Editorial: Which Exam is the Best for Radiologic Technologists Employed in Cardiac Cath Labs: The CCI RCIS Exam or the ARRT CI E

Since the 1980’s, we have been required to be credentialed in basic life support and advanced cardiac life support. These certifications opened the pathway for technologists to be trained to administer moderate sedation, emergency medications, and routine medications. In addition, technologists gained technical skills and continue to gain skills with diagnostic cardiac catheters, intra-aortic balloon insertions and intra-aortic counterpulsatile therapy, and percutaneous coronary interventional devices such as PTCA guiding catheters, PTCA guide wires, angioplasty balloons, coronary stent placements, and distal protection devices. Other equipment experiences that attributed to our professional growth include rheolytic atherectomy, brachytherapy, rotational ablation, and photo-ablation. Unfortunately, as the complexity of the duties of radiologic technologists continued to evolve, the certification process lagged. In the mid-1980’s, I felt the need to be certified in cardiac-interventional procedures. The only option in 1983 and 1985 was to take a certification exam through the National Board of Cardiovascular testing (NBCVT). I completed the second tier of the exam in 1985 and became registered as a Registered Cardiopulmonary Technologist (RCPT), which was the precursor to the Registered Cardiovascular Imaging Specialist (RCIS). In 1986, the American Registry of Radiologic Technologists (ARRT), which limited certification exams to radiography, nuclear medicine, and radiation therapy, embarked on a job analysis for technologists employed in cardiovascular settings that encompassed interventional cardiology and interventional radiology.^1-4 The first ARRT cardiovascular interventional technology (CVIT) examination to certify radiographers with a specialty in cardiovascular-interventional procedures was initiated in 1991.² This exam focused on diagnostic and interventional studies that were performed in cardiac catheterization suites and interventional radiology procedure rooms. Between 1991 and 2002, radiographers employed in the radiology settings were reluctant to take the exam because they were deficit in the knowledge of invasive and interventional cardiac procedures, while their fellow peers, who worked in the cardiac areas, complained that they lacked the competency needed to pass the radiology-focused part of the CVIT exam.^2-3 In early 2000, the ARRT decided to undertake another comprehensive practice analysis. The members of the ARRT CV Exam committee, along with the ARRT psychometric staff, created a task analyses form that encompassed over 130 possible tasks performed by technologists in cardiac and/or radiology settings.² One thousand two hundred technologists, who were certified with the Cardiovascular-International (CV) credential, were randomly selected to complete a questionnaire.² Over 800 technologists, who were employed as full-time employees in an invasive interventional cardiology setting and/or in interventional radiology, responded.^1-2 The indications clearly presented a pattern where many technologists, who worked solely in cardiology-based areas, performed tasks that were extremely different from their counterparts in other areas.^1-2 With the relevant results, the ARRT decided to divide the CV exam into a cardiac-interventional (CI) exam and into a vascular-interventional (VI) exam.^1,2,4 I have been certified with the ARRT CV and CI credentials, the Cardiovascular Credentialing, Inc. (CCI) Registered Cardiovascular Imaging Specialist (RCIS), and the Certified Cardiographic Technician (CCT) credentials. I can attest the credibility of both exams from my personal experience. There are many similarities between both professional testing organizations. Both undertake comprehensive practice analyses every five years. Their exam committees present their findings to their Board of Trustees for review, discussion, and approval. Applicants are required to meet procedural competency levels and both are required to have knowledge in radiobiology and radiation safety. The two major differences are: 1. For the CCI track, the exam is open to any qualified allied health worker in a cath lab who can meet the competency guidelines.¹ 2. With the ARRT track, the examinees, who must be an active ARRT Registered Technologists, must present written documentation of competent experiences with a minimum of 150 invasive and interventional cardiac procedures.¹ Many cardiac cath facilities require all allied health workers to gain certification as a Registered Cardiovascular Imaging Specialist through CCI. Some centers may require radiologic technologists to be certified in cardiac-interventional procedures. For a radiologic technologist, the person can take either the CCI exam and/or the ARRT exam. For unregistered cardiovascular technologists, registered nurses, registered respiratory technologists, registered or certified pulmonary function technologists, and state along with nationally certified emergency medical technicians with paramedic credentials, the CCI exam would be the proper pathway. I would suggest that radiologic technologists take both exams. The main reason for this suggestion is based on long-term personal knowledge of nurses, radiologic technologists, and other well-qualified allied health workers slighted from cath lab positions where the cardiac cath lab personnel are required to be Registered Cardiovascular Imaging Specialists (RCIS). In conclusion, advanced certification in cardiac-interventional procedures clearly displays the competency and credibility of technologists who have chosen to excel in their cardiovascular imaging careers. The process enhances trust between cardiologists, patients and the caregivers. Also, advanced certified employees embellish the image of the medical facility in which they are employed. Most importantly, the allied health workers must choose which testing organization will best serve their professional needs and the needs of their employer. Charles (Chuck) Williams can be reached at codywms@msn.com

1. Williams CO. Both exams are good - Just get certified. Advance for Imaging and Radiation Therapy Professionals 2002;15(23):35.<p>2. Raymond MR, Williams CO. Empirically mapping the subspecialties of cardiovascular-interventional technology.<i> Journal of Allied Health</i> 2004;33(2):95-103.</p><p>3. American Registry of Radiologic Technologists: The history of the American Registry of Radiologic Technologists. St. Paul, MN: ARRT, 1996: 111-112.</p><p>4. American Registry of Radiologic Technologists. Open letter to Cardiovascular-Interventional Community. In: Annual Report to Registered Technologist. St Paul, MN: ARRT, 1992:9-10.</p><p>5. American Registry of Radiologic Technologists: Cardiovascular-interventional exam to split into cardiac, vascular. In: Annual Report to Registered Technologist. St Paul, MN: ARRT: 2001:11. </p>