The ASRT Practice Standards for Medical Imaging and Radiation Therapy (2022)

Preface

These practice standards serve as a guide for the medical imaging and radiation therapy profession. These standards define the practice and establish general criteria to determine compliance. Practice standards are authoritative statements established by the profession, through evidentiary documentation, for evaluating the quality of practice, service and education provided by individuals within the profession.

Practice standards can be used by individual facilities to develop job descriptions and practice parameters. Those outside the profession can use the standards as an overview of the role and responsibilities of individuals within the profession.

The medical imaging and radiation therapy professional and any individual who is legally authorized to perform medical imaging or radiation therapy must be educationally prepared and clinically competent as a prerequisite to professional practice. The individual should, consistent with all applicable legal requirements and restrictions, exercise individual thought, judgment and discretion in the performance of the procedure. Federal and state statutes, regulations, accreditation standards and institutional policies could dictate practice parameters and may supersede these standards.

Format

The ASRT Practice Standards for Medical Imaging and Radiation Therapy are divided into five sections:

  • Introduction – defines the practice and the minimum qualifications for the education and certification of individuals in addition to an overview of the specific practice.
  • Medical Imaging and Radiation Therapy Scope of Practice – delineates the parameters of the specific practice.
  • Standards – incorporate patient assessment and management with procedural analysis, performance and evaluation. The standards define the activities of the individual responsible for the care of patients and delivery of medical imaging and radiation therapy procedures; in the technical areas of performance, such as equipment and material assessment safety standards and total quality management; and in the areas of education, interpersonal relationships, self-assessment and ethical behavior.
  • Glossary – defines terms used in the practice standards document.
  • Advisory Opinion Statements – provide explanations of the practice standards and are intended for clarification and guidance for specific practice issues.

The standards are numbered and followed by a term or set of terms that describes the standards. The next statement is the expected performance of the individual when performing the procedure or treatment. A rationale follows and explains why an individual should adhere to the particular standard of performance.

  • Criteria – used to evaluate an individual’s performance. Each standard is divided into two parts: the general criteria and the specific criteria. Both should be used when evaluating performance.
  • General Criteria – written in a style that applies to medical imaging and radiation therapy professionals and should be used for the appropriate area of practice.
  • Specific Criteria – meet the needs of the individuals 42 in the various areas of professional performance. Although many areas of performance within medical imaging and radiation therapy are similar, others are not. The specific criteria were developed with these differences in mind.

Within this document, all organizations are referenced by their abbreviation and spelled out within the glossary.

Introduction

Definition

The medical imaging and radiation therapy profession comprises health care professionals identified as a bone densitometry technologist, cardiac-interventional and vascular-interventional technologist, computed tomography technologist, limited x-ray machine operator, magnetic resonance technologist, mammographer, medical dosimetrist, nuclear medicine technologist, quality management technologist, radiation therapist, radiographer, radiologist assistant or sonographer who are educationally prepared and clinically competent as identified by these standards.

Furthermore, these standards apply to health care employees who are legally authorized to perform medical imaging or radiation therapy and who are educationally prepared and clinically competent as identified by these standards.

The complex nature of disease processes involves multiple imaging modalities. Medical imaging and radiation therapy professionals are vital members of a multidisciplinary team that forms a core of highly trained health care professionals, who each bring expertise to the area of patient care. They play a critical role in the delivery of health services as new modalities emerge and the need for medical imaging and radiation therapy procedures increases.

Medical imaging and radiation therapy integrates scientific knowledge, technical competence and patient interaction skills to provide safe and accurate procedures with the highest regard to all aspects of patient care. A medical imaging and radiation therapy professional recognizes elements unique to each patient, which is essential for the successful completion of the procedure.

Medical imaging and radiation therapy professionals are the primary liaison between patients, licensed practitioners and other members of the support team. These professionals must remain sensitive to the needs of the patient through good communication, patient assessment, patient monitoring and patient care skills. As members of the health care team, medical imaging and radiation therapy professionals participate in quality improvement processes and continually assess their professional performance.

Medical imaging and radiation therapy professionals think critically and use independent, professional and ethical judgment in all aspects of their work. They engage in continuing education to include their area of practice to enhance patient care, safety, public education, knowledge and technical competence.

Bone Densitometry

The practice of bone densitometry is performed by health care professionals responsible for the administration of ionizing radiation for diagnostic, therapeutic or research purposes. A bone densitometry technologist performs bone densitometry procedures and acquires and analyzes data needed for diagnosis at the request of and for interpretation by a licensed practitioner.

Bone densitometry technologists independently perform or assist the licensed practitioner in the completion of densitometric procedures.

Cardiac-Interventional and Vascular-Interventional Technology

The practice of cardiac-interventional and vascular-interventional technology is performed by health care professionals responsible for the administration of ionizing radiation for diagnostic, therapeutic or research purposes. A cardiac-interventional and vascular-interventional technologist performs radiographic, fluoroscopic and other procedures and acquires and analyzes data needed for diagnosis at the request of and for interpretation by a licensed practitioner.

Cardiac-interventional and vascular-interventional technologists independently perform or assist the licensed practitioner in the completion of cardiac-interventional and vascular-interventional technology procedures. Cardiac-interventional and vascular-interventional technologists prepare, administer and document activities related to medications and radiation exposure in accordance with federal and state laws, regulations or lawful institutional policy.

Computed Tomography

The practice of computed tomography is performed by health care professionals responsible for the administration of ionizing radiation for diagnostic, therapeutic or research purposes. A computed tomography technologist performs computed tomography and molecular imaging procedures and acquires and analyzes data needed for diagnosis, interpretation and the performance of interventional and therapeutic procedures at the request of and for interpretation by a licensed practitioner.

Computed tomography technologists independently perform or assist the licensed practitioner in the completion of computed tomography and molecular imaging procedures. Computed tomography technologists prepare, administer and document activities related to medications and radiation exposure in accordance with federal and state laws, regulations or lawful institutional policy.

