Stuart E. Mirvis, MD, FACR
Thinking back over my training in radiology, I recall more than
a few occasions when technologists' advice definitely saved the
day, most often in the interventional domain. With a wealth of
previous experience, our angiography technologists (only two in
those days) taught the "wet behind the ears" resident, and later
fellow, many tricks of the trade needed for difficult procedures.
Spending a few years at a single hospital, you get to know many of
the technologists, probably become good friends with some, and
still lean on them occasionally for advice in challenging
situations. Of course, as is true in any profession, some
technologists, just like some radiologists, are not top flight,
thereby making your job, and theirs, more difficult.
The technologist plays a pivotal role dealing with and
coordinating many different interests within the hospital. Staff
radiologists, other staff physicians, nurses, transport personnel,
housekeeping services, and residents/fellows in teaching hospitals
are among the many people who may impact the job that the imaging
technologist is trying to perform. Sometimes these various entities
have different and, to an extent, competing interests. Within this
framework, the technologist must often prioritize studies, maintain
high patient throughput, assure proper patient preparation for a
study, determine any special study procedures or image processing,
generate image copies, and so on.
Sitting down for a half-day and watching the technologist
perform his or her duties should be enlightening to most
radiologists. Performing imaging studies is really only a small
part of their overall responsibilities. Coordinating studies,
answering the ceaselessly ringing telephone, helping transfer
patients, seeing to patients' safety and comfort, and dealing with
patients' anxiety are baseline activities. There are many obstacles
that technologists face daily, such as delays in patient arrival,
inadequate or no venous access, lack of appropriate nursing and
other patient care personnel, incomplete study protocols, inability
to find radiologists to discuss questions or concerns, use of their
consoles by physicians to review cases, and failure of physicians
to request appropriate studies. Even worse is the not infrequent
situation in which a technologist, especially one working in the
acute care setting, is caught between physicians, each of whom is
demanding study preference for his or her patient; this is never an
appropriate position for a technologist.
Is this the routine that technologists, who are willing to work
in the demanding hospital setting, should expect? Can we as
radiologists make their jobs less stressful and more satisfying?
How can radiologists help our technologists work more efficiently
and maintain high study quality?
Physicians and administrators must appreciate radiology
technologists as the professionals they are, as essential a part of
radiology as nurses are in medicine or surgery. Technologists are
not ancillary or support staff any more than nurses or physician
assistants. Radiologists should take available opportunities to
teach technologists radiology pathology and the reasons why a
particular study or protocol is optimal for a given case.
Personally, I have yet to find a technologist who was not eager and
interested to learn such material. Too often the technologist is
made a "scapegoat" for conflicts over imaging studies that involve
clinical staff and radiologists. It is far more prudent to learn
the technologists' view of matters carefully and to defend them
vigorously whenever appropriate to the circumstances. Physicians
have no right to browbeat or try to intimidate an imaging
technologist. Problems regarding a technologist's performance
should be brought to the attention of an immediate supervisor,
preferably, or a staff radiologist for discussion.
Technologists should have input into the design and
implementation of quality improvement initiatives in their areas.
They should be included in decisions regarding purchase of imaging
equipment and room design and modifications to optimize workflow.
Direct and open lines of communication between the radiology staff
and the technology staff should be well established. Members of the
technology staff possess a lot of great ideas to improve many
aspects of the imaging process, including imaging protocols,
workflow and efficiency, and patient safety and satisfaction. They
should be encouraged to share them.
Radiologists and technologists are a team. The team works best
with mutual support and allegiance. Take the opportunity, often
overlooked during the hectic workday, to interact more closely with
the technologists and to improve the ultimate product of our
efforts. The outcome will provide high-quality imaging studies,
which will promote high-quality interpretation, and ultimately
benefit the patient.
Dr. Mirvis is the Editor-in-Chief of this journal and
Professor of Radiology, Diagnostic Imaging Department, University
of Maryland Medical Center, Baltimore, MD.