Introduction by Croakey: Excitement about the potential for new technology like artificial intelligence, which holds great promise in the medical radiation sciences, has to be balanced with responsibilities for the ethical, social and legal issues, as well as what it means at the very human level.
That is one of the key issues raised by multiple speakers at the #ASMIRT2023 conference, who shared their thoughts on future opportunities and challenges for the profession with Croakey editor Marie McInerney.
Below, the speakers discuss other challenges, including workforce shortages and ensuring equitable access to care. As with many discussions already at #ASMIRT2023, they emphasise the importance of patient-centred and culturally safe care.
The closing session at #ASMIRT2023 conference – for the medical radiation sciences (MRS) – will include a panel session on ‘The MRS practitioner for the future’.
Featuring key international and national speakers, it will look at what the future looks like in the profession, its evolving scope of practice in the profession, and a presentation on ‘next gen tech needs next gen techs’.
Bookmark our coverage of #ASMIRT2023 here. Follow the conference hashtag #ASMIRT2023, link to our conference Twitter List and follow @ASMIRTorg at our rotated Twitter account @WePublicHealth during the conference, as well as @CroakeyNews and @AlisonSBarrett for more conference coverage.
Care must be the moral compass
Dr Christina Malamateniou, Director of Postgraduate Radiography program at City, University of London, Chair of the AI Advisory Group, Society and College of Radiographers
What excites and/or worries you most about the future in MRS?
Artificial intelligence (AI) is exciting because of the possibilities to improve healthcare, both effectiveness and safety-wise. AI is also the thing that worries me most, because it can do a lot of damage if not used within appropriate governance frameworks and within appropriate regulation and standards.
What are the biggest opportunities facing the MRS practitioner in the future?
There are big opportunities on the interaction between AI and person-centred care, but we need to get the balance right.
What are the biggest challenges facing the MRS practitioner in the future?
The challenges are low staffing and low morale. Healthcare practitioners have worked hard during the pandemic and saved the lives of millions of people. They need to be properly compensated for their work, formally recognised and their wellbeing should be a priority to ensure quality of the clinical service.
What are the priorities in medical imaging and radiation therapy for ensuring culturally safe, patient-centred, sustainable healthcare?
Priorities include:
- Strong partnerships between clinical practitioners, academics, patients and industry and also multidisciplinary partnerships to address complex healthcare needs.
- Updated education with digital competencies and attention to patient needs and preferences.
- Evidence based clinical practice, grounded on high quality, funded research.
What do you hope attendees take away from your presentations?
Attendees should feel excited that our profession is leading the changes for a digital future. This is also a huge responsibility, to get things right, for everyone else.
Any other comments?
Our profession is a caring profession, one that serves and helps others and has patient benefit as its core value. This should continue to underline all our efforts and practice, including the digitalisation of healthcare. This will be the moral compass that will help us safely navigate the digital future.
Diversity and AI are two unifying global challenges
Dr K Elizabeth Hawk, nuclear medicine physician and neuroradiologist, Stanford University School of Medicine and University of California, San Diego, USA
What excites and/or worries you most about the future in MRS?
MRS has been on the cutting edge of innovative patient-centred care since its inception. Even today, this field continues to lead the way in developing elegant strategies to treat a variety of diseases effectively and efficiently.
I am perhaps most excited about the continued growth of theranostics, and our ability to both image and treat disease at the same time.
The emergence of different artificial intelligence tools, and their integration into MRS is also something that particularly excites me. As we carefully examine the AI design process, and the careful integration of AI tools into our art of patient care, it is critical that we do so in a way that lessens global healthcare inequities and deepens the patient/physician relationship.
Opportunities
Opportunities are limitless in the field of MRS. Perhaps some of the biggest potential breakthroughs lie in developing disease-specific radiopharmaceuticals. While historically we have some fantastic radiotracers that can be used to image a variety of different disease processes, we are now seeing more and more diagnostic radiotracers and theranostic agents that are specifically designed for a certain cell type or disease process.
Challenges
While different countries experience different and unique challenges relative to their own socio-politico landscapes, there are two main global challenges that unite us.
The first is ensuring that the field of MRS welcomes a diversity of practitioners. Women and other underrepresented minorities are an essential part of the healthcare team, and it is critical that we continue to find ways to foster more diversity across the different roles in MRS.
The second challenge we face globally is the adaptation of AI tools into our time-honoured art of patient care. During both the AI design process, as well as implementation into clinical care, there are number of different ethical issues that must be addressed.
