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This paper will address the role that certification and recertification will have on radiologic technologists and the profession. The history of education and the development of certification within the field of radiology will be distinguished between with the upcoming regulations and compared to alternative means for recertification. It will discuss the process of continued qualifications (CQ)/2011 and how it will affect radiologic technologists that will fall under the new criteria. We will discuss the advantages and disadvantages that CQ/2011 may pose for future radiologic technologists and what the American Registry of Radiologic Technologists ( ARRT) may recommend. A solution will also be proposed on alternative methods of recertification as well as establish what is used for other health care professions current certification processes.
 * The Radiology Recertification Plan ** **Abstract **

**Introduction:** **With the continual growth in technology into the future, it has become apparent the need to establish guidelines for continued educational requirements within the field of radiology. Since the implementation of the time-limited certification process, a debate has formed regarding the validity of recertification verses continued education as well as why the process should exist. Throughout this paper we will discuss the background behind radiology and the recertification plan, advantages and disadvantages for recertification, and propose a solution for the continued growth within the radiology field. **

Radiology was first developed in 1895 requiring no licensure, educational, or certification process. The phenomenon “x-ray” was used without any formal knowledge or training for many years (Constable & Somerville, 2011). Most medical x-ray equipment was operated by independent businessmen including chemists, engineers, and electricians (“History of the American,” 2011). By 1910 physicians were the first radiologic technologists, however, they soon realized that developing and processing x-rays was time consuming, therefore had “technicians” perform the basic functions of x-ray. These technicians were women, and in most cases were receptionists or secretaries (Miley, 2011).



It was not until an organization now known as the American Society for X-ray Technicians (ASXT) established the movement that developed the first standardized curriculum in 1952. This formal education led to greater standards and organizations for education, certification, and licensure (“History of the American,” 2011). In 1964, the ASXT changed its name to the American Society of Radiologic Technologists (ASRT) that is still used today. This change incorporated the growth of membership to nuclear medicine technologists and radiation therapists. It also created a shift from technicians to technologists putting a greater emphasis on professional education. In 1968, the ASRT asked the federal government to establish a standards regulation. A bill was soon passed that proposed standards for licensure and issuance of standards (“History of the American,” 2011).

In 1991 The Board of Trustees of the American Registry of Radiologic Technologists (ARRT) announced that it would begin putting together continuing education (CE) requirements, and in 1995 CE’s became a mandatory requirement for renewal or reinstatement of registration. “Certification is a way of assuring the medical community and public that an individual is qualified by knowledge and skills to practice within the profession” (“ARRT Continuing Education,” 2010). According to the ARRT, participation in CE’s demonstrates accountability to peers, physicians, healthcare facilities, and the public, and also reinforces the Code of Ethics endorsed by the ARRT and the ASRT (“ARRT Continuing Education,” 2010).

**What is CQ/2011:** With technology continually changing, the ARRT proposed a time-limited recertification plan for future technologists known as continued qualifications (CQ)/2011. In June 2007, the ARRT announced four years in advance the plan to begin time-limited certifications (“ARRT Announces”, 2007). This need for change was discovered when the approach coined “once certified, forever qualified” discussed that knowledge has a “limited shelf life” and is now obsolete (“CQ 2011,” 2011). In April 2009, the ARRT announced the details of CQ requirements (“ARRT Announces,” 2007). Section 2.05 of ARRT’s Rules and Regulations states: All new certifications awarded on or after January 1, 2011 will expire ten years from the date of issue. Completion of requirements to assure continued qualifications (which may be amended from time to time) must be documented prior to the end of the ten-year period to continue certification for an additional ten-year period. All requirements for annual renewal of registration will remain in effect during the 10-year period as will all reinstatement requirements. Certifications awarded prior to January 1, 2011 and for which registration is continuously maintained are not subject to the requirements of Section 2.05. If a certification awarded prior to January 1, 2011 is revoked for any reason, and that individual ever regains certification, the <span style="font-family: Arial,sans-serif; margin-bottom: 0in; margin-left: 0.5in;">new certification will expire 10 years from the date of issue. (2010)