Limited X-ray Machine Operator

The operation of x-ray equipment in a limited scope is performed by health care employees responsible for the administration of ionizing radiation for diagnostic purposes. A limited x-ray machine operator performs radiographic procedures within the limited scope of practice and acquires and analyzes data needed for diagnosis at the request of and for interpretation by a licensed practitioner.

Limited x-ray machine operators are individuals other than a radiographer who perform static diagnostic radiographic images on selected anatomical sites. Limited x-ray machine operators perform their duties under the direction of a licensed practitioner, radiographer or, when indicated, a medical physicist.

Magnetic Resonance

The practice of magnetic resonance is performed by health care professionals responsible for the use of radiofrequencies within a magnetic field for diagnostic, therapeutic or research purposes. A magnetic resonance technologist performs magnetic resonance and molecular imaging procedures and acquires and analyzes data needed for diagnosis at the request of and for interpretation by a licensed practitioner.

Magnetic resonance technologists independently perform or assist the licensed practitioner in the completion of magnetic resonance and molecular imaging procedures. Magnetic resonance technologists prepare, administer and document activities related to medications in accordance with federal and state laws, regulations or lawful institutional policy.

Mammography

The practice of mammography is performed by health care professionals responsible for the administration of ionizing radiation and multi-frequency sound waves for diagnostic, therapeutic or research purposes. A mammographer performs breast imaging procedures and acquires and analyzes data, including mammographic and sonographic images needed for diagnosis, at the request of and for interpretation by a licensed practitioner.

Mammographers independently perform or assist the licensed practitioner in the completion of mammographic and sonographic breast imaging procedures. Mammographers prepare, administer and document activities related to medications and radiation exposure in accordance with federal and state laws, regulations or lawful institutional policy.

Medical Dosimetry

The practice of medical dosimetry is performed by health care professionals responsible for designing a treatment plan for use in the administration of ionizing radiation for the purpose of treating diseases, primarily cancer. Medical dosimetrists independently perform duties and complete responsibilities under the supervision of qualified medical physicists and radiation oncologists. Medical dosimetrists generate an optimal treatment plan and ensure the appropriate transfer of data that the radiation therapist will use to treat the patient. Medical dosimetrists maintain a commitment to a high degree of accuracy, thoroughness and safety.

Medical dosimetrists must maintain a high degree of accuracy in treatment planning optimization, treatment techniques and positioning. Medical dosimetrists assist the radiation oncologist in localizing the treatment area, generate a treatment plan and actively communicate with the radiation oncology team to enable and ensure the appropriate transfer of information.

Nuclear Medicine

The practice of nuclear medicine is performed by health care professionals responsible for the administration of ionizing radiation (radioactive material and computed tomography), nonionizing radiation and adjunctive medications for diagnostic, therapeutic or research purposes. Radioactive materials, medications and imaging and nonimaging equipment are used in nuclear medicine and molecular imaging to study various organs, body systems and samples to aid in the diagnosis, treatment and treatment planning of various pathological conditions. A nuclear medicine technologist performs nuclear medicine and molecular imaging procedures or therapies and acquires and analyzes data at the request of and for interpretation by a licensed practitioner and under the supervision of an authorized user. Nuclear medicine technologists also administer the prescribed radionuclide therapy to the patient at the request and under the supervision of an authorized user.

Nuclear medicine technologists independently perform or assist the licensed practitioner and authorized user in the completion of nuclear medicine and molecular imaging procedures and treatments. Nuclear medicine technologists prepare, administer and document activities related to ionizing radiation (radioactive material and computed tomography), nonionizing radiation, medications and radiation exposure in accordance with federal and state laws, regulations or lawful institutional policy.

Quality Management

The practice of quality management is performed by health care professionals responsible for the identification, measurement, control and improvement of the various core processes that will ultimately lead to improved medical imaging and radiation therapy department performance.

Today’s medical imaging and radiation therapy departments involve multiple modalities, creating an interdisciplinary team. The quality management technologist is a member of the health care team, which includes clinicians, management, support staff and customers.

Quality management has four main components: quality planning, quality control, quality assurance and quality improvement. Quality management focuses on the means to achieve image and service quality. A quality management technologist combines all of these components to ensure efficient and effective patient care.

(Video) The External and Internal of Radiotherapy Patient Safety

Quality management technologists independently perform or assist the medical physicist in the completion of quality control procedures. Quality management technologists prepare, administer and document activities related to all facets of quality management in accordance with federal and state laws, regulations or lawful institutional policy.

Radiation Therapy

The practice of radiation therapy is performed by health care professionals responsible for the administration of high doses of ionizing radiation for the purpose of treating pathologies, primarily cancer. A radiation therapist acquires and analyzes data in preparation for patient treatment, uses various imaging technologies to localize the treatment area, participates in treatment planning and performs radiation therapy procedures as prescribed and supervised by a radiation oncologist.

Radiation therapists are the primary liaison between patients and other members of the radiation oncology team. They also provide a link to other health care providers, such as social workers and dietitians. Radiation therapists must remain sensitive to the needs of the patient through good communication, patient assessment, patient monitoring and patient care skills. Radiation therapy often involves daily treatments extending over several weeks using highly sophisticated equipment. It requires thorough initial planning as well as constant patient care and monitoring.

Radiography

The practice of radiography is performed by health care professionals responsible for the administration of ionizing radiation for diagnostic, therapeutic or research purposes. A radiographer performs a full scope of radiographic and fluoroscopic procedures and acquires and analyzes data needed for diagnosis at the request of and for interpretation by a licensedpractitioner.

Radiographers independently perform or assist the licensed practitioner in the completion of radiographic and fluoroscopic procedures. Radiographers prepare, administer and document activities related to medications and radiation exposure in accordance with federal and state laws, regulations or lawful institutional policy.

