By Marilyn Sackett, MEd, RT(R), FASRT
In the September 2022 issue of the RSNA journal, Radiology, an article appeared about research done in the United Kingdom’s National Health Service Screening Program that requires double readings from screening mammograms. The study included radiologists and radiographers. It evaluated two-dimensional screening digital mammograms using the double reading model that is the standard of care in the United Kingdom. The screening performance metrics included cancer detection rates, recall rates and positive predictive values. The results of the study indicated no differences between trained non-radiologists and radiologists if experience levels were approximately the same. The results suggest experience affects reading performance rather than the advanced medical education done by radiologists.
Before any comparisons can be made for the radiographer workforce in the United States, a look at basic education requirements for radiography must be considered. In Great Britain, a statutory regulatory body, the Health and Care Professions Council (HCPC) registers and regulates the majority of the professional workforce. There are outliers HCPC does not regulate who are sonographers or midwives or nurses who are otherwise regulated. Many radiology departments have practitioner-led examinations, interventional procedures and gastro-intestinal studies. Many members of the professional diagnostic radiography workforce issue written reports, especially in ultrasound departments.
The educational requirements for entry in a radiography program in Great Britain is a 4-year baccalaureate degree with a minimum GPA of 2.7. The programs are considered Master’s degree level and usually lasts 3 years. The Scope of Practice for a radiographer is defined legally and professionally by the Code of Conduct and Ethics published by the Society and College of Radiographers. The HCPC publishes the Council’s Standards of Conduct, Performance and Ethics. In 2008, the profession’s education and professional development strategy introduced advanced and consultant practice roles in line with healthcare policy and independent research. Using these guidelines and rules, a radiographer or radiation therapist can develop their own scope of practice as he or she determines, provided the radiographer is adequately educated and trained and competent to practice. They must work ethically and in accordance with the Code of Conduct and Ethics. There is a checklist to provide guidance for the decision making about what to include in their scope of practice.
A radiographer’s scope of practice can develop over time. The individual manages this process to ensure that their knowledge and skills are appropriate to the changes in scope of practice. Best practice and enhanced patient care should be goals. By defining the scope of practice based on education, competence, and performance, there are no limits to professional practice.
Medical radiographers have been on Great Britain’s occupational shortage list since 2017. Applying for registration on the HCPC website can take longer than 3 months after verifying your education, experience, and credentials. It requires a visa to work in healthcare in the United Kingdom. There are rules about pay scales, how much money you must have to immigrate to Great Britain to work, and how long you may stay. The tax rates are much higher (40%) than the United States, and there is the risk of double taxation if proper forms and documentation is not completed. There is also a medical levy of 2% for the form of government funded medical insurance.
When considering the study that appeared in the journal Radiology, great care must be used in trying to compare the practice of mammography in Great Britain with the practice of mammography in the United States. They are not the same. Neither the education nor the philosophy of practice can compare. Some of the Advanced Practice radiographers in Great Britain interpret extremity radiographs and issue reports. Sonographers in Advanced Practice can issue their interpretation reports. There may be departments that allow some of these protocols in U.S. hospitals, but they are not publicized.
It is expected that experienced mammographers in the United States have skills that are not fully utilized. I have seen it in action. More experience means more skills. We just do not have the infrastructure to use those skills.
Next edition, I will consider other differences in training and scope of practice for radiographers in many countries.