I have been very fortunate to work with Dr Currie, a Professor in Nuclear Medicine at Charles Sturt University here in Australia, on these issues. The ethical standards outlined in our 2020 paper Ethical principles for the application of artificial intelligence (AI) in nuclear medicine were adopted by the European Association of Nuclear Medicine (EANM) in their position paper on the application of artificial intelligence in nuclear medicine.
Priorities for ensuring culturally safe, patient-centred, sustainable healthcare
I strongly believe that building a team of diverse providers is key to ensuring excellence in patient-centred care. Finding ways to support women and other underrepresented minorities to explore and excel in careers in MRS ensures a team of diverse mindsets that can understand and uniquely respond to different patient needs.
What do you hope attendees take away from your presentations?
I hope attendees walk away with a refreshed love of MRS. Conferences such as this are a great chance to reconnect with our own academic passions, meet colleagues to collaborate with and move ideas forward, and renew our sense of optimism and hope as we face the future challenges ahead.
I also hope that my discussions on AI inspire more people to consider the ethical challenges of implementation of this new technology, and critically evaluate new tools with an understanding on how they may impact healthcare inequities. As always, I also hope that my own path encourages other women and underrepresented minorities to pursue their careers in leadership in MRS.
Additional comments
MRS is truly a global community. I welcome ongoing discussion, collaboration and networking. I hope that we can all use this conference as only the beginning of a conversation, and that we all continue to connect in the months and years to come.
Unique stories, cultures and needs
Dr Amanda Bolderston, Faculty Educator, Radiation Therapy Program, University of Alberta, Canada; Editor-in-Chief of the Canadian Journal of Medical Imaging and Radiation Sciences. See our earlier story and tweets on her presentations on LGBTIQ2S patients and professionals.
What excites and/or worries you most about the future in MRS?
My field is radiation therapy and what excites me are the leaps and bounds in hybrid imaging, especially medical radiation guided treatments that are increasingly becoming available. To be able to see and adapt our treatments in such exquisite detail is a huge advancement.
What worries me (as always!) is that we may continue to lose focus on caring for the whole patient, not just their tumour, in our excitement about new technology!
Opportunities
Our biggest opportunities are the boundless ways we can expand our practice, technically, in research and in all areas of patient care. I think that, as a unique profession, medical radiation technologists are coming into their own!
Challenges
The biggest challenges are the post pandemic shortage of healthcare professionals in general. It’s a tough time to sell the advantages of our profession and we’re looking at increasing health human resource issues as well as difficulty recruiting students.
Priorities for ensuring culturally safe, patient-centred, sustainable healthcar
I am always banging the same drum but I hope we can continue to see the whole patient, with their unique story, culture and needs. This means embedding person-centredness in our undergraduate curricula, our workplace policies and strategic planning and in the work of our professional organisations instead of empty rhetoric.
What do you hope attendees take away from your presentations?
That we can be professionals AND bring our whole selves to the clinical workplace, to research and education. We need a diverse and authentic healthcare workforce to care for our diverse patients.
Workforce shortages and shifting demarcations
Professor Geoff Currie, Professor in Nuclear Medicine, School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga; chair of the #ASMIRT2023 nuclear medicine program, and presenter at the conference on an important trial in prostate cancer, a session on AI and radiation dosimetry, and on next generation workforce.
See his editorial published last week in Radiography: Next Generation Technologists for Next Generation Technology
What excites and/or worries you most about the future in MRS?
What excites me is the advances in technology that improve our capabilities. These enhanced capabilities translate to better outcomes for patients. Technologies and advances like theranostics, hybrid scanners, artificial intelligence and targeted radiopharmacy all allow earlier detection, more accurate diagnosis, improved treatment planning, and early response to therapy.
Nuclear medicine is the heart of these advances with the capacity for both diagnosis and therapy; hence theranostics. Nuclear medicine these days includes hybrid imaging to combine the molecular insights of nuclear medicine imaging with the anatomy of CT or MRI.
My specific concern is that there is a chronic shortage of nuclear medicine technologists/ scientists. We are graduating across the country less than half the number of students annually than required to fill job vacancies.
The issue largely lies in recruitment of students from high school, with most having had x-rays before they finish school and knowing what radiography is but few having any insight into what nuclear medicine is.
That is why we developed new student facing career material we hope will find its way into schools.