Radiologist Assistant

A radiologist assistant is an advanced-practice radiographer who practices under the supervision of a radiologist and enhances patient care in radiology services. As a member of the radiologist directed team, the radiologist assistant performs invasive and noninvasive procedures at the request of and for interpretation by a licensed practitioner.

Radiologist assistants act as liaisons between patients, radiographers, radiologists and other members of the health care team. Radiologist assistants remain sensitive to the physical, cultural and emotional needs of patients through good communication, comprehensive patient assessment, continuous patient monitoring and advanced patient care skills.

Radiologist assistants maintain their radiographer credentials; therefore, both the radiologist assistant and radiography sections of the practice standards should be consulted when seeking practice information for the radiologist assistant. The clinical activities are delegated by the supervising radiologist in accordance with federal and state laws, regulations and lawful institutional policies.

Sonography

The practice of sonography is performed by health care professionals responsible for the administration of multi-frequency sound waves and other techniques for diagnostic, therapeutic or research purposes. A sonographer performs sonographic and molecular imaging procedures and acquires and analyzes data needed for diagnosis at the request of and for interpretation by alicensed practitioner.

Sonographers independently perform or assist the licensed practitioner in the completion of sonographic and molecular imaging procedures. Sonographers prepare, administer and document activities related to medications in accordance with federal and state laws, regulations or lawful institutional policy.

Advisory Opinion Statements

Advisory opinion statements provide explanations of the practice standards.

ASRT issues advisory opinions to clarify what constitutes appropriate practice and offer guidance for specific practice issues.

The profession holds medical imaging and radiation therapy professionals responsible and accountable for rendering safe, effective clinical services to patients and for judgments exercised and actions taken in the course of providing those services. The advisory opinion statements assist medical imaging and radiation therapy professionals in safe practice.

The medical imaging and radiation therapy professional’s performance should be evidence-based and consistent with federal and state laws, regulations, established standards of practice and facility policies and procedures.

The ASRT recognizes the use of GRADE for measuring the quality of evidence and strength in recommendations for the development of advisory opinion statements.

Each medical imaging and radiation therapy professional must exercise prudent judgment when determining whether the performance of a given act is within the scope of practice for which the individual is licensed, if applicable within the jurisdiction in which the person is employed, educationally prepared and clinically competent to perform.

Guidance for the Communication of Clinical and Imaging Observations and Procedure Details by Radiologist Assistants to Supervising Radiologists

After research of evidentiary documentation the ASRT issued opinions contained herein.

Advisory Opinion

It is the opinion of the ASRT based on evidentiary documentation and where federal or state law and/or institutional policy permits that:

  1. Communication of clinical and imaging observations and procedure details by the radiologist assistant to the supervising radiologist is an integral part of radiologist assistant practice. Without clear, consistent, appropriate and ascribed communication between members of the radiology team, there is a possibility of inadequate patient care, incomplete reports and diminished departmental productivity. To create a safe and productive radiology environment, communication between the radiologist assistant and supervising radiologist must be free-flowing, consistent and relevant to the patient examination or procedure. This communication can take many forms, including verbal, written and electronic correspondence. These communications may be included and taken into consideration by the radiologist in creating a final report. However, initial clinical and imaging observations and procedure details communicated from the radiologist assistant to the radiologist are only intended for the radiologist’s use and do not substitute for the final report created by the radiologist. These communications should be considered and documented as “initial clinical and imaging observations or procedure details.”
  2. While assisting radiologists in the performance of imaging procedures or during the performance of procedures under radiologist supervision, the radiologist assistant must be able to communicate and document procedure notes, observations, patient responses and other types of information relevant to the radiologist’s interpretation and creation of the final report. Radiologist assistants do not independently “report findings” or “interpret” by dictation or by any other means; and to avoid any confusion, these terms should not be used to refer to the activities of the radiologist assistant. However, radiologist assistants may add to the patient record (following the policies and procedures of the facility) in a manner similar to any other dependent nonphysician practitioner. Radiologist assistants who are authorized to communicate initial observations to the supervising radiologist using a voice recognition dictation system or other electronic means must adhere to institutional protocols ensuring that initial observations can be viewed or accessed only by the supervising radiologist. Initial clinical or imaging observations or procedure details created by the radiologist assistant resulting from the radiologist assistant’s involvement in the performance of the procedure that are included in the final report should be carefully reviewed by the supervising radiologist and should be incorporated at the supervising radiologist’s discretion.

GRADE: Strong

Definitions

See glossary.

Evidentiary Documentation

Current Literature
Not applicable

Curricula

  • Radiologist Assistant Curriculum (ASRT, 2020)

QUALITY OF EVIDENCE: High

Scopes of Practice and Practice Standards Reference

  • Scope of Practice
    • Communicating the supervising radiologist’s report to the appropriate health care provider consistent with the ACR Practice Guidelines for Communication of Diagnostic Imaging Findings.
    • Evaluating images for completeness and diagnostic quality and recommending additional images.
    • Obtaining images necessary for diagnosis and communicating initial observations to the supervising radiologist. The radiologist assistant does not provide image interpretation as defined by the ACR.
    • Providing follow-up patient evaluation.
  • The ASRT Practice Standards for Medical Imaging and Radiation Therapy
    • Performs and documents a radiology-focused physical examination, analyzes data and reports findings to the supervising radiologist. (Standard One, radiologist assistant only)
    • Performs follow-up patient evaluation and communicates findings to the supervising radiologist. (Standard Seven, radiologist assistant only)
    • Reports clinical and imaging observations and procedure details to the supervising radiologist. (Standard Eight, radiologist assistant only)
    • Maintains documentation of quality assurance activities, procedures and results. (Standard Eight, General Criteria)
    • Documents diagnostic, treatment and patient data in the medical record in a timely, accurate and comprehensive manner. (Standard Eight, General Criteria)
    • Communicates and documents a radiologist’s 1570 order to other health care providers. (Standard Eight, radiologist assistant only)
    • Documents and assists radiologist in quality reporting measures for the purpose of improved patient care. (Standard Eight, radiologist assistant only)

QUALITY OF EVIDENCE: High

Federal and State Statute References
Not applicable

Other
Not applicable

Medication Administration in Peripherally Inserted Central Catheter Lines or Ports With a Power Injector*†

After research of evidentiary documentation the ASRT issued the opinions contained herein.

