Radiologist Assistants Research Articles

Assessing the impact of trained Radiologist Assistants in a busy emergency teleradiology practice: a comprehensive evaluation.

This study aims to study the feasibility and usefulness of trained Radiologist Assistants in a busy emergency teleradiology practice. This is a retrospective study over a 21-month period (January 2021 to September 2022). The study analysed archived data from 247118 peer review studies performed by Radiologist Assistants (RAs) out of a total case volume of 828526 and evaluated the rate of discrepancies, the study types commonly noted to have discrepancies, and the severity of errors. These missed findings were brought to the attention of the radiologists for approval and further decision-making. Peer review by RAs was performed on 30% (n = 247118) of the total volume 828526 studies reported, and yielded additional findings including but not limited to fractures (218; 23%), hemorrhage,(94; 10%) pulmonary thromboembolism, (n = 104; 11%), Calculus (n = 75; 8%) lesion (n = 66; 5%), appendicitis(n = 50; 4%) and others. These were brought to the attention of the radiologist, who agreed in 97% (1279 out of 1318) of cases, and communicated the same to the referring facility, with an addended report. Trained RAs can provide value to the peer review program of a busy teleradiology practice and decrease errors. This may be useful to meet the ongoing radiologist shortages.

Rules and Regulations Relating to Roles of Nonphysician Providers in Radiology Practices.

Nonphysician providers (NPPs) in radiology practices include nurse practitioners, physician assistants, and radiologist assistants. The number of NPPs has been increasing both within and outside of radiology departments. In order for leaders in radiology departments to incorporate NPPs effectively into their practice, they require nuanced knowledge of appropriate coding and billing for services these professionals render. Furthermore, the existing body of literature suggests that with a defined and appropriate scope of practice and proper supervision, NPPs can provide care that is at least equivalent to that provided by attending physicians for narrowly defined tasks. A broader understanding of the rapidly evolving NPP workforce both within radiology practices and throughout other health care specialties will inform practice leaders who are adapting to a health care system that is moving rapidly toward value-based incentive payment models. ©RSNA, 2018.

Three-Dimensional Reconstruction of Cone Beam Computed Tomography Images Using Oscar-Analysis On 36 Projections

The use of Cone-Beam Computed Tomography (CBCT) scanner has become powerful tools for medical imaging techniques. This will allow medical surgeons and radiologist assistants to diagnose patients before any treatment can be taken place. However, the CBCT concepts require high demand for computer resources to reconstruct three-dimensional (3D) model from two-dimensional (2D) images. Based on this problem, Open Source Cone-Beam Reconstructor (OSCaR) was used to train medical and biomedical engineering students in understanding the concepts of computed tomography scanner. This software requires only a small capacity of computer resources, thus allowing students to practise using their own computer. With a small number of projections, the authors evaluated the performance of OSCaR to reconstruct 36 numbers of 2D x-ray images. By using the cone-beam x-ray tube, 36 images of lemon and chicken bone were captured and saved into Digital Imaging and Communication in Medicine (DICOM) files. The DICOM files were then imported to the OSCaR software for the reconstruction process. Based on the results, this study successfully reconstructed 3D images of lemon and chicken bone. In conclusion, higher number of projections would produce better results in terms of accuracy and high resolution. However, the use of 36 numbers of 2D images is adequate for students to understand the concepts of computed tomography scanner.

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Operational and Educational Implications

The numbers of nurse practitioners (NPs) and physician assistants (PAs) are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. The use of radiologist assistants is growing in some radiology practices as well. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside radiology departments warrants closer review, particularly with regard to their potential influence on radiology education and medical imaging resource utilization. In this article (the second in a two-part series), the authors review recent literature and offer recommendations for radiology practices regarding the impact NPs, PAs, and radiologist assistants may have on interventional and diagnostic radiology practices. Their potential impact on medical education is also discussed. Finally, staffing for radiology departments, as a result of an enlarging nonradiology NP and PA workforce ordering diagnostic imaging, is considered.

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Regulatory, Billing, and Compliance Perspectives

The numbers of nurse practitioners and physician assistants are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. Some practices have instead embraced radiologist assistants. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside of radiology departments warrants closer review. The authors evaluate the recent literature and offer recommendations to radiology practices regarding both regulatory and scope-of-practice issues related to these professionals. Additionally, billing and compliance issues for care provided by nurse practitioners, physician assistants, and radiologist assistants are detailed. An analysis of the integration of these professionals into interventional and diagnostic radiology practices, as well as potential implications for medical education, is provided in the second part of this series.