Opportunities
Across the specialisation of MRS (nuclear medicine, radiography and radiation therapy), we define training and professions the same way we have for decades. But the industry has changed and those demarcations may not be fit for purpose in the future. There is an opportunity to re-engineer our thinking.
Registration as a medical radiation practitioner requires capabilities in six domains (AHPRA/MRPBA) and five of those are common to everyone. So it is only one of six domains that makes a person a radiographer as opposed to a nuclear medicine scientist and, within that domain, CT is common to all. Departments are integrated, especially radiography and nuclear medicine. There is opportunity to consider the work functions of the future practitioner and maybe hybrid qualifications or specialist qualification will emerge.
The advances in nuclear medicine (AI, hybrid technology, radiopharmaceuticals, theranostics) are very exciting and create amazing career opportunities but also create the unique opportunity to genuinely create patient-centred care in a precision medicine environment.
Challenges
The biggest challenge is the work environment. A shortage in the workforce puts pressure and stress on the existing workforce; potential burnout. In nuclear medicine there has been a push to bring people out of retirement or attract international colleagues to fill voids in the local workforce in the short term.
There is so much attention focused on the future workforce demands associated with the AUKUS nuclear submarine project but our current workforce across the entire nuclear sector (including nuclear medicine) is short. Some Government attention to build that workforce would seem fitting.
Priorities for ensuring culturally safe, patient-centred, sustainable healthcare
A sustainable workforce is the first step. Shortages in the workforce reduce opportunities for training and continuing professional development. Culturally safe workplaces and patient environments, and patient-centred care require education and training, but also the time to allow workers to provide that care.
That is challenged when there are workforce shortages. But conferences and university courses provide cultural proficiency and patient-centred care programs, it is the core of the job and you will see those themes sprinkled through the ASMIRT program.
What do you hope attendees take away from your presentations?
A working understanding of patient reactions and deterioration, and the ability to recognise and respond to those patients so that our patients leave our care in no worse condition than they arrived.
An appreciation of the leadership we are playing in AI developments in the MRS domain (on the global stage) and focus not on “what is possible” with AI because much of that is of no value or benefit to our patients but rather “what is needed” to fill the gaps in existing capabilities.
My presentation on AI, digital twins and radiation dosimetry directly addresses a shortcoming in current capability and possible solutions to improve patient outcomes. This dovetails with my poster that extends this technology to more socially sustainable pre-clinical imaging.
PSMA theranostics in prostate cancer is revolutionary and combined with our research paper (presented with Peter Tually) and poster, we would like people to appreciate not all patients have access to state of the art PSMA theranostics but our research using 99mTc based PSMA could provide improved outcomes for those geographically isolated from state of the art theranostic centres.
The ‘next gen’ presentation (at the closing session) is more a think piece to challenge delegates to think about whether historic approaches to education, training and qualifications are fit for purpose in the evolving MRS space.
I have two posters that hopefully inspire delegates to explore how AI can support patient-centred care, and the importance of cultural competence in patient-centred care.
Maintain focus on patients, equity, and embrace AI
Bronwyn Hilder is the immediate Past President of ASMIRT. She is Chief Radiation Therapist at the WP Holman Clinic at the Royal Hobart Hospital.
What excites and/or worries you most about the future in MRS?
Excites: advances in technology in all medical radiation practitioner fields; better imaging allowing for more precise diagnosis and targeting of tumours; this increase in technology will allow for treatments that we have not seen before, AI as part of these, to increase efficiencies and improve timeliness.
Worries: on the other side of this is remembering that there will always need to be a human element, that at the imaging and treatment interfaces radiation therapists, radiographers and nuclear medicine technologists will be providing care to patients.
Cost of new technology and equitable access for healthcare for everyone.
Opportunities
Radiation therapists and radiographers working to enhanced/expanded scope of practice – with a view to improving access, timeliness of care and quality of care. When this is done well, the patients benefit. There are many examples from overseas (UK, Ontario in Canada and Singapore) where medical radiation practitioners have taken on advanced roles, with appropriate education, training and mentorship, to provide high quality timely care to patients and I’m keen to see roles like these progress in Australia.
Embracing AI and all it has to offer —for example to enable adaptive radiation therapy.
Challenges
Increase in the number of patients (? effect of COVID over last few years). An increasing numbers of cancer patients survive their initial diagnosis but live with recurrent disease requiring ongoing treatment. Additional complexities arise from retreatment and in combination with other therapies.
Staff shortages — recruitment, retention, career pathways for medical radiation practitioners to keep them engaged.
