Running head: ETHICAL ISSUES AS A RADIOLOGY 1

Ethical Issues in Radiology
Interview Paper
Annelia Cyril
Adventist University of Health Sciences

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Abstract
As a health care professionals we live through our career with sincere dedication to our patients. Ethics encompasses a variety of issues that all medical professionals, including medical imaging technologists must ultimately tackle. When considering ethics, medical imaging professionals need to take into account their responsibilities to patients, colleagues, employers, the imaging profession, and themselves. This interview will review these responsibilities with respect to medical imaging and the challenges that imaging technologists may face in approaching their work from the perspective of ethics. The American Registry of Radiologic Technologists (ARRT) has developed a Standard of Ethics in which radiologic technologists have to abide by. With the continual invention and improvement of lifesaving medical technology also comes the burden of ethical decision making. Radiologists today face more ethical issues than meet the eye.

3 N.C is a 29 year old female graduate from St. John’s University in Queens, New York. She graduated five years ago with her Bachelors of Science in Radiology. N.C is now a registered Radiologic Technician and has also furthered her education in Magnetic Resonance Imaging (MRI). This interview was conducted in a face to face manner in the home of the healthcare professional. N.C is currently working in a hospital setting near New York City and has deep devotion to her patients and the responsibilities that go along with being a healthcare provider.

Q: What does a Radiologic technician do?
A: RT’s (radiologic technicians) are most often employed in hospital settings, but are also often at work in doctor's offices, diagnostic laboratories and diagnostic imaging centers. Primary duties include preparing patients for X-rays, as well as taking and developing the film for use in medical diagnosis. To capture images of the bone and tissue structures of their patients, electromagnetic radiation is used.
Q: Are you able to specialize in anything specific in Radiology?
A: Experienced radiologic technicians sometimes specialize in particular diagnostic imaging practices, including mammography, computed tomography (CAT), ultrasound, Magnetic Resonance Imaging (MRI), or fluoroscopic imaging. State laws regulate the types of diagnostic imaging techniques these technicians may perform. 4
Q: Is there growth in your field of work in the healthcare industry?
A: This growth rate is somewhat higher than the average growth rate across all industries. With the increase of outpatient care, radiology technician employment opportunities outside of hospitals are expected to increase. Technicians who are familiar with a variety of imaging techniques will have a distinct advantage, as well.
Q: Is there a difference between a Radiologist, X-Ray Technician and Radiologic Technologist?
A: Basically, radiologists, X-Ray Technicians and Radiologic Technologists all work in the radiology field and that's why these different job titles are so often used interchangeably. While there are minor distinctions in job responsibilities in some instances, for the most part Radiologic Technologists and X-Ray Technicians are very similar career choices. X-Ray Technologists usually have a little more training and experience than Technicians, but both use diagnostic imaging machines to take images of the inside of a patient's body. Because they usually have bachelor's degrees in radiology, X-Ray Technologists may enjoy more supervisory roles than a standard X-Ray Tech.
Q: Do you mind explaining that to me in further detail?
A: Sure! While X-Ray Technicians are actively involved in administering X-rays, their role in the diagnostic process ends there. This is where the real difference between an X-Ray Tech and a 5
Radiologist comes in to play. After taking the X-Ray, the technician will pass on the image to the Radiologist, a professional more qualified to diagnose a patient according to the visual evidence provided. X-Ray Technicians do not discuss results with patients. While radiologists are often more professionally qualified than X-Ray Techs, the job of a radiologist is also more dangerous. For instance, Radiologists are sometimes required to handle radioactive substances during the course of an imaging process.
Q:What do you feel is your ethical obligation to the patient?
A: High Quality Examinations. When patients enter the clinic, hospital, urgent care setting, emergency department, or other medical facility, they assume and expect that everyone they encounter during the visit is a skilled professional. When imaging examinations are ordered, they have a right to the highest quality examination that the imaging technologist can provide. Imaging technologists should respect the fact that the imaging examination is a major factor in the patient's diagnosis and can affect following medical care. Imaging technologists are human and similar to any other medical technologist, their work can be affected by fatigue, long shifts, and internal politics. Despite these potential distractions, we have to always remember our responsibility to the patient. We should always strive to deliver the best quality images for the sake of a patient's care.
Q: Thank you so much for helping me understand that. Now, as for ethical issues, are there any in ethical issues you find in your line of work as a Radiologic Technician in NYC or even in general? 6
A: Yes, several. They range from unnecessary testing, patient privacy, mammography, court cases and even determining brain death.

