made possible by technological advances that permit more procedures to be performed outside the hospital.
Technologists are even working on the road. In response to rural needs, radiologic technologists travel in large vans equipped with sophisticated diagnostic equipment. This trend is likely to continue.
Most jobs will come from the need to replace experienced technologists who leave the profession. Turnover is relatively high in radiation therapy technology, because of the considerable stress in treating patients who may be close to death.
The demand for additional workers brought about by the growth and aging of the population, expansion of the kinds of facilities that provide radiologic services, technological advances in the field, and replacement needs may be increasingly difficult to meet. Currently there are reports of a widespread shortage. Although all areas of radiologic technology are affected, radiation therapy technologists and Sonographers are hardest to find.
The current situation is highly favorable for jobseekers. Enrollments in accredited training programs have declined sharply in part because the college-age population has been decreasing. Educators are taking steps to recruit older students to offset the drop in the number of young adults. However, unless there is a marked increase in the supply of radiologic technologists or a sharp drop in demand for their services, prospects for jobseekers should continue to be very favorable.
Sick leave, vacations, health insurance, and other benefits are comparable to those covering other workers in die same organization.
Related Occupations:
Radiologic technologists operate sophisticated equipment to help physicians, dentists, and other health practitioners diagnose and treat patients. Workers in related occupations include nuclear medicine technologists, cardiology technologists, cardiopulmonary technologists, cardiovascular technologists, perfusionists, respiratory therapists, clinical laboratory technologists, and electroencephalographic technologists.
