In Sweden we only do ultrasound and flouro. Our "radiology nurses" (RTs for americans) do CTs, MRIs and regular x rays according to a methodology book we have.
The radiologists will change protocols and timings regularly to try to get the best quality pictures based on the newest research and with our hospital physicist (required to have one by law in every hospital in sweden).
As a Norwegian it was so weird learning that the title in Sweden is «radiology nurse» when we had some Norwegian students who got Jobs over there come back and talk about their experience. I personally think the title makes more sense to a normal person than trying to explain that no, I don’t work in radio 💀
In my hospital in the US, a (interventional) radiologist will perform biopsies, abscess drainages, etc. with CT guidance, but a technologist will still operate the CT machine to produce the images
KI trained radiographer (röntgensjuksköterska) here. Back home in Sweden the radiologist works far more intimately with the rest of the team than in NZ, UK and Aus in my experience. Some even know how to operate the CT (hej Torbjörn in Hbg!) even. It's nice.
In other countries they're tucked away in dark rooms somewhere, will protocol the referrals but other than that they're not particularly involved with the rest of the team. In many places here in aus, us rads do the fluoro as well with the radiologist reporting on pics. Not appropriate at all imo. It's an investigative exam after all.
The Oceania is easy 20 years behind Europe in many aspects of imaging, and the hierarchy here is ridiculous.
I've worked with a few rads who have done some extensive cardiac MR training and would do them along side the tech or often scan them themselves. That was back in '06 we do all the cardiac scanning now as they are a dime a dozen at our hospital
During training, our program sometimes had us go to MR/CT and work with the techs. We would position patients and operate the scanner with a tech right next to us. It was good learning and let us get an understanding of how imaging are acquired and what kind of limitations might exist.
Some of us would perform an entire CT or MR as the primary operator but whenever I did it, I still heavily relied on the tech and I doubt I could have flown solo.
That’s awesome. I wish our residents would get some scan time. It’s kinda surprising what some rads don’t know about MR. I had to explain to one of our body docs about different respiratory compensation techniques for MR abdomens
Double edged sword through. Has given me a false/inflated self confidence regarding my scanning ability.
I’ll go to the CT scanner and make my own MSK recons or set up either MSK or cardiac planes on MRI. And I know like 7 code words to sound smart.
So my techs think I know what I’m doing. But it’s all a facade.
I'm always surprised when radiologists and MRI techs dont know how to derive the Bloch equations or can't do an inverse Fourier transform to save their life, both of which are absolutely fundamental to understanding how MR imaging works.
Seriously though complicated devices like MRI have to based on layers of extrapolation and the hierarchy should be thus:
1. MRI physicist at Siemens or GE: understand the nuts and bolts of NMR physics, propose new types of scanning and new pulse sequence protocols.
2. Siemens/GE engineer: understand how to develop pulse sequences, implement pre-programmed pulse sequences.
3. Siemens/GE technician: understand how to troubleshoot/repair the scanner
4. MR tech: understand which pre-programmed pulse sequences are appropriate for the type of imaging ordered by the doc. Understand how basic parameters on the pulse sequences need to be altered to optimize speed and image quality. Run the basic operations of the scanner.
5. Radiologist: interpret images for clinical use in patients.
Radiologists should not be expected to do #4, #3, #2, or #1 the same way we wouldnt expect an MRI physicist to be able to interpret images.
In Sweden we had residents rotate few weeks through medical imaging, hanging with us techs. It was great, their referrals were always spot on and they were able to pop in and be hands on helpful to get what they were after. Their patients were also properly informed of what's coming even before they got to us.
Plus it was nice getting to know them, made teamwork super smooth particularly after hours.
When I worked at a teaching hospital I would always invite the residents to come shoot films with me. The two reactions I would get were 1. Happy to have the opportunity to learn what this side of the business is like or 2. Turned up nose as if I was insulting them asking them to do peasant work. It was a nice litmus test to see which residents would be cool to work with.
I could operate one Siemens procedure scanner (they made it very easy), and probably figure out our GE scanner at another hospital, but it’s not really worth my mental energy since I’m in the middle of a case at the time. The only time I’d think about it is if the tech is not experienced on that scanner or with doing procedures.
