The 14th World Congress, Denver, Colorado June 2006

LEADERSHIP AND MANAGEMENT COLUMN The 14th World Congress, Denver, Colorado June 2006 Rita Eyer, Admin Director, Diagnostic Imaging, Misericordia Health Centre, Winnipeg, MB Have you ever attended an international conference? You really must consider doing so. An international conference will allow you first hand knowledge in learning where other nations are heading professionally and how Canadian medical radiation technologists fit in on the global scale. The International Society of Radiographers and Radiological Technologists’ (ISRRT) 14th World Congress was an extraordinary experience and opportunity. From my perspective, it was the largest international conference of strictly technologists that I have ever been involved in. Hosted by the ISRRT, the American Society of Radiologic Technologists (ASRT) and the Association of Educators in Radiologic Sciences Inc., this conference brought together over 1200 medical radiation technologists at the Adams Mark Hotel in the beautiful city of Denver, Colorado. Attendees benefited educationally from outstanding presentations that covered topics pertinent to all, whether a front line worker or manager, and for each of our CAMRT disciplines. We were also treated to wonderful warm western hospitality with opportunities to a wide array of entertainment venues from theaters, museums and theme parks, to tours of the spectacular Rocky Mountains. Many international attendees had only viewed this mountain range previously in pictures and, needless to say, were in awe of their magnificent splendor. I would have liked to attend every lecture, but of course that is impossible when the sessions overlap. Because the issue of role development of medical radiation technologists continues to be a major topic of interest around the world, this was the area that I felt I should focus upon, and luckily had pre-registered. Pre-registration, by the way, is imperative at an international conference as it is often next to impossible to enroll once at the conference. In almost every ISRRT member country, the practices of medical radiation technology face the same pertinent issue: maintenance of an adequate workforce to meet service demands. Some nations have really stepped up to the plate in doing the right thing - modifying the training of medical radiation technologists to meet the health care needs of the 21st century. As was clearly demonstrated in the lectures that I attended, further education will not only allow technologists to expand their role into new areas, such as molecular imaging, it will enable us to gain further recognition in multidisciplinary teams. The chronic shortage of radiologists in the United Kingdom coupled with the belief that radiographers should not be restricted by outdated too restrictive boundaries, has resulted in expansion of the radiographer’s role. The United Kingdom has moved to a four-tier system of an assistant radiographer, state registered radiographer, advanced practice radiographer and consultant radiographer. An assistant radiographer undertakes a two-year post high-school diploma training program and works under the direct supervision of a qualified radiographer. The state registered radiographer has a

three-year Bachelor of Science Honors Degree and then undergoes a two-year preceptorship role transition. The advanced practioner must demonstrate evidence of role extension, have contributed to research, be considered to be a clinical expert, and be at a Masters level. The consultant radiographer is at PhD level. There are now fifteen consultant radiographers in the UK. Radiographers in the UK undertake tasks that historically were in the domain of the radiologist, routinely performing barium enema studies, undertaking breast biopsies and providing first line reports on skeletal studies. Radiographers are now reporting not only on plain films but also intravenous urography, ultrasound examinations, CT head scans, nuclear medicine scans and magnetic resonance imaging scans. Ultrasound reporting is the most established with final reports being provided with treatment recommendations. These advanced roles have, of course, been supported by postgraduate education described in the beginning of this paragraph and professional body policy. Based on this evolving role of the UK experience, case studies were presented in Denver on how the UK radiographers have accepted the challenge of expanding professional boundaries, how patient care has improved, job satisfaction has increased and costs have been reduced with the advanced radiographer role. As well in this presentation, it was pointed out that expanding the role of the radiographers has enabled radiologists to work more efficiently. The College of Radiographers in the UK supports a further extension of the radiographer’s role to provide an initial written report on all examinations they conduct by 2010. One presentation that I attended from the Queen Elizabeth Hospital in Barbados provided the results of studies evaluating the ability of a radiographer’s interpretation of accident and emergency radiographers in comparison to the emergency clinicians. The interpreting radiographer demonstrated a sensitivity of 80% and a specificity of 89%, while the emergency clinicians recorded a sensitivity of 69% and specificity of 70%. The bottom line was certainly that interpreting radiographers have the potential to make outstanding contributions to the management of accident and emergency patients by assisting emergency clinicians to accurately detect normalities and abnormalities on extremity radiographs. The combined detection rates provided a detection rate of 98.5%. The University of Salford in the United Kingdom also provided their evaluation on a radiographer-led image reading service. They also reviewed the “red dot image interpretation by radiographers” that many of you are undoubtedly familiar with. The radiographerled image reading service study provided conclusive evidence of improved timeliness and an increased number of x-rays being reported – an improvement in image reading rate from 39.7% to 80.4%! And in regards to the red dot image interpretation which has been in place in the UK since the early 1980’s. It was initiated in order to reduce errors in the x-ray interpretation of fractures in accident and emergency situations by capitalizing on the expertise of

| Fall 2006 | The Canadian Journal of Medical Radiation Technology | Automne 2006