Advisory Opinion

It is the opinion of the ASRT based on evidentiary documentation and where federal or state law and/or institutional policy permits that:

Medical imaging and radiation therapy professionals can access and/or use an FDA approved:

  1. Peripherally inserted central catheter (PICC) line by inserting an approved connective device. The PICC line must be designated for use with power injectors. Manufacturer guidelines regarding infusion rate and pressure must be followed.
  2. Port by inserting an approved non coring needle. The port must be designated for use with power injectors. Manufacturer guidelines regarding infusion rate and pressure must be followed.

GRADE: Strong

Definitions

See glossary.

Evidentiary Documentation

Current Literature
Not applicable

Curricula

  • Computed Tomography Curriculum (ASRT, 2018)
  • Magnetic Resonance Curriculum (ASRT, 2020)
  • Nuclear Medicine Technology Competency-Based Curriculum Guide (SNMMI, 2015 Amended April 2020)
  • Radiography Curriculum (ASRT, 2017)
  • Radiologist Assistant Curriculum (ASRT, 2020)

QUALITY OF EVIDENCE: High

Certification Agency Content Specifications

  • Components of Preparedness (NMTCB, 2020)
  • Computed Tomography (ARRT, 2017)
  • Positron Emission Tomography (PET) Specialty Examination Content Outline (NMTCB, 2016)
  • Vascular Interventional Radiography (ARRT, 2017)

QUALITY OF EVIDENCE: High

Scopes of Practice and Practice Standards Reference

(Video) Diagnostic Imaging Standards – TJC Survey Expectations

  • Scope of Practice
    • Administering medications enterally, parenterally, through new or existing vascular access or through other routes as prescribed by a licensed practitioner.*†
    • Administering medications with an infusion pump or power injector as prescribed by a licensed practitioner.*†
    • Identifying, calculating, compounding, preparing and/or administering medications as prescribed by a licensed practitioner.*†

QUALITY OF EVIDENCE: High

Federal and State Statute References
Not applicable

Other
Not applicable

*Excludes limited x-ray machine operator†
†Excludes medical dosimetry

Medication Administration Through New or Existing Vascular Access*†

After research of evidentiary documentation the ASRT issued opinions contained herein.

Advisory Opinion

It is the opinion of the ASRT based on evidentiary documentation and where federal or state law and/or institutional policy permits that:

  1. It is within the scope of practice for medical imaging and radiation therapy professionals to access and administer medications through new or existing vascular access by an approved method of administration (e.g., hand injection, power injection, slow push, bolus, infusion) as prescribed by a licensed practitioner.

GRADE: Strong

Definitions

  • access – The process of inserting an approved connective device through the access point of an existing vascular access device to deliver intravenous (IV) fluids or medication.
  • existing vascular access – Peripheral or central vascular implanted devices or external access lines that include, but are not limited to, peripherally inserted central catheter lines, intravenous lines, central lines and ports.

Evidentiary Documentation

Current Literature

  • ACR Committee on Contrast Media. ACR Manual on Contrast Media. American College of Radiology; 2020. Accessed September 4, 2020.
  • American College of Radiology. ACR practice parameter for performing and interpreting diagnostic computed tomography (CT). Revised 2017. Accessed November 30, 2018.
  • American College of Radiology. ACR practice parameter for performing and interpreting magnetic resonance imaging (MRI). Revised 2017. Accessed November 30, 2018.
  • American College of Radiology. ACR-SPR practice parameter for the use of intravascular contrast media. Revised 2017. Accessed November 30, 2018.
  • Rockwell D. A competency for central line use in radiology. J Radiol Nurs. 2008;27(2):84. doi:10.1016/j.jradnu.2008.04.016

QUALITY OF EVIDENCE: High

Curricula

  • Cardiac-Interventional and Vascular-Interventional Curriculum (ASRT, 2019)
  • Computed Tomography Curriculum (ASRT, 2018)
  • Magnetic Resonance Curriculum (ASRT, 2020)
  • Mammography Curriculum (ASRT, 2018)
  • National Education Curriculum for Sonography (JRC-DMS, 2016)
  • Nuclear Medicine Technology Competency-Based Curriculum Guide (SNMMI, 2015 Amended April 2020)
  • Radiation Therapy Curriculum (ASRT, 2019)
  • Radiography Curriculum (ASRT, 2017)
  • Radiologist Assistant Curriculum (ASRT, 2020)

QUALITY OF EVIDENCE: High

Certification Agency Content Specifications

  • Components of Preparedness (NMTCB, 2020)
  • Computed Tomography (ARRT, 2017)
  • Examination Overview: Registered Cardiovascular Invasive Specialist (CCI, 2019)
  • Magnetic Resonance Imaging (ARRT, 2020)
  • Nuclear Medicine Technology (ARRT, 2017)
  • Radiography (ARRT, 2017)
  • Registered Radiologist Assistant (ARRT, 2018)
  • Vascular-Interventional Radiography (ARRT, 2017)

QUALITY OF EVIDENCE: High

Scopes of Practice and Practice Standards Reference

  • Scope of Practice
    • Administering medications enterally, parenterally, through new or existing vascular access or through other routes as prescribed by a licensed practitioner.*†
    • Identifying, calculating, compounding, preparing and/or administering medications as prescribed by a licensed practitioner.*†
    • Performing venipuncture as prescribed by a licensed practitioner.*†
    • Starting, maintaining and/or removing intravenous access as prescribed by a licensed practitioner.*†

QUALITY OF EVIDENCE: High

Federal and State Statute References
Not Applicable

Other
Not Applicable

*Excludes limited x-ray machine operator
† Excludes medical dosimetry

Placement of Personnel Radiation Monitoring Devices

After research of evidentiary documentation, the ASRT issued opinions contained herein.