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">With the changing pace of technology, the ARRT realized that time-limited certifications are needed to keep technologists’ education and knowledge current. The CQ/2011 exists because the ARRT’s mission is to be able to promote high standards of patient care (“CQ 2011,” 2011). This goal of higher standards of patient care can only be proven if it is known that the certified individual is demonstrating their continued qualifications.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in;">The ARRT has recognized that patients want to be reassured the best quality care and believe that their solution of CQ/2011 will meet consumers’ needs. Newly certified technologists from here on out will be required to demonstrate their education and knowledge through a three-step component which includes: An assessment component tailored to an individual’s particular practice pattern, an activities component specific to their areas of need, and a verification component that assures that the areas of need have been addressed (“ARRT Announces,” 2007). This method combined with the current biennial continuing education program introduced in 1995, will ensure that the individual is able to provide the best patient care possible.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in;">The ARRT believes that one day all medical professions will have to move to some type of recertification process. “Consumer and regulatory activism are leading to more accountability for all professions, and the continuous quality improvement movement has set the tone in healthcare (“CQ 2011,” 2011). The ARRT wants their profession to be prepared should this ever become a requirement.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">There are currently some other medical professions who have already adopted a recertification process to keep their professionals up-to-date. Some of these professions include: Physician assistants, radiologists, and sonographers. The National Commission on Certification of Physician Assistants (NCCPA) is the governing body for recertification. The NCCPA is committed to assuring the community that certified physician assistants that are certified meet all the professional standards including knowledge and expertise throughout their entire career. All 50 states including the District of Columbia utilize the NCCPA’s certification standards for regulation of licensure for certified physician assistants.
 * <span style="font-family: 'Comic Sans MS',cursive; font-size: 130%;">Supporting Research: **

I<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">n order to ensure continued education that is current with times, certified physician assistants must pass a recertification exam every six years as well as complete a log of 100 continuing medical education hours every two years. The physician assistant must complete the recertification exam by the end of their sixth year cycle but is allowed to start taking the exam up to one year in advance allowing the maximum of four opportunities to pass the exam. There are two different recertification examinations including the Physician Assistant National Recertifying Exam (PANRE) or the Pathway II. These two exams are similar in format and degree of difficulty. The 300 multiple choice questions evaluate the physician assistants’ knowledge of general medicine and surgery. Along with the Pathway II one must receive 100 elective points that can be earned any time during the six year certification cycle (“Registering for the 2010,” 2010). <span style="font-family: Arial,sans-serif; margin-bottom: 0in;">The American Board of Radiology (ABR) is the certifying organization for radiologists. The ABR carries out the initial qualifying and final examinations to assess the qualification of those physicians that studied radiology. This person is termed a board-certified radiologist or radiologic physicist. This initial certification is important to provide credentials and prove ones performance standards to potential employers as well as patients. It is important once ABR-certified that continued education is upheld (“What Is IC,” 2010). <span style="font-family: Arial,sans-serif; margin-bottom: 0in;">This continued education and certification is completed through Maintenance of Certification (MOC). This ABR MOC program was developed within guidelines of the American Board of Medical Specialties (ABMS). The MOC process is designed to document the professional development of each ABR-certified diplomat by focusing on the quality of care. MOC is developed on the basis that “lifelong learning is critical to ensure that new information and knowledge are incorporated into clinical practice” (Becker, et al., 2005). The program is supported by documentation within the four components of the MOC; these include: Professional standing, lifelong learning and self-assessment, cognitive expertise, and performance in practice. These components break down further into competencies including medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based learning (Becker, et al., 2005).

<span style="font-family: Arial,sans-serif; margin-bottom: 0in;">The requirements for diagnostic radiology include completing 500 approved continued medical education (CME) requirements over a 10 year period, 250 of these must be Category 1 and at least 70% must be related to practice specialties. Self-assessment is also mandatory and is completed through 20 modules over the 10 year MOC cycle (Becker, et al., 2005).

