Is it Time for a New Type of Imaging Technologist?

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In 1969 JRCERT was established to accredit radiologic technology schools. JRCNMT began certifying nuclear medicine schools in 1970. JRCERT began accrediting MRI schools in 2003. Most radiologic technology schools have been and are currently at the associate level. Although Nuclear Medicine schools are trending toward the baccalaureate degree, many remain at the associate level. In 2010, JRCERT recognized 4 disciplines in radiologic sciences: radiography, radiation therapy, MRI, and medical dosimetry. A 5th discipline, nuclear medicine and molecular imaging, a major component in advanced imaging, is missing.

In 2002 the PET-CT Consensus Conference recognized that radiologic technologists, nuclear medicine technologists, and radiation therapists could perform PET/CT with additional training. Subsequently, PET and CT certifications were offered by the ARRT and NMTCB to all technologists meeting requirements. Some enterprising imaging technology schools are offering a pathway for both radiologic technologists and nuclear medicine techs to receive the required training and experience needed to sit for the CT or MR advanced certification. However, very little has been done to restructure the imaging educational experience to embrace the knowledge needed to understand and operate the complex imaging systems of today and tomorrow in a wholistic way. It has been fragmented at best.

Today, we have hybrid systems that utilize principles found in MR, PET, SPECT, CT and Mammography. High end CT scanners perform non-invasive angiography and utilize principles taught in cardiovascular technology schools and in nuclear medicine. Cardiac and Breast MRI rely on nuclear medicine and mammography principles. There is also functional MR (fMRI) which measures brain activity by detecting changes associated with blood flow.

During the 2018 ASRT Foundation HealthCare Industry Advisory Council Meeting, the manufacturers of high-end imaging equipment were concerned with the length of time needed to train the technologists. The few days of provided equipment training has morphed into weeks. Often additional education is purchased by the imaging center to help the technologists improve their skills and understanding of the technology.

Norman E. Bolus, the current SNMMITS President attended this meeting. The message resounded personally with him. He is the Director and Assistant Professor at the University of Birmingham School of Health Professionals Nuclear Medicine Program where an entry level Master of Science in Nuclear Medicine is offered.

After discussing the need to move our profession forward, he asked me to chair a taskforce to explore, and possibly create, a differently educated imaging professional that has the knowledge and skills to provide radiologists with the information they need, specific to each patient that can be delivered using advanced imaging equipment when used to its full potential.

Because this new equipment relies on principles of radiography, CT, magnetic resonance, molecular imaging and pharmacology, the entire imaging technologist community needed to be involved. A consortium consisting of representatives from the AHRA, SNMMITS, ASRT, SMRT (ISMRM), JRCERT, JRCNMT, NMTCB, ARRT, and Program Directors of a Radiologic Technology and Nuclear Medicine program was formed.

The first conference call was 9/19/18. Although participants were receptive to the idea there were two major concerns.

  1. Do Imaging Department Directors utilize advanced imaging equipment in high enough numbers to warrant creating a different training model? If many departments do use this equipment is there a need to train the technologist differently than in the past? Would there be push back from Imaging Directors to hire these individuals at a higher salary?
  2. What are high end equipment vendors planning 5 years down the line? Is R&D creating scanners that take advantage of artificial intelligence to produce excellent images, leaving the tech as a “buttonologist”?

To answer these questions, AHRA volunteered to send out a survey to AHRA members. 130 responses were received. 70% of all respondents agreed that additional education was needed for those technologists using advanced imaging equipment. Some were unsure and 18% did not believe additional training was needed.

I attended the RSNA and met with the four major imaging vendors: Canon, GE, Siemens, and Philips. All stated that technology introduced 5 years from now will expand hybrid equipment to include all variations of modalities. Operating the equipment will be easier, but the big data generated by these scanners will be such that the tech will have to understand it, manipulate it, and analyze it so that the final image is specific to the patient. They all agreed that a differently trained tech needs to be created.

One vendor indicated they were going to create their own educational model that techs would have to attend before they could be in-serviced by the vendors. Besides classes on the technology itself, they were thinking of providing didactic lectures in disease pathology, molecular biology, and imaging physics based on the imaging principles and physics specific to the equipment purchased. This vendor had not reached out to the professional societies and seemed unaware that the professional organizations define a profession’s scope of practice, enable appropriate curriculum to be developed and taught, at an accredited school, and assure that competency of knowledge learned is verified by a certifying body.

Conference calls have focused on the curriculum needed and the delivery system for this education.  There were also calls that discussed possible licensing and credentialing roadblocks and how these could be mitigated proactively.

The team is preparing for a full day retreat in April to dialogue and debate the path forward. It is hoped that the organizations that define and support our profession will be good stewards and will enable imaging technologists to evolve as quickly as the technology they operate. Stay tuned…

Lynne Roy, MBA, MS, CNMT, FSNMMITS is the Executive Director of Imaging at Cedars Sinai Medical Center, Los Angeles, CA. She is Chair of the Imaging Scientist Task Force for SNMMITS. Lynne can be reached at

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