Journal of— E n g l is h e d iitio
t io n —18

20

The Japan Association of Radiological Technologists

Journal of1820— E n g l is h e d it io n —The Japan Association ofRadiological Technologists

CONTENTS
2

Overview of the Japan Association of Radiological Technologists /general principles
Foreword

3

Regarding Publication of the English Edition
Yasuo Nakazawa, President, The Japan Association of Radiological Technologists

History

4

History of The Japan Association of Radiological Technologists (JART)6

New Year Discussion Meeting:Special Feature

Future importance of the Japan Association of Radiological Technologists (JART)
Yasuo Nakazawa, Mikio Sano, Masayuki Kumashiro, Hironobu Tomita

23

The 21st Asia-Australasia Conference of Radiological Technologists: President’s speech

Radiation Protection and Monitoring in Japan
Yasuo Nakazawa

29

Toward revision of the designation regulations for radiological technologist
training schools
Naoki Kodama, Yasuo Nakazawa, Mikio Sano, Masayuki Kumashiro

40

The 33rd Japan Conference of Radiological Technologists: Invited lecture

Current Situation and Future Perspective of Education for Radiographersand Radiologic Interpretations by Radiographers in Europe
Dr. Håkon H. Hjemly, European Federation of Radiographer Societies, President

54

The 32nd Japan Conference of Radiological Technologists: Symposium 1 (Disaster Countermeasure Committee)

Response to the Kumamoto Earthquakes and Future Earthquake
Countermeasures
Akihiro Kitagawa, Yasuhiro Hiai, Nobuaki Anai, Hiroshi Kuwahara, Masaaki Nakata, Eiichiro Konishi

Arts and Sciences

77

material

A follow-up system of radiograph interpretation reports by the remotediagnostic reading doctor at our hospital
Asuka Ishii, Tomoyuki Hasegawa, Yoshitaka Nemoto, Takahisa Araki, Yoshiyuki Kawasaki, Yoshiyuki Seya84

the original work

The Employment Environment of Radiological Technologists
Hiroe Muto, Kanae Matsuura, Satoshi Nakanishi

Note: The contents of this magazine are those that have been published in JART magazine.

Overview of the Japan Association ofRadiological Technologists
The Japan Association of Radiological Technologists, a public interest incorporated
association under the jurisdiction of the Ministry of Health, Labour and Welfare, wasestablished in 1947 with the purpose of contributing to the health of citizens throughraising the professional ethics of members, improving and furthering the study of medical
radiology and medical radiological technology, and enhancing public health.
In light of the startling progress being made in the fields of image diagnostics andradiation therapy where radiological technologists work, it is necessary to stay constantly
aware of the latest know-how and technology. JART collaborates with other certification
agencies to enhance the capacity of all radiological technologists in general throughproviding lifelong learning seminars, short courses, academic conferences and numerous
other learning opportunities. We believe that such activities constitute our obligation as
medical professionals to the general public.
As the only medical profession that has “radiological” in its name, we strive to limit
medical exposure, to raise the standing of our profession, and to realize a professionof specialist technologists that can be advertised. And we are committed to promoting
services with you all for the provision of safe and secure medical care.

general principles
We will render our services to those in need of health care.
We will act as individual members of a health care team.
We will perform our duties in our field of specialty.
We will continue to study for the benefit of mankind.
We will respect and practice the policy of informed consent.

2 ◆ Journal of JART English edition 2018

F o r e w o r dRegarding Publication of the
English Edition
Yasuo Nakazawa (President)

The journal of the Japan Association of Radiological Technologists (JART) has a monthly circulationof around 30,000 copies, and has been well received by our members and the public. The JART
journal fulfils three major roles. First, in collaboration with the Japanese public and medical
professionals, it publishes seminars on lifelong learning, thereby improving access to high-quality
medical technology. Second, it publishes field-specific information on scientific technology andclinical radiology-related research papers written by JART members. Third, through the preface andintroduction of the journal, it stimulates discussion on future possibilities for medical care in Japan,
and on how clinical radiologists can contribute to the wellbeing of the nation.
To give our radiological technologists from across the globe an insight into our business, I will
briefly explain the history of JART. In March 1896, we succeeded in taking the first X-ray image inJapan. In 1897, Shimadzu Corporation released an X-ray generator for educational use. In 1925,
there were approximately 1,500 X-ray technicians. In 1927, the first Shimadzu X-ray Technician
Training Institute was established, and evidence-based education was put in place. JART wasfounded in 1947 to make “radiological technologist” a national qualification. Since its establishment,
we have worked towards broad acceptance of this national qualification, in collaboration with thegovernment, the Diet, the Japanese Medical Association, and occupational military authorities.
As a result of our blood, sweat, and tears, in June 1951, we were finally able to see thepromulgation of the Radiology X-ray Technicians Act, Act No. 226 of 1951. Since then, we have
responded to the changing needs of the society, revising the original act to get the Radiology X-ray
Technicians Act of 1968 passed, and partially revising that to get the Radiology Technicians Act andRadiology X-ray Technicians Act of 1983 passed, and finally getting the Radiology Technicians Act,
which is in place currently, passed. Back then, the scope of work was limited to general X-ray
testing, television X-ray testing, angiography, X-ray computed tomography scanning, RI scanning,
and radiation therapy. In 1993, the Radiology Technicians Act was further revised, and MRI
scanning, ultrasonic testing, and non-mydriatic fundus camera examination were added to the list.
In 2010, image interpretation assistance, radiation examination explanation, and consultation work
were added. In April 2015, intravenous contrast agent injection using automated contrast injectors,
needle removal and hemostasis, lower digestive tract examination (anal catheter insertion andadministration of contrast medium), anal catheter insertion, and oxygen inhalation during radiation
therapy were further added as new operations that could be performed by radiological
technologists.
JART will continue to respond to the needs of the medical industry, and we hope to broaden theoperational scope of radiological technologists based on our foundation in scientific evidence. We
will feature clinical, educational, and research-based achievements by radiological technologists inthe monthly issues of the JART journal, and continually work to improve the magazine. I truly hopethat this English edition will benefit radiological technicians worldwide.
Foreword ◆ 3

History

The Japan Association ofof Radiological Technologists (JART)

1947
1951

Establishment of JART (July 13)
Promulgation of the Act on Medical Radiographers (June 11)

1979

1983

Authorization for Establishment of the Japan
Association of Radiographers (June 13)

1954

1956

1962

1968

1985
First national examination for Medical Radiographers (May 30)

Event to commemorate the 15th anniversaryof founding and 10th anniversary of enactment of the Act on Medical Radiographers,
attended by Her Imperial Highness Princess
Chichibunomiya
Promulgation of the Act to Partially Revise
the Act on Medical Radiographers (establishment of two professions) (May 23)
First national examination for radiological
technologists

1969

1975

1987

1989

1991

1993

Renaming as the JART
Staging of the 4th International Society of Radiographers & Radiological Technologist (ISRRT) World Congress at Tokyo Palace Hotel,
attended by Her Imperial Highness Princess
Chichibunomiya
Event to commemorate the 80th anniversaryof the discovery of X-rays, attended by Her
Imperial Highness Princess Chichibunomiya

4 ◆ Journal of JART English edition 2018

Partial revision of the Act on Medical Radiographers and the Act on Radiological Technologists (unification of the professions)
Event to commemorate the 90th anniversaryof the discovery of X-rays, attended by Her
Imperial Highness Princess Chichibunomiya
Staging of the 1st Japan Conference of Radiological Technologiststh

Event to commemorate the 10 anniversaryof founding, attended by Her Imperial Highness Princess Chichibunomiya

Completion of the Education Center for
JART

1994

1995

1996

General assembly resolution for establishment of the New Education Center and afour-year university
Completion of the New Education Center(Suzuka City)
Opening of Suzuka University of Medical
Science
The Act to Partially Revise the Act on Radiological Technologists, and Ministerial Ordinance to Partially Revise the Enforcement
Orders (April 28)
Appointment of the President of JART as the
11th President of ISRRT
Event to commemorate the 100th anniversaryof the discovery of X-ray, attended by Her
Imperial Highness Prince Akishinomiya
Start of the Medical Imaging and Radiologic
Systems Manager certification system• History of The Japan Association of Radiological Technologists (JART)

1998

1999

2000

2001

2003
2004

2005

2006

Staging of the 11th ISRRT World Congress at
Makuhari
Start of the Radiation Safety Manager certification system

2009

2011

2012
Start of the Radiological Technologists Liability Insurance System

Launch of the Radiological Technologists
Liability Insurance System with participationby all members

2013

2014

Establishment of the committee on Autopsy
imaging (Ai)

Appointment of the President of JART as
chairperson of the Central Social Insurance
Medical Council specialist committee

Signing of the Comprehensive Mutual Cooperation Agreement on Prevention of Radiation Exposure (September 21)
Consignment of work to measure personal
exposure of residents
Revision of the Act on Radiological Technologists, Government Ordinance to Partially
Revise the Enforcement Orders, and Revisionof the Enforcement Regulations (June 25)

Revision to the national examination for radiological technologists
Launch of the Team Medicine Promotion
Conference, with the President of JART as its
representative

Registration of transition to a public interest
incorporated association (April 1)

Renaming as public interest incorporated association JART

Relocation of offices to the World Trade
Center Building in Tokyo

Staging of a joint academic conference between Japan, South Korea, and Taiwan

Support activities following the Great East
Japan Earthquake

Event to mark the 65th anniversary of founding and transition to a public interest incorporated association (June 2)

Enactment of X-Ray Week

Start of the Medical Imaging Information Administrator certification system

Health Policy Bureau Directorʼs notification
concerning promotion of team medicine

Staging of an extraordinary general meeting
concerning transition to a public interest incorporated association” Presentation of the Medical Exposure
Guidelines (Reduction Targets)” for patients

Revision of the Medical Exposure Guidelines

2008

2010

Launch of the radiation exposure advisor
certification system

2015

2017

Event to commemorate the 120th anniversaryof the discovery of X-rays
Event to mark the 70th anniversary of founding and transition to a public interest incorporated association (June 2)

History of JART ◆ 5

New Year Discussion Meeting:Future importance of the Japan
Association of RadiologicalTechnologists (JART)

mashiroMasayu, kJAiRTKu
nt

Vice-Presideawa

Yasuo NT akaz
R

President, JA

Editor-in-Chief of this journal

Hironobu Tomita
Director, JARTno
Mikio Sa
, JARTnt

Vice-Preside

6 ◆ Journal of JART English edition 2018

Introduction
Editor-in-Chief: We are grateful that you haveall managed to take time out of your busy
schedules to meet here today.
Today, at this New Year Discussion Meeting, I hope we will be able to discuss issues
including the future for radiological technologists with the President and Vice-Presidents of
JART from various perspectives.
Starting quickly, as I am sure you are allaware, a member of JART, Shogo Azemoto,ran for the House of Councilors election lastyear in 2016, but was unfortunately defeated.
I think that JART members do not yet fully appreciate the need to include radiological technologists in the legislature. Accepting this situation, at this meeting, I would like the President of JART, Mr. Nakazawa, and Vice-Presidents Messrs. Sano and Kumashiro to discuss
the “Future importance of JART” and to speak
freely and include your opinions.