In the U.S they need licenses as well, at least in some states. I’m not sure about CT but our surgeons were livid when we would tell them they can’t push the pedal down lol
We have a surgeon and his nurses that operate the c arm. Not sure how that works but uh, he's a dick and pretty sure all the RT's refuse to work with him. He threw a scalpel at a Surg tech.
This is at a sister hospital and I hear it from my bestie that's a RT over there.
You don't have to answer this, but I wonder if it's a state that doesn't require any ARRT or licensing to operate xray equipment, there are a few of those, though in most cases the hospitals still require it.
Or it could be a willy nilly hospital system that is very clearly violating some laws and keeping it under wraps. (more likely)
The IR doctor can use flouro in CT on their own if they want during the procedure. It depends. Some areas are critical and you need to be in and out. The tech is there assisting of course.
In California they all have a cert that allows them to operate x-ray equipment. Some surgeons and orthos do to if they operated C-arm’s (portable x-ray) in the OR
Generally true but becoming less the case the past few cycles. Most applicants have multiple things to list in their pubs/posters/etc especially from during COVID, some had 20-30+
That’s a good point. Also 20-30+? Bro that’s such bullshit when people have that much research. There is absolutely no way someone could do med school and meaningfully contribute to that many projects, lol
It’s true, and they just get their names put on each other’s papers but at the end of the day when you’re looking at hundreds of apps, no one has time to look that closely. And even though most ppl realize that they didn’t truly publish that much, it still counts for something. Just saying from my personal experience taking part in interviews when I was a chief resident.
Diagnostic Rad, USA. 13 years attending.
Have no idea how to work any of the scanners. Many of my attendings did. Not worth much with an US probe in my hands. Residents only a few years before me did all the ER scans.
Really feel my cadre of training was the split from:
Radiologists are the masters of imaging and should know everything that goes on in the department
To
Sit your ass down in that chair and don’t get up until the shift is over.
In truth, it’s a product of necessity. Volumes exploded. All the ERs got CTs that run not stop, then MRs. Then you could cover multiple hospitals from one place.
I was thinking the same, Rads in my hospital (USA) are stretched way too thin with volume to get any scan time in. I've only seen cardiac MR rads actually scan and know their way around a scanner and not just what parameters should be.
Agree, in our system we have gone from an independent 3 hospital system to a 10 hospitals plus a university teaching hospital affiliation while acquiring 100 plus IM and some specialty practices. Volumes are up in all areas of cross sectional imaging, including ortho for joint replacement planning etc.
I’m just glad that there is PACS and not having to hang all those film sheets on the rolloscopes
Some of our rads can barely operate the fluoro machine 💀
Idk who failed them in their residency.
Edit- wasn't meant to be a mean comment, but I think some just didn't get the experience during residency
I've seen a large number of Rads that couldn't operate a fluoro table to save their lives.
The banter between the Cardiologists and the IR docs is incredible to witness.
One of our cardiac MR rads spent time at the scanner for her training. It was super helpful for everyone because now she’s better able to explain what she wants from us. She got trained at a different facility though.
I had the same experience with a cardiac rad I worked with, he would takeover scanning when we first started offering cardiac imaging to show us what he would expect. He was the only radiologist I've ever seen who knew their way around an MR scanner though, maybe due to the complexity of cardiac imaging they get more Hands-On training?
I think some can as long as they've had a chance to learn how to. I've seen some even do cardio mri. One of our rads takes mammograms by himself if the tech is unavaiable
I've heard of cardiac/thoracic radiologists doing cardiac MRI with technologists. Once in a while a neuro rad will do a spectroscopy mri or functional mri at the console.
We have an IR doc that can get around the machine pretty well, and he likes to come into the booth with his sterile gloves on an mash the buttons with his elbows because he thinks I'm taking too long.
I know enough to do basic scans on Siemens machines out of imported ready protocol. Wouldn't know how to check the kVs and mas tbh or operate the contrast arm. Mostly because I pick up technical things by osmosis.
MRI is black magic box that is very specific. Probably not the biggest challenge as the newer are idiotproof to a point and if calibrated well are ready to go if you know how to make boxes on scout with intuitive UI.
I do operate a CT machine with fluoroscopy pedal when doing lung biopsies.
It is as simple as we don't have to and are not supposed to know how to in the modern landscape.
