and establishing a career path by which to attract and retain radiation technologists (RTs), who are also in short supply, to the field. The RA’s duties are proposed to include patient management, certain routine procedures under direct supervision of a radiologist, and the communication of results to referring physicians; image interpretation, even on a preliminary basis, is expressly excluded. However, because individual states control licensing and regulation of nonphysician practitioners, an RA’s role and responsibilities may depend on his or her location.5,111 With ASRT funding, RA training programs catering to experienced RTs have been initiated at Loma Linda University, Midwestern State University, the University of North Carolina, and the University of Medicine and Dentistry in New Jersey, and are being developed at eight additional institutions.5
While RAs would enable breast imagers to focus on image interpretation and biopsies, physician extenders who interpret screening mammograms under the supervision of breast imaging specialists can further extend capacity. Evidence suggests that RTs could be specially trained to prescreen mammograms for the presence or absence of abnormalities25,111 or to double-read mammograms along with a radiologist.122 A series of studies supports the prospect for training and evaluation of physician extenders in mammographic interpretation.
Some of the most relevant experience of nonphysicians interpreting screening mammograms has occurred in the United Kingdom, where—despite a less burdensome malpractice environment and a different reimbursement structure—there is also a long-standing shortage of radiologists who interpret mammograms.40,122 One English “rapid access” breast clinic faced with unacceptably long wait times due to increased demand for mammograms coped with this problem by allowing mammograms of patients meeting specific criteria for concern to be interpreted initially by two specially trained RTs.25e (Candidate patients were not pregnant or lactating and were over 35, without clinically obvious cancer or axillary problems, but with worrisome symptoms such as breast pain, palpable masses, Paget’s disease, or nipple discharge.) Their findings were later reviewed by two radiologists, who decided whether the women should be recalled for additional studies. In 511 women thus screened and tracked for approximately two years, the sensitivity, specificity, and accuracy obtained by the RTs was comparable to that of radiologists. The women reportedly did not object when informed that an RT would provide the initial read on their exams.