Nearly Forty Years of Radiology Experience: Three Questions with Gary Allbutt

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Gary Allbutt, visiting relief radiographer in North Dandenong, Victoria, Australia

Editor’s note:  We sat down with Gary Allbutt, who is currently a visiting relief radiographer in Cath Labs, Angiography and General Radiography, in North Dandenong, Victoria, Australia.  We asked him a few questions to get his thoughts on changes in radiology over the past 40 years, observed from his vast experience across commercial and regulatory roles as well as administration, training and other specialties.

Q:  You’ve been involved in radiology for nearly forty years. What was radiology like when you embarked in this profession 38 years ago?

I entered Radiography in  1975 as a student in the Royal Melbourne Institute of Radiography (RMIT) three year course for  “External Studies Students,” who were employed outside of metropolitan hospitals across Australia.

From day one, students undertook an apprenticeship, working side by side with experienced Radiographers, absorbing the culture and work practices.  Logbooks listed required examinations and procedures to be observed and conducted with a progression through general radiography of extremities increasing in complexity to procedures such as Angiography, in the final year.

Modalities such as CT and Ultrasound had just started to appear. Early Angiography was undertaken by “Direct Stick” in Carotids and Trans–Lumbar Aortograms. The Seldinger Technique and selective catheterisation was just emerging overseas and major metropolitan departments here inAustralia.  Manual cassette changers and rapid serial film changers acquired sequential images of the contrast bolus’ passage through the vessels.

Looking back the introduction of new technologies and techniques has been dazzling and un-abated. Take radiographic support in theatre for a hip pinning — radiographs from two mobile machines and manual film processing! The advent of Mobile Image Intensifiers made the guidance of internal fixations more accurate and reduced the patient’s time under anaesthetic.

Compound that now with the advent of hybrid theatres with systems supporting neuro surgeons, as well as vascular, orthopaedic and others. This is just one phenomenal area of growth let alone Ultrasound, 3D and Cone Beam technologies. From my early days in 1975 these developments would have been almost inconceivable.

Q:  You’ve followed the industry’s approach to training and education very closely. How has the educational paradigm changed?

Originally training and education ran in parallel, a regular and repeated sequence of actions from preparing the room, equipment and accessories, to assessing the referral, identifying and confirming the patient, region and examination to be done, selecting exposure factors, setting up the projections, making the exposures, processing images, assessing, evaluating, accepting, logging and transporting images and dismissing the patient. I draw parallels with aviation as another complex operating environment requiring a regular and systematic way to achieve consistent and reproducible results of a high standard.

Now education precedes the practical application, training if you will, often by many months.  This is to some extent is indicative of the evolving complexity of the medical imaging industry.  I feel we have lost something along the path of progress in terms of the root core technical proficiency of radiographers.  We don’t seem to appreciate the skill required to produce consistently high quality images in General Radiography, the poor cousin now to the big, bright and shiny Modalities.

While being a branch of Applied Science, Medical Imaging, Radiography, is at its core an Art Form.

I recall, many years ago, a conversation between my father, a Boat Builder, and his friend, the manager of a major metal foundry.  The friend bemoaned the shift fromSeniorTechnicalCollegeto Universities for metallurgists saying they found it took a year to “un–train” the graduates to the point where they could then acquire the particular skills required of their industry.

InAustralia, we have the Professional Development Year (PDY), now to be known as the National Professional Development Programme (NPDP).  This is to top off the didactic with the practical with an additional 6 to 12 months of Clinical Practice.

Does the University educational paradigm in Radiography have to be so different that it is impacting General Radiographic Practice in this way?

Q: At the same time, medical imaging has moved out of radiology into difference clinical specialities.  How has this changed the Radiographer’s role?

Around the early to mid 1980s I was in a position to observe the migration of a branch of angiography out of the Radiology department into Cardiology.  I was an X-Ray Systems Specialist for a company introducing a new Cine film product.  Before I entered a given Cath Lab I needed to know whether it was Radiologist or Cardiologist driven— the answer to this question elicited 2 quite different sets of assumptions when setting up imaging parameters.

Initially radiographic support for the Labs in cardiology suites were from angiographically-qualified staff in radiology.  For example, Cine Film processing contributed to the complexity of the radiographic input required.  Evolution from the fixed Tube–Image Intensifier combinations, with “Tumble Tables”, through to parallelograms and then “C” Arms saw enormous strides in visualisation of the coronary arteries.

This was made possible by developments in selective catheterisation.  The arrival of balloon and stent technologies ramped up the immediacy of treatment.  But at their core Cath Labs are a radiological facility.  The instant replay of acquisitions defined that immediacy compared to the delays in processing and viewing 35mm Cine Film.

These advancements fed the growth in specialist surgical private hospitals and the realisation that Cath Labs could be incorporated into their business models.  So we now see a radiological facility, the Angiography Machine, adopted by a non–imaging entity, a small private hospital, managed by a non–imaging professional, a Nurse, bringing in seconded radiographic expertise from elsewhere.

The issues discussed above can now be applied to the hybrid theatres appearing in increasing numbers in these hospitals.  However, a number of these Labs, around the world, are managed by Radiographers, and an increasing number actively promote Multi–Skilling, or Cross–Training, where Radiographers may undertake scrubbing or monitoring roles for example.

Sharing roles in this way enhances ones time in the workplace and secures the depth of expertise to cover un–planned staff absences.  However, the Radiographic role and its Radiation Safety implications are not transferrable to other staff, much like Nurses administering medications.

Where do you see Radiography going?