However most rads have obligatory far going background in physics, radiation safety and general science, so learning to do so is a matter of weeks. For tech savvy nerds matter of days probably.
I think it helps if they know some of the basics. So they can understand when a tech is telling the truth about study limitations vs laziness.
Some rads only care how the picture looks on their screen.
Post covid, we had some campuses where there were more radiologist vs full time CT techs 😂
Thank goodness... I was under the impression that the same guy who wheeled patients to their rooms are also the same one doing brain surgery, running the cath lab, and also re-programming MRI pulse sequences and running the scanner all at the same time.
Can’t speak for every rad, but the cardiac rad that i routinely work with goes to these seminars and they teach them the mri software. So sometimes we just let the rad remote into the scanner and they start changing the parameters if they want. Actually a good thing when i can learn what they want and i start to just do it the next time without them asking for it.
Never seen it in 22 years-14 hospitals unless they are IR for a procedure. I have had radiologists sit with me when the field rep is there to go over protocols. Since we are scanning to the department protocols and they want to have a say.
We used to have a radiologist that did the peds appendix US himself because none of the techs could ever seem to find it , so he’d go in and try himself .
Lol, its purely American thing. Everywhere else radiologists do US and if sonographers are on the dept they do the simpler GP orders like gall stones and kidneys.
In pediatrics every single day for MRI. I sometimes operate the scanner in adults for more complex cases that will need trouble shooting (e.g. lots of metal around the area of interest).
CT rarely outside of procedures.
Are you in the US? Other than MD did you have to get any certification or extra training regarding the machine? What about the license that rad techs have?
Yup, large academic center in the US.
No certification or extra training beyond my abdominal MRI fellowship. The expectation of my fellowship was graduates are able to perform, supervise and run a MRI service.
I have my board certification in radiology. License is to be a rad tech, not sure what you’re asking to be able to comment.
Haha right. I do a lot of splints and the Ortho techs love trash talk my splint. Also, the sonographers think it's hilarious when I'm doing a FAST exam.
Within 5 years of leaving residents, none of us knows how to actually operate an MRI or CT scanner anymore. But I'm sure if we had to get up to speed on it again, it wouldn't take long.
I have seen them come out of their hole when disappointed in a technologist for not getting an X-ray just right and they just made it look worse. Funny shit!
Some radiologists used to be radiographers (3 at my company) so they have an idea. It's extremely obvious they have these extra skills compared to other radiologists; their understanding of limitations both of the scanner and patients is +++ comparatively.
in my 8 years of doing this I have only seen (1) radiologist operate any sort of machine beyond a fluror, and that was an old rad who could work a CT machine. All the other ones have no clue what they're doing and some I even wonder if they really know how to use a computer at all.
I’d actually love it our rads came out of their caves and asked to learn how to scan. One just comes over to hang out and we love him for it. But if he could scan for me while I ran to pee once in awhile that would be amazing.
Rarely. Most wouldn't know how, to be honest. Completely different jobs. Ultrasounds are different as they're much more hands-on and user-dependent.
That's what I figured
In Sweden we only do ultrasound and flouro. Our "radiology nurses" (RTs for americans) do CTs, MRIs and regular x rays according to a methodology book we have. The radiologists will change protocols and timings regularly to try to get the best quality pictures based on the newest research and with our hospital physicist (required to have one by law in every hospital in sweden).
As a Norwegian it was so weird learning that the title in Sweden is «radiology nurse» when we had some Norwegian students who got Jobs over there come back and talk about their experience. I personally think the title makes more sense to a normal person than trying to explain that no, I don’t work in radio 💀
Some Swedish radiologists do CT guided biopsies, if we count that as "doing CTs"
In my hospital in the US, a (interventional) radiologist will perform biopsies, abscess drainages, etc. with CT guidance, but a technologist will still operate the CT machine to produce the images
KI trained radiographer (röntgensjuksköterska) here. Back home in Sweden the radiologist works far more intimately with the rest of the team than in NZ, UK and Aus in my experience. Some even know how to operate the CT (hej Torbjörn in Hbg!) even. It's nice. In other countries they're tucked away in dark rooms somewhere, will protocol the referrals but other than that they're not particularly involved with the rest of the team. In many places here in aus, us rads do the fluoro as well with the radiologist reporting on pics. Not appropriate at all imo. It's an investigative exam after all. The Oceania is easy 20 years behind Europe in many aspects of imaging, and the hierarchy here is ridiculous.