Comparative Analysis of Physician Extender Curricular Requirements in Radiology: A Detailed View

This article provides a detailed analysis comparing the educational requirements for physician assistants, nurse practitioners, and radiologist assistants (RAs) working in radiology. The authors examine the curricular requirements as they pertain to radiology for each program and highlight the advantages and limitations of each within potential roles in radiology. A literature review was performed using the following databases: CINAHL Plus, MEDLINE, and Academic Search Complete. The search parameters were English-language peer-reviewed articles published from 2002 through 2010. The search terms included "physician assistant," "nurse practitioner," "radiologist assistant," "radiology practitioner assistant," and "physician extender." The inclusion term applied was "radiology" to further hone results. The RA curriculum includes a core education that is comparable with the physician assistant and nurse practitioner curricula, with the exception of prescriptive authority and health promotion and disease prevention. The RA curriculum adds instruction in radiobiology, radiation safety, radiologic procedures, fluoroscopic unit operation and safety, and radiopharmaceuticals. The RA curriculum is specific for the radiologic imaging area and advantageous to radiologists, radiology managers, and patients undergoing diagnostic procedures.

Putting the Light (Not the Heat) Back Into Radiology Morbidity and Mortality Conferences

Jonathan L. Mezrich, MD, JD, MBA, LLM, has proposed some interesting ideas, one in particular that all of us should think about seriously. Radiologists in general do not pay enough attention to trying to uncover their mistakes and learn from them. On a typical working day, a radiologist might read several dozen cases, maybe even more than 100. Many are routine normal studies or “no changes,” but there are bound to be some that have interesting, perplexing, or unexpected findings. We read these cases, transmit our reports to the referring physicians, and maybe consult with them by phone or in person. But often, we never get clinical follow-up to see if our interpretations are correct. Any follow-up we do get is sporadic and informal. I would be willing to bet that there is no radiology department in the country, academic or private, that tracks every single challenging case to find out whether the radiologist’s interpretation was correct. That means that we are all missing out on opportunities for learning and quality improvement. At most, academic departments have occasional bland “quality assurance” (QA) or “missed case” conferences, at which anonymous cases are shown, identities are scrubbed, and no blame is attached. What to do about this? There are no easy answers. All of us are busy, working long hours, and already overburdened with bureaucratic and administrative demands. To track every challenging case and get definitive follow-up would be a huge logistic undertaking: time consuming and probably necessitating the hiring of several administrative assistants or radiologist assistants or adding additional work for the residents. It is not likely to happen in this era of belt tightening. Moreover, no one likes to publicly admit mistakes. It is easier and more discreet to sweep them under the rug and keep them private. Even good QA programs such as the ACR’s RADPEERTM do not necessarily require that definitive follow-up be obtained. Dr Mezrich, currently a resident in radiology, has used his background as an attorney and surgical resident to propose that radiologists adopt the more rigorous approach that has been used by surgeons for decades: the morbidity and mortality (M&M) conference. He describes M&M conferences as being more adversarial and confrontational than the typically passive QA or interesting case conferences that are held in many academic radiology departments. Presumably all or most complications that occur on a surgical service are discussed during these M&M conferences. One problem with trying to use this approach in radiology has to do with the sheer volume of cases. A typical general surgery service might perform several dozen operations per week. Everyone gets to know who the operating surgeon is because that surgeon becomes involved with the patient for an extended period of time. Because of the nature of surgery, the final diagnosis and the occurrence of complications have become apparent by the end of the patient’s hospital stay. In contrast, a radiology service might

Medicare Payment Is Contingent on Appropriate Supervision of Diagnostic Tests and Proper Use of Radiologist Assistants: Is Your Practice Meeting the Current Requirements?

The Medicare rules governing the supervision of diagnostic tests have changed over time, as have the skills and training of radiologist assistants, who may have the education and clinical skills to deliver surgical and invasive procedures often performed as part of a radiology practice. However, for the purposes of Medicare coverage, radiologist assistants are not yet recognized as independent providers or suppliers whose services are reimbursed separately from those of radiologists. As a result, services rendered by radiologist assistants are significantly limited by the Medicare physician supervision requirements and other Medicare billing rules. The authors describe the Medicare coverage and payment rules for working with radiologist assistants in hospital and nonhospital settings for both diagnostic testing and surgical or invasive procedures. The article also includes a summary of the current Medicare supervision requirements for a diagnostic test on the basis of the place of service: hospital, physician office, or independent diagnostic testing facility.

