The Wave Continues: Radiology Practitioner Assistants (RPAs) Hold Their 8th Annual Conference

The board of directors of the NSRPA, planning committee and members of the society express sincere gratitude to our corporate sponsors: AngioDynamics Inc., B|Braun, Burlington Medical Supplies, Inc., Cardinal Health, Cook Inc, Elsevier and Kyphon. Attendance Over 200 certified RPAs, several RPA students from Weber State University, in Ogden, Utah; one ARRT-certified radiology assistant (RA); and the Board of Directors of the CBRPA were in attendance. ASRT officer Kevin Powers, an associate member of the NSRPA who is also the ASRT Director of Education, attended the meeting and monitored the length of each speaker's lecture to insure the time and credit approved by the ASRT met their RCEEM guidelines. Cardiology & Vascular Presentations Ninety-nine health professionals, which included RPAs, RPA students and 2 physicians, were recertified after a 4-hour ACLS recertification course presented by Neil Holtz, EMT-P and sponsored by the NSRPA. The structure of Mr. Holtz's lecture on ACLS was the only one of its kind presented in the United States. This continuing educational organization remains the sole medical-related educational organization offering this workshop on an annual basis. A four-hour PICC certification workshop was presented by instructor Guy LaRue, RN CRNI. Dr. James R. LePage lectured on Evaluation and Treatment of Emergency Department Patients Presenting with Headaches. The focus was on recognizing common and a few exotic intracranial pathologic emergencies requiring emergent medical intervention. Interventional oncologist Dr. Mahmood Razavi discussed how the explosion of technologies for minimally invasive therapies has fueled the emergence of the new field of interventional oncology, also known as image-guided interventions (IGI), paralleling advances in medical imaging and early detection of cancer. The advantages of IGI are: 1) Procedures are minimally invasive; 2) Procedures can be performed in outpatient settings; 3) The approach is accurate and targeted; 4) Targeted therapy creates a more destructive local environment and reduces complications substantially; 5) Super-selective intra-arterial approaches permit larger doses of chemotherapeutic or radioactive medications to be deposited into a malignant growth, which reduces risks of systemic issues; 6) Embolization reduces drug washout and creates ischemia of the tumor; and 7) Image-guided interventions are easily repeatable, with higher patient acceptability. Dr. Razavi is an expert in treating coronary arterial fistulae. He discussed the uses of chemo-embolization, oily chemo-infusion, circulatory isolative therapy and gene therapies that are administered through the intra-arterial approach. In addition, he discussed the modalities that are used to perform ablative interstitial therapies with molecular agitation with radiofrequency ablation, photo-ablation and focused ultrasound, heat, cryotherapy and chemicals such as alcohol and acetic acid. He noted that the main limitation of IGI is the absence of sufficient level-1 data confirming improved survival. Dr. Robert Hannon presented on coronary computed topographic angiography (CTA). Dr. Hannon reviewed the anatomy of the coronary arteries, coronary CTA-slice multi-detection techniques, image interpretation and some excellent case studies. He also addressed the functionality and invaluable integration of three RPAs into his radiology group practice. Throughout his discussion, he commended the knowledge and skills of the RPAs who work with him and how they contribute to the success of CTA in his imaging facilities. Randy Benham, RPA-RA (CBRPA) RT(R)(CV) ARRT, spoke on Venous Intervention Techniques: Techniques for Access, Complication Comparisons, Complex Cases, and Financial Implications. Mr. Benham discussed venous anatomy, the types of access and techniques for success. He also presented a comparison of complications between radiologists and radiology practitioner assistants, complex case studies, and concluded with a look at the financial considerations that are involved with such procedures. Dr. Manual Viamonte, Jr., presented two lectures, Pitfalls in Chest Radiology and Multicultural Spirituality and Medicine. The latter discussion focused on how spirituality is interwoven with medical care in countries such as Tibet and India. The ancient processes of medical care are based on positive spiritual levels of the healers and their patients. Dr. Viamonte's two-hour presentation on chest radiology focused on many tips on evaluating chest radiographs that aid identification of the disease processes affecting the cardiothoracic areas of the human body. He elaborated on such radiology secrets as the feeding vessel sign and the Beret sign, often found in the vascular structures of the cardiopulmonary system. He covered other signs such as: 1. Chest wall a. Gingko Leaf b. Scapular 2. Diaphragm a. Dependent viscera b. Collar 3. Airway a. Bronchial cutoff b. Fallen Lung c. Finger-in-glove 4. Lung Parenchyma a. Air Bronchogram b. Air Crescent c. CT angiogram d. CT Halo e. Hampton's Hump f. Hurricane g. Ivory Heart h. Luftsichel i. Silhouette j. S sign of Golden 5. Pleura a. Continous diaphragm b. Deep Sulcus Groove c. Hemocrit d. Holly Leaf e. Split Pleura The basis of this globally-renowned medical professor's lecture was the article Signs in Thoracic Imaging¹, which he highly recommends for study. Jeff Davis, Director, Program of Cardiovascular Technology at Edison College in Ft. Myers, Florida, spoke on hemodynamics of the cardiopulmonary system. Mr. Davis discussed the equipment needs to achieve accurate hemodynamic monitoring and physiological causes of intra-cardiac and vascular events. He demonstrated the phases of the cardiac cycle from an electrophysiologic and pressure standpoint. In addition, he explained which waveforms are needed if a clinical history of valvular stenosis exists. Basic Intracranial Vascular Anatomy was presented by Dr. Harvey A. Koolpe, a featured speaker at the past three NSRPA meetings, an associate member of the