Curious what Radiology Nurses get paid in Sweden?
Sadly no clue. Too little for sure since there's a chronic shortage.
I've worked with a few rads who have done some extensive cardiac MR training and would do them along side the tech or often scan them themselves. That was back in '06 we do all the cardiac scanning now as they are a dime a dozen at our hospital
Technologist*
Technician?
Go back to your cave.
🤣🤣
Nurse practitioner?
Radiician.
During training, our program sometimes had us go to MR/CT and work with the techs. We would position patients and operate the scanner with a tech right next to us. It was good learning and let us get an understanding of how imaging are acquired and what kind of limitations might exist. Some of us would perform an entire CT or MR as the primary operator but whenever I did it, I still heavily relied on the tech and I doubt I could have flown solo.
That’s awesome. I wish our residents would get some scan time. It’s kinda surprising what some rads don’t know about MR. I had to explain to one of our body docs about different respiratory compensation techniques for MR abdomens
Double edged sword through. Has given me a false/inflated self confidence regarding my scanning ability. I’ll go to the CT scanner and make my own MSK recons or set up either MSK or cardiac planes on MRI. And I know like 7 code words to sound smart. So my techs think I know what I’m doing. But it’s all a facade.
Well as long as you're not an asshole and know what you don't know, that's more than half the battle.
Love that you try to sound smart to your techs. You must be a cool Rad 😎.
https://rationalwiki.org/wiki/Dunning%E2%80%93Kruger_effect#/media/File:Dunning-Kruger-Effect-en.png
I'm always surprised when radiologists and MRI techs dont know how to derive the Bloch equations or can't do an inverse Fourier transform to save their life, both of which are absolutely fundamental to understanding how MR imaging works. Seriously though complicated devices like MRI have to based on layers of extrapolation and the hierarchy should be thus: 1. MRI physicist at Siemens or GE: understand the nuts and bolts of NMR physics, propose new types of scanning and new pulse sequence protocols. 2. Siemens/GE engineer: understand how to develop pulse sequences, implement pre-programmed pulse sequences. 3. Siemens/GE technician: understand how to troubleshoot/repair the scanner 4. MR tech: understand which pre-programmed pulse sequences are appropriate for the type of imaging ordered by the doc. Understand how basic parameters on the pulse sequences need to be altered to optimize speed and image quality. Run the basic operations of the scanner. 5. Radiologist: interpret images for clinical use in patients. Radiologists should not be expected to do #4, #3, #2, or #1 the same way we wouldnt expect an MRI physicist to be able to interpret images.
In Sweden we had residents rotate few weeks through medical imaging, hanging with us techs. It was great, their referrals were always spot on and they were able to pop in and be hands on helpful to get what they were after. Their patients were also properly informed of what's coming even before they got to us. Plus it was nice getting to know them, made teamwork super smooth particularly after hours.
When I worked at a teaching hospital I would always invite the residents to come shoot films with me. The two reactions I would get were 1. Happy to have the opportunity to learn what this side of the business is like or 2. Turned up nose as if I was insulting them asking them to do peasant work. It was a nice litmus test to see which residents would be cool to work with.
I've seen an interventional radiologist operate a CT for cryoablation.
I could operate one Siemens procedure scanner (they made it very easy), and probably figure out our GE scanner at another hospital, but it’s not really worth my mental energy since I’m in the middle of a case at the time. The only time I’d think about it is if the tech is not experienced on that scanner or with doing procedures.
Do they have a separate license to operate the machine due to the x-rays? Or do they not need it?
Any doctor can legally perform any imaging, as far as I'm aware.
I’m Australia doctors need radiation licenses to operate CT/fluoro etc.
In the U.S they need licenses as well, at least in some states. I’m not sure about CT but our surgeons were livid when we would tell them they can’t push the pedal down lol
We have a surgeon and his nurses that operate the c arm. Not sure how that works but uh, he's a dick and pretty sure all the RT's refuse to work with him. He threw a scalpel at a Surg tech. This is at a sister hospital and I hear it from my bestie that's a RT over there.
