Re: Deregulation of MRI and ultrasound imagi

["Dr. Geoff Clarke" <CLARKE@physics.SWMED.EDU>]

On Tue, 16 Jan 96 17:17:42 -0600 Vere Smyth siad

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 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.

-------------------------------------------

Dear Vere:

Appropriate training and registration of MRI technologists has 
absolutely nothing to do with radiation safety.  These are people who 
are charged with performing a complicated and important diagnostic 
functions.  Perhaps in New Zealand every tech performs the 
same protocol on every patient, but here in the states MRI exams are 
far from being turn key operations.  New methods, such as MR angiography 
require that the tech has a through understanding of NMR physics.  
Newer methods, such as functional MRI and quantitative flow 
measurements will place even greater demands on the technologist.  

Most importantly, the technologist is the person directly responsible 
for the patient's condition during the exam.  She needs to be capable 
of handling any emergency situation, such as the patient has a heart 
attack in the magnet.  She also must ensure that safe procedures 
are followed, such as in the administration of contrast agents and 
ensuring that ferromagnetic objects, which might become projectiles, 
are kept away from the magnet.  If you look at hospital statistics, 
you will see that the risks from radiation of all kinds are miniscule 
compared to the risks of being dropped from a gurney or having the 
wrong body part operated on.

Here in the states, there is as much pressure on radiological quality 
improvement (patient services,as well as image quality) as there is 
on reducing costs, even though these two goals inherently conflict at 
some point.  A facility's registration of its MRI technologists is a 
good first step toward the development of a quality assurance 
program for the MRI clinic, but should be combined with other prudent 
measures.  Assuming that the administrators of all facilities will 
provide good quality of care without personnel who have met 
established  guidelines, such as those provided by the registry 
exams, is wishful and dangerous thinking.

Geoff Clarke
U.T. Southwestern Medical School
Dallas, TX
clarke@physics.swmed.edu