Status of CT Training by Manufacturers

1. Status of CT Training by Manufacturers Today’s Training Status – Ed Toerek, Philips Proposed Enhancements – John Jaeckle, GE MITA Meeting, November 30, 2009

2. CT Technologists Training ARRT – The American Registry of Radiologic Technologists ASRT – American Society of Radiologic Technologists MITA Meeting, November 30, 2009 • Recommendations/Requirements for CT Technologists • ARRT Registered Radiology Technologist (RT) • ARRT Certified in CT, license renewed every 2 years • Manufacturer’s specific training (includes Train the Trainer)

3. Training by Manufacturers MITA Meeting, November 30, 2009 • Manufacturer’s training curriculum are reviewed /approved by ASRT to be CE credit eligible • Training provided/available by manufacturers with each system • Manufacturers’ training is recommended for CT Technologists • Manufacturers’ Training Centers provide CT fundamentals, theory, and physics training in both classroom and hands-on environments, away from busy imaging department environments. • Continuation of training at customer site includes protocol development, image quality, buttonology, practical use, image archiving, etc. (entire clinical workflow)

4. Training by Manufacturers MITA Meeting, November 30, 2009 • Flexible Training methods and materials • Training Class/lab, CBT, IFU, On-Line Help, On-Line/Webinar Training • Hands-on learning and clinical applications practices at customer site, remote training sessions, training checklists, reference guides • Applications support available via toll free lines

5. Dose/Brain Perfusion Training MITA Meeting, November 30, 2009 • Standard Scanner training includes Dose Management, Dose Measurements, Reporting, etc. • Additional/refresher onsite or remote access training • Dose Management in CT • Pediatric Dose • Neuro – Brain Perfusion • CT Image Quality and CT Parameters • Dual Energy • CCT • Some advanced classes for physicians and technologists • Image Gently initiative for Pediatric Dose Reduction

6. Training Records MITA Meeting, November 30, 2009 Manufacturers maintain training records for manufacturer provided training Manufacturers have no records of training provided to technologists by their own in-house experts at the user facilities

7. Training Challenges The challenges are the result of decisions made by the sites and are not within the control of the manufacturers MITA Meeting, November 30, 2009 Techs not attending entire training course at customer site. Up to 40% of the time, customer rotates techs in/out of training course Not having SAME techs attend both offsite and onsite training sessions to build on training/skills. ~10% of the time non-CT certified RT’s attend training Site readiness - no patients on schedule, inspections not complete, IT connections not complete (internal readiness) ~50% of the time, too many patients scheduled during training period Approximately 20-25% of customers choose to not follow the manufacturer’s established training agendas

8. Site Operational Challenges MITA Meeting, November 30, 2009 Non-CT certified RT’s operating CT Scanners New techs rotating in/out of CT Department without same level of manufacturer provided training Effectiveness of training provided by designated site ‘experts’ (those completing train the trainer) Approximately 80% of the times the Radiologists are not actively participating in protocol development. It is left to the technologists. Many radiologists face challenges in scheduling personal training time to learn about equipment capabilities and software. They will instead rely on the technologists to make important protocol decisions.

9. Proposed Training Enhancements MITA Meeting, November 30, 2009 • ACR or other professional organizations should consider • Establish minimum requirement for technologists (training, usage, etc.) • Require periodic dose refresher training/certification • Competency assessments of all technologists operating CT Scanners and Workstations • Accreditation should require proof of sufficient CT specific training • ARRT re-certification should require CT Dose education training via ASRT recommendations for CT Technologists • Imaging sites should clearly designate responsibility for the content of and adherence to protocols • The roles and responsibilities of radiologists, technologists, physicists, radiation safety officers should be clearly established and documented. Training should be required and assured accordingly. • Imaging sites should better utilize the education already available from the CT manufacturers.

10. Summary MITA Meeting, November 30, 2009 • All manufacturers provide a robust and wide variety of training to the users. • Hospitals/Sites designate who is trained by the manufacturer • The great majority (~ 90%) of manufacturers’ training is delivered to the persons operating the CT scanners (technologists) • The risk-benefit trade-off between dose and image quality embodied in the protocols is fundamentally a medical decision, therefore radiologists have the primary responsibility • Appropriate trade-off decisions often involve model specific information hence the need for training involvement by radiologist on specific equipment • Manufacturers feel that radiologists need to be more integrated into the overall site training and quality assurance (QA) program to assure full utilization of the dose saving features of the installed equipment

11. Summary MITA Meeting, November 30, 2009 Manufacturers are willing to continue working with ACR, Image Gently (SPR), ASRT, AAPM to harmonize CT Dose training for radiologists, technologists, physicists and other provider professionals.