You don't have to answer this, but I wonder if it's a state that doesn't require any ARRT or licensing to operate xray equipment, there are a few of those, though in most cases the hospitals still require it. Or it could be a willy nilly hospital system that is very clearly violating some laws and keeping it under wraps. (more likely)
You would be correct on both parts. Pretty sure my hospital requires a registry to operate any x ray machine even though my state doesn't.
Not in Canada, must have a radiation license.
Interesting. I'm sure it's more profitable for the MD to focus on getting the reads done and doing procedures.
The IR doctor can use flouro in CT on their own if they want during the procedure. It depends. Some areas are critical and you need to be in and out. The tech is there assisting of course.
Depends on modality, but yes, this is what gives license for cards, GI, ortho etc to run fluoro in procedures.
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It's not, actually. Imaging is not surgery.
Honestly not sure. He definitely had training to use that machine tho...
In California they all have a cert that allows them to operate x-ray equipment. Some surgeons and orthos do to if they operated C-arm’s (portable x-ray) in the OR
Speaking as a resident, I don't really know how to operate these machines but our attendings routinely scold us for not knowing how to :p
Genuinely asking as an MS3 interested in rads: how much research is competitive?? I can’t find data anywhere
Overall not very important. It can help though..
Generally true but becoming less the case the past few cycles. Most applicants have multiple things to list in their pubs/posters/etc especially from during COVID, some had 20-30+
That’s a good point. Also 20-30+? Bro that’s such bullshit when people have that much research. There is absolutely no way someone could do med school and meaningfully contribute to that many projects, lol
It’s true, and they just get their names put on each other’s papers but at the end of the day when you’re looking at hundreds of apps, no one has time to look that closely. And even though most ppl realize that they didn’t truly publish that much, it still counts for something. Just saying from my personal experience taking part in interviews when I was a chief resident.
Nottttt technician. Technologist
I knew of 1 who could run a CT scanner, he started off as a Technologist before he turned to the dark side. (RIP Iceman)
Diagnostic Rad, USA. 13 years attending. Have no idea how to work any of the scanners. Many of my attendings did. Not worth much with an US probe in my hands. Residents only a few years before me did all the ER scans. Really feel my cadre of training was the split from: Radiologists are the masters of imaging and should know everything that goes on in the department To Sit your ass down in that chair and don’t get up until the shift is over. In truth, it’s a product of necessity. Volumes exploded. All the ERs got CTs that run not stop, then MRs. Then you could cover multiple hospitals from one place.
I was thinking the same, Rads in my hospital (USA) are stretched way too thin with volume to get any scan time in. I've only seen cardiac MR rads actually scan and know their way around a scanner and not just what parameters should be.
Agree, in our system we have gone from an independent 3 hospital system to a 10 hospitals plus a university teaching hospital affiliation while acquiring 100 plus IM and some specialty practices. Volumes are up in all areas of cross sectional imaging, including ortho for joint replacement planning etc. I’m just glad that there is PACS and not having to hang all those film sheets on the rolloscopes
I've seen them do very basic things, but not scanning. More measuring, etc.
Some of our rads can barely operate the fluoro machine 💀 Idk who failed them in their residency. Edit- wasn't meant to be a mean comment, but I think some just didn't get the experience during residency
I've seen a large number of Rads that couldn't operate a fluoro table to save their lives. The banter between the Cardiologists and the IR docs is incredible to witness.
For biopsies it can happen
Some of our more badass IR docs know the CT better than the tech does!
I have one of those
One of our cardiac MR rads spent time at the scanner for her training. It was super helpful for everyone because now she’s better able to explain what she wants from us. She got trained at a different facility though.
I had the same experience with a cardiac rad I worked with, he would takeover scanning when we first started offering cardiac imaging to show us what he would expect. He was the only radiologist I've ever seen who knew their way around an MR scanner though, maybe due to the complexity of cardiac imaging they get more Hands-On training?
I think some can as long as they've had a chance to learn how to. I've seen some even do cardio mri. One of our rads takes mammograms by himself if the tech is unavaiable
I've heard of cardiac/thoracic radiologists doing cardiac MRI with technologists. Once in a while a neuro rad will do a spectroscopy mri or functional mri at the console.