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">For sonography, the American Registry for Diagnostic Medical Sonography (ARDMS) is also making changes of their own. “The ARDMS is launching a recertification assessment program in 2012 and the first examinations will be offered in 2019” (“ARDMS recertification,” 2011). The assessment program will have to meet the required standards of the International Standards Organization (ISO) and the American National Standards Institute (ANSI), accredited by the ARDMS (“ARDMS recertification,” 2011). The ISO-ANSI states that registrants should have an up-to-date knowledge of current practices and that CE’s alone are not enough to prove such. “Beginning in 2012, Registrants, assigned a recertification assessment period will take a recertification examination in each clinical specialty area in which they hold active credentials” (ARDMS recertification,” 2011). This examination will be available online for registrants to take during the last three years of a ten year recertification period. Everyone who holds an active status will be required to take the examination. There will be no grandfathering according to the ARDMS.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">There are still many professions who have not moved to a recertification process, such as the nursing field. Although these professions have their education and certification requirements in place, it is possible that they may be lacking the current knowledge and skills that can enhance their ability to provide a high standard of patient care that the radiology field is already able to offer. As with most other health care fields, nursing has certification requirements mandated at the state level. The National Council of State Boards of Nursing (NCSBN) is the organization responsible for overseeing the nursing licensure process, including the examinations, practice research, education developments, and clinical data. This organization instituted two examinations, the NCLEX-RN and the NCLEX-PN to assess entry-level nursing competence of candidates for licensure as either registered nurses or licensed practical nurses. The NCLEX is required for state licensure to practice as a nurse (“NCLEX Examinations,” 2011).

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">Once the nursing license is obtained, it must be renewed annually, but no re-certification is necessary. This means that examinations only need to be taken on a one-time basis. The only other requirement for maintaining licensure is to complete a certain amount of continuing education, which varies from state to state on a biannual basis (“History,” 2011).

<span style="font-family: 'Comic Sans MS',cursive; font-size: 130%;">**PROS to CQ/2011:** <span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">There are many benefits to the implementation of the time-limited certification for radiologic technologists. The biggest benefit is that it creates requirements for maintaining the professional standards set by the ARRT to provide high quality patient care. The ARRT makes a good point in light of this: <span style="font-family: Arial,sans-serif; margin-bottom: 0in; margin-left: 0.5in;">It’s a professional obligation that you assumed when you decided to become a professional. It’s in your patients’ best interest, in the profession’s best interest, and in your best interest. <span style="font-family: Arial,sans-serif; margin-bottom: 0in; margin-left: 0.5in;">Time-limited certification will demonstrate that the registered technologist (R.T.) has relevant current knowledge that enhances his or her ability to provide high-quality patient care. (“CQ <span style="font-family: Arial,sans-serif; margin-bottom: 0in; margin-left: 0.5in;">2011,” 2011)

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">The theory is that the more education and training you receive, the better you will be able to provide exceptional care for patients and meet their needs in a variety of situations. It also keeps technologists current in terms of their knowledge and experience in the field. The time-limited certification law allows registered radiologic technologists to go beyond their initial understanding and reach their full potential in respect to changing technology, techniques, and patient care issues. Furthermore, it keeps them accountable for this knowledge by setting the requirements in place. Every individual in healthcare should want to seek out a profession that really strives for this mission. Healthcare consumers want to know that they are receiving the best care possible by a professional who is competent in their skills. If it was simply optional, most people may not utilize this opportunity.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">Finally, time-limited certification is expected to be a requirement for all healthcare professions in the future. Implementing this prior to it becoming mandatory puts radiologic technology ahead of the other career fields. It demonstrates leadership, diligence, advancement, and excellence.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">Time-limited certification is beneficial in some aspects but also has its downfalls. Time-limited certification will be very costly to the ARRT and the members that must continue to become certified. ARRT will have to form a committee to organize and standardize what will be evaluated, as well as how, when, and to whom. It will be costly to research and formulate a particular evaluation that will meet the standards and expectations of its members and organization. Time-limited certification will most likely cost technologists more money because as of now no one is certain to what and how much CQ/2011 will cost but it will be added upon their biannual continued education and their initial board exam, which is currently $200.00. It will also cost money to prepare for recertification, such as prep books that the ARRT will most likely offer, study tools via continued education material, or time taken off to prepare for recertification. However, these variables may change but they are still possibilities as of right now that could be costly to a radiologic technologist and the ability for him or her to maintain proper credentials. This all adds up to be very costly on both ends of the time-limited certification.
 * <span style="font-family: 'Comic Sans MS',cursive; font-size: 130%; margin-bottom: 0in; text-indent: 0.5in;">CONS to CQ/2011:﻿ **