Why is There a Need for RadiologicalTechnologists in the National
Government?
Editor-in-Chief: Today, we first discuss why

there is a need for radiological technologists
in the national government. Your turn first,
President Nakazawa.
Nakazawa, President: The national govern-

ment has three roles.
The first role is making laws and enabling
the national population to function in a fairand just manner to maintain and enhance national order. This is the law-making role.
The second major role is evaluating national development based on the allocation of thenational budget derived from tax revenues.
This is the budgeting role.
The third role is making agreements withpeople from various overseas countries. The
best example is the TPP, although there arevarious international agreements for coexistence and co-prosperity. After these aresigned, the clauses are ratified in Japan. Thisis the coexistence and co-prosperity role, involving coexistence and co-prosperity withother countries while negotiating agreementswith them.
From the perspectives of the above threeroles, three requirements emerge if we are toparticipate in the national government.
The first requirement is the national certification stipulated in the Personal Status Law.
There are national certifications appropriate
to all healthcare-related personnel. However,it might be necessary to revise the part of theRadiology Technicians Act relating to national
certification to be in accordance with advances in national and healthcare development, as
it is now 65 years since the Radiology Technicians Act was passed in June 1951. Therefore,in terms of needing to revise the Radiology
Technicians Act to suit the current era, it
seems that JART needs representatives in thenational government.
The second point is that no progress in this
occupational field can be achieved without
progress in education and training. Therefore,
while expanding our activities, we are tackling various types of lifetime education. The
fundamental process takes place at four-year
universities, or at present, at two-year andspecialist colleges. However, it is first necessary to transform basic education to reliable,sound, four-year universities, and thus progress in a more appropriate to the current age.
In addition, after graduation, people remainin the workplace for about 40 years, during
which time lifetime education should play ahighly important role. Various professional
and academic associations are responsible forthis education; therefore, JART, as a professional association, must handle the lifetime
education of its members. To change the education system at colleges, the changes must be
based on debate within the national governSpecial Feature ◆ 7ment, and from that perspective, it is necessary to participate in the national government.
The third point is the question as to whatshould be done to achieve further advances inteam-based healthcare. As you are all aware,physicians, dentists, pharmacists, and nurses
are currently actively employed in the Japanese Ministry of Health, Labour and Welfare(MHLW) and Ministry of Education, Culture,
Sports, Science and Technology. These personnel are involved in the national government to some extent, where they employ their
specialist backgrounds. Furthermore, decisions
about the national budget are made with the
involvement of these personnel in lifetime education to ensure they progress in their occupational areas. However, the government environment is currently such that unfortunately,budget decisions do not relate to occupations
other than physicians, dentists, pharmacists,
and nurses. Therefore, I consider that the
MHLW must establish a team-based healthcare
section for budget allocation consistent withthe current situation. A team-based healthcare
section should be established, and budget allocation for all healthcare personnel̶not only
physicians, dentists, pharmacists, and nurses
̶should be implemented within the MHLW.
For this reason, I think it is essential that weparticipate in the national government.

8 ◆ Journal of JART English edition 2018

From the above three perspectives, I conclude that it is necessary to participate in thenational government.
Editor-in-Chief: President Nakazawa, thankyou very much. What do the two Vice-Presidents think?
Sano, Vice-President: I agree with the Pres-

ident. From the viewpoint of healthcare
quality, taking JARTʼs mission to be a healthcare-related professional association, there is arequirement to achieve progress in healthcare
and maintain the health of the Japanese public. From a global perspective, to maintain thelevel of healthcare alongside other occupational areas, we have a major responsibility to
strive to improve knowledge and techniques
as a specialist occupational area based on thefundamental stance of team-based healthcare,and to increase our own personal standards.
Therefore, we have many requests for anddisputes about the national government. Of
course, these overlap with the aspirations ofother occupational areas. Furthermore, we areconfronted with various areas where progress
is not being made. As with other occupational
areas, as a specialist occupational area, we are
fulfilling our professional roles in the context
of a certification-based society. In Japan, theNew Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

healthcare field has a rigid, quasi-feudal structure that has developed over its long history,and I therefore consider it essential for JART
to have a platform so that its voice can reachthe national government.
Editor-in-Chief: Thank you very much. Whatdo you think, Vice-President Kumashiro?
Kumashiro, Vice-President: Yes, the principal

aim of sending a representative to the national government is a definitive step in achieving
appropriate policies. Taking as an analogy theJapan Nursing Federation, another professional association, the posting criteria for nurses
were changed based on the policies it puts
into practice. This may have been in 2006, but
it had a huge impact, and yes, these are policies generated to focus on the safety of the
publicʼs healthcare. They were formulated byconsidering which method of posting nurses
would provide safer healthcare. I think thatunless the national government provides anarena for people who can talk accurately andknowledgeably about such policies, they will
not be discussed within the legislature.
In addition, as a major reform, as part of
the revision of the Public Health Nurses, Midwives, and Nurses Act in 2009, a nationally
examined qualification and four-year university for nurses was legally stipulated, which had
a major impact. To strengthen the practicalachievement of policies, as the President said
earlier, unless we send representatives to thenational government and make appropriate
laws, we will not be able to achieve a breakthrough.

tion submits documents to the MHLW stating
its opinions on existing problems and how
to address them. The Japan Nursing Federation clearly states, “This is not a task for us orother professional associations, but for politicians.” We think that JART should refer to this.
Well, I think I have largely understood thepositions of the three members of JARTʼs Executive Committee ̶ the President and twoVice-Presidents̶and as President Nakazawa
is the chief of the Executive Committee, I
think that revising the laws has been an important activity to date. We also have greathopes in this regard. The President has thoroughly presented the current issues relating to
the Radiology Technicians Act, but I would be
grateful for a simpler explanation of these.

Problems with the Current
Radiology Technicians Act andItems to be Revised

Editor-in-Chief: Currently, the top page of the

Nakazawa, President: As it was necessary

Japan Nursing Federation ʼ s website clearlystates its involvement in politics. It includes
text stating that it is essential that the national
government include politicians who appeal
for issues such as the better treatment of nurses. In addition, the Japanese Nursing Associa-

to revise the Radiology Technicians Act, theRadiology Technicians Act Problems Assessment Committee explored the options over a
period of one year from 2012. Following this,the findings were reported to the Board of
Directors and public comments received. The
Special Feature ◆ 9comments were collected and summarized in2013.
Among the comments, Clause 2 of the Radiology Technicians Act defines the type ofwork to which this occupational area in the
Act refers. However, although it previously
referred to people whose jobs involved theapplication of radioactivity, application of theMedical Care Law after its revision on April
1, 2007 has resulted in the safe managementof medical devices, which is also classified asa highly important activity. The findings of along-term questionnaire-based survey carriedout between 2009 and 2014 indicated thatradiological technologists constitute approximately 20% of medical device safety managers. Therefore, radiological technologists
include not only people involved with the application of radioactivity, but also those who
reliably manage medical devices from theviewpoint of healthcare safety, involving safety management, maintenance spot-tests, andregular tests. Therefore, a revision of Clause 2of the Radiology Technicians Act is essential.
In addition, as Vice-President Kumashiro
commented previously, Clause 20 of the Radiology Technicians Act presents the qualification of candidacy for an examination. The
four-year university graduation system, which

10 ◆ Journal of JART English edition 2018is recognized by the Ministry of Education,
Culture, Sports, Science and Technology andrated highly by the Japanese Nursing Association, is included in the qualification ofcandidacy for an examination. However, in
our terms, most people have graduated fromthree-year universities. In this respect, in common with the Japanese Nursing Association,
we should prioritize the four-year university
system for qualification of candidacy for an
examination. However, the three-year university system still exists, and it is therefore
important to provide the qualification of candidacy for an examination with this system
included. Clause 20 must be revised based on
this assertion.
We now discuss the revision of Clause 24.
This contains details about our performanceof test procedures. However, I think various
items are not included in government ordinances, although they should be includedin the main clause, including magnetic resonance imaging, ultrasonography, and othertest procedures. Regarding the revision of
governmental and ministerial ordinances, one
significant point is that inclusion in the mainclause will make such revision very difficult,but change is feasible if included solely in
the governmental or ministerial ordinances.
Therefore, I think that this term does not relate to the test procedures in Clause 24, butthat fundamentally, usable modalities should
perhaps be included.
The next item is Clause 26. This has notbeen revised since 1951, but “definitive instructions” by physicians and dentists are included in the main text. As such, comprehensive instructions based on changes to thosefor physicians and dentists can be made, andcomprehensive instructions for tasks relating
to the series of medical devices included. Alternatively, comprehensive instructions aboutbreast and gastric cancer tests can be provided for test facilities. Thus, the revision ofClause 26 should also enable efficient use of

New Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

our more specialized areas of activity from theviewpoint of the Japanese public.
The next item is Clause 28. The current
version of this Clause states that regarding irradiation records, after the completion of tests
and treatment, the physician or dentist mustbring the test slip with him/her and sign it
on-site. However, based on the current law,because of the issue of whether or not operations are carried out at the clinical institution
and because an environment in which operations are impossible is established before they
are carried out, changes are likely necessary.
I think that after the completion of tests andtreatment and/or before treatment, it will benecessary to clearly divide the site and proceed as such. In addition, currently, the storage term for irradiation records has not been
stipulated. Therefore, I think that the storage
duration should be specified as five years.
Related to the above, we are currently reporting anew about tasks relating to uncertainty inquiries, but making uncertainty inquiries
relating to the instructions for physicians anddentists in all occupational areas. Radiological
technologists are given different commands
by orthopedic surgeons, for example, depending on whether the left or right knee is being
treated, or by cardiovascular specialists depending on whether upper or lower abdominal computed tomography is being carriedout. However, for the test request slips, if our
medical staff make an expert judgment basedon the test objectives, we may understand if
the test objective is incorrect. If we then makean uncertainty inquiry and/or investigate theactual situation, even if the radiological technologist makes the uncertainty inquiry to a reliable physician in the requesting department,
an incident/accident report is unfortunately
sometimes not released.
For the above reason, unless the law clearlystates that when there are uncertainties about
tests requested by physicians or dentists, uncertainty inquiries must always be made, andafter confirming these, changes are made to
the mode in which tests and treatment are
carried out, major problems will occur fromthe viewpoint of healthcare safety. This is not
an issue solely for radiological technologists,
and I think that the duties of all healthcare
personnel in relation to uncertainty inquiries
must be stated in the law.
In addition, from the viewpoint of compliance, it is necessary to revise the law. For
example, physicians, dentists, dental technicians, dental hygienists, nurses, midwives, andpublic health nurses must notify the prefectural government after being appointed in theirfields. Alternatively, they may have the duty
to notify the MHLW. I therefore think that wemust also reliably provide such notifications,and that from the viewpoint of compliance,
this must be changed in the law.
Editor-in-Chief: Thank you, President Naka-

zawa. Starting with Clause 2, in relation to
proposals for the revision of several points,
you explained the problems in a readily comprehensible manner. Now, do either of theVice-Presidents have anything to add?
Kumashiro, Vice-President: Yes, that is so, is

it not? The President just spoke about ClausSpecial Feature ◆ 11

es 24, 26, and 28. I am particularly concernedwith Clause 26, namely “Definitive instructions,” which I will interpret. Clause 2 simply
states “in accordance with instructions” in relation to being in accordance with instructions
by physicians or dentists. However, Clause 26
uses the word “ definitive. ” I think that itshould be considered that there are limits forwhich the interpretation is highly unclear orthat this text is inconsistent and detached fromthe actual situation.
For the above reasons, in relation to thedefinitions in Clause 2, yes, as the President
said, I think we must include items relating
to actions such as uncertainty inquiries andhealthcare safety. Currently, uncertainty inquiries are only mentioned in the Pharmacists Act, not in the Public Health Nurses,
Midwives, and Nurses Act. Thus, I think it isessential to include statements relating to uncertainty inquiries covering various other occupational areas.
Editor-in-Chief: Thank you. What do you

think, Vice-President Sano?
Sano, Vice-President: If the focus is on

Clause 26, in the context of the current rapid
aging of society, the main activities at healthcare sites are shifting from medical treatment
to nursing care. In this context, I think that
if in the future “ Definitive instructions ” ischanged to “Comprehensive instructions,” thiswill definitely constitute a key to expanding
occupational tasks. In relation to nursing care,
there is a potential for organizations that facilitate activities in a single mode as business entities, even without affiliation with medical institutions, such as home-visit nursing stations.
Currently, we as radiological technologists
cannot do this. Affiliation with medical institutions is needed, and there is a clear mismatchwith the requirements of society. Even at thelatest Gifu Scientific Meeting, personnel fromMHLW participated in a discussion on these12 ◆ Journal of JART English edition 2018

issues and their opinions were ascertained.
Of course, clear, legally based responses were
not obtained, but there are concerns that unless we obtain such responses in the future,
the outcome will be a specialist occupational
area incapable of responding to the demandsof the public. In the current situation, in
which the rush towards a highly aged society
has continued for a considerable time, there
are hopes for a legal framework that covers
nursing care.
Nakazawa, President: That is indeed the case.

In other words, home-visit nursing and radiological technologist stations are to be prepared for radiological technologists, who willvisit nursing and welfare institutions basedon the instructions for comprehensive liaison with medical institutions. First, the mostfrequent event is currently death due to aspiration pneumonia. Therefore, simple, frontal
X-radiography and portable X-radiography ofthe chest are performed. In addition, deaths
due to pulmonary occlusion caused by venous thromboembolism have occurred. Therefore, in tests using ultrasonography, radiological technologists can use ultrasonography inwhich X-rays are released. Furthermore, basedon a system involving simple chest X-radiography, leg venous ultrasonography, and/or
cervical ultrasonography, a system enabling
comprehensive instructions will now be designed for us by Kuwayama (RT).
As pointed out by Vice-President Sano, thisis not legally possible, and we will therefore
now submit a request to the MHLW. The
MHLW has personnel in the pipeline, so wewill submit our request to these physicians.
In addition, the law must be revised in relation to MHLW personnel, after which I think
it will be necessary to achieve understanding
by Dr. Yokokura, President of the Japan Medical Association and the rest of the association
as stakeholders. Following this, radiological
technologists, through thoracic simple X-ra-New Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

diography and ultrasonography carried out atnursing institutions and welfare institutions,will need to establish an arena for activities
capable of responding to the disease structureof an aging society.
However, the number of cases per institution is probably not great. Therefore, while
senior radiological technologists are being
effectively used, and liaising with each otherand sharing work through half-day work, they
will enroll in these stations, put healthcare
into practice with a focus on the stations, andmake progress while liaising with the Japan
Medical Association. Kuwayama (RT) and amanufacturer are developing a plan for thistype of system.
Kumashiro, Vice-President: In other words,

this is a reorganization of tasks, right? Is thisnot the next new strategy, which is connected
to support for image interpretation?
Editor-in-Chief: It is excellent, is it not? Regard-

ing efficiently using seniors, senior physicians
gradually age and the younger generation
takes over. It seems the pie might be getting
bigger, right? In this context, if there are newjobs, personnel can be assigned as appropriate. However, part-time pay for radiological
technologists is now much lower than whenI entered the field. If both the on-site requirements and efficient use of human resources
are considered, I think this will be an excellent way of thinking from the perspective of
JART.

ridden and/or require special care, it appears
that the rule is now that chest imaging must
be carried out once per month. My impression is that in practice, this may not reallybe achieved reliably. Of course, there is aburden on bedridden patients solely due tobeing bedridden, but there also seems to be aburden on the party performing the imaging.
However, the potential for future expansionof tasks targeting nursing care and including
judgments about aspiration pneumonia andnosocomial infection by thoracic X-radiography, bedsores, and PDF (leg deep-vein
thrombosis), and arteriosclerosis based on intimal-medial thickness have not been publicly
discussed.
This institution is similar. Since about
20 years ago, when the rules were relaxed,
general nurses have been paired with visiting
nurses and staff have performed at-home imaging using portable equipment. As explained
previously by President Nakazawa, places
where activities at the senior level are conducted are expected to increase in future, andour dream is that at the same time, JART will
include personnel who can rescue and provide support even during earthquake-related
disasters.
Editor-in-Chief: Oh, I see. Turning to places

Nakazawa, President: As we intend to con-sider this design in the business schedule forthe period starting in April, we are currently
having it prepared. I first want to verify thecontent of specific sections.
Sano, Vice-President: Another thought is thatcurrently in legal terms, in the case of treatment institutions with patients who are bedSpecial Feature ◆ 13

recent electoral failure, only JART can submit
requests to the MHLW. The general membersof JART understand this, and I think the importance of having Diet members is continuously increasing.
This means “ reconsidering the House ofCouncilors election.” However, in including
this reconsideration, I would be grateful forcomments from the President and Vice-Presidents, which do not have to be especiallyclear, on what the JART should do in the future and/or how representatives should be
sent.
such as home-visit nursing stations, if for example, pneumonia is diagnosed with imaging. This is linked to support for imaging byreporting to a physician. Regarding infection,
it is best that this takes place as soon as possible, and I feel that for our tasks, there is asingle sequence of connections.
Considering the context of the “Definitive
instructions” in Clause 26, President Nakazawa
has spoken about radiological technologistsʼ
current on-site work. However, this is notbased on definitive instructions, and therefore, computed tomography and so on can be
carried out differently at different hospitals. In
many cases, radiological technologists makejudgments and then carry out imaging. They
may perform additional imaging later; thus,
the instructions in this regard are not definitive. This issue is under discussion even for
on-site cases. Thank you very much.

