Radiography – more than just taking pictures

As a radiologist, I interpret thousands of imaging studies every year. Of the few hundred thousands of medical images that have crossed my FDA-approved computer screen, the one thing they have in common is that they were all acquired by radiographers.

Radiographers, also called technologists, specialise in acquiring images of body structures using sophisticated machines. These images are analysed by radiologists to make a diagnosis and/ or solve a clinical question. Truth to be told, many credible radiographers have a greater knowledge base and skill set regarding the technical components of image acquisition in their own specialty than I and many of my other clinical colleagues do.

With the advent of technology in healthcare, clinicians increasingly rely on medical imaging to aid diagnosis or management of a patient. Imaging studies that cost hundreds and thousands of dollars have become commonplace with several parties ignorant to the role that imaging appropriateness and quality have on diagnostic accuracy. A low-quality study or a scan ordered for the wrong reason has the potential to increase uncertainty and medical costs by generating vague information, but a high-quality examination ordered for the right reason can save a life.

In the old days, appendicitis which is a commonly encountered diagnosis would be diagnosed by physical examination. Now, CT is almost always requested in cases clinically suspicious for appendicitis, even in children. On the one hand, a highly trained CT radiographer using the appropriate equipment has the capability to reduce radiation to the child while still providing a diagnostic image. On the other hand, a polished sonographer can avoid the relatively higher cost of CT and radiation altogether by locating the appendix with ultrasound.

Speaking of which, ultrasound is the most operator-dependent modality in radiology. If the sonographer is inexperienced, normal structures can be made to look abnormal and vice versa. Performing an ultrasound is much more complicated than just setting a probe on the patient and pushing a button or taking a cine-clip of the region of interest. The sound waves have to be properly calibrated to each and every patient. This can only be done with precise technical coordination, knowledge of anatomy, attention to detail and extensive practice, in that order.

For MRI, radiographers are first-line when it comes to managing the safety risks that are associated with the powerful magnetic force of the machine. With release of new generation MR machines and techniques over the last couple of years, MR radiographers must constantly learn and relearn how to acquire exams while minimising scan time without compromise of image quality, preventing motion blur and overcoming artifacts that degrade the images, and satisfying radiologists as well as clinicians who have high expectations.

The role of radiographers is vital in the healthcare setting and is not an easy one.
Very much similar to how a pilot can’t fly a plane without aircraft engineers building safe and quality machines, I too cannot perform my role until the radiographers do theirs.

I have a team of radiographers whom I cannot thank enough for their dedication and for working so hard to produce quality exams so that every patient who comes through our door gets the answers that they came for and more.

Blog entry by Dr Lee Su Ann, a radiologist who has been practising radiology for the past 12 years

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