Radiologic Technologists: The Most Important Health Care Professionals You’ve Never Heard Of

A glimpse into the work of radiologic technologists, who often go unnoticed and unacknowledged, despite that much of patient care hinges on their work.

Radiation Therapists' Role in the CT Simulation Room

Radiologic technologists: they are the third largest group of healthcare professionals in the nation, and you’ve probably never even heard of them. Maybe you’ve met one before when you broke your arm or when you went for your annual mammogram. Maybe you even mistook them for the nurse—something that happens so often and is such a point of frustration for radiologic technologists that there is a thriving market for “I’m not the nurse” merchandise aimed at disgruntled rad techs. But these unsung medical professionals are a crucial element of the healthcare industry. They are the ones who operate the equipment that captures images of what is going on inside the body—from bone to organs to veins to brain activity. In fact, it is often the work of radiologic technologists that allows physicians to diagnose, track the progression of, and perform surgery and treat diseases and traumas. They are the linchpins of radiology, the “eyes of medicine,” and somehow we are largely blind to them.

Radiologic technologists

Recently, however, the critical role radiologic technologists are playing in the protracted COVID-19 pandemic has brought them some acknowledgement from the mainstream media. Back in December of 2020, the Associated Press reported on an X-ray technologist in Kansas who slept for a week in an RV in the parking lot of the hospital where he worked to keep it operational after all his colleagues contracted COVID-19, leaving him the last man standing. A radiologic technologist also appeared briefly in a Super Bowl commercial for Rockstar Energy Drink, masked up, in blue scrubs, with a stethoscope around his neck. You probably mistook him for a doctor. Or maybe a nurse. But he was a radiologic technologist, sure enough.

X-ray technologist Michael Benzaia appears at 0:23, in a series of images of “real rock stars,” who, according to the commercial, do not chase the spotlight, but rather are chased by it.

Outside of this pandemic, however, radiologic technologists, or “rad techs” as they often refer to themselves, have gone largely unacknowledged as healthcare professionals with the exception of some specialized radiology-focused news sources. What coverage does exist is largely comprised of articles aimed at people considering the profession—sterile lists of advantages, job outlooks, salaries, prerequisite learning, and job duties. Maybe a “listicle” of myths about the profession, but still targeting potential students of the field. There is little that celebrates the role of radiologic technologists, little that acknowledges the difficulties of the job and the skill it requires. This article intends to remedy that, to offer a more in-depth look at what it’s like to be a rad tech and to acknowledge and celebrate the profession and the professionals who, by and large, go unseen and unsung in daily life.

Just What, Exactly, Is a Radiologic Technologist?

Rad techs are skilled medical imaging professionals who are critical components of radiology teams. Medical imaging and radiology, while relatively new fields, have revolutionized medicine in a short period of time, such that today, medical imaging is used across all stages of the healthcare process and across disciplines. Given the breadth of uses for medical imaging in healthcare, it is no wonder that radiologic technologists have an extraordinarily large scope of practice. Rad techs are certified to work in specific imaging specialities called modalities, and these include X-ray, magnetic resonance imaging (MRI), computed tomography (CT), mammography, ultrasound, fluoroscopy, nuclear medicine, interventional radiology, positron emission tomography (PET), and angiography. Many technologists are certified to work in multiple modalities and do so in their daily practice. They can be found in private clinics, such as mammography clinics or chiropractic clinics, elderly care centers, and in hospitals across a variety of departments, including the emergency room and operating room. Some are even mobile or traveling rad techs, working across multiple facilities within a specific area each day.

It’s no surprise to find technologists spread across such vast swathes of the healthcare continuum, disciplines, and facilities: being able to see inside the body allows doctors and researchers to more accurately diagnose patients, plan treatments, and monitor the effects of those treatments. The images acquired by radiologic technologists are even used to guide surgical procedures. This means that rad techs who capture these images are, in effect, the fulcrum of patient care. The images they produce of patients’ otherwise invisible inner workings form the foundation of diagnosis and treatment for all manner of ailments, from broken bones to cancers of all kinds to epilepsy to heart and liver disease—the list is practically interminable. And those images do not simply produce themselves.

So Much More Than “Button-Pushers”

There is a common misconception, and a rather degrading one at that, that radiologic technologists are little more than button-pushers, that the complicated, expensive machines do all of the work. Yes, it is true that rad techs do push buttons on those machines, but pushing those buttons requires a lot of knowledge, skill, and on the spot critical thinking and problem-solving. And, quite frankly, you couldn’t do it. It is not some automated task, some simple set of steps or flow chart to follow—if this, then that. No, it is far more involved than that. Knowing what parameters for a machine, or more simply, deciding which buttons to push and what settings to use, for any given patient in any given situation with any given machine relies on a host of factors that would make the average person’s head spin. Essentially, capturing medical images is a scientific balancing act between multiple, interrelated considerations that are as often utterly unique as they are familiar.

