From Each According to His Ability


When roles blur in radiology.

I’ve worked with some darned good radiology techs. Of course, there are those who have the skills and/or attentiveness to ideally position their patients, recognize when repeat image acquisition is needed, etc…and that gets my abundant appreciation all on its own.

Then, there are those who take things to another level, performing some tasks that others could (justifiably) say is the radiologist’s job. Rest assured, I’m not talking about the dreaded “practicing medicine without a license” thing.

More like a tech at the scanner controls who recognizes an intracranial hemorrhage and makes sure the case is the very next one the rad sees. Or the tech who sees subdiaphragmatic free air on a chest X-ray, but notes that the patient is fresh from an ex-lap, and annotates the images so nobody panics.

Part of my admiration for such techs is that they are sticking their neck out further than necessary, without expectation of reward. They’re taking the risk of being wrong, with the associated ego-bruising. Further, the rad with whom they’re working might not appreciate the assist, and respond unpleasantly.

When the rad/tech team are accustomed to working together, and know one another’s style, this becomes less of an issue. A given rad might like certain techs taking the initiative,  but might prefer that others do not (for instance, if the tech at the scanner makes a habit of interrupting the rad’s work for “important findings” that turn out to be artifact, normal variants, etc.).

An experience of mine from a couple of weeks ago was a shining example of when a tech’s eagerness to go above and beyond…shall we say, overrides what, for me, is the boundary I normally expect between our respective roles. To be fair, I’m a telerad, and the tech does not know me personally, nor my working style; perhaps the rads in that facility feel differently.

I’d read a head/neck CTA, and considered it normal. A bit later, I got word that there was a request for me to re-look at image #whichever, regarding vessel X. As much as one might dislike being yanked from a current case to revisit a former (especially if there is an anxiety-producing suggestion that one has missed an abnormality), of course I obliged. Looked, still saw nothing the matter, made a note that my interpretation was unchanged, and moved on.

In came a phone-call from the site; doc wanted to discuss the case. Figuring this clinician (in the ER) was the one who expressed concern about the image, I get on the line…and find out that, no, the tech had been the one asking about the image…and had proceeded to tell the ER doc of her concern. The doc, as she put it, now felt as if she was “caught in the middle,” despite my reassurance that there was no abnormality.

Again, I’m not on-staff at the site. I have no idea what their policies and procedures are. Maybe their rads have the highest confidence in this tech, and like it when she expresses herself about what she thinks is abnormal on a scan. Maybe the tech was even a practicing radiologist in another country, and read scans like this for years…but has not (yet) pursued licensure in the USA.

Regardless, we have our various credentials and professional roles for a reason. In specific instances, it might be fitting for us to blur boundaries a little bit, to make the most of staff who bring particularly strong abilities to the team. If doing so, I believe that we should err on the side of caution...even if it means squelching some enthusiasm in the process.

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