Reconsidering the House ofCouncilors Election
Editor-in-Chief: We now largely accept that

JART members must be sent to the national
government, and that there are problems withthe current Radiology Technicians Act. As forthe actual approach JART should take in the
future, the Japanese Association of Medical
Technologists as well as physicians and nurses currently have Diet members. Despite the

14 ◆ Journal of JART English edition 2018

Nakazawa, President: The results of the 23rdand 24th House of Councilors elections werereleased on July 10. I think it is necessary toreconsider the activities during that three-year
period.
Therefore, I recommend that the main bodyof JARTʼs Political Federation and its branches in the 47 prefectures be consolidated as asingle organization, and that Shogo Azemoto
be advanced as energetically and forcefully as
possible. Acknowledging our errors, one point
to reconsider is that activities to urge people
to vote were not implemented consistently asa single unit.
For the above reasons, preparations are
already being made for the 25 th House ofCouncilors election, which will take place inthree years. In addition, based on the above
reconsideration in relation to the Political
Federation, places with no branches or only
marginally active branches are encouraged
to carry out branch activities more reliably.
Furthermore, as the number of federation
members remains at only around 550, it must
increase to at least 10,000 to ensure an organization that enables vigorous efforts. We needto expand the organization, as appropriate
activities cannot be achieved without at least
20 members in each prefecture and 1,000
members in total. Therefore, we need to implement activities to expand the organization.

New Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

Of course, there are issues about methods such as how to find candidates and withwhich organizations to liaise. For example, forthe 24th House of Councilors election, JART
held a conference entitled, “Supporting healthcare, nursing, and welfare in the 21st century”
collaboratively with the Japan Dental Technologists Association, Japanese Paramedics
Association, and Japan Association for ClinicalEngineers. The strategy was planned at theconference. It is necessary to think carefully about that strategy and include the efforts
and energy of the main section of the Political Federation. Therefore, yes, the number ofmembers must increase. I think that this is themost important point.
Editor-in-Chief: Thank you very much. Is it

unreasonable to think that when people join
JART they should also join the Japan Federation of Radiological Technologists (JFRT)?
Of course, that will cost more money. I hearthat we will enter together with the JapaneseNursing Association, but can this somehow beeffectively implemented?
Nakazawa, President: It is unacceptable tocollect the money together. It is acceptable if
there are separate application forms.
Some organizations used the same application forms, and it was difficult to distinguishthem. This was previously pointed out by the
Ministry of Internal Affairs and Communications, and is considered unacceptable.
Sano, Vice-President: Yes, I fully understandthat at the intermediate level, the member level, the world of nursing had a need for a federation. This has been established based on along history. I feel that a continuous flow has
been achieved to some degree. Unfortunately,
regarding JART, my perception is that the history until where that can be understood reasonably well is still insufficient. Our recent experience is that our efforts were clearly insuf-

ficient, and I think that radiological technologists will have to take this outcome to heart.
Yes, as an organization relating to a specialist
field that has accumulated a high level of goal
consciousness over a long history, nurses
have now fully accepted these requirements.
Editor-in-Chief: Yes, that is indeed the case.

If you talk to numerous nurses, they say, “I
will definitely join.” However, I do not hearsuch enthusiasm about joining from radiological technologists, and the opinion that
there is no sense of crisis is expressed even
within the Executive Committee in Saitama
Prefecture. Therefore, reconsidering issues
at this discussion meeting with the President
and Vice-Presidents, and looking at possible
connections with future steps is one approachthat should be shared with all JART members
and for which something must be done.
Kumashiro, Vice-President: The selection of

Shogo Azemoto as a candidate in the previous
and most recent House of Councilors elections has increased awareness and recognitionof JART among the public, and resulted in its
major role. Therefore, I would like to express
my respect for this. I think that the repeatedchallenges were truly difficult and required
much effort. It is wonderful that the challenges were addressed. I think that this will continue to reflect well during Shogo Azemotoʼslife, and notwithstanding defeat, the campaign
has generated a lot of networking that will be
helpful in the future. However, one point toreconsider is that we did not have the organizational capacity to provide on that basis.
Nine years ago, to support the candidate Mr.
Nakanishi, the then President of the Japan
Dental Technologists Federation, I rode in theelection campaign car with him. As we drove
around, we made a particular point of visiting
all the workshops. As the strategy at that time,for example, I lived in Okayama prefecture,and our activism involved holding meetingsSpecial Feature ◆ 15

with powerful supporters in each of the fiveelectoral districts in Okayama prefecture andcollecting a register of names to increase thenumber of supporters. The history of dental
technicians in terms of the Japan Dental Technologists Federation is long, and the historyof the Japanese Nursing Association is evenlonger, so they have firmly established bases.
I therefore gained a strong perception about
controlling an arena in which the struggle
takes place at the time of an election, regardless of who is elected as the candidate. We
did not achieve that control. As the President
said, I think the direction to take in the future
should be presented to Shogo Azemoto.
Nakazawa, President: JFRT has not yet

reached all JART members, and lectures centered on political lecture meetings will therefore in future be held collaboratively by JARTand JFRT at eight places in Japan per year. In
the North Kanto region, for example, a wellknown lecturer will be invited to present, andthere will be lectures at eight places per year.
In this context, unless activities to increase
the number of JFRT members are established,numerous people will remain unaware of theexistence of JFRT. I therefore fully appreciate
the necessity of the JFRT and for a drive to increase the number of JFRT members.
Editor-in-Chief: As to increasing the numberof JFRT members from 550 to 10,000, I do
not think that we will achieve this number,but I agree that it is difficult to campaign or
have much effect with only 550 members. I
also think the Executive Committee should be
asked for their involvement. Thank you very
much.

JFRT
Editor-in-Chief: The next theme in this meet-ing relates to the JFRT. The fundamental political activism involved in the process to date16 ◆ Journal of JART English edition 2018has been carried out by JFRT, while JART is
the professional association. I think that all
readers likely understand the difference, andregarding what should be done including additions, the President has just spoken a little
about the number of members.
Nakazawa, President: The JFRT membershipfee is currently ¥2,000 per person, so 10 members means ¥20,000 and 100 means ¥200,000.
Therefore, a membership of 10,000 would
generate ¥20 million for use to fund activism.
As membership fees are used to fund activism,it seems that ¥20 million is needed. Various
types of activism are essential; thus, 10,000
members are needed.
JART has approximately 28,500 members.
Therefore, if 50% of these were to join JFRT,
it would be possible to establish candidates
from within our organization and campaign
on that basis.
Kumashiro, Vice-President: Yes, these areappropriate figures. The Japanese Nursing
Association has 700,000 members, and theJapan Nursing Federation has about a third ofthat number at 200,000. Therefore, the figureof 10,000 members the President proposed
would be appropriate if JART had 30,000
members. If the same level of activism is to beachieved, it will be necessary for 10,000 people to work together.
Sano, Vice-President: The male/female ratio

among JART members is currently 7:3, but
the ratio among students at training colleges
is now 5:5. In the future, the proportion of
women may increase further. Regarding JFRT,I think that in the future, women may becomeof central importance. At present, an unexpected finding is that men are now unable
to strongly influence their wives and family
members. Female technologists, on the other
hand, have the ability to strongly influence
their husbands and thus obtain their votes,

New Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

meaning they are in a strategic position. In
future, I think there is a need for various strategies including the Executive Committee increasing their involvement with younger people, making requests for cooperation to all an
ex-colleague, and approaching female technologists. In addition, there are various ideas
about ways to approach training colleges.
In future, regarding electoral campaigns,
unless the organization is reestablished andfundamental changes made to a rigid system,
the outcome will be the same. It is not possible that JART cannot do these things whileother professional organizations can. If JART
members are reasonably satisfied and do nothave a sense of crisis, this must be affirmed,
but it is certain that in the future people will
indeed have a sense of crisis in relation to the
expansion of tasks, employment positions,and qualifications. As such, the coming era
presents grounds for anxiety. This means thattechnologists will be aware of the promotionof JART membership and the existence of
JFRT, and in the context of the recent major
electoral defeat, have an important place formembership in their consciousness. It is expected that an increasing number of technologists will understand these points. In future,
our intention will be to continue to carry out
energetic and reliable activities, but one important activity is that everyone gets together
to discuss activism.
I think that the recent defeat must be converted to a major opportunity. Whether inthree or six years, I look forward to a situation
when for individuals who struggle successfully as candidates within the organization, allmembers are excited in terms of awarenessof the situation and their keen voices will beheard inside and outside the organization. I
will be grateful to everyone if such an outcome is ultimately achieved when I am appointed Campaign Manager.

the federation in Okayama Prefecture, several
female technologists who worked at one-person workplaces unexpectedly joined. The
number was not great, but I felt they represented a positive future. Perhaps they wishedto maintain and protect the occupational fieldof radiological technology and do something
about the present situation, so they joinedand supported the federation. I thought they
had a stronger tendency than male technologists and/or technologists at large facilities tothink that the Executive Committee should be
involved in activism. My impression is that theparticipation of female technologists has thepotential to provide great strength.
Sano, Vice-President: Yes, I think so too. Thisis the general tendency in the world now, andif properly understood, a great energy andpurity of heart is specific to women. I feelthat men tend to have selfish and rambling
thoughts and to be hair-splittingly logical, unlike women. Women often understand things
intuitively without the need for reasoning,and I have great hopes for the future in thisregard.
Editor-in-Chief: At JART, for various reasons

such as supporting the return of women to theworkplace, we think there may be items to include in the policies. Thank you very much.

Kumashiro, Vice-President: When I foundedSpecial Feature ◆ 17

of women in the future.
Editor-in-Chief: Thank you very much. I also

see that JART is made up of people. Yes, I
think that people will support the organization, and am therefore hopeful about selecting
the directors. Thank you very much.