Advisory Opinion

It is the opinion of the ASRT based on evidentiary documentation and where federal or state law and/or institutional policy permits that:

  1. Radiation workers wear a personnel radiation monitoring device outside of protective apparel with the label facing the radiation source at the level of the collar.
  2. In specific cases, a whole-body monitor may be indicated. This monitor should be worn at the waist inside of protective apparel with the label facing the radiation source.
  3. In some cases, a ring monitor may be indicated. This monitor should be worn on the hand likely to receive the highest exposure with the label facing the radiation source.

GRADE: Strong

Definitions

See glossary.

Evidentiary Documentation

Current Literature

  • Bushong S. Occupational radiation dose management. In: Radiologic Science for Technologists: Physics, Biology, and Protection. 12th ed. Elsevier; 2020: 547 - 549.
  • By standards number: 1910.1096(d)(3)(i) – ionizing radiation. Occupational Safety and Health Administration website. Accessed November 30, 2018.
  • Gilmore D, Watersham-Rich K. Radiation safety in nuclear medicine. In: Nuclear Medicine and PET/CT: Technology and Technique. 8th edition. Elsevier; 2016:116.
  • Statkiewicz-Sherer MA, Visconti PJ, Ritenour ER, Welch-Haynes K. Radiation monitoring. In: Radiation Protection in Medical Radiography. 8th ed. Elsevier; 2018:75- 92.

QUALITY OF EVIDENCE: High

Curricula

  • Bone Densitometry Curriculum (ASRT, 2019)
  • Limited X-ray Machine Operator Curriculum (ASRT, 2020)
  • Nuclear Medicine Technology Competency-Based Curriculum Guide (SNMMI, 2015 Amended April 2020 )
  • Radiation Therapy Curriculum (ASRT, 2019)
  • Radiography Curriculum (ASRT, 2017)
  • Radiologist Assistant Curriculum (ASRT, 2020)

QUALITY OF EVIDENCE: High

Certification Agency Content Specifications

  • Cardiac-Interventional Radiography (ARRT, 2017)
  • Components 1733 of Preparedness (NMTCB, 2020)
  • Limited Scope of Practice in Radiography (ARRT, 2018)
  • Nuclear Medicine Technology (ARRT, 2017)
  • Radiation Therapy (ARRT, 2017)
  • Radiography (ARRT, 2017)
  • Registered Radiologist Assistant (ARRT, 2018)
  • Vascular-Interventional Radiography (ARRT, 2017)

QUALITY OF EVIDENCE: High

Scopes of Practice and Practice Standards Reference
Not applicable

Federal and State Statute References

  • § 19.12 Instruction to Workers (NRC, 2018)
  • § 20.1208 Dose Equivalent to an Embryo/Fetus (NRC, 2018)
  • § 20.1502 Conditions Requiring Individual Monitoring of External and Internal Occupational Dose (NRC, 2018)
  • Regulatory Guide 8.34: Monitoring Criteria and Methods to Calculate Occupational Radiation Doses (NRC, 1992)
  • Regulatory Guide 8.36: Radiation Dose to the Embryo/Fetus (NRC, 2018)
  • Regulatory Guide 8.7: Instructions for Recording and Reporting Occupational Radiation Exposure Data (NRC, 2016)

QUALITY OF EVIDENCE: High

Other

  • AAPM Report No. 58: Managing the Use of Fluoroscopy in Medical Institutions. Appendix A: Radiation Safety/Quality Assurance Program

QUALITY OF EVIDENCE: High

Use of Postexposure Shuttering, Cropping and Electronic Masking in Radiography

After research of evidentiary documentation the ASRT issued opinions contained herein.

Advisory Opinion

It is the opinion of the ASRT based on evidentiary documentation and where federal or state law and/or institutional policy permits that:

  1. It is within the scope of practice of a radiologic technologist to determine and apply appropriate pre-exposure collimation to individual projections of examinations to comply with the principle of ALARA. Postexposure shuttering, cropping, electronic collimation or electronic masking to eliminate the visibility of large regions of brightness are acceptable, where automatic processing fails to do so.
  2. It is outside of the scope of practice of a radiologic technologist to use postexposure shuttering, cropping, electronic collimation or electronic masking to eliminate any anatomical information. This information is a part of the patient’s permanent medical record and should therefore be presented to the licensed practitioner to determine whether the exposed anatomy obtained on any image is significant or of diagnostic value.
  3. It is outside the scope of practice of a radiologic technologist to use postexposure shuttering, cropping, electronic collimation or electronic masking to duplicate and use any acquired image for more than one prescribed view or projection on any exam. Facilities acquiring digital images are legally required to retain information in the DICOM information of each image that identifies the selected view or projection at the time of image acquisition. Using the same acquired image to represent two different prescribed views or projections is a falsification of the information in the patient medical record and imaging study made available to the licensed practitioner.

GRADE: Strong

Definitions

See glossary.