<span style="font-family: Arial,sans-serif; margin-bottom: 0in;">Another negative aspect to time-limited certification is many individuals may be discouraged to specialize or maintain their credentials in other modalities because of re-certifying every ten years. Many individuals do not like paying for recertification and may decide that it is not worth re-certifying. With this in mind, radiologic technologists may not advance to other modalities therefore creating an overflow in diagnostic radiology or lose their certification. Also, it may be costly for re-certifying for every modality that he or she may be certified in. Along with the extra money that it will cost to maintain his or her credentials, he or she may fail to remember that they are under a time-limited certification. Many individuals will most likely forget to properly re-certify, therefore will lose their license, which is definitely a downfall. Another thing to think about is many may choose another career in order to avoid ten year recertification, therefore this could create a shortage in the radiology field.

<span style="font-family: Arial,sans-serif; margin-bottom: 0in;">One suggestion for recertification requirements for the CQ/2011 would be to create a tool to document the continued education of radiologic technologists certified after January 1, 2011. The solution includes requiring technologists to provide documentation of a log of examinations that they are competent in and provide examples. Examples may be provided through film or CD devices sent to the ARRT with appropriate legal documentation including markers.
 * <span style="font-family: 'Comic Sans MS',cursive; font-size: 130%; margin-bottom: 0in;">SUGGESTIONS/SOLUTIONS: **



<span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">One proposal would be to have the technologist complete online modules over the current initial examination categories including: Radiation protection, equipment operation and quality control, image production and evaluation, radiographic procedures, and patient care and education. These modules would have an educational presentation at the beginning followed by an assessment tool such as a quiz on each category. The technologists need to complete each section with a 75% competency. The technologists may begin taking the assessments as early as the 9th year after initial certification or recertification, and must be completed by the end of the 10th year of recertification. The allotted time frame after registration to take the modules will be three months long. This allotment will allow up to four tries to complete the recertification process over the recertification year. On top of these additional recertification requirements, the technologist will have to provide documentation of the regular 24 credits of continued educational requirements.

<span style="font-family: 'Comic Sans MS',cursive; font-size: 130%;">** CONCLUSION: ** <span style="font-family: Arial,sans-serif; margin-bottom: 0in; text-indent: 0.5in;">In conclusion, looking back at the history of radiology and looking forward to the future we have came a long way in the transition between new technology and continued education. With the ten year recertification, the quality of patient care will be increased due to better technologist competency in the field of radiology. Although the outcome of CQ/2011 cannot be stopped or completely determined at this time we are able to make suggestions. By providing documentation of logged exams, online modules, and 24 credits of continued education, this will demonstrate retention of knowledge within the field of radiology.

<span style="font-family: 'Comic Sans MS',cursive; font-size: 130%;">**Presented by:** <span style="font-family: 'Comic Sans MS',cursive; font-size: 120%;">**Whitney Hunt** <span style="font-family: 'Comic Sans MS',cursive; font-size: 120%;">**Wendy Johnson** <span style="font-family: 'Comic Sans MS',cursive; font-size: 120%;">**Jennie Martinez** <span style="font-family: 'Comic Sans MS',cursive; font-size: 120%;">**Megan Niehaus** <span style="font-family: 'Comic Sans MS',cursive; font-size: 120%;">**Sarah Wiseheart** <span style="font-family: 'Comic Sans MS',cursive; font-size: 120%;">**Ashlee Wittmann**

<span style="font-family: Arial,sans-serif;">References

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