Editor's note: In his regular column, Europe's very own maverick radiologist, Dr. Peter Rinck, addresses the latest controversial topic. Find out now what's on his mind.
One of the topics at ECR 2011 in Vienna was carefully kept under wraps: the decision of a major Dutch hospital's department of radiology to train some of its radiographers to read images. It was not discussed on the stage, but rather in the corridors and at the coffee tables. The overall initial response seemed positive: Why shouldn't a well-trained radiographer be competent to read certain imaging studies, for instance in emergency rooms?
The move in the Netherlands follows similar concepts in the U.K. and Scandinavia but goes well beyond the existing "red dot system," under which radiographers check the images of a patient and place a red dot on any image where they see or suspect an abnormality, mostly at emergency units or casualty departments.1 This established role of technicians is now being extended into one of "reading radiographers."
Dr. Peter Rinck, PhD, Maître de Conférence and visiting professor of medical imaging at the University of Mons, Belgium.After special training and an examination in the U.S., so-called registered radiologist assistants are already allowed to perform selected radiology examinations and procedures, and may be responsible for evaluating image quality and making initial image observations. However, the supervising radiologist remains responsible for providing a final written report, an interpretation, or a diagnosis. Could this be a way around further turf wars and into strengthening radiology -- or will it create new turf wars?2,3
The annual salary of such a radiologist assistant in the U.S. is about 72,000 euros (approximately $102,000 U.S.), which is similar to a board-certified hospital-based radiologist in Germany or two-thirds of the salary of a radiologist in Norway.
What are the reasons for this and similar developments elsewhere? There are not enough trained radiologists to read all the pictures produced today. The number of x-rays, CT and MR images, ultrasound examinations and others have exploded, not only the number of studies but also images per study. Teleradiology and computer-assisted radiology were going to be the way out. But there is still overproduction, and the daily heaps are growing into mountains.
It would be better to cut down on unnecessary examinations and focus upon the meaningful use of imaging studies. And this has to happen in the foreseeable future. We don't need bigger storage spaces on the computers but a rational limitation of the overproduction. We need referring physicians and radiologists to understand the advantage of thinking (with their own brains) and to critically assess the ever increasing workload.
We also have to take into account legal and ethical aspects. For instance, who will be responsible for the contents of the final radiological reports? We should also think twice about what kind of consequences such a solution will have. Will we create "bare-foot" radiologists? Some patients and doctors will think that radiology now delivers inferior services, not provided by professionals but by paramedics, and they might think radiologists are easily replaceable. To play with fire means to court disaster. Does the end justify the means?
You don't heal a growing cancer with aspirin or even morphine, even if the patient might feel better for some hours or days. You have to grab the problem by the roots. You might get through the heap of images with the help of radiographers, no doubt. However, this won't solve the problem. It's the typical political and administrative approach of our times: leveling downward, by management of the consequences, but not by solving the causes. Guidance from a high chair is easy, but being constructive, creating more positions for highly trained (and well-paid) professionals, and fighting extravagant waste medicine for the monetary benefit of parasites require real women (and men).
What will happen when new positions for specially trained technologists are introduced everywhere? There will be a new class of image readers who are in between radiologists and "simple" technicians. They will be upper-class technicians, looking down on their former comrades in arms. Envy, malevolence, and bickering will move into the departments, and the atmosphere will be tense, as it was some time ago when radiographers fought against radiology nurses who did not have the technical training they had.
You tell me that this is no argument? Wait and see and live with it. Psychology is part of the job. Today you don't find radiologists, and it is often even more difficult to find department heads to fight off the bureaucrats; in some places you already have technicians as department heads because no radiologist wants to take that job -- with (in politically correct lingo) interesting results.
References
Smith LAC. The Red-dot system in medical imaging: Ethical, legal and human rights considerations. Radiographer. 2006;53(3):4-6.
Rinck PA. Expertise and judgment ensure turf war success. http://www.rinckside.org/Rinckside Columns/2002 12 Expertise and judgment ensure turf war success.htm.
American Medical Association: Registered radiologist assistant. http://www.ama-assn.org/ama1/pub/upload/mm/40/mi07-radiog-asst.pdf.
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