Q&A with Pam Johnson, BS, MT, RTR, BD, CDT, Bone Densitometry Technologist in New York City, New York
Pam Johnson is a bone densitometry technologist at New York Physicians. She graduated from St. Barnabas X-ray School in Minneapolis, Minnesota, and the University of Minnesota with a degree in Laboratory Medicine. Pam is a certified medical technologist (MT) and radiologic technologist-registered (RTR), and is ARRT-certified in bone densitometry (BD) and an ISCD-approved certified densitometry technologist (CDT). Pam says that "going beyond what is considered my duty" is one of the most rewarding parts of the job.
Q: What motivated you to become a radiology professional?
A: I wanted to go into medicine, but not nursing. A family friend introduced me to the field of radiology, and I loved what I heard.
Q: Can you walk us through your education as a bone densitometry technologist?
A: After taking the ISCD (International Society for Clinical Densitometry) bone densitometry course in 1998, I took a couple advanced classes—Lateral Vertebral Assessment, and the CCD (Certified Clinical Densitometrist) course for doctors. I couldn't get a CCD certification because that is reserved for MDs and PhDs, but it provided me with priceless information for doing my job. CDT is the ISCD certification and stands for Certified Densitometry Technologist. The new CBDT (Certified Bone Densitometry Technologist) certification has been recently implemented and replaces CDT.
Q: How large is the facility you work for, and what services are offered?
A: New York Physicians spans two floors and one office across the street (the clinic plans to expand and move in about five years). Our 20 doctors represent orthopedics, internal medicine, gastroenterology, vascular surgery and OB/GYN. Special services offered include physical therapy, acupuncture, vascular ultrasound and bone densitometry.
Q: What's it like working at New York Physicians?
A: Very upscale, low key and highly professional. The decor is lush with fine art. While our clientele runs the gamut of the economic spectrum, most are upper-middle- or upper- class. Many don't use insurance but pay their bills directly by check or charge. Patients include celebrities who can also be encountered on the elevators, which serve other offices in this 19-story building. I don't think I've encountered any yet, though.
Q: When and how did you start at New York Physicians?
A: Almost two years ago, the manager asked ISCD to recommend someone in NYC to substitute for their BD/X-ray technologist when he took time off. They had simply been canceling those days for doing BD, and they sought to keep the revenue and service generated instead. I was doing mobile X-ray for a chiropractic service three to five days a week and finally six days a month, so it was easy to adjust my schedule to serve this clinic. When the technologist finally retired, I asked for full-time. Currently I'm still on per diem full-time, but hope and expect to achieve payroll status soon.
Q: Typically, what are your day-to-day responsibilities as a bone densitometry technologist?
A: I do the Quality Assurance on the X-ray processor and DXA machine first thing in the morning. I pull all ortho films from the file for each ortho day (there are two per week) and re-file when the day is finished. Other clinic films are over-read by Columbia radiology across the street and are returned to us at about 3 pm, which I return to the respective clinicians. The only X-ray file is for orthopedics. Each clinician takes care of his/her own patients' X-rays. I also take care of ordering supplies for ortho.
Q: What types of patients/diagnoses do you encounter most frequently?
A: The typical orthopedic, rheumatologic and internal medicine type cases. I do a lot of spine and chest X-rays, a few extremities, very little skull work, and no pediatrics. The cornerstone of the office is orthopedics.
Q: Can you share any stories about working at your facility?
A: Recently I had a patient who, upon walking into the X-ray room, declared, "What! You don't have digital?" She was a retired veterinarian who then said, "You mean my animal patients had better care than I do?"
Another patient watched me try to choose a technique on the machine and asked, "Don't they have machines today that do that for you?" I replied, "Yes, but not here." I think it proves patients recognize standard of care even in technical matters.
Q: Are there other areas of interest for you as a bone densitometry technologist that you plan to pursue?
A: I've served in multiple delegate roles in the ASRT House of Delegates through the years and would love to serve again. I aim to increase the quality of work BD techs produce. I've seen too much bad practice. ISCD offers a site visit program for those who want to ensure their practice is excellent, but that doesn't reach those who don't care or prefer to stay ignorant of their bad practices.
Q: What are the greatest challenges you face as a CBDT?
A: Influencing non-radiology oriented doctors and management about technology needs, and convincing them I'm a good source of information.
Q: What do you like most about your job? What do you dislike?
• It's only a half-hour long bus ride along Central Park from my home in Harlem (the commute home on Madison Avenue past many designer stores isn't bad either).
• The people I work with are exceptional.
• I get to work independently without micromanagement.