The establishment of an advanced clinical role for radiographers in the United States

Faced with growing personnel shortages and increasing patient demand, radiology and radiologic technology organizations in the United States began collaborating in the early 2000s to develop an advanced clinical role for radiographers. By 2005, the first radiologist assistants were nationally certified and working at facilities throughout the country. This paper traces the development of the radiologist assistant profession in the United States, examines its contributions to patient care, and explores its future as a solution to radiology's work force challenges.

What Is Your Radiologist Assistant Student Worth to You?

To associate a monetary value with the productivity of a radiologist assistant (RA) student during the educational process, as a predictor of the potential impact on radiology practices acting as preceptors to RA students. Eight RA students' productivity was analyzed using preexisting data composed of a list of examinations completed as part of the educational process. The Institutional Review Board at the University of Arkansas for Medical Sciences classified this study as exempt. The data were correlated with current Centers for Medicare and Medicaid Services reimbursement rates. Analyses included descriptive statistical tests for the sum of the amount of potential reimbursement calculated for each student and the mean and median for the study sample. The results conservatively predict the productivity of an RA student. The average number of procedures performed by the RA students was 581 during the minimum of 1,500 clinical internship hours. The average potential professional fee reimbursement for the procedures performed by the RA students during the educational process was $58,957. Unless radiology practices increase their capacity to handle larger volumes of examinations, the risk of losing business to others is likely to persist. By performing varying radiologic procedures, RAs can help address workforce shortages in radiology. Radiologist assistants enable radiologists to increase practice productivity by lessening the burden placed on radiologists, which permits radiologists to spend more time on image interpretations. The potential reimbursement produced by RA students is worth the time and effort invested by radiologists during the educational process.

The Radiologist Assistant: What Radiologists Need to Know Now

States are increasingly considering legislative and regulatory avenues to establish the role of radiologist assistants (RAs) under current state medical practice acts or state radiation control regulatory programs. It is critical that radiology practices be cautious to comply with federal and state laws and regulations to ensure that these advanced practice professionals provide the appropriate services under the appropriate level of supervision. For quality-of-care reasons, the ACR remains concerned about the scope of practice of radiology practitioner assistants and some misinformation that has spread to state officials about the assistants' role in radiology practice. Another potential source of confusion may be the fact that physician assistants and nurse practitioners are being increasingly used in many areas of health care (including radiology) and may derive delegated authority (from physicians) to perform services that physicians determine nurse practitioners or physician assistants to be qualified to perform. The authors in particular emphasize current federal and state legislative activities and describe possible exposure and risks associated with the extension of the scope of practice by radiologic technologists without commensurate changes in state statutes and regulations.

ACR intersociety conference 2003: radiologist assistants and other radiologist extenders

Improvements in imaging technologies are contributing to increases in the demand for radiology services. Efforts to match this rising demand are limited by the Centers for Medicare & Medicaid Services cap on resident positions and the challenges in obtaining appropriate visas and medical licenses for international medical graduates. This rising gap in the demand for and capacity to deliver radiology services has created a need for radiologist extenders. A variety of roles have been developed for these radiologist extenders, depending on the skills of the individuals and the subspecialty areas in which they work. Prominent among these are radiologist assistants, physician assistants, nurse practitioners, dosimetrists, and advanced-practice nuclear medicine technologists. Quality patient care is best accomplished when radiologist extenders function under the guidance of qualified radiologists, nuclear physicians, or radiation oncologists.

Radiologist assistant certification

The American Registry of Radiologic Technologists (ARRT) is the largest national, voluntary certification organization for radiologic technologists, with 235,000 registered technologists and an annual examination volume of 20,000 to 25,000. The ARRT’s board is appointed by the ACR (four members) and the American Society of Radiologic Technologists (five members). The ARRT is in the process of developing a certification for radiologist assistants. Standards of education, ethics, and examination will be adopted to identify individuals qualified to assume this new role. The program is scheduled to be available in the fall of 2005.