Bigger picture: equitable access for all Australians and funding for care. Understanding from a health economics point of view that not every modality or treatment can be available at every local hospital – but ensuring that networks exist so that regional and rural patients are not disadvantaged.
There are some amazing technologies that can assist with this but again we need to ensure that medical radiation practitioners are providing education, training and care.
Priorities for ensuring culturally safe, patient-centred, sustainable healthcare
A summing up from a Medical Imaging Educator: that for every patient it is the best examination experience that they could have. For us, it is our everyday but for patients, it can be a scary and daunting time. Providing care and support to patients, building rapport, ensuring dignity and that explanations are provided every step of the way go a long way to helping our patients deal with what is happening to them.
Education to ensure that all practitioners have an understanding of what culturally safe, patient-centred care is and how to provide it, for example provision of resources such as ASMIRT Person Centred Care workshops.
Adding a focus on culturally safe care to our everyday work – not just a case of providing the “best care” for everyone but realising that what is best for one group of people may not be for another. Taking time to discover how you might best provide care to culturally and linguistically diverse patients so that their care is culturally safe and truly patient-centred.
With respect to sustainable care, ensuring that the right people are at the table when decisions are made to provide advice on how this could impact care – this could be at Commonwealth level (e.g. MBS item number review) or State (funding for equipment and location of services). MRPs work with other professions to provide multidisciplinary care and it is important that each of the groups have input into consultations.
What do you hope attendees take away from your presentations/the conference?
There are some very exciting things going on in the medical radiation space around Australia and the world. I hope that attendees take up opportunities to learn from their peers and from experts, to network and follow these insights up in their own departments and centres to improve patient care. Even if only one idea resonates as applicable in their own department, that one idea may also spark others.
Sometimes we can get very caught up in the technology, so it is important to maintain a focus on our patients.
Additional comments
I’m passionate about my job, the people I work with and the patients we provide care to. I am so proud of the work that we do to provide care to people at a time in their life that can be very difficult. The medical radiation professions have a blend of technology and patient interaction and when both of these come into play equally lead to positive patient outcomes.
Research boom and entry requirements
Associate Professor Andrew Kilgour, Assistant Associate Dean Medical Radiations, RMIT University; Chair, ASMIRT Professional Standards Committee
What excites and/or worries you most about the future in MRS?
What excites me the most is the boom in MRS professionals undertaking research. This needs to be fostered in students right from their first year of study, and at every stage of their training, they need to be taught its relevance and importance. I really enjoy being a part of this.
I am concerned about the entry requirements for students to enrol in MRS degrees. Having very high ATARs to get into the programs excludes a lot of students who would make excellent practitioners. Whilst the ability to study and learn is important, I am not sure that HSC/VCE etc reflects the kind of learning that is required to excel in the career. I would ideally like to see interviews to select the students who enter the programs, to guarantee the future direction of the profession is heading in the right direction.
Opportunities
Many people would answer this question in the context of advancing technology. However, I think the greatest opportunities are related to the advancing status of our professions in the pantheon of health professions.
The increasingly high standards of education, CPD, and research in our field are increasing our profile as professions. Also, a significant part of our research is heading in the direction of being interprofessional, rather than isolated to our professions. This indicates that what we have to contribute to healthcare research overall is being increasingly recognised as of value.
Integral to this is an increasing focus in the professions on patient-centred care. All the technology in the world is not going to be realised to its full potential unless we are at the forefront of caring for the patients for whom it is utilised.
Challenges
One of the biggest challenges has always been bringing the profession along with us. I graduated as a radiographer in 1985, and the profession had a very different landscape then. We were TAFE trained and had a very technical focus in our education. Every change that has occurred in MRS education has met with resistance from some quarters of the profession. This is understandable, but I am confident that contemporary education is producing graduates more open and adaptable to change.
Another challenge, which is somewhat unique to New South Wales, is getting NSW Health to recognise the value of dedicated tutors in medical imaging. NSW is way behind Victoria and Queensland, who have had these roles in the public system for many years. NSW is many years behind in not appointing such positions.
Finally, a challenge I am hoping will gain traction is national radiation licensing for MRS. If we can have national registration, we also should be able to have national licensing. Having different rules and different administrative bodies in every state and territory is needlessly complex and produces inconsistent regulations.
Priorities for ensuring culturally safe, patient-centred, sustainable healthcare
The answer to this point is largely related to two points that I have previously mentioned – interprofessional research and interviewing potential students before they are permitted to enrol.
