How to Maximize the Radiologist-Technologist Relationship

It's been a long day. Your eyes are tired, but you have one more study to read. You pull the image up and breathe a sigh of relief -- it comes complete with an exhaustive patient history and notes that a spot might require some focused attention. Within a few minutes, you've easily rendered your diagnosis and call it a day.

Whether it's a burgeoning growth that could have been mistaken for a shadow or a hairline fracture you could have overlooked, having extra input often makes the difference not only in how quickly you produce your report, but also in how thorough your diagnosis can be. And, it's all thanks to the technologist.

When it comes to delivering the highest quality patient care and streamlining your workflow, having open, clear communication lines with your technologists is paramount, said Leonard Berlin, MD, radiology professor at Rush University.

"I learned from day one in my residency there's nothing like a having a good technologist," he said. "There's nothing better."

Of course, there are instances throughout the industry in which radiologists and technologists have been at odds over what appears on an image. In these cases, technologists feel strongly about what they see and persist even when radiologists either disagree or don't welcome the input because they see it as a professional encroachment. Arguments can erupt, but these situations are quite rare, said David Larson, MD, professor of pediatric radiology at Stanford University Medical Center.

But, even then, they illustrate the need for good communication channels. So, what exactly qualifies as good communication between radiologists and technologists? How can you create and support it? What are the best strategies for sharing information and thoughts?

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Everyone involved with diagnostic imaging services has a well-defined role, including technologists, according to Greg Crutcher, spokesperson for the American Society of Radiologic Technologists (ASRT).

Technologists work closely in line with the ASRT Standard of Ethics, he said, to provide information by collecting images, conveying observations, and sharing pertinent patient information. They play no official diagnostic role, but their input and how they work with radiologists is integral, he said.

"The partnership between a radiologist and radiologic technologist is very important and can only be improved by clear and open lines of communication," he said.

Best Strategies
And, there are best tactics for fostering open communication, Larson said. He and Alexander Towbin, MD, a pediatric radiologist with Cincinnati Children's Hospital Medical Center, have researched the most effective ways to improve radiologist-technologist communication.

According to Towbin, communication works best when plans and protocols exist, allowing everyone to voice an opinion. Not only does it improve office morale, but it can also produce actionable results.

Good listening is the cornerstone, he said. Radiologists and technologists must make concerted efforts to sit and listen to one another. For example, Cincinnati Children's gathers radiologists, technologists, and department leaders twice annually for operational rounds.

"We want to know from our techs - our front line - what their problems and concerns are. What do they feel needs improvement?" Towbin said. "These meetings ensure everyone feels like we're a team - that what we're all doing really makes a difference."

Fluid communication must be available year-round, however. Encourage your technologists to contact you by phone or face-to-face if they have additional information about a study or if they feel you've overlooked something. Listen to their concerns because it could change your assessment, he said. For instance, he once changed a protocol based on a technologist-identified problem with a patient's ovary.

Additionally, Larson said, radiologists and technologists alike must invest in getting acquainted. Knowing each other's names can go far in creating respectful relationships. Also, proactively request your technologists' input - if they know you welcome their insight, they'll be more likely to share their observations.

Benefits
Overall, open communication has several benefits, Towbin said, especially because technologists are the most patient-facing part of diagnostic imaging. Communication clarifies your expectations and empowers technologists to trouble-shoot problems that arise.

With clear communication channels, you and your technologists can discuss the best positioning and dose levels. You can also specify how they should collect a patient's history, and they can alert you to any case urgency.

Open communication can also be significantly valuable with ultrasound technologists, Larson said. They develop significant clinical understanding over time, and considering their assessments could help you avoid errors.

Addressing Problems
Still, concerns about particular studies will occur, Larson said. But, if you have a system in place to address any worries, you can keep communication open and respectful. For example, some facilities make it easy for technologists to get answers by filtering questions to one particular radiologist each day.

"You must have a process to work through challenges or disagreements," he said. "The process must acknowledge the person with the concern feels uncomfortable and allow for discussion, but it must be done in a respectful way that doesn't undermine authority."

If a technologist or radiologist doesn’t follow your institution's established protocol or responds to a situation negatively, you can easily point to the existing process to change or re-direct the behavior, as well as explain why final diagnostic decisions are made.

Barriers
There are a few things that can hamper communication. Identify which ones affect your facility, Larson said, and devise a solution that best fits your facility.

1.Hierarchical culture: Environments with a clear division between radiologists and technologists often breed a reluctance to speak up. Both new and experienced technologists can feel too uncomfortable to approach and offer input to radiologists who adopt condescending attitudes or show minimal appreciation for a technologist's work. Be sure the culture in your office is respectful and acknowledges everyone's contributions.

2.Physical barriers: The wide variety of existing practice structures frequently creates a physical division between providers. It's difficult to discuss patient cases when the radiologist reading the scan is based in one office and the technologist is located in another across the city or state. This is  particularly a problem, Towbin said, with teleradiology.

3.Different employers: Within the same facility, technologists and radiologists could have different employers. If a technologist works for the hospital and the radiologist works for a practice contracted by the hospital, there's a lack of shared leadership. Little coordination can lead to a communication breakdown.

The Technologists' Perspective
For technologists, high-quality patient care is the main reason for making good communication a priority. It's how technologists know exactly how to meet providers' wants and needs, said Becky Apodaca, BS, RT(R), CRA, ASRT Director of Professional Practice.

"Radiologists must provide feedback," she said. "It's the only way a technologist can improve or change their behavior."

For example, previously, her department conducted routine quality reviews with department leaders and technologists, spot-checking whether a sample of studies fulfilled specifications. These reviews identified areas for improvement.

Alternatively, according to Erin Adkins, a pediatric imaging technologist, Cincinnati Children's uses a coaching/mentoring model to facilitate communication. By pairing experienced technologists with newer technologists, the department created an effective method for disseminating any protocol changes and updates. Radiologists were recruited to answer questions, as well as provide educational examples of how to conduct and combine exams when appropriate.

"The end goal is making sure we're on the same page with the radiologists," she said. "But, it also ensures the radiologists are on the same page."

Overall, Towbin said, you should make every effort to keep the communication lines open and flowing freely. They are critical to the quality of services you provide, as well as to your daily functioning.

"The more ways you have to communicate, the better off you'll be. You rarely have problems because you over-communicate," he said. "It can be phone, face-to-face, or through your PACS. Use every method available to you."