Frequently asked questions

The Medical Radiation Practice Board of Australia’s (the Board) Professional capabilities for medical radiation practitioners (the Professional capabilities) describe the minimum requirements for registration, they also describe the minimum level of performance that can be expected of a registered medical radiation practitioner in the relevant division of registration.

For education providers the Professional capabilities are referred to in Accreditation standards. In meeting the accreditation standards an education provider must ensure graduates of a program of study have met each of the minimum capabilities relevant to the division of registration (diagnostic radiography, radiation therapy, nuclear medicine technology). A graduate of an accredited program of study, whose qualification is approved by the Board, is qualified for general registration in the profession.

The short answer is, No. The capabilities for ultrasound and MRI are needed to describe the minimum capabilities for safe independent practice in those areas.

Education providers who want to produce graduates that are capable of safe independent practice in US or MRI, need to demonstrate that graduates can meet the minimum capabilities for both US and MRI.

All registered practitioners and all graduates must have a broad understanding of imaging and treatment pathways that exist within medical radiation practice.

The Professional capabilities do not describe every task, function or activity that a medical radiation practitioner may engage in. The role of the Professional capabilities is to establish a minimum threshold level of capability needed for safe independent practice.

It is recognised that many registered medical radiation practitioners will engage in relevant practice that is not necessarily reflected in the Professional capabilities. For example, there are practitioners whose area of practice relates to higher education, health management, equipment applications specialists or policy development work. This type of practice is not included in the Professional capabilities as it is not part of foundational practice and, more often than not, practice is usually carried out by more experienced and skilled practitioners.

Workplace roles and practice change, adapt and respond to a range of influences. The intent of the Professional capabilities is to reflect the dynamism of practice and health service needs.

You must apply the Professional capabilities in the context of your current scope of practice or intended future scope of practice. It is expected that, over time, your scope of practice will generally change. This may occur because you decide to focus on a particular area of practice (e.g. MRI or theronostics), or a patient group (sports imaging) or by moving into a different role such as a manager, researcher or academic.

In changing to a more focused area of practice, your scope of practice can become limited to that area of practice i.e. your scope of practice may become more restricted or limited.

It is therefore important that you:

1. recognise and work in the limits of your competence and scope of practice, which may change over time
2. ensure that you maintain adequate knowledge and skills to provide safe and effective care, and
3. when moving into a new area of practice, or resuming a broader scope of practice, you complete sufficient training and/or qualifications to achieve competency in that area.

For most practitioners, you will already be meeting your relevant professional capabilities either through formal education or other continuing professional development (CPD) activities (e.g. formal education, training courses or learning activities). Your obligation from this point on is to ensure that you maintain competency in your area of practice, which also includes completing training or other development activities relevant to your practice.

No. The Recency of Practice registration standard requires that you practice for at least 450 hours in the previous three-year period. The definition of practice is broad and recognises that practice can take a variety of forms.

See Case study 1 on Professional capabilities and recency of practice below.

The Professional capabilities are used by education providers to guide training and education requirements.

As a registered practitioner you must ensure that you meet the capabilities relevant to your area of practice. You are only required to meet the capabilities relevant to the area of your practice. Put another way, you do not need to meet capabilities for those areas that you are not practising in.

For example, if you do not practise in the area of computed tomography (CT) you do not need to meet the capability.

However, as described in the Code of conduct (the Code), practitioners have an obligation to

1. recognise and work within the limits of your competence and scope of practice, which may change over time
2. ensure that you maintain adequate knowledge and skills to provide safe and effective care, and
3. when moving into a new area of practice, or resuming a broader scope of practice, that you have completed sufficient training and/or qualifications to achieve competency in that area.

No. If you are not working in those areas you do not need to meet the capabilities for that area of practice.

The capabilities for CT, US, MRI only apply if you are engaged in or is otherwise providing health services using the relevant piece of equipment.

The Professional capabilities describe the minimum capabilities that apply to your relevant area(s) of practice at any given point in time. Similar to the question above, you need to ensure that you meet the Professional capabilities relevant to your area or scope of practice.