society and a very strong supporter of the RPA movement. In his presentation, Dr. Koolpe focused on the simplicity of remembering the intracranial vascularity by using the Rules of Threes. He discussed the three types of arteries (muscular, fibro-elastic, and arterioles), which all run in cisterns of the brain unless the vessels perforate or penetrate structures of tissue. His theme focused on how to easily remember the neuro-anatomic vascularity by using the Rules of Threes. He then applied the other two Rules of Threes to the cerebral vessels, looking at how midline cortical structures receive blood from the anterior and posterior cerebral arteries and how lateral cortical structures receive a supply of blood from the anterior, middle, and posterior cerebral arteries. Dr. Koolpe, an interventional practicing radiologist, applied the same learning objectives to identifying the intracranial veins that drain blood from the brain. He concluded by discussing the circulation of the posterior fossa. (A copy of this presentation can be obtained by request through the NSRPA.) Dr. Aaron Shiloh discussed uterine fibroid embolizations, covering the background of uterine fibroid embolization, pre-procedure assessment of the patient, the procedure in detail and post-procedural care. He emphasized the importance of patient assessment and how important an explanation of the procedure to the patient is and along with post care management. Society Acknowledgement The NSRPA honored Jane Van Valkenburg, PhD, RPA-RA, RT(R)(N) for her dedication to the progression of the RPA as an advanced-level medical imaging specialist assistant. In August 2006, Dr. Van Valkenburg retired as an educator from Weber State University, in Ogden, Utah. This highly-renowned educator completed thirty continuous years of teaching radiologic science students on campus and through distance learning. RPAs & RA Training Differences RPAs receive an advanced-level masters degree and/or equivalent with extensive clinical training. They are required to complete didactic instruction consisting of a minimum of graduate level 92 course credit hours, and a required minimum of 256 hours of clinical instruction during their two years of advanced-level education. The mean average of clinical training for an RPA is approximately 425 hours. Their clinical preceptors are approved primary physicians, who are board-certified radiologists, and/or secondary preceptors delegated by their primary physicians. All preceptors, who are required to be physicians, evaluate RPA students as strictly as radiology resident encounters. Radiologist assistants (RA) receive a bachelors degree and must only meet one year of post-graduate clinical experience to be accepted at one of the last 4 originally ASRT-funded universities with RA programs. (Three of these four universities have now closed their bachelor's degree programs due to the low numbers of applicants. Two of three are reinventing the wheel, changing their curriculum to master's degree programs in order to shed the need for the high number of students needed to maintain a bachelor's degree program in good standing.) Licensure Issues During an open forum of the business meeting held during the conference, over 20 RPAs expressed concern about states passing licensure laws eliminating the terms CBRPA and RPA from their proposed licensure laws or who have passed licensure laws to that effect. RPAs in Florida and in New Mexico have laws in place negating the RPAs, who have been told that if they want to continue to practice, they will be required to take and pass the Radiologist Assistant (RA) examination offered by the American Registry of Radiologic Technologists. Some of these CBRPA-certified RPAs have lost their jobs over state licensure law changes. If RPAs in Florida have not taken and passed the ARRT examination by April 1, 2007, they will be required to by Florida law to cease practice. This same issue is being mandated by Tennessee and New Mexico. What is extremely interesting about these changes is that none of these states have radiologist assistants working in their borders. The laws have been written for a group of undergraduate level technologists who literally do not exist. Inter-Society Discussions Representatives from the ACR, ARRT, ASRT, CBRPA, and NSRPA attended a second summit meeting on January 28th. The meeting was a follow-up to the first summit meeting, held October 8-9, 2006, at the ARRT offices in St. Paul, Minnesota. No agreement between the parties has yet been reached. Some of the issues that were outlined in the November 2005 article, The Progression of the Advanced Practice Levels of RPA-RAs (CBRPA)² continue to be discussed at the summit meetings. A copy of the synopsis can be retrieved from the NSRPA website. The 2007 agenda³ included discussion regarding: 1. Grandfathering all CBRPA-certified RPA-RAs as ARRT RRAs without further education or examinations. 2. What period of time for completion would be acceptable for RPAs to achieve a bachelor's degree for those without one; if more education is mandated. 3. The definition of the ASRT Scope of Practice Proposal with final presentation to the ASRT House of Delegates Meeting at the Annual ASRT Conference in June 2007. 4. CBRPA's application to NCCA to obtain accreditation for the RPA examination. 5. CME requirements to accept AMA credits. Note: Due to statements of confidentiality drafted by the CBRPA and signed by all past and present participants, the details of the negotiations can not be divulged unless formal legal agreements are made, accepted and signed by all parties involved for release to the general public.

1. Marshall, GB, Farnquist, BA, MacGregor, JH, Burrowes, PW. Signs in thoracic imaging. J Thorac Imaging 2006;21(1):76-90.

2. Williams CO, Oberoi B, Abraham JL, Hall VL. The progression of the advanced practice levels of RPA-RAs (CBRPA). Cath Lab Digest 2005:13(11): 22, 24, 26, 30.

3. National Society of Radiology Practitioners. (February 15, 2007). NSRPA Update. Available at: http://www.radiologypa.org/ uploads/documents/NSRPA%20Update%202-15-2007.htm. Accessed March 20, 2007.