Future Direction and the Need forRadiological Technologists

Nakazawa, President: After establishing ahuman resources bank, progress is currently
being made with a female human resourcesbank by Kuwayama (RT). Yes, in this area fulluse is made of women. Women take maternity leave, and some give up work after that,
but it is important to create an environment
in which this is not necessary and they can be
employed with a work-sharing arrangement.
Although nearly 30% of JART members are
now female, about 50% of new university
graduates in this field are currently female.
Therefore, I think it is necessary to change
so that at least 30% of executives are female.
To achieve this, JART has 25 directors, and
30% of that figure is about 7, although currently only 2 are female, meaning the number
should increase by 5. As women are gradually
appointed, the operations of JART will haveto reflect a more female way of thinking.
Going through various regions, I looked
around to determine excellent female technologists. In various places, I meet female leaders
who may bear the burden of responsibility forthe next generation in 10 or 20 years. There
were excellent female directors even at the
Gifu Scientific Meeting. I think that the people
we want to be involved in activism in the future are currently not only at training colleges,
but also in JART. In this context, I think it will
be necessary to appoint an increasing number

18 ◆ Journal of JART English edition 2018

Regarding the direction and requirementsof radiological technologists in the future, thePresident and Vice-President provided various opinions in the discussion. Among these,as the final summary, I would like to offer aheartfelt message to the leading professionals in JART that radiological technologists do
think like that and will strive to put that wayof thinking into practice.
Nakazawa, President: At the moment, I findit regrettable that these have not thoroughly
spread, although a notification was releasedby the Director of the Pharmaceutical Affairs
Bureau on April 30, 2010 and support forimage interpretation, test explanations, andconsultations initiated. Furthermore, JART also
acted in concert, establishing an Image Interpretation Sub-Committee and holding various lecture meetings and evening seminars
throughout Japan to support image interpretation.
I am reconsidering this, but a system forcertification of technologists for image interpretation must be established and the instructions presented in scientific terms. However,in pioneering the certification of technologists
for image interpretation, such as technologists
with specialist certification for interpreting
images of the head, neck, abdomen, or chest,
JART must clearly define the curriculum. In relation to seminars and training courses alone,
I am reconsidering the need for these to be
together and diffused widely.

New Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

What will this field be like in five or
ten yearsʼ time? The use of artificial intelligence (AI) for image interpretation has begun.
Therefore, I think that an AI-based image interpretation support system will exist in the
future. Our role as radiological technologists,
in other words, image interpretation technologists certified for primary image interpretation,
will be to check image interpretation supplementary reports generated by AI and provide
them to physicians in the relevant clinical departments, namely cardiovascular specialists,brain surgeons, or emergency physicians.
In the field of diagnostic imaging, radiological technologists certified for image interpretation will check AI-supported reports generated by the AI diagnosis support system, andthe results sent to physicians in the relevant
clinical departments. I tend to think that thiswill be the operational flow followed in fiveor ten yearsʼ time.
For these reasons, during a transitional period, it will be necessary to establish a system
for the certification of technologists for image interpretation, and in future to train suchcertified technologists by means of a masterʼsdegree course to produce technologists capable of such interpretation at universities.
This system must be fully established within
ten years. If not, I think it will be difficult to
win societyʼs trust.
The second point is that I think the radiotherapy field will continue to expand in future, and reliable quality control of radiotherapy will therefore be possible based on theappropriate operation of external radiation in
the radiotherapy field. It seems necessary toestablish a system of this type. Therefore, radiotherapy should become a full-time job, andtechnologists involved with radiotherapy musthave technical competence achieved by training for six rather than four years.
Overall, I think that by including the fields
of diagnostics and radiotherapy, all fundamental education probably requires a six-year

course. If you do not want courses that long,an alternative approach would be for only
technologists who carry out image interpretation in the diagnostic field and/or perform
quality control of treatment to have masterʼsdegrees. Other technologists would have fouryear degrees. Considering this, fundamental
education will thus change to six years. I
think this will be the reality over the next fiveto ten years.
Editor-in-Chief: Thank you very much. What

do the Vice-Presidents think?
Sano, Vice-President: Regarding organiza-

tional reinforcement, the promotion of JART
membership, and JART activism, I think that apublicity section for younger members will beneeded to accurately transmit the opinions of
the head division. We must again reconsider
how best to express and transmit information
to young technologists of the current generation; otherwise, it will merely look as though
we executives are directing activities in aself-satisfied manner. In other words, I think
we must strive to take an appropriate stancetowards that happening without forgetting
how this looks from the perspective of general JART members.
Next, we are currently energetically promoting human resources development seminars for young people centered in the Central Japan region. This spark has also lit up
the Kansai region, and the number of active
technologists including both young and coretechnologists has recently increased in Kansai.
These groups remain small-scale with 20 to 30
participants, and no rapid spread is evident,
but it is clear that the number of facility directors at various medical institutions who participate has started to increase.
Regardless of the meeting, that participants
are JART members has been established as an
essential requirement. I think that this steadyand consistent activism and that of the JART
Special Feature ◆ 19

organization from several years ago are probably comprehensible from the viewpoint ofyoung technologists and penetrate various
workplaces. I cooperate from various viewpoints and provide back up. The outcome
cannot be expressed concisely, but I believethat in five or ten years these personnel will
form the backbones of their workplaces, theirunderstanding and cooperation will enhanceorganizational capability, and the thus-activated workplaces will represent the fields inwhich professional associations will grow. I
do my own bit with support from all sides.
Thus far, the results are insufficient, but I believe that someday they will constitute a tideof change.
Editor-in-Chief: This is the time for sowing

seeds, is it not?
Sano, Vice-President: Yes, on a previous oc-

casion, in those terms, all the senior technologists came here. What were they discussing?
The meeting was full. Therefore, although
there are miscellaneous internal issues, for theissue of how to train and encourage young
technologists interested in this area, rather
than internally, senior technologists at each
institution should meet, which will reinforce
the organization.

were similar to managers, and organizationally, personnel made efforts at the regional
level, which constituted the team of Vice-President Sano. Through this organization, opinions were communicated in various ways tovarious people, and it is perhaps advisable toconsider a similar mechanism.
Kumashiro, Vice-President: In addition, theindividuals making the most effort on a regional level were appointed as managers, but
unfortunately, that was not achieved in organizational terms. For example, although there
were three people in Okayama Prefecture,other regions did not even have one person.
The allocation was not consistent between the
47 prefectures. These are distributed consistently throughout Japan; however, the current
Executive Committee established the current
system of Educational Committee members.
There are Educational Committee members in
all 47 prefectures, and Educational Committee
managers who represent these regions are
positioned there. The eight managers in eightregions and Educational Committee membersin 47 prefectures are organized systematically.
Therefore, I think they now function effectively.
Editor-in-Chief: I see. Therefore, they are Edu-

cational Committee members.
Editor-in-Chief: Previously at JART, directors
Kumashiro, Vice-President: Yes, that is correct.

The current Educational Committee members
are responsible for that, are they not?
Nakazawa, President: Was it not previously

the managers? Now it is members of the Educational Committee.
Sano, Vice-President: It might be difficult toachieve absolute consistency across Japan, but
we are hoping for improvements.
Kumashiro, Vice-President: Among the opin-

20 ◆ Journal of JART English edition 2018

New Year Discussion Meeting: Future importance of the Japan Association of Radiological Technologists (JART)

ions of the future conceptions of the President
and Vice-President Sano, as Vice-President
Mr. Sano commented, I agree that to become
active in various regions it is essential that therelevant persons understand and cooperatewith our activism. I do not think our operations can be established without cooperation
between all 47 prefectures.
The records of the interview on image interpretation support were passed to the Editor-in-Chief the other day. However, I am
working with the Chairperson and responsible
directors for Okayama Prefecture in this respect. A consultation has been held between
physicians in the Healthcare Coordination
Section of Okayama Prefectural Health andWelfare Dept., which is responsible for directing and supervising healthcare, and welfare-oriented businesses within the prefectureand executives of the Okayama Prefectural
Association of Radiological Technologists. The
theme of the consultation was “Support forimage interpretation by radiological technologists.” The status of this consultation between
the two parties was published in Osera, aninformation agency magazine widely read in
Okayama Prefecture. Osera has readers froma range of occupations within the prefecture,from corporate managers to full-time housewives, and seemed to have major results interms of wide publicity among prefectural citizens. I think that another important outcome
is that support for image interpretation byradiological technologists, and thus contribution to healthcare safety, is currently widely
known within the prefecture. For attempts ofthis type, I think it is necessary for JART to
actively cooperate with the prefectural associations.
Next, regarding the system for the certification of technologists to support image interpretation, as presented by the President, we
think there is a need for certification of theimage interpretation support hoped for by all
physicians including radiologists. Even if theworkplace includes technologists with reliable image interpretation capability, currently, no-one can evaluate and provide quality
assurance for that interpretation. In terms ofworkplace units, this should not be the roleof the senior technologist, a radiologist, or thehospital director. I strongly contend that on
an official level, if it is necessary for the institution director to provide certification at theworkplace-unit level for technologists who
have been reliably certified by a third party, it
will be practical for image interpretation support to be provided within the workplace.
Nakazawa, President: Yes, a technologist certification system trusted by the population is anecessity. Therefore, considering the specialist
occupational field of radiological technologists, it is necessary to involve physicians in
the Japan Radiological Society and mutually
establish the system. When the Director of thePharmaceutical Affairs Bureau released a notification about image interpretation support
on April 30, 2010, a discussion was requested
with the President of the Japan RadiologicalSociety on how to establish a certification
framework. However, this was unfortunately
canceled.
Editor-in-Chief: Thank you, President andVice-Presidents, for telling us about the future
direction of progress and the aspects needed.
I was surprised to hear the term “AI” usedby the President. In Japan, as in other countries, progress with AI is part of national policy, and although my understanding was accurate in terms of AI for image interpretation not
yet having spread much in Japan, this may infuture be explosively fast. Therefore, appropriate preparation is needed.
Nakazawa, President: With the initiation of di-agnostic imaging big data collection from thepublic, will this not be difficult? Therefore, depending on the degree to which AI image inSpecial Feature ◆ 21

terpretation report precision can be increased,neither radiological technologists nor diagnostic imaging specialists in the Japan Radiological Society can remain unfettered by this area.
Thus, I think a sense of crisis is essential.

