Ideas in Hospital-Based Imaging

Support Staff
Medical City Relies on Mid-level Radiology Staff
Used Imaging Equipment: Know Your Risks

Support Staff

A small number of RPAs provide services in underserved areas

By Renee DiIulio

The radiologist staffing shortage continues to present challenges throughout the country, particularly in rural areas, but radiology practitioner assistants (RPAs) are stepping in to take up the slack. About 350 RPAs practice nationwide, including Brenda Barnes-Smith, who is the only RPA in Dallas. Barnes-Smith completed the RPA program at Weber State University, Ogden, Utah, and passed her boards last year. According to the National Society of Radiology Practitioner Assistants, Weber State is one of only two RPA schools in the United States; an additional seven offer radiology assistant programs. Like most RPA students, Barnes-Smith completed the requirements for the certification while working full time, and she still is employed at the same facility: Medical City, a 660-bed tertiary medical center in Dallas. Axis Imaging News spoke to Barnes-Smith about her RPA experience.

IE:  What is your background?

Brenda Barnes-Smith, RPA

Barnes-Smith: I’ve been a radiographer for 35 years, and I have done a little of everything, including cross-training in CT. Before Medical City, I was a radiologist supervisor in special procedures, and I’ve also done some teaching. I had been looking for a new challenge, and a radiologist at Medical City pushed me to enter the RPA program, saying I was performing at that level already.

IE:  You graduated with a class of 35 students, but it started with 53. Was the program very difficult?

Barnes-Smith: We covered a lot of coursework in every aspect of medicine, not just our specialty—medical ethics, for instance. We reviewed material we learned earlier, such as medical histories, equipment, and radiation protection. Many of the books we used were the same ones radiologists use when they intern, so we developed a very good base. Patient care and education were emphasized, and we received lots of hands-on training. But it was hard. We lost four students between orientation and the first class once they realized how much work it was going to be.

IE:  Did the RPA program prepare you for the job you have now?

Barnes-Smith: It made me more aware. I already had been managing many of the same tasks, but the education made me realize how important my responsibilities are and prepared me to handle more. Now, when I go to a radiologist with an interpretation of a physician’s orders, I’m often told to proceed rather than having to call the physician first; the notes are included in the [radiologist’s] dictation. Most physicians appreciate this service.

IE:  What are your specific responsibilities?

Barnes-Smith: At Medical City, I do all of the adult fluoro. I review medical histories and talk to the patient about why the physician ordered the study. I determine what the physician is looking for, perform the study, and record my observations. With a regular technologist, the radiologist would perform the study. Now, he reviews the pictures and does the file dictation.

IE:  Have you benefited from the RPA training?

Barnes-Smith: I really feel that patient care has improved. I’m a patient advocate and can spend more time with patients than the radiologist, who may have three or four other cases at the same time. Sometimes, all it takes is listening to the patient. Whatever the problem is, if we can detect it, I will find it.

IE:  What challenges have you encountered?

Barnes-Smith: I think the main challenge is support. I have that here, but some technologists don’t. It’s important to have a radiologist or mentor who will give you the instruction and the space you need to learn. It’s also important that the physicians have confidence in you.

IE:  Do you have any tips for others looking into RPA certification?

Barnes-Smith: Many of those accepted into the program already know what it takes to be an RPA. [The program selected 52 students out of 450 applicants for the 2004 matriculating class.] The main thing is to be dedicated. Many of us worked all day and then stayed up until 3 am to make class deadlines. Without the desire to finish, you won’t make it through the first semester. Whatever your expectations are, double them.

IE:  Was it worth it, economically?

Barnes-Smith: The main thing is the sense of accomplishment. I never would have dreamed I would do such a thing. I did receive a raise and plan to stay here—although I do have people calling every other day or so with new opportunities. There are so few RPAs in the United States, and even fewer in the Southwest. There are only 25 RPAs in Texas. Economically, it did benefit me, but no one should base their decision on that.