• Currently my X-ray machine is a 40+-year-old, unlabeled first generation (single-phase) dinosaur. The non-radiology oriented decision makers in the clinic don't realize how bad the situation is. I've heard, "The machine still works, so why replace it?" They do plan to go digital at some point, but not soon. I hear they think it costs $3 million. The radiologists expect perfection and that is extremely difficult when the factor choices are limited and the maximum MA is only 300.
• Almost all readings include a comment about motion. It leads to a lot of repeats. Add repeats to already inefficient equipment, and you have a recipe for over-radiation. A few years ago, the law mandated that laboratories upgrade to state of the art. Maybe that's what we need in radiology—a law to force these relics to the recycling plant or the museum. An X-ray machine repairman recently told me that there are still some manual wet tanks in New York.
The room's arrangement, too, reminds me of an early Star Trek episode where aliens discovered a mangled human and they tried to put him/her back together not knowing what a human was supposed to look like. The control panel's back is to the wall beside the upright bucky. Usually I find patients looking over my shoulder watching me set technique. The exposure switch is outside the door on the wall. The door has to be completely closed in order to expose. Hence the old adage to never leave the patient alone doesn't apply here. There are no dressing rooms, so patients change into gowns in the X-ray room. If I don't catch them in time, I find them looking through my records on my small counter.
Overall, no job is perfect and it's better to have a job than not.
Q: Are there any projects you would like to be involved with?
A: I would like to see a radiologist assistant role for BD technologists. In my clinic there is no doctor of bone densitometry, so I am the closest to that role. I'm always expanding my knowledge and I'm glad I know all I do. I recently had an order for a bone density scan for an 88-pound, 31-year-old woman, but the doctor hadn't ordered a body composition study. I went to him and he thanked me for noticing and said he had meant to order that, too.
Q: Do you feel that the role of technologists has changed over recent years?
A: Technologists are responsible for more highly technological things. With the crossover technologies they have to expand their expertise into other modalities they didn't used to.
Q: What do you feel is of the greatest concern to radiology professionals today?
A: Jobs, jobs, jobs. Years ago experts predicted that soon, due to retirement and attrition, radiography would need thousands of new professionals. I don't think that prediction has come to fruition and I don't know why except that many technologists probably need to work beyond their retirement years thanks to the economy.
Q: What is the most rewarding part of your job?
A: Going beyond what is usually considered my duty. In my previous job we had X-rays read once a week, and the doctors and physician assistant appreciated when I noticed a problem on a patient's X-ray and showed them before it was officially read so they could send the patient for treatment early.
Since in bone densitometry I prepare the dictation using the automatic program, I can use my skills to correct the usually incorrect automatic program to give the patient an accurate diagnosis. The automatic program is usually incorrect because it just evaluates everything and doesn't recognize fractures, artifacts, implants, degeneration, etc., that have to be eliminated to get an accurate diagnosis. I notice other technologists often leave the inaccurate automatic reading and don't correct it. The automatic program was never intended to be used without editing. From what I've seen, generally it's wrong 60-80% of the time due to patient bone problems, previous procedure interference, artifacts, and numerous other things. And wrong means misdiagnoses. The program also doesn't communicate well. It includes regions of interest that shouldn't be used for diagnosis.
Q: What is the most important thing you've learned over the course of your career?
A: Stay involved, keep your resume updated, and expand and maintain your network.
Q: What advice do you have for others thinking of entering your specialty?
A: There aren't many jobs in bone densitometry. Be patient and get backup certifications in fields like CT, US, MRI, and Information Management. I regularly read the job postings in NYC. I laughed when I read a posting that sought someone certified in CT, MRI, US, Mammography and BD. I bet the pay wasn't that great either. That's a lot to expect.
Other things to do: Distinguish yourself in the BD field by working with ASRT, ARRT and ISCD. Take all the advanced ISCD courses like CCD and LVA.
Q: How has working in bone densitometry allowed you to grow professionally?
A: I got involved with bone densitometry, then with ASRT, ISCD and ARRT. I wrote the resolution making BD a chapter in ASRT. I helped write the curriculum for ASRT. I helped write the questions for the ARRT and ISCD certification exams and taught other item writers how to write questions. I wrote columns for ASRT and ISCD about bone densitometry for newsletters. I did a research project for ISCD and served on several committees. I, as one of several regional representatives, still answer questions people present to ISCD. I've also served on several ASRT focus groups. And finally I wrote about male osteoporosis for Merrill's BD section.
Q: If you could sum up your job in one word, what would it be and why?
A: "Fun" because I get to do what I love.
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