By Jenny Lower

Most Americans assume that when they’re sent to the doctor’s office for a scan, the staff person operating the machinery is qualified to do so.

But in Michigan, where members of the Michigan Society of Radiologic Technologists (MSRT) are striving to see House Bill 4869 passed, that’s not the case. While federal statutes require that mammographers and CT personnel be certified in their chosen modalities, Michigan is among 11 states that lack similar standards for individuals operating equipment that disperses ionizing radiation.

HB 4869 would alter that practice indirectly by attaching regulations to the machinery, though not to the technologists themselves. According to Cindy Kramer Reszke, president of MSRT, the law would require that fluoroscopy, radiography, and radiation therapy machines be operated by qualified personnel.

“If we want quality healthcare for patients, why are we not controlling this?” said Reszke. “[Studies are] predicting an increase in radiation-induced cancers. The only way we’re going to solve that problem is to make sure that people who run these machines are qualified.”

According to the American Society of Radiologic Technologists (ASRT), the disparity is due to a misfortune of the legislative process. The Consumer-Patient Radiation Health and Safety Act of 1981 culminated a 15-year effort by the ASRT to establish national guidelines for licensing technologists, but by the time the law was passed, all penalties for noncompliance had been removed. As a result, several states including Michigan have gone their own way, with potentially dangerous consequences.

How widespread is the problem? Gary Duehring, PhD, chair of MSRT’s legislative committee, cites an unsettling statistic: in Michigan, 20,000 facilities are licensed for x-ray equipment, but only 9,000 registered technologists reside in the state. In some offices, a receptionist might also serve as an untrained technician. Duehring recently visited a podiatrist’s office where a staff member began x-raying patients’ feet in the waiting room, exposing others to harmful radiation. In some cases, Duehring said, those operating machinery were certified at the time of hire, but have since let their certification lapse.

That may not sound like a big deal, until you consider the pace of innovation in the medical industry. “If you’re not maintaining continuing education, your competencies disappear. You’re living in the past,” Duehring said. “You can’t do what needs to be done and do it safely.”

In addition to affecting patient and technologist safety, the issue is complicated by financial implications. Practices might prefer to allow receptionists or medical assistants to take scans because they command lower pay. Meanwhile, many qualified technologists, including those just out of school, cannot find jobs.

The apparent savings in hiring unqualified personnel is deceptive, Duehring said. The Congressional Budget Office has estimated that incompetent imaging—leading to duplicate or follow-up procedures, delayed care, and a greater burden on the healthcare system down the road—costs the system $100 million per year.

HB 4869 was introduced by Representative Ben Glardon and is currently awaiting a hearing in the Committee on Health Policy. According to Reszke, MSRT is optimistic their effort will succeed. It’s been a long road: Reszke recalls hearing discussions surrounding this topic when she began her career in 1983.

“Patients do whatever the doctor says, trusting that the doctor would never send them to someone who isn’t qualified,” Reszke said. “Raising the level of awareness is absolutely necessary.”

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Jenny Lower is the Imaging Economics associate editor.

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