For non-clinical practitioners, the capability domains such as professional and ethical practice, communication and collaboration and life-long learning are still to be relevant to your practice.

For some managers, who occasionally provide direct clinical care, you must still be deliver care in a manner that is consistent with the minimum capabilities for your area of practice.

This is outlined in more depth in the public consultation paper on the professional capabilities. There are a number of reasons for this change. The revised professional capabilities are more fulsome and describe capability in a way that allows a practitioner to perform US examinations in a safe and effective way.

The New Zealand Medical Radiation Technologist Board (the New Zealand Board) developed US competencies in consultation with professional associations and advocates in both Australia and New Zealand. The revised capabilities reflect the capabilities described by the New Zealand Board.

Sonographer is not a protected title under the National Law and can be used by registered and unregistered practitioners alike.

The Professional capabilities for medical radiation practice only apply to registered medical radiation practitioners who perform US. If you are a registered medical radiation practitioner, then yes, the revised Professional capabilities will apply to you.

If you are a registered nurse, physiotherapist or medical practitioner, the Professional capabilities with respect to US do not apply to you.

If you are not a registered medical radiation practitioner, then the capabilities do not apply to you.

This is a question about scope of practice. The Board protects title, not practice (although noting there are practice protections that exist in the National Law but do not apply in this case). What this means is that, any registered health practitioner can use US in their practice, so long as they demonstrate that they meet the requirements of the Code of conduct, and in terms of practice they meet the Professional capabilities, relevant to the simple activity.

The Code of conduct gives direction on what good professional practice looks like when changing one’s scope of practice. Part 2.2 of the Code describes the obligations you have as a registered medical radiation practitioner including:

Maintaining a high level of professional competence and conduct is essential for good care. Good practice involves:

1. recognising and working within the limits of a practitioner’s competence and scope of practice, which may change over time
2. ensuring that practitioners maintain adequate knowledge and skills to provide safe and effective care, and
3. when moving into a new area of practice (or reverting to a more fulsome scope of practice) ensuring that a practitioner has undertaken sufficient training and/or qualifications to achieve competency in that area.

Ordinarily competent practice in diagnostic US requires formal education and/or training that properly prepares a practitioner to provide a broad range of safe US examinations and procedures. However, there are a number of simple US uses that are limited in nature and scope.

Good professional practice requires that before carrying out, even simple examinations or procedures, you must ensure that you are competent to provide that limited or simple service in a safe way. In terms of limited use US, the Professional capabilities place an obligation on a medical radiation practitioner to use US in a safe and effective way.

If you are using US, even for simple activities, you must be able perform it safely and effectively in a manner consistent with the Key capability and meeting the Enabling components that are relevant for the limited nature or scope.

For example, when a practitioner wishes to expand their scope of practice to include using US for vascular access purposes, training could be completed through a short course with a relevant professional association. Alternatively, training could be delivered in the workplace by an experienced practitioner who holds formal qualifications in diagnostic ultrasound and capable of assessing competency. For a broader scope of practice in US, for which there are greater levels of risk for patients, the skill and knowledge and competency requirements ordinarily require education that is delivered in a formal training program.

Note:

The US capabilities do not apply to unregistered practitioners or practitioners who are registered in another health profession such as the nursing or medical professions.

Practice guidance or concerns about other registered health practitioners (e.g. nurses and medical practitioners) are dealt with by the Nursing and Midwifery Board of Australia, the Medical Board of Australia or the National Board relevant to the health profession.

Practice guidance and any concerns about unregistered practitioners is covered in the Code of conduct for unregistered health professions. Further information may also be provided by the health complaints entity in the state or territory.

As with the capabilities for US the professional capabilities for MRI provide a more fulsome description of capability that allows a practitioner to perform MRI examinations in a safe and effective way.

The New Zealand Board developed a scope of practice statement for MRI competencies in consultation with professional associations and MRI advocates in both Australia and New Zealand. The revised professional capabilities reflect the same requirements described by the New Zealand Board.

Following feedback its consultation the Board has included a definition of safety in MRI in the Professional capabilities.