Evidentiary Documentation

Current Literature

  • American College of Radiology. ACR-AAPM-SIIM-SPR practice parameter for digital radiography. Revised 2017.
  • Bomer J, Wiersma-Deijl L, Holscher HC. Electronic collimation and radiation protection in paediatric digital radiography: revival of the silver lining. Insights Imaging. 2013;4(5):723-727. doi:10.1007/s13244-013-0281-5
  • Carroll QB. Radiography in the Digital Age. 3rd ed. Charles C Thomas; 2018.
  • Carter C, Vealé B. Digital Radiography and PACS. 3rd ed. Elsevier; 2019.
  • Chalazonitis AN, Koumarianos D, Tzovara J, Chronopoulos P. How to optimize radiological images captured from digital cameras, using the Adobe Photoshop 6.0 program. J Digit Imaging. 2003;16(2):216-229.
  • DeMaio DN, Herrmann T, Noble LB, et al; American Society of Radiologic Technologists. Best practices in digital radiography. Published 2019.
  • Don S, Macdougall R, Strauss K, et al. Image Gently campaign ba 1800 ck to basics initiative: ten steps to help manage radiation dose in pediatric digital radiography. AJR Am J Roentgenol. 2013;200(5):W431-W436. doi:10.2214/AJR.12.9895
  • Fauber TL, Dempsey MC. X-ray field size and patient dosimetry. Radiol Technol. 2013;85(2):155-161.
  • Fauber TL. Radiographic Imaging and Exposure. 5th ed. Elsevier; 2017.
  • Goske MJ, Charkot E, Herrmann T, et al. Image Gently: challenges for radiologic technologists when performing digital radiography in children. Pediatr Radiol. 2011;41(5):611-619. doi:10.1007/s00247-010-1957-3
  • Lo WY, Puchalski SM. Digital image processing. Vet Radiol Ultrasound. 2008;49(1 suppl 1):S42-S47. doi:10.1111/j.1740-8261.2007.00333.x
  • Russell J, Burbridge BE, Duncan MD, Tynan J. Adult fingers visualized on neonatal intensive care unit chest radiographs: what you don’t see. Can Assoc Radiol J. 2013;64(3):236-239. doi:10.1016/j.carj.2012.04.004
  • Seeram E. Digital Radiography: An Introduction. Cengage Learning; 2011.
  • Seeram E. Digital Radiography: An Introduction. Boston, MA: Cengage Learning; 2011.
  • Uffmann M, Schaefer-Prokop C. Digital radiography: the balance between image quality and required radiation dose. Eur J Radiol. 2009;72(2):202-208. doi:10.1016/j.ejrad.2009.05.060
  • Willis CE. Optimizing digital radiography of children. Eur J Radiol. 2009;72(2):266-273. doi:10.1016/j.ejrad.2009.03.003
  • Zetterberg LG, Espeland A. Lumbar spine radiography—poor collimation practices after implementation of digital technology. Br J Radiol. 2011;84(1002):566-9. doi:10.1259/bjr/74571469

QUALITY OF EVIDENCE: High

Curricula

  • Limited X-ray Machine Operator Curriculum (ASRT, 2020)
  • Radiography Curriculum (ASRT, 2017)

Certification Agency Content Specifications

  • Limited Scope of Practice in Radiography (ARRT, 2018)
  • Radiography (ARRT, 2017)

Scopes of Practice and Practice Standards Reference

  • Scope of Practice
    • Applying principles of ALARA to minimize exposure to patient, self and others.
    • Selecting the appropriate protocol and optimizing technical factors while maximizing patient safety.
  • The ASRT Practice Standards for Medical Imaging and Radiation Therapy
    • Participates in ALARA, patient and personnel safety, risk management and quality management activities. (Standard One, General Criteria)
    • Employs professional judgment to adapt procedures to improve diagnostic quality or therapeutic outcomes. (Standard Two, General Criteria)
    • Analyzes images to determine the use of appropriate imaging parameters. (Standard Two, limited x-ray machine operator and radiography only)
    • Verifies that exposure indicator data for digital 1842 radiographic systems has not been altered or modified and is included in the DICOM header and on images exported to media. (Standard Two, limited x-ray machine operator and radiography only)
    • Adheres to radiation safety rules and standards. (Standard Four, General Criteria)
    • Positions patient for anatomic area of interest, respecting patient ability and comfort. (Standard Four, General Criteria)
    • Uses pre-exposure collimation and proper field-of-view selection. (Standard Four, limited x-ray machine operator and radiography only)
    • Evaluates images for optimal demonstration of anatomy of interest. (Standard Five, General Criteria)
    • Adheres to the established practice standards of the profession. (Standard Twelve, General Criteria)

QUALITY OF EVIDENCE: High

Federal and State Statute References
Not applicable

Other
Not applicable

(Video) What is the CODE of ETHICS for Medical Imaging PROFESSIONALS?

Glossary

The glossary is an alphabetical list of defined terms or words specifically found in the ASRT Practice Standards for Medical Imaging and Radiation Therapy. The terms or words have meaning that might not be general knowledge. The definitions are formulated using evidentiary documentation and put into place following extensive review and subsequent approval. The glossary is not all-inclusive. New terms and new usage of existing terms will emerge with time and advances in technology.

AAPM – American Association of Physicists in Medicine

ACR – American College of Radiology

advanced-practice radiographer – A registered technologist who has gained additional knowledge and skills through the successful completion of an organized program or radiologic technology education that prepares radiologic technologists for advanced-practice roles and has been recognized by the national certification organization to engage in advanced-practice radiologic technology.

adverse event – Any undesirable experience associated with the use of a medical product in a patient.

ALARA – Acronym for “as low as (is) reasonably achievable,” which means making every reasonable effort to maintain exposures to radiation as far below the dose limits as practical, consistent with the purpose for which the licensed activity is undertaken, while taking into account the state of technology, the economics of improvements in relation to state of technology, the economics of improvements in relation to benefits to the public health and safety and other societal and socioeconomic considerations, and in relation to the use of nuclear energy and licensed materials in the public interest. The ASRT recognizes the concept of ALARA to include energies used for magnetic resonance and sonographic imaging.

anatomic (anatomical) landmarks – Bones or other identifiable points that are visible or palpable and indicate the position of internal anatomy.

archive (archival) – The storage of data in either hard (film) or soft (digital) form.

