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.