Safety in MRI includes maintaining the integrity of MRI safety zones, applying principles of electromagnetic fields and forces (static, gradient and radiofrequency), minimising the bioeffects of magnetic fields (including tissue heating and peripheral nerve stimulation) exposure limits (including specific absorption rates), assessing and managing device / implant / projectile / acoustic risks, pre-examination safety screening, procedures in the event of quench and emergency procedures for the distressed or deteriorating patient.

The Key Capability for medicines used in practice (Domain 1, Key Capability 8) applies to risks associated with contrast agents used in MRI.

It is expected that any training or education designed to meet the Professional capabilities should thoroughly address the elements identified in the definition of MRI safety.

Technological progress is a consistent feature of practice in the medical radiation professions. Traditional practice boundaries in the profession, which are often described in terms of the equipment that a practitioner uses, are being challenged by technological advancements that fuse, or indeed introduce, new methods of therapy or imaging. The result being that imaging and therapy equipment (often referred to as modalities) which has been traditionally associated with a specific division of practice are now increasingly being used by practitioners in the other divisions.

Acknowledging the changing environment of practice, the Board has decided to address these changes and is of the view that regardless of the division of registration, practice in particular area or using a specific modality, needs the same minimum capability.

• Threshold capabilities for the provision of computed tomography (CT), MRI and US health services. For registered medical radiation practitioners who provide health services that involve CT, MRI or US, regardless of the division of registration, they must be able to meet the threshold requirements in the relevant area of practice.
  
  A registered practitioner must meet these threshold requirements when CT, MRI or ultrasound forms part of their scope of practice.
  
  
• Threshold requirements for using medicines in practice. This includes using various contrast agents in CT and MRI.
  
  A registered practitioner who is using iodinated contrast connected with CT imaging must meet the threshold requirements for safely using medicines in practice.
  
  

The purpose of the National Consensus statement on essential elements for recognising and responding to deteriorating physiological condition is to describe the elements of a safe system of care that are essential for prompt and reliable recognition of, and response to, physiological deterioration of patients in acute healthcare facilities in Australia. These obligations attach the healthcare organisation.

The Professional capabilities impose an obligation on medical radiation practitioners, as members of the healthcare team, to contribute to the system of safe healthcare by recognising and responding to acute deterioration.

While the obligations will most commonly arise in acute care settings, you are expected to exercise the same principles of care when practising in private practice or community healthcare facilities. In most cases, you will apply clear protocols for managing a deteriorating patient, but in other cases medical radiation practitioners will need to apply a high level of professional judgement to provide the best care for the deteriorating patient.

The National Safety and Quality Health Service (NSQHS) Standard 8 (the standard) describes a standard for recognising and responding to acute deterioration. It should be noted that the standard applies to a healthcare organisations and medical radiation practitioners who are an essential component of the healthcare team; they are then expected to actively contribute to making the system of care a safe one for patients.

In general, a healthcare organisation will have protocols that specify criteria for escalating care, including:

• agreed vital sign parameters and other indicators of physiological deterioration
• agreed indicators of deterioration in mental state
• agreed parameters and other indicators for calling emergency assistance
• patient pain or distress that is not able to be managed using available treatment, and
• worry or concern in members of the workforce, patients, carers and families about acute deterioration.

Medical radiation practitioners are expected to be able to respond to the acutely deteriorating patient and:

• make a reasonable assessment of a patients’ physiological status
• understand and interpret abnormal vital signs, observations and other abnormal physiological parameters
• initiate appropriate early interventions for patients who are deteriorating
• respond with life-sustaining measures (basic life support) in the event of severe or rapid deterioration, pending the arrival of emergency assistance, and
• communicate information about clinical deterioration in a structured and effective way to the attending medical officer or team, to clinicians providing emergency assistance and to patients, families and carers.

Completing training in BLS or similar first aid training is fundamental to being able to appropriately recognise and respond to acute deterioration. However, such training may not cover all the elements of capability. Where there are identifiable gaps, additional training or development can be completed as part of CPD obligations.

There can be some differences between BLS and first aid training. BLS programs are usually designed for healthcare professionals, while first aid programs are designed for the broader public who don’t have a healthcare background. Generally, both programs will develop capability to identify and implement life sustaining measures in a range circumstances, however as identified above, specific training regimes may not cover all elements of the key capability. In this circumstance you are expected to develop your skills and knowledge to meet the minimum obligations of a registered practitioner.

