Deregulation of MRI and ultrasound imagi

[Vere Smyth <vere@nrl.moh.govt.nz>]

Dear Radsafers

I would very much appreciate your comments on the following, or the
addresses of any other people who may be able to help.

I am on a committee reviewing regulation in the health system in NZ,
currently looking at technologists (ie MRTs, radiographers) who do MRI and
ultrasound.  Under the present system here it is a legal requirement for
anyone doing this to be registered as an MRT.  Registration is on the basis
of acceptable training and experience.

The argument for continuing with regulation (compulsory registration) goes
like this:

It is essential for patient safety, both physically and  in terms of
providing valid diagnostic information that technologists are sufficiently
competent.  Particularly in ultrasound, the tech takes considerable
independent responsibility for reporting scans.  Medical establishments are
 under increasing pressure to cut costs and there is a temptation to employ
less qualified staff because they are cheaper.  The only defence against
this is regulation.    Furthermore, if establishments throughout the country
do accept that they must employ suitably trained staff, it is much more
efficient for a central registering agency to assess training than for each
establishment to spend time and resources on this.

The argument against regulation is:

MRI and ultrasound are not as physically hazardous as ionising radiation.
 The quality of work in these  occupations is effectively "regulated from
above".  Hospitals must provide quality health services.  The reporting of
scans is the responsibility of a radiologist (obstetrician, cardiologist,
etc) who must be registered to practice.  He/she must take responsibility
for the quality of work done by the techs.  There is sufficient pressure
both from the need for the establishment to provide a good service, and from
the clinician's professional body to protect the patient from the effects of
an incompetent tech.  Therefore the added cost to the country in having a
central registering agency is not justified in terms of benefit to the
patient.

Both arguments are plausible.  I am interested in comments from as many
different states and countries as possible.  Please send to:

Vere Smyth
National Radiation Laboratory
PO Box  25 099
Christchurch
NEW ZEALAND
Ph:    0064-3-366-5059
Fax:  0064-3-366 1156
email:  vere@nrl.moh.govt.nz