Group offers guidelines on qualifications

September 18, 2002

After obtaining additional education and proving his or her competency, any registered nuclear medicine technologist, radiographer or radiation therapist is qualified to operate hybrid imaging equipment such as PET-CT machines, according to a group of experts that met recently to discuss issues surrounding the new and rapidly growing field of fusion imaging.

Group participants reached their conclusions at a July 31 meeting convened in New Orleans by the Society of Nuclear Medicine Technologist Section and the American Society of Radiologic Technologists.

The participants' goal was to make recommendations concerning the education, qualifications and regulation of personnel who operate PET-CT, SPECT-CT and other hybrid imaging equipment. After studying the issues, participants found that they could not recommend one particular type of technologist over any other. Instead, they determined that any registered nuclear medicine technologist, radiographer or radiation therapist would be capable of performing the examinations with appropriate additional education.

"It is wrong to say that only a nuclear medicine technologist or only a CT technologist should be performing these examinations," said Frances Keech, M.B.A., R.T.(N), president of the SNMTS. "The reality is, fusion imaging is a new type of technology that requires a new type of technologist."

Fusion imaging combines two independent imaging modalities to produce a diagnostically and clinically superior image. The most common type of fusion imaging today is performed on hybrid equipment that combines a nuclear medicine procedure known as positron emission tomography, or PET, with computed tomography, or CT. The PET portion of the examination provides physiological information about an organ's metabolic function, while the CT portion of the exam provides information about the organ's anatomy.

"PET-CT and other types of fusion examinations allow us to depict the human body with a level of precision never before achievable, but these examinations also are technically demanding and require a high level of skill from the person performing them," said Ms. Keech. "The goal of our July 31 meeting was to ensure that the people operating PET-CT equipment are qualified and competent, so patients receive the best possible care."

The outcome of the meeting was a 10-page consensus paper that is being mailed this month to the director of every state radiation control program and radiologic technology licensure board.

"The consensus paper provides guidelines for how the states should regulate personnel who operate PET-CT units, as well as guidelines for employers trying to determine who is qualified to operate this equipment," said Ms. Keech.

Participants in the July 31 meeting included imaging technologists, physicians and educators, as well as representatives from state regulatory agencies, companies that manufacture hybrid equipment and supply radiopharmaceuticals, educational accreditation agencies, certification bodies and professional associations.

In its consensus paper, a statement from the group reads, "Any registered radiographer with the credential R.T.(R), registered radiation therapist with the credential R.T.(T) or registered nuclear medicine technologist with the credentials R.T.(N) or CNMT may operate PET-CT equipment after obtaining appropriate education or training and demonstrating competency." The paper notes that some individuals will require more education and training than others. A task force will be established to identify the core competencies that any operator of PET-CT equipment must possess.

"We did not feel it was necessary for individuals to be certified in both nuclear medicine and radiography in order to perform PET-CT examinations," explained ASRT President Donna Newman, B.A., R.T.(R), CNMT, a participant in the July 31 meeting. "Instead, we recommend that multiple pathways be created to educate or train registered nuclear medicine technologists, radiographers and radiation therapists to operate PET-CT equipment."

Currently, 38 states license radiographers, 28 states license radiation therapists and 21 states license nuclear medicine technologists. The consensus paper developed by the group recommends that licensure states amend their regulations "to permit any of these individuals to perform PET-CT examinations after they have received appropriate additional education or training and demonstrated competency."

State licensure is designed to protect the public, but "the licensure laws are not set up to deal with personnel who use hybrid equipment," said Ms. Newman. For example, some states require that people operating PET-CT equipment possess dual certification in nuclear medicine and radiography. If a dually certified technologist is not available, two technologists - one certified in nuclear medicine and one certified in radiography - would be required to operate the machine. Fewer than 5,000 radiologic technologists nationwide are registered in both nuclear medicine and radiography, and less than 200 are certified in nuclear medicine and have the advanced qualification in CT.

"Requiring that technologists possess dual certification or that two technologists be present for PET-CT examinations could limit patient access to this important technology," said Ms. Newman.

Following the distribution of the consensus paper to state regulatory agencies, the next step is for a task force appointed by the ASRT and SNMTS to determine appropriate levels of education or training. The task force will outline a professional course of study for PET-CT technologists and recommend appropriate methods for delivering the educational content. The task force's work should be completed early in 2003.
The full text of the PET-CT consensus paper is available on the ASRT Web site,, and on the SNMTS Web site, which is part of the Society of Nuclear Medicine's site, at

Society of Nuclear Medicine

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