There are serious consequences associated with staffing under-trained radiologic technologists in computed tomography (CT) positions in rural hospitals. These positions should be filled by radiologic technologists who are CT certified, have experience with trauma and atypical situations, who possess high level critical thinking and decision making skills, and who are experts on each CT scanner they work on. Staffing under-trained personnel can lead to the utilization of improper imaging protocols, the need for repeat CT scans, and increased radiation dose to patients.
Under-trained staff performing CT scans is concerning for any healthcare consumer. According to Mahmoudi et al. (2019) approximately 2% of cancers can be attributed to previous radiation exposure from a CT scan. Radiation is a known carcinogen and it is imperative that staff reduce a patient’s exposure to radiation as much as possible. Under-trained staff may not have the knowledge or experience to utilize appropriate imaging protocols or adjust exposure factors due to the patient’s age or size, leading to non diagnostic exams which may need to be repeated (Mahmoudi et al., 2019).
There are multiple reasons for under-trained staff performing CT scans in rural hospitals, the first of which is wages. Anecdotally, rural hospitals tend to pay less than their urban counterparts. CT technologist wages in rural upper midwestern communities can be $8 – $10 less per hour than in the closest metropolitan area. The pay discrepancies between rural and urban areas is called the urban wage premium (Shutters & Applegate, 2022). Higher pay can attract highly trained CT technologists away from rural areas, thus leaving smaller, rural hospitals understaffed.
Another root cause of under-trained staffing in CT departments is the nature of the role. Working as a CT technologist in a rural hospital limits your exposure to traumas and atypical cases. Rural hospitals just don’t have the volume of patients one would see in a more urban setting, and thus there is a lack of training and experience in high-stress situations where seconds and accuracy matter. And because CT technologists in rural hospitals often work alone at night, on weekends and holidays, etc., they may not have adequate support if there are problems with the scan, or questions about which imaging protocols are appropriate for any given situation.
A third reason under-trained staff are filling CT positions is due to the designations of rural hospitals. If a hospital is designated a Critical Access Hospital (like many rural hospitals are), they are not required to have a CT certified technologist on staff. This means in a rural hospital, any radiologic technologist could perform CT exams without proper training or experience. The burden of determining whether or not a technologist is competent falls on the department supervisor or manager. When a department is short-staffed, training can be rushed and inadequate.
Finally, the process for a technologist to become certified in CT is inherently part of the problem. CT certification is a credential that ensures you are competent in performing a variety of procedures, and that you understand basic CT concepts. CT certification does not however, ensure a technologist is competent on CT scanners made by different manufacturers. There are a variety of CT scanners made by different manufacturers, all of which have very different features and scanning abilities. According to a study conducted by Mahmoudi et al. (2019), only 30.1% of CT technologists understood the need to alter CT scan parameters based on the patient’s age, size, anatomical region, or clinical indication, “Indicating that patients may potentially be exposed to higher doses than necessary” (p. 48). CT technologists should be experts on the CT scanner they are using to reduce the likelihood of mistakes and excessive radiation exposure to the patient.
One possible solution to address under-trained CT technologists in rural hospitals includes implementing a CT Team with individuals on the team each performing a designated role (Larson et al., 2014). According to Larson et al. (2014), a dedicated CT Team should consist of a radiologist, physicist, protocol manager, education specialist, and a CT Technologist manager. Assigning dedicated roles and specific responsibilities holds each team member accountable for quality assurance measures, and ensures imaging concerns are identified and addressed in a collaborative manner.
A second possible solution includes implementing statewide campaigns to educate physicians and technologists about the appropriate CT protocols and imaging guidelines for all patients, and children in particular (Nabaweesi et al., 2021). Children’s tissues are more radiosensitive than adults, making that population especially susceptible to the negative effects of radiation exposure. A study by Nabaweesi et al. (2021) demonstrated reduced CT radiation exposure and reduced CT scan repeat rates among pediatric patients, after a statewide education campaign.
Finally, I propose a minimum hourly training requirement be established for CT technologists for each CT scanner they use. Minimum hourly equipment training is the standard for breast imaging. Mammographers must demonstrate at least eight hours of training on the specific mammography machine they use. This additional training requirement would help alleviate the issue of under-trained staff performing CT scans on machines that they don’t know how to operate safely, and prevent managers/supervisors from rushing the crucial training process.
References
Larson, D. B., Molvin, L. Z., Wang, J., Chan, F. P., Newman, B., & Fleischmann, D. (2014). Pediatric CT quality management and improvement program. Pediatric Radiology, Suppl.Supplement, 44, 519-24. https://doi.org/10.1007/s00247-014-3039-4
Mahmoudi, F., Naserpour, M., Farzanegan, Z., & Talab, A. D. (2019). Evaluation of radiographers’ and CT technologists’ knowledge regarding CT exposure parameters. Polish Journal of Medical Physics and Engineering, 25(1), 43-50. https://doi.org/10.2478/pjmpe-2019-0007
Nabaweesi, R., Akmyradov, C., Aitken, M. E., Kenney, P. J., & Ramakrishnaiah, R. H. (2021). Impact of a statewide computed tomography scan educational campaign on radiation dose and repeat CT scan rates for transferred injured children. Journal of clinical and translational science, 5(1), e129. https://doi.org/10.1017/cts.2021.793
Shutters, S. T., & Applegate, J. M. (2022). The urban wage premium is disappearing in U.S. micropolitan areas. PloS one, 17(4), e0267210. https://doi.org/10.1371/journal.pone.0267210
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