Closing Remarks
Editor-in-Chief: Thank you very much. I would

like to ask President Nakazawa to say a few
words to close this discussion meeting.
As this is a New Year Discussion Meeting,
I will be grateful if you would present yourmessage to JART members on your feelings
about this year.
Nakazawa, President: It is an important slo-

gan for JART that it aims to coordinate teambased healthcare with the Japanese public. I
therefore think that healthcare professionals
including ourselves as radiological technologists must at all times be aware of the need

22 ◆ Journal of JART English edition 2018

to ascertain from the public what they desirefrom healthcare professionals.
In our opinion, it seems that the public
hope for the provision of safe, reliable, andhigh-quality healthcare. Therefore, we haveprovided scientific support to guarantee safety. It is essential to use evidence-based tests
and treatment with reference to data andpublished documents. In this context, I think
it is important to determine the demands ofthe public, and then in terms of our specialty, to increase quality in our occupational
field. During 2017, together with the public, I
would like to be able to achieve progress inhealthcare. I also hope we will have mutual
recognition in this regard. With this, I would
like to conclude my comments.

Editor-in-Chief: Thank you very much. With

that, I would like to close this discussion
meeting.

The 21st Asia-Australasia Conference of Radiological Technologists

Presidentʼs speech

Radiation Protection andMonitoring in Japan
Yasuo Nakazawa
President, The Japan Association of Radiological Technologists

The 21st Asia-Australasia Conference of Radiological Technologists (AACRT) in conjunction with 5th Asia
Radiotherapy Symposium (ARS) and 3rd Hong Kong Radiographers and Radiation Therapists Conference(HKRRTC) at Hong Kong Science Park, from 23-25 June 2017.

I am Yasuo Nakazawa, President the Japan
Association of Radiological Technologists.
Today, I would like to make a presentation,
entitled “Radiation Protection and Monitoringin Japan”.
First of all, Iʼd like to introduce the present
report in Japan and our activities as the Japan
Association of Radiological Technologists, especially high-colored 4 items out of 10 items
in BONN CALL FOR ACTION (Table 1).

IAEA・WHO
BONN CALL FOR ACTION（2012.12）

10 Actions to Improve Radiation Protection in Medicine
in the Next Decade1.
2.

Enhance the implementation of the principle of justification
Enhance the implementation of the principle of optimization ofprotection and safety
3. Strengthen manufacturers’ role in contributing to the overall safety
regime4. Strengthen radiation protection education and training of healthprofessionals
5. Shape and promote a strategic research agenda for radiation
protection in medicine
6. Increase availability of improved global information on medical
exposures and occupational exposures in medicine
7. Improve prevention of medical radiation incidents and accidents
8. Strengthen radiation safety culture in health care
9. Foster an improved radiation benefit-risk-dialogue
10. Strengthen the implementation of safety requirements globally2

Table 1
Special Feature ◆ 23

(Action 1)
Enhance the implementation of the principleof justification

estimates based on regional cancer registries,2011).
At least 13,000 patients die due to breast
cancer (Vital statistics, 2013).

Question. Is there any example of principle
Proposal for clinical parameters of breast can-of justification of request for examination?
Answer. In Japan, there is no principle of jus-tification of request for examination.
We have no choice but to entrust judgement of the attending physicians.

cer screening (Table 2).

We compare the past and present parameters in this table.
Proposal for clinical parameters of breast
cancer screening(Action 1-6)

Next, I will talk about additional criteria to
the justification of medical imaging diagnosis
for patients without the symptom.
Further develop criteria for justification ofhealth screening programmes for asymptomatic populations (e.g. mammography screening) and for medical imaging of asymptom-

1987〜

2000〜

2004〜

１）Screening method
・an interview
・visual inspection
and palpation

１）Screening method
・visual inspection andpalpation
・Screening
mammography

１）Screening method
・Screening
mammography
・Ultrasonography may beintroduced in the future.

２）qualifying age
・30 years old or older

２）qualifying age
・50 years old or older

２）qualifying age
・40 years old or older

３）inspection
frequency
・Once a year３）inspection frequency
・Once every two years

３）inspection frequency
・Once every two years

atic individuals who are not participating in

6

approved health screening programmes (e.g.

Table 2use of CT for individual health surveillance).

I will introduce you the current efforts inJapan and approaches related to Clause 6 of
Action 1.
Current trends of breast cancer screening inJapan (Fig.1).

More than 80,000 people suffer from breast
cancer (including carcinoma) a year (National
Current trends of breast cancer screening inJapan• More than 80,000 people suffer from breast cancer (including
carcinoma) a year (National estimates based on regional

cancer registries, 2011).

• At least 13,000 patients die due to breast cancer(Vital statistics, 2013).

Current issues of breast cancer screening (Fig.2).

There is no legal regulation for the quality
control of breast cancer screening.
The percentage of people who get cancer
screening in Japan is extremely low with 3040%, while it is 70-80% in the OECD (theOrganization for Economic Cooperation andDevelopment) participation countries.
Current issues of breast cancer screening• There is no legal regulation for the quality control of breast
cancer screening.
• The percentage of people who get cancer screening in Japanis extremely low with 30-40%, while it is 70-80% in the OECD(the Organization for Economic Cooperation andDevelopment) participation countries.

USA

The number of deaths of women with breast cancer

Fig.1

24 ◆ Journal of JART English edition 2018

5

FranceSouth Korea

UK

Germany

Australia

Japan

Cancer screening consultation rate＜breast cancer ＞

Fig.2

7

Radiation Protection and Monitoring in Japan(Action 2)

Background of Diagnostic Reference Levels

Enhance the implementation of the principleof optimization of protection and safety
Question. Is there any local, regional or coun-

try level Diagnostic Reference Level setup in
your country?
Answer. Yes.
Japan Network for Research and Information on Medical Exposure (J-RIME), which
consists of societies, administrations, andindustries related to Medical exposure, published “Diagnostic Reference Levels Based on
Latest Surveys in Japan ̶Japan DRLs 2015̶”
for the first time in Japan.

Diagnostic Reference Levels Based on Latest
Surveys in Japan ̶Japan DRLs 2015̶

J-RIME consists of the Japan Association ofRadiological Technologists and many other societies, administrations, and industries related
to Medical exposure, including those shownin this slide (Fig.3).

Based on Latest Surveys (DRLs 2015).

Since global interest in medical radiation
exposure has increased, each country has set
the diagnosis reference levels for radiation
protection in medical care. However, diagnosis reference levels were not established until
recently in Japan.
In Japan, national interest in medical radiation exposure has increased after the Fukushima Daiichi nuclear disaster in the Great East
Japan Earthquake despite of the fact that it
posses the largest number of CTs in the world.
Thus, development of diagnostic reference
level was demanded.
DRLs 2015 is the first diagnostic reference
level in Japan which was set via cooperation
among societies, administrations, and relatedgroups.
Recently published DRLs 2015 includes the
Diagnostic Reference Levels for the following
7 items:
Medical X-ray imaging and Computed Tomography (CT), Adult CT scans, Childhood CT
scans, General CT scans, Mammography, Intraoral radiography, IVR, and Nuclear Medicine.
About the contents of the diagnosis reference level for adult CT, please see this table(Table 3).
About the contents of the diagnosis
reference level for adult CT

J-RIME• Japan Association of Radiological Technologists• Japan Association on Radiological Protection in Medicine• Japan Society of Medical Physics• Japan Radiological Society• Japanese Society of Nuclear Medicine• Japanese Society of Nuclear Medicine Technology• Japanese Society for Oral and Maxillofacial Radiology• Japanese Society of Pediatric Radiology• Japanese Radiation Research Society• Japanese Society of Radiological Technology• Japan Medical Imaging and Radiological Systems Industries
Association• National Institute of Radiological Sciences

Head CT scan without
contrast

CTDIvol（mGy）
85

1350

Single-phase Chest CT

15

550

Single-phase ChestPelvis CT

18

1300

20

1000

Liver dynamics

15

1800

Coronary arteries

90

1400

Single-phase Upper
Abdomen-Pelvis CT

Note 1. Standard body weight: 50-60 kg (“Coronary arteries” case: 50-70 kg)
Note 2. “Liver dynamics” did not include “Chest-Pelvis”.
12

9

Fig.3

DLP（mGy・cm）

Table 3Special Feature ◆ 25

About the contents of the diagnosis reference level for childhood CT scans, please see
this table (Table 4).

1-5 yoPrioritize radiation protection education and training
for health professionals globally, targeting
professionals using radiation in all medical and dental
areas;

Radiation-related medical education contents
in Japan (2016) include:

About the contents of the diagnosis
reference level for childhood CT scans
Less than 1 yo

(Action 4-1)

6-10 yoCTDIvol

DLP

CTDIvol

DLP

CTDIvol

DLP

Head

38

500

47

660

60

850

Chest

11
（5.5）

210
（105）

14
（7）

300
（150）

15
（7.5）

410
（205）

Abdomen

11
（5.5）

220
（110）

16
（8）

400
（200）

17
（8.5）

530
（265）

Note 1. Values for a 16 cm phantom are shown. Values for 32 cm are shown in parentheses.
Note 2. The units for CTDIvol and DLP are mGy and mGy/cm, respectively.

• Effect of radiation on the human body and radiation
hazard,• Human body and radiation,• Medical radiation and effect of radiation on the humanbody,• Radiation risk communication, and• Radiation hazard medical care.