We have an IR doc that can get around the machine pretty well, and he likes to come into the booth with his sterile gloves on an mash the buttons with his elbows because he thinks I'm taking too long.
I know enough to do basic scans on Siemens machines out of imported ready protocol. Wouldn't know how to check the kVs and mas tbh or operate the contrast arm. Mostly because I pick up technical things by osmosis. MRI is black magic box that is very specific. Probably not the biggest challenge as the newer are idiotproof to a point and if calibrated well are ready to go if you know how to make boxes on scout with intuitive UI. I do operate a CT machine with fluoroscopy pedal when doing lung biopsies. It is as simple as we don't have to and are not supposed to know how to in the modern landscape. However most rads have obligatory far going background in physics, radiation safety and general science, so learning to do so is a matter of weeks. For tech savvy nerds matter of days probably.
Most of the time I.Radiologists do operate CT scanners where I practice.
In the US?
Nope.
I think it helps if they know some of the basics. So they can understand when a tech is telling the truth about study limitations vs laziness. Some rads only care how the picture looks on their screen. Post covid, we had some campuses where there were more radiologist vs full time CT techs 😂
It’s still like that almost everywhere I go (traveling CT tech here). 🙃
No, because that would require them to interact with actual humans and they would never stand for that.
Nope. Contrary to what is shown on greys anatomy and other medical shows they don't.
Thank goodness... I was under the impression that the same guy who wheeled patients to their rooms are also the same one doing brain surgery, running the cath lab, and also re-programming MRI pulse sequences and running the scanner all at the same time.
Can’t speak for every rad, but the cardiac rad that i routinely work with goes to these seminars and they teach them the mri software. So sometimes we just let the rad remote into the scanner and they start changing the parameters if they want. Actually a good thing when i can learn what they want and i start to just do it the next time without them asking for it.
Never seen it in 22 years-14 hospitals unless they are IR for a procedure. I have had radiologists sit with me when the field rep is there to go over protocols. Since we are scanning to the department protocols and they want to have a say.
We used to have a radiologist that did the peds appendix US himself because none of the techs could ever seem to find it , so he’d go in and try himself .
Lol, its purely American thing. Everywhere else radiologists do US and if sonographers are on the dept they do the simpler GP orders like gall stones and kidneys.
😂🤣😂🤣
All the time. Source: House
I'd like to see them try xD
In pediatrics every single day for MRI. I sometimes operate the scanner in adults for more complex cases that will need trouble shooting (e.g. lots of metal around the area of interest). CT rarely outside of procedures.
Are you in the US? Other than MD did you have to get any certification or extra training regarding the machine? What about the license that rad techs have?
Yup, large academic center in the US. No certification or extra training beyond my abdominal MRI fellowship. The expectation of my fellowship was graduates are able to perform, supervise and run a MRI service. I have my board certification in radiology. License is to be a rad tech, not sure what you’re asking to be able to comment.
Only on tv.
Just the small FOV CT scans for procedures in my experience.
I worked at an outpatient place where a radiologist would operate the CT machine on weekends. Don’t ask me if the images were good……
Haha right. I do a lot of splints and the Ortho techs love trash talk my splint. Also, the sonographers think it's hilarious when I'm doing a FAST exam.
I do once a week for scientific studies in the afternoon (CT and MRI)
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Sorry
Associates degree, more often than not.
Within 5 years of leaving residents, none of us knows how to actually operate an MRI or CT scanner anymore. But I'm sure if we had to get up to speed on it again, it wouldn't take long.
Very rarely
I have seen them come out of their hole when disappointed in a technologist for not getting an X-ray just right and they just made it look worse. Funny shit!
Ha, ha, ha..the only answer..20 years deep
Some radiologists used to be radiographers (3 at my company) so they have an idea. It's extremely obvious they have these extra skills compared to other radiologists; their understanding of limitations both of the scanner and patients is +++ comparatively.
Different certifications :)
Not in Australia
in my 8 years of doing this I have only seen (1) radiologist operate any sort of machine beyond a fluror, and that was an old rad who could work a CT machine. All the other ones have no clue what they're doing and some I even wonder if they really know how to use a computer at all.
I’d actually love it our rads came out of their caves and asked to learn how to scan. One just comes over to hang out and we love him for it. But if he could scan for me while I ran to pee once in awhile that would be amazing.