One governing rule of rad techs’ work in “pushing buttons” is to abide by what is known as the ALARA principle of radiation safety, which stands for “as low as reasonably achievable.” Essentially, they need to expose patients to as low a radiation dose as possible to achieve a high-quality image that can be used for diagnosis and treatment decisions. Repeating procedures exposes patients to unnecessary radiation risks, and so, technologists need to get it right the first time, as often as possible. This requires knowledge of the amount of time patients are exposed to radiation sources, the distance from those sources, and the types of shielding or protection to be used in a particular procedure. This may seem simple enough until you account for all the other factors that come into play with medical imaging procedures.

While ensuring the lowest possible patient dose to get the job done, a radiologic technologist must also adjust equipment parameters to account for the patient’s build and age (pediatric patients require entirely different considerations from adults when it comes to acceptable radiation doses), the part or parts the doctors need to visualize, the type of tissue that body part is made up of, the suspected pathology, radiologic anatomy, physiology, and patient positioning. Yes, patients must be placed into specific positions at specific angles in order to visualize the body parts needed. And that is not always easy.

Proper patient positioning often presents a challenge for reasons that are legion. Patients are not usually aware of what is needed of them during a specific procedure, meaning radiologic technologists must develop clear and compassionate communication skills in order to ensure patients understand the procedure itself and its purpose and follow instructions to avoid needing to repeat imaging. This becomes even more difficult when the patient is a young child or does not speak a language in which the technologist can communicate or has visual or hearing impairment. Sometimes, patients are not able to position themselves, such as patients with severe injuries or trauma, patients who are weakened by painful chronic illnesses, elderly patients with limited mobility, patients suffering from dementia, even babies in the neonatal intensive care units. Sometimes patients are prisoners who are handcuffed, and the accompanying officer refuses to remove the restraints. Sometimes patients are under the influence of a substance and uncooperative or even violent. Achieving the proper positioning and getting the patient to hold that position is as much an art as it is a science.

Proper Positioning

And as if the considerations above were not enough, rad techs must also draw on knowledge of the type of imaging equipment used, even the manufacturer of that particular piece of equipment, as well as on an understanding of the physics behind each procedure and various types of equipment and the interactions of radiation and magnetic fields with different types of body tissues when deciding “what buttons to push.” Getting all these right can mean catching a disease early enough to change the outcome for a patient. Getting any of these wrong can result in substandard images and a poor diagnosis or misdiagnosis with major repercussions for patients in the future.

You get the picture: not just anyone is able to sling photons and magnetic fields at patients. It requires specific and rigorous education, critical thinking, and interpersonal skills.

You Need A Degree and Credentials to Push Radiologic Buttons

Alongside the wholly inaccurate image of radiologic technologists as mere button-pushers comes the (also erroneous) assumption that their jobs do not require much in the way of education. While minimum requirements vary from state to state, RTs are degreed and certified healthcare professionals who have completed an associate’s or bachelor’s degree in radiologic technology from accredited 2 or 4-year programs which include clinical practice components. They must pass rigorous registry exams to obtain credentials for specific modalities and hold professional credentials or licenses in compliance with state boards of medicine.

You can see a rad tech’s credentials in the letters after their names on their badges. The basic R.T.® certification means “registered technologist,” a title awarded when a healthcare professional completes classroom and clinical education requirements, passes the state and/or national American Registry of Radiologic Technologists® (ARRT ®) examination, and meets all ethical requirements for state licensing and/or certification and registry with the ARRT ® organization. The ARRT ® organization supports 15 credentials, with many technologists holding more than one. In its March 2021 census, the ARRT ® organization recorded some 343,328 radiologic technologists in the United States holding a total of 539,900 credentials among them. Each credential requires technologists to complete additional and different training and pass additional examinations and is represented by a letter following R.T. and then ending with (ARRT), such as R.T.(R)(ARRT) ® (radiography) certification or RT(R)(M)(ARRT) (radiography and mammography) certification or RT(R)(MR)(ARRT) (radiography and magnetic resonance imaging) certification. Next time you are in for a scan of some kind, check your rad tech’s badge and see just how credentialed they are. You’ll be impressed.

Initial Education is Just the Beginning for Radiologic Technologists

And their education doesn’t stop with the degree or exams. The exponential rate of change in technology, the findings of new research, the development of new procedures, all mean constant training and retraining, constant learning and practice. In addition to the occasional on-site training on new equipment by expert application specialists, radiologic technologists in most states are required to remain up to date with their practice through completing a set number of continuing education credits every two years in order to maintain their credentials. And unless they have a generous employer, most radiologic technologists pay for this requirement out of pocket, and it can get pricey.

