The future of the radiography profession

"The best way to predict the future is to anticipate it.” While this sentence seems philosophical, the concept could apply to clinical and academic radiographers, radiography education institutions and researchers responsible for making a strategic action plan and being proactive instead of reactive in (re)adapting the radiography profession to the demands of the future.

A massive technological evolution and scientific developments have dramatically changed our social habits and our way of life. This is a new “digital society” with specific needs and different information – every day is more demanding.

Patients are now part of the process, becoming more active and making better-informed choices based on rankings, scores and other types of information. They start to ask more questions to better understand what is being proposed. They want to take part in decision making, becoming more and more demanding and having higher expectations, especially for access to imaging procedures.

It is amid this socio-technical complexity that medical imaging has turned into one of the main pillars of modern healthcare, from screening to diagnosis, treatment and patient follow-up. Together with several other pressures on health systems, such as economical constraints and technological developments, namely the rise of artificial intelligence¹, these are potential drivers for the exponential increase in the number of imaging procedures.

Aware of these complexities and the need to anticipate the future, the European Federation of Radiographer Societies (EFRS) has published its White Paper on Radiography Education, Research and Practice. This is a guidance tool for national societies and education institutions to support them in taking the actions and making the changes necessary to provide what will be expected of the 2031 radiographer².

It is in these three dimensions – education, research and practice – that our profession must develop to adapt itself to meet the expectations of societies, healthcare systems and citizens.

If we want to succeed as a profession and survive the impact that new technological developments will bring into the health sector in general and medical imaging in particular, we must understand, once and for all, that the three dimensions (education, research and practice) must be interlinked. We must combine our efforts towards achieving the same objective: to develop the profession by using research to improve the radiography field of knowledge.

For the moment, despite some good exceptions, the three pillars have been working as isolated islands, with low (in some cases no) interaction between them. The main challenge we face currently is how to break the historical barriers that have been created between the three pillars and bring them all together under the same goal: to develop the profession. A failure to do so will compromise the future of radiography.

To face this challenge, the EFRS White Paper’s Statement 9 for Education clearly defines that: “The development of highly skilled clinical radiographers requires both clinical and academic radiographers to be at the forefront of clinical practice, leading advanced and/or specialist practice, and undertaking research to further develop the evidence base for practice. Close collaboration between clinical and academic departments is essential, enabling clinical radiographers to fulfil their important roles in student education and training and engage in research alongside their clinical roles, and academic radiographers to sustain and continue to develop their clinical and research roles. Qualification as educators will become important for both clinical and academic radiographers.”²

Taking this into consideration, there is no doubt that failing to implement this concept in our professional community will risk the development of the “new radiographer”, who has the knowledge, skills and competences necessary to meet the needs and expectations of modern healthcare systems.

The outputs of evidence-based research will play a fundamental role in defining the “new radiographer”, as stated in EFRS White Paper’s Statement 9 for Research: “New technologies and techniques, including automation, artificial and augmented intelligence, and robotics will also be a feature of the profession’s research, with radiographers undertaking research to examine critically the impact of these on the safety and quality of care of patients, and the value they offer to the public. Research radiographers will become integral to research, development and evaluation teams employed in healthcare engineering and manufacturing organisations.”²

Therefore, it is clear that radiographers need to commit more to the profession, incorporate new competencies and develop advanced practice as a strategy to increase their relevance in healthcare systems and their importance in contributing to the improvement of the quality of patient care.

This is evident in the EFRS White Paper’s Statement 9 for Practice: “Radiographers are required to practise in accordance with the principles of professional ethics and evidence-based practice. Integral to their fundamental role, they must ensure that patients are properly identified, prepared, and cared for before, during and after each examination or treatment episode, and that their patients and carers understand who is examining or treating them.

Empathy, compassion, and effective communication should be evident at all times, recognising and respecting individuals’ particular needs, values and rights when carrying out medical imaging examinations and/or treatments. Proper account must be taken of people with special needs, whether physical, mental, or emotional, and patients who fear their condition is serious, has worsened, relapsed, or recurred must be supported. All interactions with patients must demonstrate inclusivity and equality and recognise and respect diversity.”² 

It is under this concept that radiographers need to engage more with patients, comfort them, talk with them and show that they care about them by developing high clinical and professional standards as a tool to avoid the commoditisation of radiology³. This will only be possible if hospital managers and health authorities understand the need to support and fund the implementation of lifelong learning programmes and offer  sustainable career progression⁴.