Interprofessional research leads to best practice in patient-centred care, which has been a focus of other healthcare professions for longer than it has been for MRS. Seeing ourselves as integral to patient care will encompass cultural sensitivity, putting the patient experience first, and ensure that our care is sustainable.
Accepting students into programs of study based on interview rather than ATAR alone will allow experienced academics and practitioners the opportunity to screen out unsuitable potential students, who do not have patient-centredness as their focus.
What do you hope attendees take away from your presentations/the conference?
My presentations are focused on the student experience on clinical placement. I have a passion for the education of the future of our profession, and I believe it is imperative that workplace supervisors understand what they’re actually assessing, why they’re doing it, and how to do it. They need to understand that they’re not just assessing technical competence, but actual capability.
Capability encompasses so much more than just knowing how to operate the equipment and position the patient. I hope that people attending my presentations come away with a renewed interest in and passion for the students under their care.
I hope conference attendees come away with a great sense of belonging to an amazing professional community, and a renewed enthusiasm for the best possible practice in their chosen fields. ASMIRT is the best networking opportunity on our calendar, and a great chance to catch up with friends past and present.
Additional comments
Thank you for this opportunity. We belong to a great professional community, and I am looking forward to ASMIRT very enthusiastically.
Expanding scope of practice
Alan Malbon, ASMIRT’s Diagnostic Imaging Project Officer, former ASMIRT president, who was previously Chief Medical Imaging Technologist at St Vincent’s Hospital in Melbourne. He will be presenting on the administration of scheduled medicines by MRS practitioners, in the wake of the tragic death of Melbourne mother Peta Hickey during a CT scan.
What excites and/or worries you most about the future in MRS?
Given my longevity in the profession, I have experienced medical imaging before the advent of computed tomography (CT) and magnetic resonance imaging (MRI), with ultrasound being in its infancy. To experience the technological changes between then and today, the possibility off what can be achieved technologically in the future does excite me. Conversely, resilience of the current national MRS workforce is an issue to be concerned about, like for all healthcare workers who have come out of the pandemic.
Opportunities
The biggest opportunity for medical radiation practitioners both today and in the future is the potential to expand their scope of practice. The evolutionary technology in tele-radiology, particularly in regional and rural Australia, has created changes in the way that medical imaging radiology reporting of images are performed. The traditional established process for having a reporting radiologist directly onsite is declining.
Consequently, medical radiation practitioners are being instructed by their employers to be trained and instructed to obtain skills to administer scheduled medicines which directly pertain to their medical radiation science procedures in order to maintain both high quality patient care and ensure service delivery productivity.
The question of whether medical radiation practitioners should be able to administer medications such as IM adrenaline in the cases of severe contrast reactions and anaphylaxis is also an issue that needs to be addressed in this climate of change.
It should be noted that both primary and secondary school teachers can inject IM adrenaline if one of their students has an anaphylactic reaction. While they adhere to strict departmental administrative protocols, they are not medically trained or working in healthcare and the teaching profession is not expressly mentioned in any of the Australian state and territory Drugs and Poisons Acts.
Challenges
The biggest challenge for the profession is to establish themselves within the national identity profile of the holistic approach to the diagnosis and treatment of disease nationally. Ranging from BreastScreen, elective surgery and including radiation treatment for cancer, these procedures are not possible or are severely hampered without the professional expertise of medical radiation practitioners.
Priorities for ensuring culturally safe, patient-centred, sustainable healthcare
The underlying priority is the commitment to the understanding of the evolutionary nature of the development of the equipment which the profession is required to use and have the commitment to use it to its full advantage. Add to this, a liberal dose of empathy for each and every patient that comes under our care. The responsibility of both acquiring images for diagnosis or radiation doses for treatment as well as the overall well-being of these individuals under your care is key.
Today’s Australia is a culturally diverse country. There is an obligation on the profession to understanding this cultural diversity to the best of their ability. The profession has an opportunity to engage with diverse ethnic groups to showcase what the profession has to offer in Australian healthcare. It should not be left to happen by osmosis.
What do you hope attendees take away from your presentations?
Primarily, to have the belief in yourself to be the best possible professional medical radiation practitioner you can be. This leads to the best possible outcome for both patient needs and health service delivery demanded by Australian society.
Additional comment
The only thing that is constant, is change.
Follow the conference news on Twitter at #ASMIRT2023 and via this Twitter list of presenters and participants.