A Physically Demanding Job

In addition to the intellectual demands of the job, being a radiologic technologist is physically demanding. In fact, programs in radiologic technology warn applicants in advance of the physical rigors they can expect to endure on the job before they sign up, and they are not negligible.

Meme Rad techs

Rad techs spend a great deal of time on their feet. For hours on end throughout their shift, they are standing, walking, pushing patients in wheelchairs or on gurneys, and moving portable equipment such as C-arms (X-ray equipment) that weigh hundreds of pounds from place to place. They often need to lift patients onto examination tables for positioning, supporting their weight in part or lifting patients and carrying them entirely, such as patients who are suffering from cancer or other diseases and cannot move under their own power. Sometimes the patients are very heavy. This is such a common demand on radiologic technologists that it appears in memes in circulation around the internet and professional groups.

Rad techs may also reach up above their shoulders to manipulate and adjust equipment for what amounts to about 6 hours of their 8-hour shift. They often hold objects weighing up to some 15 pounds out from their bodies and lift heavy cassettes and equipment throughout the day. Often they are required to lift heavy loads of up to 45 pounds up 25 times per hour without assistance. X-ray technologists must wear lead aprons, many of which weigh well over 10 pounds, to protect themselves from radiation exposure. While perhaps none of these alone seems like much, combined and extended over an 8-hour shift, they are considerable, and radiologic technologists are at increased risk of injury. (You can find samples lists of the physical demands on radiologic technologists developed by programs in radiologic technology here, here, here, and here.)

Being a Radiologic Technologist is Not for the Faint of Heart

A great deal of news has focused lately on the increased emotional strain healthcare workers are experiencing due to the COVID-19 pandemic, staff shortages, and hospitals trying desperately to operate beyond capacity and with dwindling supplies. The recent crisis in Los Angeles County comes to mind. We covered this emotional stress in our article last summer on radiologic technologists as frontline healthcare workers. Here, however, we aim to appreciate the emotional strength required of technologists on the average day, outside of extraordinary circumstances.

Like all healthcare workers, rad techs, especially those working in emergency rooms or trauma centers, witness some truly horrific and traumatic scenes—gunshot wounds, injuries from terrible car accidents, patients who have suffered domestic abuse. They may be asked to image body parts that are grotesquely out of place or hanging on by a thread. Those rad techs working in other facilities not addressing emergency care are also subject to emotional trauma, watching an elderly patient waste away, seeing a child succumb to cancer. These may not be as gory as the scenes from an ER, but make no mistake: they too leave their mark.

These traumas, however, are not unique to rad techs. Healthcare workers and physicians of all types may witness such things. But rad techs do have to deal with an emotional challenge unique to their profession. They take images of patients’ innards all day. They see thousands of images in their careers, and over time and in many cases, they come to know what they are looking at on the screen—but they cannot tell a patient, even when that patient asks or pleads for answers, even if that patient is a friend, a relative, and loved one of a loved one. They are legally forbidden to speak of or otherwise indicate what they see. That includes keeping their facial expressions utterly neutral and their voices unwavering when a brain tumor is clearly visible on the scan of a child, when the lump in the patient’s breast is obviously cancer, when the telltale signs of some fatal disease appears on the screen. Imagine the effort of will to see such a thing and maintain your composure, to answer the woman who does not yet know that she has cancer with a sterile, even-toned “I cannot say,” when she asks you what you saw.

Often, patients mistake the legal prohibition against rad techs telling patients what they saw on a scan for simple unwillingness to communicate, and so respond with indignance or even verbal abuse. They are unaware, of course, that what they are asking their radiologic technologist to do is illegal, in all fifty states. For a rad tech to say what they see on an image would be to offer an interpretation of that image—a diagnosis—which is considered practicing medicine. And as radiologic technologists are not physicians, to answer the patient’s question would be to practice medicine without a license, which again is illegal in all states, and a felony offense in some. So, rad techs must remain neutral in face and in tone and obstinate in speech, no matter how emotionally charged the situation, or risk legal repercussions and their credentials. No easy feat, but one that they do every day.

To Be Seen

Despite the difficulties of the job—intellectual, emotional, physical—radiologic technologists love their work. They know that it is critical, that they are essential, that patient care practically hinges on their ability to coax patients into position and manipulate machinery to get that perfectly exposed image. And they don’t seem to ask for a lighter load, or even a stronger back to manage that load. What they ask for is simple: to be seen and to have their work acknowledged for the skill it requires and importance that it holds for patient care. And that seems to us a rather fair request. They are, after all, the eyes of medicine, and without them, we would be blind.