Nevertheless, radiographers have to overcome several barriers, namely: a) the fact that education and training in Europe is heterogeneous, with substantial differences in the duration and quality of training programmes between countries, which is likely to impact on the quality of patient care delivered⁵ and b) the fact that new technologies can also drive up costs, particularly if they are overused or misused⁶, so radiographers must be more aware of their importance in the process of justification. 

To overcome these barriers, it is very important that radiographers’ professional societies develop strategies to engage with health authorities, patients’ associations and industry to promote the importance of the role and responsibilities of radiographers as  healthcare professionals and the need to stimulate the implementation of advanced practice and new roles, even though some radiographers might feel not financially compensated to take up new roles and responsibilities⁷.  Nevertheless, radiographers must be aspirational and make all the efforts to move the profession forward into a new dimension, for the benefit of the main reason of our existence – the patients⁸.

To achieve this desideratum, the leaders of our profession have an important role to play. They should not only act as role models but be at the forefront, standing for the profession and its development and taking part in integrated teamwork with other health professionals – radiologists, radiation oncologists, nuclear medicine physicians and medical physicists, among others – with the same level of intervention, professionalism and with a solid professional identity⁹.

According to the EFRS White Paper: “The decade ahead demands that radiographers at all levels and in all roles are flexible and innovative, able to problem solve, challenge current practices, exercise leadership and take on new roles that improve imaging, interventional and treatment services. Their roles will become increasingly diverse, and they will be able to make much greater use of their clinical and associated skills to support and enhance care pathways efficiently and effectively, optimising the care they provide.”²

Despite all the constraints, difficulties and problems that we might identify, the future of our profession is in our hands. Each individual radiographer and their professional societies have the responsibility to do whatever it takes to continue to develop our profession at the highest standards possible for the benefit of our patients and health systems.

Each of us has the responsibility to contribute to the development of radiography, not only to honour the founders of our profession but to (re)build upon what we inherited and (re)invent what we do to promote a professional (re)volution. By doing this, we will leave future generations of professionals something that will make them proud. In the words of Pink Floyd: “Hey, you, don't tell me there's no hope at all; together we stand, divided we fall.”

Graciano Paulo PhD is President of the Higher School of Health Technology at the Polytechnic of Coimbra, EURAMED Board Member and Head of the World Health Organization’s collaborative Centre for Radiation Protection.

References

1. Ryan ML, O’Donovan T, McNulty JP. Artificial intelligence: The opinions of radiographers and radiation therapists in Ireland. Radiography. 2021. 27:S74-S82. doi:10.1016/j.radi.2021.07.022.

2. European Federation of Radiographer Societies. EFRS White Paper - Radiographer Education, Research, and Practice: 2021–2031. 2021.

3. Taylor A, Bleiker J, Hodgson D. Compassionate communication: keeping patients at the heart of practice in an advancing radiographic workforce. Radiography. 2021. 27: S43-S49. doi:10.1016/j.radi.2021.07.014.

4. Simcock IC, Reeve R, Burnett C et al. Clinical academic radiographers – a challenging but rewarding career. Radiography. 2021. 27: S14-S19. doi:10.1016/j.radi.2021.06.008.

5. Foley S, Paulo G, Vassileva J. Large differences in education and training of radiographers in Europe and Central Asia: results from an IAEA coordinated study. Radiography. 2022. 28(1): 48-54. doi:10.1016/j.radi.2021.07.016.

6. OECD. Health at a Glance: Europe 2020. Vol 6011. 2020.

7. Field LJ, Snaith BA. Developing radiographer roles in the context of advanced and consultant practice. J Med Radiat Sci. 2013. 60(1): 11-15. doi:10.1002/jmrs.2.

8. Strudwick R, Harris M, McAlinney H et al. The College of Radiographers Research Strategy for the next five years. Radiography. 2021. 27:S5-S8. doi:10.1016/j.radi.2021.06.010.

9. Knapp KM, Courtier N. The future role of radiographers. Radiography. 2021. 27: S1-S2. doi:10.1016/j.radi.2021.08.005.