Radiologist assistants in North America:
How far have we come? Cindy Petree
The radiologist assistant (RA) is a relatively new role, which has been in place for little more than a decade. Since its inception, the road has been far from smooth not least due to legal inconsistencies across states and among health insurers in recognising the role. However, the continued collaboration of key organisations including the American Society of Radiologic Technologists and the American College of Radiology in support of the role helps to ensure its survival.
T
his article considers the history and development of the RA. It outlines current scope of practice and discusses the possible future direction for this role. A radiologist assistant (RA) is defined as 'an advanced level radiographer who could take
responsibility for patient assessment, patient education and patient management, perform fluoroscopy and other radiology procedures, and make initial image observations'. This definition was developed by an advance practice advisory panel in 20021
. The advisory panel consisted of representatives from the American
Society of Radiologic Technologists (ASRT), and American Registry of Radiologic Technologists (ARRT), state regulatory agencies, the National Society of Radiology Practitioner Assistants, American College of Radiology (ACR), industry and academic programs. The RA role was created to fill a projected shortage of radiologists, ease the burden of the increase in imaging utilisation, and provide a desirable career pathway for radiologic technologists (the United States equivalent of UK radiographers)2
. There are currently 10 RA educational programs in the United States, with the majority of these programs
granting master's degrees upon completion. The programs are very similar in content but do vary somewhat in format. Most offer 'hybrid' education, where the student will come to campus for designated periods each semester. There is required book work for each program but most of the learning is obtained in the clinical setting. All programs require students to obtain the same number of clinical hours (approximately
-54-
24 hours per week) for five semesters. Only one program organises clinical rotations for the student. The others expect students to have identified their own radiologist preceptor who will have agreed mentoring responsibilities until course completion. RAs must pass a registry administered by the ARRT to earn the title 'registered radiologist assistant'. There are currently 336 registered radiologist assistants in the United States.
The ARRT further defined an entry level radiologist assistant and published its role delineation, eligibility requirements, and examination content specifications in 20053
. In 2012, surveys were sent to all registered
radiologist assistants and also the radiologists for whom they worked. This resulted in the second generation document entitled Entry Level Clinical Activities, which was implemented in July 20144
This document
contains three pages of clinical activities which may be performed by a radiologist assistant. These activities range from physical examinations, non-invasive procedures such as upper gastrointestinal studies, and minimally invasive procedures such as arthrograms.
The role of the radiologist assistant Radiologist assistant practices can vary considerably between radiology centres. RAs may work in interventional departments or centres doing history and physical examinations, pre-procedure work ups, and post-procedure documentation. My current role consists mostly of performing history and physical examinations for procedures I undertake, consenting patients, barium procedures, cystograms, hysterosalpingograms, arthrograms, lumbar puncture, and myelograms. In addition, I perform paracentesis, thoracentesis, place peripherally inserted central catheters and position central lines. I also do image observation on bone densitometry scans, which go for final approval to the radiologist. All my cases are reviewed by myself and the radiologist before final dictation. Radiologists who have worked with RAs will likely all agree that an RA can add value to the practice by doing some of the non-invasive and minimally invasive procedures, while the radiologist focuses on more complicated examinations like reading MRI and PET scans. However, the centres for Medicare and Medicaid, which are large government-sponsored programs designed to help meet healthcare costs in the United States, do not recognise the role of radiologist assistant. To them, a radiologist assistant is no different to
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