IMAGING WITH CARE

Legislation requiring education and certification for nuclear medicine and molecular imaging technologists could improve patient safety and save the system millions of dollars.

Each year, an estimated 17 million nuclear medicine and molecular imaging procedures are performed in hospitals and medical settings across the United States. Despite the important implications these procedures can have for patients’ health, in many states nuclear medicine and molecular imaging technologists are not required to have certification or a license to perform these tests.

Nuclear medicine and molecular imaging technologists are responsible for performing a wide variety of highly specialized procedures. It is essential that technologists perform these scans correctly to ensure that high-quality information is provided to physicians, that patients receive the lowest achievable dose of radiation, and that health care costs are minimized.

To address these concerns, the Society of Nuclear Medicine (SNM) has issued Imaging with CARE, a report that looks at the need for training and education for technologists and offers solutions to help ensure high-quality medical imaging.

The Need for High-Quality Imaging

Much depends on the quality of nuclear and molecular imaging procedures. When performed properly, a molecular imaging scan can provide unique information that allows doctors to better diagnose, guide management of, and treat diseases; however, when performed improperly, the resulting scan can be useless.

Before the nuclear or molecular imaging procedure takes place, a technologist must determine the appropriate dose of radioactive materials needed to obtain a high-quality imaging scan based on a patient’s height, weight, and affected part of the body. Based on this information, technologists also calculate the length of time a patient should be scanned.

Scan quality is affected by the positioning of the patient and the scanning device. Scanners must be placed over the appropriate body part, with the height and angle of the scanner precisely measured. Based on the body part to be imaged, technologists adjust the controls on the scanner to account for density, detail, and contrast.

If a scan is performed incorrectly, a poor-quality image may be produced. This can result in the misdiagnosis of disease, delays in treatment, and needless anxiety for the patient. If additional testing is required, patients are exposed to an increased amount of radiation. While imaging can be an invaluable tool, the procedures do carry a potential health risk, and radiation can be harmful if administered improperly.

Reducing Health Care Costs

Poor-quality imaging affects not only individual patients but also the US health care system as a whole. Repetition of medical imaging examinations due to improper positioning or poor technique costs the US health care system millions of dollars annually in needless medical bills.

According to the Radiological Society of North America journal Radiology, approximately 130 million diagnostic radiology procedures—including x-rays, MRI, CT scans, and nuclear medicine scans—are performed on 30 million Medicare enrollees a year.¹ Approximately $2.4 billion was spent by Medicare on medical imaging in 2006, according to the Government Accountability Office Medicare Part B Imaging Services report.² An estimated 4% to 7% of these procedures are repeat procedures due to poor imaging.³ It is conceivable then that by ensuring high-quality imaging and avoiding repeat scans, the federal government could possibly generate $132 million each year.

Current Requirements for Technologists

The field of nuclear medicine and molecular imaging is constantly changing. While PET and SPECT are common imaging techniques, modalities like hybrid imaging with PET/MR and optical fluorescence imaging are the new wave of the future. With new technologies upon us every year, it is critical that nuclear medicine and molecular imaging technologists are up to date on the techniques required to appropriately perform the imaging scans. Without this education, a technologist may be relying on knowledge that was acquired during their initial training, which can quickly become out of date.

Nuclear medicine and molecular imaging technologists are regulated on a state-by-state basis. Certification and ongoing registration in nuclear medicine are managed by two national organizations—the American Registry of Radiologic Technologists (ARRT) and the Nuclear Medicine Technology Certification Board (NMTCB).

To be certified by the ARRT, nuclear medicine technologists must have—within the past 5 years—successfully completed an educational program that is accredited by a mechanism acceptable to the ARRT. After meeting the ARRT Standard of Ethics, candidates must then pass an ARRT examination, which assesses the knowledge and cognitive skills underlying the intelligent performance of the tasks typically required of staff technologists practicing at entry level within the discipline.

Prospective technologists who graduate from approved nuclear medicine technology programs or meet alternative requirements (eg, related coursework or clinical experience) are eligible to take the NMTCB certification examination. Candidates who pass the examination receive certification. Currently, 30 states, as well as the District of Columbia, have licensure or regulatory provisions for nuclear medicine technologists that require them to be certified by either the ARRT or the NMTCB. The remaining 20 states do not regulate this profession at all.

Improving Medical Imaging

Across the United States, it is possible that individuals with little or no training are performing sophisticated medical imaging procedures that, if performed improperly, could harm patients and—further—cost the health care system millions of dollars. To improve the quality of medical imaging, the Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging (CARE) bill has been introduced on Capitol Hill. If enacted, this bill would establish minimum education and certification standards for personnel who perform nuclear medicine and molecular imaging procedures. As a result, institutions that provide medical imaging or radiation therapy to Medicare patients would be required to employ personnel who meet or exceed the standards set by the federal government.

The CARE bill is supported by the Alliance for Quality Medical Imaging and Radiation Therapy, a group cofounded by SNM, its Technologist Section, and the American Society of Radiologic Technologists in 1998. Since then, an additional 20 organizations have joined the alliance; together, the 23 groups represent more than 500,000 health care professionals. Many consumer and medical organizations such as the American Cancer Society, the Cancer Research Foundation of America, Help Disabled War Veterans, the National Coalition for Cancer Survivorship, and others also support the bill.

In June 2011, the CARE bill (HR 2104) was introduced in the House of Representatives by Rep Ed Whitfield (R-Ky). As of July 13, 2012, it had 130 bipartisan cosponsors. In June 2012, a companion bill was introduced in the US Senate as S 3338 by Sen Mike Enzi (R-Wyo), Sen Tom Harkin (D-Iowa), and Sen Roger Wicker (R-Miss).

Guiding Patients

Individuals undergoing nuclear and molecular imaging studies should know that even in states that do not have formal requirements, many technologists do hold certifications and are skilled in their profession. Patients should be encouraged to discuss with their physician what the recommended imaging procedure entails and other pertinent details, as an informed patient is the best patient. Examples of potential questions include:

• Does my state require licensure for nuclear medicine technologists?
• Does the facility performing my scan require certification for nuclear medicine technologists?
• What type and dose of radiopharmaceutical will I receive as part of my examination?
• Are there any side effects of the radiopharmaceutical of which I should be aware?

Regardless of whether a state has licensure or regulatory provisions, all individuals should contact their Congressional representatives to encourage them to support the CARE bill.

How SNM Is Helping

At the Society of Nuclear Medicine, we take keeping our patients safe seriously; that’s why it is important to have minimum education and certification standards for technologists.

In addition to advocating for the CARE bill on Capitol Hill, SNM has several initiatives in place to help technologists remain current on the latest technologies. The society offers continuing education courses, opportunities for advanced education, and publications on new modalities. SNM also has a road show in which it travels to its chapters throughout the country promoting the importance of radiation safety.

More information about the CARE bill, including a copy of SNM’s report, Imaging with CARE, can be found at www.snm.org/CARE.

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Ann Marie Alessi, BS, CNMT, NCT, RT(N), is a Product Sales Manager of Nuclear Medicine at Biodex Medical Systems Inc, Shirley, NY. She is the 2011-2012 President of the Society of Nuclear Medicine Technologist Section.

REFERENCES

1. Bhargavan H, Sunshine JH. Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology. 2005;234:824-832.
2. US Government Accountability Office. Medicare Part B Imaging Services. June 2008. www.gao.gov/new.items/d08452.pdf
3. American Society of Radiologic Technologists. www.asrt.org/content/GovernmentRelations/CAREBill/faq_legislative.aspx.