Technologists: Hybrid PET/MR is changing the landscape

A new standard is being set for technologists working within the emerging discipline of PET/MR. A meeting of minds from both sides of the technology is necessary to assure a high level of patient care to include diversified education and protocols within the imaging suite, according to a joint consensus statement by the Society of Nuclear Medicine and Molecular Imaging’s Technologist Section (SNMMI-TS) and the Section of Magnetic Resonance Technologists (SMRT) published April 30 in the Journal of Nuclear Medicine Technology.

C. David Gilmore, chair for the medical imaging program at Regis College in Weston, Mass., and colleagues determined that the challenges of the dual-system demand a wider range of training and experience that will have to go beyond primary training programs to require extended education and certification and potentially more technologists in the room.

“Because of the complexity involved in operating PET/MR technology, for the safety of the technologist, the patients, and others involved, a new pathway for PET/MR imaging must be created,” wrote Gilmore et al. “This should come in the form of an educational program that goes beyond entry-level for both modalities.”

In 2012, two brands of simultaneous PET/MR systems were available for purchase with the addition of a PET/CT and MR system that co-registers data. From the perspective of the PET market as a whole, the authors estimated that about 2,085 sites across the country are performing PET, and of these, 14 percent are said to be acquiring new PET systems within the next three years, whether that be a PET standalone system, PET/CT or PET/MR. This is down from the 22 percent projected in 2008 by the same source, the IMV PET Market Analysis, but even with the current numbers, if projected PET/MR growth stays on track, 2 percent of fixed PET, 4 percent of PET/CT and another 4 percent of mobile sites will be incorporating PET/MR by 2014, which will change the technologist landscape significantly, beginning with new education requirements.

“Although the nuclear medicine entry-level curriculum includes a limited amount of information on MR and, likewise, the MR entry-level curriculum includes a limited amount of information on nuclear medicine, both curricula are already filled to capacity,” wrote the authors. “It is not in the best interest of either program, or the field, to add competencies to either curriculum at this time. It is recommended that the additional education needed for PET/MR technologists be in the form of advanced-level education.”

Master’s-level technologist programs appear to be developing to include PET/MR. Working technologist prerequisites would need to be retooled to include certification in at least one of the disciplines, either nuclear medicine technology or MR, and at least two to three years of clinical experience in that modality would be the gold standard.

“The reasoning for this would be to increase the likelihood of appropriate patient care and critical thinking skills, as well as the understanding of the complexity of both modalities,” wrote the authors. “The intended advantage is that an advanced level of education for PET/MR technologists will allow one technologist to perform PET/MR imaging—this is a much more useful and practical solution to hybrid imaging.”

New education programs would need to offer didactic training and criteria for appropriate use.

The task force is encouraging a registry or certification exam for PET/MR. Areas of focus include proficiency of cardiac, breast, head and neck, breast and whole-body MR imaging techniques, as well as in the clinical use of spectroscopy and functional MR imaging techniques, and competency in the instrumentation and basic physics of both PET and MR. Stakeholders will need to further hash out the specifics required of PET/MR technologists in training to fill in any gaps between the two.

“As PET/MR continues to evolve and new applications are discovered, a new specialty certification examination should be explored to demonstrate competency in this new and complex hybrid imaging system,” wrote the authors.

Less than 1,000 technologists had competed dual certification in both nuclear medicine and MR, according to American Registry of Radiologic Technologists (ARRT) data as of March 2012. Currently the ARRT is the largest certifying body of imaging professionals worldwide. More than 28,000 credentialed MR technologists and 13,000 nuclear medicine technologists have received primary certification.

Licensing also presents a new challenge. According to the consensus statement, PET/MR technologists will need to be licensed in states wherever nuclear medicine or MR licensure is available. The number of technologists that need to be present for operation is another point of departure. SMRT follows ACR guidelines that recommend at least two MR technologists or at least one MR imaging technologist and MR-safety trained personnel on site. Continued education, licensing and imaging protocols will continue to be reformed to fit the new PET/MR model.

“Previously, within the imaging modality, there was no opportunity for the SNMMI-TS and SMRT to work together on a system that requires such vivid and unique areas of expertise—a [certified nuclear medicine technologist] and a certified MR technologist,” wrote the authors. “Neither a nuclear medicine technologist (not certified in MR) nor an MR technologist (not certified in nuclear medicine) could operate a PET/MR machine properly and without potential undue harm to the patient. Therefore, it is only proper that the experts in the field, the members of the SMRT and SNMMI-TS, come together to identify an appropriate path forward to ensure the success of the PET/MR technologists within this new hybrid imaging era.”