Renee Diiulio is a contributing writer for  Axis Imaging News. For more information, contact .

Medical City Relies on Mid-level Radiology Staff

Medical City, Dallas, has grown to depend on its mid-level professionals to keep its radiology department operating. David Pandit, the facility’s administrative director of radiology, admits that the department would have had to shut down without its certified radiology nurses (CRNs). “They are very much a part of the team,” he said.

The four CRNs work in a number of areas, including interventional radiology, nuclear medicine, MRI, CT, and ultrasound. “They assist with breast imaging, biopsies, and sedation,” Pandit said. “They work with adults and pediatric patients.”

A CRN’s role is to facilitate the examination and act as a patient advocate. “They stay with the patient from beginning to end, and they know both sides: technical and patient care,” Pandit explained.

All four CRNs completed their certification last year, through the American Radiological Nurses Association, Pensacola, Fla. The program included conference coursework and boards, and it took a little over a year to complete. “They started in the spring of 2005,” Pandit said. “This was really a homegrown effort. We did not have to recruit them.”

But he will have to retain them. Competition is tight with only 434 CRNs in the nation.

—R. DiIulio

Used Imaging Equipment: Know Your Risks

As the DRA cuts exert pressure on imaging facilities to lower overhead, other methods of purchasing imaging equipment become increasingly attractive. Some facilities turn to the Web for used or refurbished equipment. Seems like a great deal for the financially savvy—but are there risks and hidden costs?

Definitely, warned Robert Ward, service manager at Simons X-ray Corp, Salt Lake City. “Would you buy your prescription drugs off a guy on the street or from a pharmacist?” he asked. “Imaging equipment is controlled just like pharmaceuticals, and anyone who sells it without tracking it properly through the FDA is doing so illegally.”

eBay and similar sites are rife with used equipment selling for enticing prices, Ward noted, but determining the quality of anything purchased online can be tricky. “I had a doctor come to me who’d purchased equipment off the Internet, and nothing on it worked,” he said. “The guy who sold it had bought it at an auction and had no idea it was damaged; he thought he was selling a great piece of equipment. The doctor had paid up front.”

If you intend to buy equipment through an unregulated auction site, Ward advised certain precautions. “Call a local service company and have them go and see the machine working before it gets pulled out,” he said. “Or, if it’s sitting in a warehouse, pay 50% up front, and if you get the machine and it works right, pay the other 50%.”

Ward suggested taking measures to ensure that the equipment you’ve paid for is the equipment you receive. “If you’re buying off of an auction site, get the serial number, the model number, and the date of manufacture before you buy it,” he advised. “And get it in writing that, yes, [the seller] realized it must be put back to the manufacturer’s original conditions.”

Ward stressed that although many people are unaware of it, imaging equipment is controlled according to the same FDA regulations as prescription drugs—its trade just isn’t supervised as strictly. “The FDA’s resources aren’t strong enough to go out and enforce [them] all the time,” he said.

And purchasing used equipment does have hidden costs. Who would know better than Jim Marsh, CEO of refurbishing and resale company TGM2 Inc, Clearwater, Fla? “A lot of people forget about what they must do to their facility to accept this equipment,” Marsh said. “There’s air conditioning, power requirements, and the logistics of moving the equipment in and out. A lot goes on that really isn’t appreciated, because as a customer, you don’t usually see it. It just happens, right down to operator training.”

So, TGM2 takes on the burden of the associated factors—including bringing the equipment back up to the original manufacturer’s specifications. “We can’t provide substandard equipment,” Marsh said. “Each system has different peculiarities. I think working with a company like us really takes the pressure away.”

Sites like ensure quality by accepting the risk themselves—paying the seller up front, refurbishing as necessary, then reselling. Still, Ward warned, “If you’re buying off of the Internet, you get what you pay for. Buyer beware.”

—C. Vasko