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front-line radiographers. Data was presented on how well the radiographers had performed and suggestions were provided on continuing professional development as this is maintained. The bottom-line on the red dot interpretation by radiographers - this has become the standard of practice. Is that not fantastic! A survey of duties and responsibilities of radiographers and radiation therapists in Australia indicates that more than half of the radiographers who responded are unofficially interpreting trauma images for physicians. A similar number indicated that they obtain written informed consent, perform PACS administration, including IT systems management, quality assurance and occupational health and safety. More than 80% of the radiation therapists that responded that they provide patient education and give advice to patients on acute treatment reactions. The Australian Society is working towards gaining formal recognition for these additional skills that medical radiation technologists are performing. And in Canada great strides have been made as well. First of all, Cathryne Palmer, Academic Coordinator of the Medical Radiation Sciences Program from the University of Toronto, gave a complete overview of how their curriculum has been completely transformed for an advanced practice role, with a Master’s level education so that medical radiation technologists are the clinical experts to meet the needs our patients in the 21st century health care environment. Several radiation therapists from Canada, including Marcia Smoke from Juravinski Cancer Centre in Hamilton, and some from Princess Margaret Hospital in Toronto, gave presentations that clearly demonstrated the elevated role for radiation therapists now and even more so for the future. Over the past two decades, Ontario has been attempting to deal with the recurring shortages of professional groups involved in radiation treatment delivery. To address the shortages, the Ontario Ministry of Health and Long Term Care (OMHLTC) funded the Ontario Radiation Therapy Advanced Practice (ORTAP) steering committee to investigate the feasibility of introducing advanced roles for radiation therapists. The primary objective of this project was to determine which roles could be implemented to enhance patient access to the highest quality of radiation therapy in Ontario, most specifically the radiation therapist.

therapists working on this project- in May of this year- just before attending the ISRRT 14th World Congress, the Ministry of Health and Long Term Care announced their support for the establishment of the “Clinical Specialist Radiation Therapy”- likely a Master’s degree level of education. All the radiation therapists involved in this project and the lectures they provided in Denver as proof of their phenomenal accomplishments are to be commended! From my own perspective, I left Denver feeling the need for more formal education. The next ten years will bring about such unbelievable and exciting changes in imaging! It’s time to get started on furthering one’s own education and assisting wherever one can to ensure that our educational programs throughout Canada meet these requirements.

LEADERSHIP AND MANAGEMENT COLUMN SUBMISSION GUIDELINES The Canadian Journal of Medical Radiation Technology welcomes article submissions, both solicited and unsolicited, for the Management and Leadership Column. Queries and ideas for future articles are also welcome. Article submissions should be relevant to issues related to medical radiation technology; they should enlighten, promote debate, inform, and entertain. Submissions may include pictures and figures. All articles submitted will be reviewed by select members of the Editorial Board. Articles should: • Provide a perspective on issues relevant to leadership and management in medical radiation technology or healthcare; • Enlighten the CAMRT membership on issues pertinent to the topic of management or leadership; • Encourage interest and debate in defining and promoting best practice in management and leadership • Be appropriate for publication regarding grammar, tone, and writing style; • Have a length of approximately 1000 words.

In 2003 the Advanced Integrated Practice (AIP) model was implemented. This model combines the roles of the expert clinician specialist with responsibilities such as scientist, educator, clinical investigator, leader or manager. An advanced professional role requires post degree/diploma educational preparation in combination with clinical skills acquisition to fulfill the requirements of the job. Elements of the role may be outside the established scope of therapy practice and may overlap current areas of responsibility of another health care professional. These areas may or may not include controlled acts. Five pilot roles were selected for investigation from a number of provincial proposals: patient assessment and symptom management therapist, palliative care therapist, planning image and contour therapist, skin cancer therapist and mycosis fundoides therapist. And how exciting for this group of radiation

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| Fall 2006 | The Canadian Journal of Medical Radiation Technology | Automne 2006