ARDMS – American Registry for Diagnostic Medical Sonography

ARRT – American Registry of Radiologic Technologists

artifact – Extraneous information on the image that interferes with or distracts from image quality.

ASRT – American Society of Radiologic Technologists

authorized user – A physician, dentist or podiatrist who meets the requirements as defined by the United States Nuclear Regulatory Commission.

beam-modification devices – Devices that change the shape of the treatment field or distribution of the radiation at (tissue) depth.

brachytherapy – A method of treatment that involves the temporary or permanent placement of radiation source(s) (isotopic or electronic) inside or immediately adjacent to a tumor-bearing region.

CCI – Cardiovascular Credentialing International

change management – Systematic approach to preparing for, implementing and sustaining a change in process.

clinical – Pertaining to or founded on actual observations and treatments of patients.

clinically competent – The ability to perform a clinical procedure in a manner that satisfies the demands of a situation, as assessed and documented by a qualified individual.

compounding medication – The combining, mixing, pooling or otherwise altering of a conventionally manufactured drug in response to or anticipation of a medication order.

compounding radiopharmaceutical – The combining, mixing, pooling or otherwise altering of a conventionally manufactured radiopharmaceutical or synthesizing/formulating a radiopharmaceutical from bulk drug substances and radionuclides.

contrast media – A substance administered during a medical imaging procedure for the purpose of enhancing the contrast between an internal structure or fluid and the surrounding tissue.

cropping – The process of selecting and removing a portion of the image.

custom blocks – Devices designed to shape the radiation field.

DICOM – Acronym for “Digital Imaging and Communications in Medicine.” The DICOM standards are a complex set of instructions to exchange and present medical image information.

dose distribution – Spatial representation of the magnitude of the dose produced by a source of radiation. It describes the variation of dose with position within an irradiated volume.

dosimetric calculations – Computation of treatment unit settings, monitor units, treatment times and radiation doses to anatomical areas of interest.

educationally prepared – The successful completion of didactic and clinical education necessary to properly perform a procedure in accordance with accepted practice standards.

electronic masking – Electronic collimation or cropping of the digital radiographic image that occurs during postprocessing of the acquired image and does not alter the size of the irradiated field.

FDA – U.S. Food and Drug Administration.

fiducial markers – Fixed reference points against which other objects can be measured. They may be placed internally, at skin surface or fixed externally to the patient.

GRADE – Grading of Recommendations Assessment, Development and Evaluation

hybrid imaging – The combination of imaging technologies that allows information from different modalities to be presented as a single set of images.

image-guided radiation therapy – A process of using various imaging technologies to localize the target and critical tissues and, if needed, reposition the patient just before or during the delivery of radiotherapy.

imaging technologies – Technologies using ionizing and nonionizing radiation to visualize physiological processes, internal structures and fiducial markers, both anatomical and nonanatomical.

immobilization device – Device that assists in maintaining or reproducing the position while limiting patient movement.

initial observation – Assessment of technical image quality with pathophysiology correlation communicated to a radiologist.

interpretation – The process of examining and analyzing all images within a given procedure and integration of the imaging data with appropriate clinical data in order to render an impression or conclusion set forth in a formal written report composed and signed by a licensed practitioner.

interventional procedures – Invasive medical imaging guidance methods used to diagnose and/or treat certain conditions.

ISCD – International Society for Clinical Densitometry

JRC-DMS – Joint Review Committee on Education in Diagnostic Medical Sonography

least significant change ‒ The least amount of bone mineral densitometry change that can be considered statistically significant.

(Video) ARRT Ethics

licensed practitioner – A medical or osteopathic physician, chiropractor, podiatrist or dentist who has education and specialist training in the medical or dental use of radiation and is deemed competent to perform independently or supervise medical imaging or radiation therapy procedures by the respective state licensure board.

MDCB – Medical Dosimetrist Certification Board

medical physicist – An individual who is competent to practice independently in the safe use of x-rays, gamma rays, electron and other charged particle beams, neutrons, radionuclides, sealed radionuclide sources, ultrasonic radiation, radiofrequency radiation and magnetic fields for diagnostic and therapeutic purposes. An individual is considered competent to practice in the field of medical physics if the individual is certified by the appropriate recognized certification organization.

medication – Any chemical substance intended for use in the medical diagnosis, cure, treatment or prevention of disease.

minimal sedation (anxiolysis) – A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.

moderate sedation – A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

molecular imaging – A noninvasive, diagnostic imaging technology that enables visualization, characterization and measurement of biologic processes at the molecular and cellular levels. Molecular imaging techniques may be applied to computed tomography, magnetic resonance, nuclear medicine, optical imaging, PET-CT, sonography and spectroscopy.

monitor units – Unit of output measure used for linear accelerators, s 1975 ometimes indicated with the abbreviation MU. Accelerators are calibrated so that 1 MU delivers 1 cGy for a standard reference field size at a standard reference depth at a standard source to calibration point.

MQSA – Mammography Quality Standards Act

NECS – National Education Curriculum for Sonography

NMTCB – Nuclear Medicine Technology Certification Board

noninterpretive fluoroscopic procedures – Use of fluoroscopic imaging under the direction of a licensed practitioner for purposes other than interpretation.

normal tissue tolerance – Radiation tolerance levels of healthy organs near or within the radiation treatment fields.