15

Fig.4

(Action 10)
13

Table 4

(Action 4)
Strengthen radiation protection educationand training of health professionals
Question. How are radiographers in yourcountry trained for radiation protection?
Answer. According to Japanese law known as
the “Act on Prevention of Radiation Hazards
due to Radioisotopes”, Medical and research
institutions which have obtained the permission from Japanese government are required
to receive annual education training once a
year.
The other institutions perform education
training independently.
(Action 4-1)

I will show you the actual situation about
Action 4-1.
Prioritize radiation protection education andtraining for health professionals globally,targeting professionals using radiation in all
medical and dental areas;

Radiation-related medical education contents in Japan (2016) include: (Fig.4)

26 ◆ Journal of JART English edition 2018

Strengthen the implementation of safety requirements globallyIʼm showing about Action 10.
Question. How are patients protected by regulations in your country?
Answer. There is no regulation on the radiation for protecting patients.
Thus, weʼd like to introduce the efforts of
the Japan Association of Radiological Technologists for Action 10.
These are the activities of The Japan Association of Radiological Technologists for Action
10.

Authorization of the radiation managers,
1,735 persons.
Advisors on radiation health risk control,
200 persons.

Radiation Protection and Monitoring in Japan

Accreditation of institutions which reduceradiation exposure, 72 institutions.
Certification system of facilities optimizing
medical exposure dose・Purpose for certification system
・Progress
・Inspection items
・Certificate and plate
・certified facilities

Purpose of the certification system.

The responsibility for optimizing medical
exposure dose naturally falls to RT, who,by doing so, gain greater trust as specialists.
Gaining the publicʼs trust in radiological examination requires a variety of measures,such as technological support for maintaining and improving the quality of radiologicalexamination for determining appropriate examinations; optimization of exposure factors
for examination purposes; quality control ofradiologic equipment; and appropriate explanations to alleviate patientsʼ anxiety regarding
examination.
By certifying and releasing the names of
medical facilities which have demonstrated
that they satisfactorily perform the above measures, the JART can ease the publicʼs fears regarding radiological examination.
Progressactions” and “optimization of protection”; forthe latter, inspections are conducted for each
modality.
Inspection scale:
A: high level
B: standard level
C: sub-standard level
NA: not applicable
Certificate and plate

This is a certificate and an authorized plateissued from the Japan Association of Radiological Technologists (Fig.5).

The founding of this system

The trial period: 2 years from 2005.
The full scale work started from 2007 untilnow.
We revised the inspection items partially lastyear.
We revised the guideline for medical exposure dose based on the Japan DRLs 2015.
Therefore we have inspected with thisguideline from this year.

Certificate and plate

Inspection items

These items are divided into “justification of

22

Fig.5
Special Feature ◆ 27

certified facilities

There are 72 certified facilities in Japan,
please see this table (Table 5).

certified facilities (May.2017, all 72 facilities)

Prefecture
Hokkaido
Aomori
Iwate
Akita
Miyagi
Yamagata
Fukushima
Niigata
Tochigi
Ibaraki
Gunma
Saitama
Chiba
Tokyo
Kanagawa
Yamanashi
NaganoIshikawa
ToyamaFukui
Shizuoka
Aichi
Gifu

Facilities
3
0
0
1
0
0
1
0
1
1
0
8
4
6
5
1
3
1
0
1
4
10
1

Mie
Shiga
Kyoto
Nara
Wakayama
Osaka
Hyogo
Okayama
Hiroshima
Tottori
Shimane
Yamaguchi
Tokushima
KagawaEhime
Kochi
Fukuoka
Saga
Nagasaki
Oita
Kumamoto
MiyazakiKagoshima
Okinawa

合計

0
0
1
0
0
3
2
2
1
0
0
1
0
0
0
0
4
0
1
1
3
1
1
0
72

facilities
23

Table 5Thank you for your attention.

28 ◆ Journal of JART English edition 2018

Toward revision of the designation regulations
for radiological technologist training schools
Naoki Kodama, Ph.D1），2）, Yasuo Nakazawa, Ph.D1），3）, Mikio Sano1），4）,
Masayuki Kumashiro1），5），6）
1）Japan Association of Radiology Technologists2）Takasaki University of Health and Welfare, Department of Healthcare Informatics
3）Showa University, Graduate School of Health Science4）Kariya Toyota General Hospital, Department of Radiological Technology5）Kurashiki Central Hospital, Department of Radiological Technology6）Okayama University, Graduate School of Health Science

Key words: radiological technologists, training school for radiological technologists, designation regulations, medical

safety, team medical care, expanding duties, national exam
【Abstract】

The designation regulations for radiological technologist (RT) training schools were revised in 2000, more than
15 years ago. In that time, medical care has become more advanced and diverse, which has both expanded andcomplicated the duties of RTs. The levels of skill and ability expected of RTs have increased and changed withthe times. A notice (Health Policy Bureau 0220.2) issued by the Japanese Ministry of Health, Labour and Welfare
on February 20, 2015, sought to revise the content of, and number of credits in, RT education to accompany thisexpansion in duties, increasing the number of credits from 93 to 95. However, a 2-credit increase in education does
not reflect the duties RTs perform, or the skills and abilities that are required of them. Further additions and changes
are needed. This report describes the initiatives undertaken by the Japanese Association of Radiological Technologists
to revise the designation regulations for RT training schools.

1. Introduction
The curriculum for training schools for radiological technologists (RTs) was reviewed
in 2000,1) and on March 30, 2001, the designation regulations for RT schools were revised.
In the 15 years that have passed since thesechanges were made, medical care has become
more advanced and diverse, which has both
expanded and complicated the duties of RTs.
The levels of skill and ability expected of RTs
have increased and changed with the times.
Meanwhile, in the interest of guaranteeing
medical safety and promoting team medicalcare, a Health Policy Bureau notice (0430.1)
dated April 30, 2010, on “ Promoting team
medical care through cooperation and collaboration between medical staff ” stated that theduties of an RT included assisting with interpretation in diagnostic imaging, and explain-

ing and consulting on radiological examinations and other matters.2) In addition, a Health
Policy Bureau notice (0220.2) dated February
20, 2015, on “Revision of designation regulations for RT schools” that accompanied a partial revision of the Medical Radiology Technician Law sought to revise the content of, andnumber of credits in, RT education to accompany this expansion in duties, increasing thenumber of credits from 93 to 95.3) However,a 2-credit increase in education does not adequately reflect the duties RTs perform, or theskills and abilities that are required of them.
Further additions and changes are needed.
This report describes the initiatives undertaken by the Japanese Association of Radiological Technologists (JART) to revise the designation regulations for RT training schools.

Special Feature ◆ 29

2. Motive
On July 25, 2014, JART sent the chiefs ofthe Ministry of Health, Labour and Welfareʼs
Health Policy Bureau and the Ministry of Education, Culture, Sports, Science and Technologyʼs Higher Education Bureau a request
to form a committee to study how clinicaltraining should be carried out in the education of RTs.4) This request was prompted byan alleged violation of the Medical Radiology
Technician Law that occurred at a clinic in
the city of Kobe on November 7, 2013. In thisincident, an associate nurse and office worker
without RT qualifications allegedly performed
X-ray imaging. The Hyogo Prefectural Policearrested the Clinical Director, an associatenurse in her 60s, and an office worker in her
40s on suspicion of violating the Medical Radiology Technician Law. The Clinic Director
allegedly ordered the associate nurse, office
worker, and others to conduct computed tomography (CT) scans and X-ray examinations
on patients on multiple occasions. In responseto this incident, the Hyogo Prefectural Police
issued the following directive to the Japanese
Medical Imaging and Radiological Systems Industries Association (JIRA).
Previously, arrests were made by the Hyogo Police over suspected violations of theMedical Radiology Technician Law at a clinic
in Kobe. A doctor is suspected of regularly
ordering nurses, nursing assistants, and otherstaff to perform X-ray imaging and CT scans.
The nurses and other staff allegedly prepared
the X-ray and CT equipment for imaging (settings), then called the doctor, who pushed
the irradiation button without checking thesettings. In addition, when the Hyogo Policequestioned the vendor that supplied the clinic with X-ray and CT equipment, they were
under the mistaken impression that it was notillegal for nurses or other staff to prepare themachines, then have a doctor push the irradiation button. In consideration of these circum-

30 ◆ Journal of JART English edition 2018

stances, the Hyogo Police requested that JIRA
notify the medical device companies in its
membership of the following directive, whichis intended to eliminate any mistaken understanding.5)

Directive
It is a violation of the Medical Radiology
Technician Law for nurses or other staff tocarry out preparations for X-ray or CT imaging(settings), then have a doctor push the irradiation button without performing a carefulcheck.
When inquiries are received from medical
institutions and elsewhere, they should be
told that equipment can only be operated bydoctors, dentists, and other legally qualified
professionals.
Moreover, the following exchange concerning clinical training for noninvasive examinations (ultrasound etc.) occurred at a meetingof Committee of training institution for Radiological Technologist in Hokkaido on June 20,
2014. An official from the Ministry of Health,Labour and Welfare was asked, “During clinical training, is there a problem with students
being the examinees so they can experience
noninvasive examinations, or with students
practicing these tests on each other at aschool?” The official responded, “ Provision
24.2 of the Medical Radiology Technician Law[In assisting with medical care, MRI and otherduties can be performed under the directionof a doctor or dentist.] does not allow a person who does not have a license to performthese acts. Performing these acts using suchdevices can be considered assisting with medical care.” The official added, “Legally, can thisbe done? In principle, no. However, a 2003
report by the Japanese Nursing Association
contained the interpretation that, under certain conditions, it would be legally justified
for students to assist with nursing as part ofclinical training. As for students performing

Toward revision of the designation regulations for radiological technologist training schools

MRI or other exams on each other, there arequestions as to its legal justification and what
students should be allowed to do for educational purposes, so I cannot, at this time, say
whether it would be illegal or not. That said,
if it is done without any rules in place, I thinkthat would be illegal.”This suggests that, in the education of RTs,
having students perform noninvasive ultrasound examinations for training purposes, to
say nothing of acts like using patients as partof clinical training, could be in violation ofprovisions 2.2 and 24 of the Medical Radiology Technician Law because students do nothave national certification. If the objective of
having students undergo clinical training withreal patients cannot be fulfilled, it could lower the standard of education, and reduce thequality of future RTs. Therefore, JART sent arequest (No. 388) dated July 25, 2014, that acommittee be established to study how clinical training should be carried out in the education of RTs.4)