Q: What ethical issues do you find with unnecessary testing in your hospital?

A: When a radiologist receives an order for a test, the first step is to consider whether the test is truly necessary. Radiologists are ethically responsible to expose the patient to as little potentially harmful testing as possible.
Q: What ethical issues do you find with patient privacy?
A: The perfection of radiological equipment allows for more and more detailed scans of a patient's body. While this is highly beneficial for diagnosis, it can become a violation of the patient's privacy if these images are not appropriately protected during storage. Q: How would you say mammography caused an ethical issue?
A: Well, another concern in radiology is the widespread use of mammography, which leads to a high number of false diagnoses. According to a medical journal of Medical Ethics, it is estimated that it takes between 5,000 and 68,000 mammograms to prevent one death due to breast cancer.
Q: Wow, that’s a lot. Moving onto the court cases, what were some ethical issues there?

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A: Responsibility comes when a court case requires a radiologist to examine images to determine if a victim has been physically abused. Improper reading of these images may result in the conviction of an innocent person or the release of a guilty one.
Q: Very True! You have also mentioned that where were ethical issues concerning brain death?
A: Yes, because radiological imaging is used when a patient is pronounced brain dead, radiologists carry an extraordinary amount of responsibility for correctly reading the images of a patient's brain.
Q: How big is communication apart of your job?
A: Adequate communication and diagnostic care may not only improve patient comfort and satisfaction, but may also reduce the risk of complications or accidental death. The Joint Commission Resources (JCR) has identified communication and patient assessment as the 2 top factors contributing to sentinel events. In other words, patient deaths during hospitalization due to an acute myocardial infarction or terminal cancer are not considered sentinel events. Meanwhile, death or permanent impairment due to an allergic reaction to a drug that was administered during a routine hospital admission because someone responsible for the patient's care neglected to notice the drug allergies listed in the chart would be characterized as a sentinel event. Obviously, communication plays a critical part in preventing these events. The imaging technologist is usually the one associate within the imaging department who will have the most contact with the patient and the most opportunity for communication.

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Analysis
Our attitudes, actions, and decisions in even the most minor aspects of daily practice can greatly affect patient care. Four basic concepts are in play when considering medical ethics are beneficence, non-maleficence, respect for patient autonomy, and justice. Beneficence is a duty to promote good, to act in the best interest of the patient, and to act in the best interest of society. One can consider beneficence as an active aspect of ethical consideration, representing not just what we think, but what we do in daily practice. Non-maleficence is a duty to do no harm to patients or society which ties into the fact that clinicians must demonstrate a respect for patient autonomy, in that they have a duty to protect the patient's ability to make informed decisions about his or her medical care. Justice comes into play in medical ethics because clinicians have a duty to be fair to the community as a whole, and to protect and promote the fair distribution of healthcare resources.
Although many aspects of medical ethics are beyond the scope of the imaging professional, there are daily opportunities to provide services that reflect ethical practice. Ethics can be approached from a variety of perspectives, and we find ourselves responsible for the ethical treatment of our patients, our colleagues, our employer, our profession, and ourselves as individuals. Radiologic imaging technologists should keep these issues in mind in their daily practice and interactions with patients, keeping in mind how our responsibilities to these different parties may impact patient care.