No, this is not a specific requirement. However, using these devices is generally not technically demanding. Medical radiation practitioners have a broad depth of skills and knowledge and the capacity to use these devices would be a useful and complimentary skill set.

Medical radiation practitioners usually work in multidisciplinary teams. Most often they work alongside medical practitioners and nurses, but they also work with a wide range of health practitioners including those involved in research or education or other non-clinical roles. Medical radiation practitioners work as members of the team and on occasion leaders of the team.

Practitioners will also work in many different teams as part of their usual practice. Often individual healthcare teams will be constructed and operate differently according to the requirements of the organisation. This means that the roles that each health practitioner fulfils in the team may also vary.

It is important that medical radiation practitioners understand, acknowledge and respect the roles and responsibilities of healthcare team members which may include registered health practitioners, accredited health professionals, and licensed and unlicensed healthcare workers.

The revised Professional capabilities require that practitioners communicate clearly and effectively with patients, their families and/or carers.

This obligation also extends to collaborating and working effectively with other health practitioners.

The National Safety and Quality Health Service (NSQHS) Standards provide a nationally consistent statement of the level of care consumers can expect from health service organisations.

Standard 6 addresses communicating for safety in a healthcare environment.

It is expected that you take an active role in communication with other health practitioners and patients to ensure that communication loops are closed, and the patient remains sufficiently informed about the next steps in their care.

The professional capabilities require medical radiation practitioners to ‘provide relevant information to patient/client and demonstrate appropriate methods to obtain informed consent.’

Consent must be given expressly. The patient’s consent may be in writing or it may be given verbally.

Given the nature of many of the examinations and procedures that occur in medical radiation practice a consent form signed by the patient is often unnecessary. However, while informed consent can be verbal, ideally the patient’s verbal consent should be recorded, and preferably in the patient record. This can include the medical imaging information system or otherwise as prescribed by the healthcare organisation.

Implied consent is not acceptable and does not discharge your obligation.

In some cases, it may not be possible to obtain consent, or timely consent, due to emergency and/or the capacity of the patient. In this case you will need to collaborate with other health practitioners to understand the nature of consent.

Medical radiation practitioners are often extremely busy, so it’s important to make time to go through the details of an examination and/or a procedure with the patient. Setting aside this time allows you to build rapport and trust and to obtain informed consent.

The Board’s Code of conduct states that informed consent is a person’s voluntary decision about their healthcare that is made with the knowledge and understanding of the benefits and risks involved.

Patients have the right to determine what happens to themselves and their health information. This creates an obligation for health professionals, including medical radiation practitioners to seek the patient’s consent before starting an examination or procedure.

It is expected that for any examination or procedure, as the primary person delivering the healthcare service, that you seek the patient’s consent before providing the health service.

In some cases, you might be a secondary provider of the health services, for example where a medical radiation practitioner is operating angiography equipment and the medical practitioner is performing the procedure. In this case the obligation for consent sits with the medical practitioner. However, good practice requires you to check that consent has been obtained, and if appropriate to provide additional information to the patient about the imaging process and their likely experience.

If the use of medicines (which includes scheduled medicines) forms part of your practice, for example using iodinated contrast or gadolinium contrast agents, or radiopharmaceuticals, you must ensure that you know how to use medicines safely.

Domain 1, Key capability 8 requires that you must apply knowledge of safe and effective use of medicines practice. This includes, but is not limited to, double checking for the correct medicines, correct dose and correct route.

You must assess and manage the risk of medicines by understanding the indications for use, the precautions and contraindications for use of that medicine(s). You must also monitor the patient and manage adverse reactions to medicines in accordance with local protocols.

Using, prescribing, and supplying medicines is subject to legislative authorisation and restriction under the relevant drugs, medicines legislation in your state and territory.

It is important for you to be aware of what authorisations and restrictions apply in your place of practice with respect to using medicines (scheduled or otherwise). You should consult your state or territory health department for guidance on medication arrangements in that jurisdiction.