NRC – U.S. Nuclear Regulatory Commission

panning – Movement of the procedure table during image production to maintain visualization of an anatomic region of interest.

personal radiation monitoring devices – Devices designed to be worn or carried by an individual for the purpose of measuring the dose of radiation received.

physics survey – Performing equipment testing, evaluating the testing results and completing a formal written report of results. The written survey report, validated by a medical physicist, contains sufficient information to document that each test was conducted according to local, federal or state requirements and includes an assessment of corrective actions and recommendations for improvements.

postprocessing – Computerized processing of data sets after acquisition to create a diagnostic or therapeutic image.

procedure – Specific course of action intended to result in an imaging study, treatment or other outcome.

processing – Manipulation of the raw data just after acquisition.

protocol – The plan for carrying out a procedure, scientific study or a patient’s treatment regimen.

quality assurance – Activities and programs designed to achieve a desired degree or grade of care in a defined medical, nursing or health care setting or program. Sometimes indicated with the abbreviation QA.

quality control – The routine performance of techniques used in monitoring or testing and maintenance of components of medical imaging and radiation therapy equipment. This includes the interpretation of data regarding equipment function and confirmation that corrective actions are/were taken. Sometimes indicated with the abbreviation QC.

radiation oncologist – A physician who specializes in using radiation to treat cancer.

radiation protection – Prophylaxis against injury from ionizing radiation. The only effective preventive measures are shielding the operator, handlers and patients from the radiation source; maintaining appropriate distance from the source; and limiting the time and amount of exposure.

radioactive material – A substance composed of unstable 2013 atoms that decay with the spontaneous emission of radioactivity. Includes radiopharmaceuticals, unsealed sources (open, frequently in liquid or gaseous form) and sealed sources (permanently encapsulated, frequently in solid form).

radiobiology – The study of the effects of radiation on living organisms.

radiography – The process of obtaining an image for diagnostic examination using x-rays.

sentinel event – An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

setup – Arrangement of treatment parameters used in preparation for delivering radiation therapy; includes patient positioning data, field alignment information and equipment configurations.

shuttering – A postprocessing technique that may be used to eliminate ambient light around an image for the sole purpose of improving the quality of the displayed image. It should not be used as a substitute for insufficient collimation of the irradiated field.

simulation – A process using imaging technologies to plan radiation therapy so that the target area is precisely located and marked; the mockup procedure of a patient treatment with medical imaging documentation of the treatment portals.

SNMMI – Society of Nuclear Medicine and Molecular Imaging

static – Any medical image that is fixed or frozen in time.

supervising radiologist – A board-certified or board-eligible radiologist who oversees duties of the radiologist assistant and has appropriate clinical privileges for the procedure performed by the radiologist assistant.

timeout – Preprocedural pause to conduct a final assessment that the correct patient, site and2038 procedure are identified.

tolerance levels (doses) – The maximum radiation dose that may be delivered to a given biological tissue at a specified dose rate and throughout a specified volume without producing an unacceptable change in the tissue.

treatment calculations See dosimetric calculations.

treatment field (portal) – Volume of tissue exposed to radiation from a single radiation beam.

treatment planning – The process by which dose delivery is optimized for a given patient and clinical situation. It encompasses procedures involved in planning a course of radiation treatment, including simulation through completion of the treatment summary.

treatment record – Documents the delivery of treatments, recording of fractional and2048 cumulative doses, machine settings, verification imaging and the ordering and implementation of prescribed changes.

T-score – Number of standard deviations the individual’s bone mineral density is from the average bone mineral density for gender-matched young normal peak bone mass.

USP – United States Pharmacopeia

vascular access device – Apparatus inserted into the peripheral or central vasculature for diagnostic or therapeutic purposes.

vascular closure device ‒ Active or passive medical devices used to achieve hemostasis after a cardiovascular or endovascular procedure that requires catheterization.

(Video) Medical Physicist assistants in radiation therapy

venipuncture – The transcutaneous puncture of a vein by a sharp rigid stylet or cannula carrying a flexible plastic catheter or by a steel needle attached to a syringe or catheter.

verification images – Images produced to confirm accurate treatment positioning and accurate treatment portals.

Z-score – Number of standard deviations the individual’s bone mineral density is from the average bone mineral density for age- and gender-matched reference group.

FAQs

Is defined as conforming to the standards of conduct of a given profession or group? ›

Ethics is defined by Webster's dictionary as conformance to the standards of conduct of a given profession or group. Such standards are often defined at a disciplinary level though a professional code of conduct, and sometimes enforced by university committees called even Institutional Review Board.

What do the initials RT R stand for? ›

The RT(R) stands for registered radiologic technologist. This title is awarded by the American Registry of Radiologic Technologists (ARRT) when a healthcare professional completes classroom and clinical education requirements, passes the national ARRT examination, and meets all ethical requirements stated by the ARRT.

What kind of monitors do radiologists use? ›

Resolution/Megapixel -The best monitors for radiology should have at least 5 megapixels or a 2592 x 1944 pixels for clarity. That's why we recommend 4K monitors which are about 8.5 megapixels which is ideal and common in the monitor market.

What does Asrt publish? ›

Monthly electronic newsletter for members. Each issue introduces readers to member benefits, advocacy news, upcoming events, continuing education opportunities and other information related to your career and professional development. Quarterly newsletter just for members with the Premium membership option.

What are the 3 types of conformity? ›

Herbert Kelman identified three major types of conformity: compliance, identification, and internalization.

What are the 7 codes of ethics? ›

Seven golden ethical principles:
  • Be an ethical leader.
  • Use moral courage.
  • Consider personal and professional reputation.
  • Set the right tone at the top.
  • Maintain an enquiring mindset.
  • Consider the public interest.
  • Consider 'the right, the good and the virtuous' actions"
20 Feb 2019

Videos

1. Introduction to Radiation Safety for CT
(Intersocietal Accreditation Commission)
2. Rad 162 Lecture 1: Video 1 of 2
(nick aston)
3. Medical Radiation: An Overview of the Issues Important to Technologists
(UCSF Virtual Symposium Radiation Safety in CT)
4. Part 1 CT Dose
(Leo Valentin MD)
5. ISRRT Special Program to cerebrate 2021 World Radiography Day
(PARI_Official)
6. ACR regulations screen cast
(Thomas Erickson)

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