3. Process of compiling “ Reportfrom the committee on statutes
and clinical training of RTs”
Table 1 shows the process JART went

through to compile the “Report from the committee on statutes and clinical training of RTs.”
To raise the quality of RT and increase thestandard of education, we believe the Ministryof Health, Labour and Welfare and Ministry of
Education, Culture, Sports, Science and Technology need to create a committee to stipulate
standards regarding which basic acts can be
performed under certain conditions as part ofthe clinical training RT schools are entrusted
with, the same as is done for doctors, dentists,
nurses, and other professions. In response tothis request, the Ministry of Health, Labourand Welfare decided it needed to understandthe state of clinical training in more detail, so
it conducted a survey to determine whether

a committee should be established to study
clinical training in the education of RTs. The
survey was conducted over about 2 weeks,
starting on January 19, 2015. The survey wassent to 46 RT schools and 41 responded, a
response rate of 89.1 percent. The results
showed that a variety of requests were madeof medical facilities regarding the clinicaltraining of RTs, and that there was a great
deal of variation between schools. Further,most schools, 85 percent, said they wanted
standards on the medical acts that are permitted under certain conditions during clinicaltraining. Schools also desired criteria for certifying clinical trainers.
Based on the results of the survey, it was
concluded that, to raise the quality of RTs
and increase the standard of education, theMinistry of Health, Labour and Welfare andMinistry of Education, Culture, Sports, Scienceand Technology should create a committee tostipulate standards regarding which basic acts
can be performed under certain conditions
as part of the clinical training permitted in RT
schools, the same as is done for doctors, dentists, nurses, and other professions. Therefore,
based on the results of the fact-finding survey
on clinical training at RT schools, JART, again,
sent a request (No. 287) dated April 20, 2015,that a committee be established to discuss
how clinical training should be carried out
as part of the education of RTs.6) On May 27,
2015, JART provided the Ministry of Health,Labour and Welfare with further clarificationof this request. At this meeting, the ministryadvised JART that, because some of the designation regulations for RT schools covering
clinical training, the designation regulations
overall would need to be revised. Thus, itwould be helpful to have a venue to discuss
the matter with the schools.
Taking this advice, JART sent a proposal(No. 364) dated June 1, 2015, to the National
Council of RT Training Institutes regarding theformation of a joint working group. However,Special Feature ◆ 31

Table 1 Process of compiling “Report from the committee on statutes and clinical training of RTs”
Nov. 7, 2013

Alleged violation of the Medical Radiology Technician Law at a Kobe clinic.
Three people (doctor, associate nurse, office worker) arrested for allegedly performing some imaging acts,
including patient positioning and device setting.

Jun. 20, 2014 59th annual meeting of the National Council of RT Training Institutes.
A Ministry of Health, Labour and Welfare official states that a student applying a probe to a human body aspart of ultrasound training could be a violation of the Medical Radiology Technician Law.
Jul. 25, 2014

Request to study clinical training submitted to the Ministry of Health, Labour and Welfare and Ministry of
Education, Culture, Sports, Science and Technology.
Ministry of Health, Labour and Welfare requests a survey on the state of clinical training.

Jan. 19, 2015 Ministry of Health, Labour and Welfare conducts a survey to determine whether a committee should beestablished to study how clinical training should be carried out in the education of RTs.
Forty-six RT schools are surveyed and forty-one respond (89.1 percent response rate), finding that a varietyof requests were made of medical facilities regarding the clinical training of RTs, and that there was a great
deal of variation between schools. Most schools (85 percent) wanted standards for the medical acts thatare permitted in certain conditions during clinical training.
Apr. 10, 2015

Request submitted to the Ministry of Health, Labour and Welfare to form a committee to study how clinicaltraining should be carried out in the education of RTs.
The ministry advises that, because some of the designation regulations for RT schools cover clinicaltraining, the overall designation regulations would need to be revised. Thus, it would be helpful to have avenue to discuss the matter with the schools.

Jun. 1, 2015

Formation of a joint working group proposed to the National Council of RT Training Institutes.

Jun. 19, 2015 60th annual meeting of the National Council of RT Training Institutes.
JARTʼs proposal is rejected.
Jun. 22, 2015 Chair and vice-chair of the 60th annual meeting of the National Council of RT Training Institutes request
meeting with JART.
Jul. 2, 2015

Meeting held with chair and vice-chair of the 60th annual meeting of the National Council of RT Training
Institutes.
Agreement reached that JART would form a committee on statues and clinical training of RTs, and that thechair of the National Council of RT Training Institutes would take responsibility for meeting with member
schools about the council sending people to serve on it.

Sep. 29, 2015 First meeting of the committee on statutes and clinical training of RTs.
The committee convenes with six members from the National Council of RT Training Institutes and fivemembers from JART.
Free discussions held on topics including problems and areas for improvement in RT education, and plans
for the future.
Oct. 26, 2015 Second meeting of the committee on statutes and clinical training of RTs.
Discussions held on how clinical training ought to be, qualifications for clinical trainers, examples ofbasic acts that would be permitted under certain conditions in the clinical training of RTs, and performing
Objective Structured Clinical Examinations (OSCE) and Computer Based Tests (CBT).
Nov. 25, 2015 Third meeting of the committee on statutes and clinical training of RTs
Discussions held on the number of credits and instructors in the designation regulations for RT schools,
and the equipment, specimens, and models needed for education.
Jan. 18, 2016 Fourth meeting of the committee on statutes and clinical training of RTs
Discussions held on how to modify educational content and targets to accompany the revision of thedesignation regulations for RT schools, and on adding members to the committee for the national RT exam.
Feb. 22, 2016 Fifth meeting of the committee on statutes and clinical training of RTs
Discussions held on the subjects and number of problems on the national RT exam. Draft report compiled.
Mar. 3, 2016

“Report from the committee on statutes and clinical training of RTs” compiled.
Agreement reached on increasing number of credits from 95 to 105 and on creating new specialized
subjects for diagnostic imaging.

this proposal was rejected on June 19, 2015, atthe 60th annual meeting of the National Council of RT Training Institutes. On June 22, 2015,
the chair and vice chair of the national councilʼs 60th annual meeting requested a meetingwith JART, which was held on July 2, 2015. At
this meeting, it was decided that JART would

32 ◆ Journal of JART English edition 2018

form a committee, and the chair of the national council would take responsibility for meeting with member schools about the council
sending people to serve on it.
After reaching an agreement with the national council, a committee was formed to
study statutes and clinical training of RTs, with

Toward revision of the designation regulations for radiological technologist training schools

six members from the national council andfive members from JART. The committeeʼs firstmeeting was held on September 29, 2015. The
second through fifth meetings were held on
October 26 and November 25, 2015, and on
January 18 and February 22, 2016, respectively. Discussions were held on targets for theeducational content in attached table No. 1of the designation regulations for RT schools,
qualifications of full-time instructors, examples
and specific content of the basic acts that canbe performed under certain conditions during
clinical training, requirements for clinicaltrainers, and the subjects and number of questions on the national RT exam. These werecompiled into the “Report from the committee
on statutes and clinical training of RTs.” Whencompiling the report, the committee discussed
what the job of an RT would look like in the
future; that the education of RTs should prepare them to play a central role and hold core
responsibilities in medical care, so they canadapt to the expansion in their duties that has
occurred as medical care has become increasingly advanced and complex; how to provide
problem-based learning that complies with
global standards and takes into consideration
the so-called 2023 problem of doctor training; and how to change clinical training froman observation-based model to a participation-based model that is future-orientated.

4. Content of the “Report from thecommittee on statutes and clinicaltraining of RTs” (summary)Table 2 describes the attached table No. 1 ofthe designation regulations for RT schools andTable 3 describes the targets for educational
content.
To improve the education of RTs, acts thatstudents can perform as part of clinical training and standards for these acts were classified and clarified, and policies for instructors
were decided. The following principles wereused in this process.
(1) When performing an act, protecting thepatientʼs rights and safety should be the highest priority. In addition, an easily understandable explanation should be provided to thepatient and his/her family beforehand, andtheir consent obtained.
(2) When performing an act, the student
should be able to fully explain what is to bepracticed, and the student should be taught
the techniques in advance so that he/she canperform them.
(3) Depending on the patientʼs condition or
the studentʼs learning level, an act may not
be appropriate to perform using the standards that were set in advance. In such cases,
the clinical trainer may change the standards
based on the following considerations.

Table 2 Designation regulations for RT schools, attached table No. 1
Educational content

Credits

Basic fields

Basics of scientific thinking
Humans and life

14

Specialized basic fields

Structures, functions, and diseases of the body
Scientific basics of health, medical care, welfare; radiation science and techniques

13
15

Specialized fields

Medical imaging techniquesRadioisotope examination techniques
Radiation therapy techniques
Medical image information
Radiation safety management
Medical safety management
Diagnostic imaging
Clinical training

17
7
7
6
4
2
5
15

Total

105

Special Feature ◆ 33

・If the student performs the act, will it beconsiderably more physically invasive to thepatient than if an RT did it?
・Has the student sufficiently learned the tech-niques or acquired the knowledge required toperform the act?
・Is the student having trouble communicatingwith the patient or his/her family?

Table 3 Educational targets
Educational content
Basic fields
Specialized basic fields
Specialized fields

14

Give students the ability to think scientifically and ethically, elevate their humanity, andimprove their ability to act and decide independently. Acquire a wide understanding of
bioethics and human dignity.
Gain the abilities needed to adapt to an increasingly globalized and information-basedsociety.

Structures,functions, anddiseases of the
body

13

Understand how the structures, functions, and diseases of the human body areorganized. Acquire the basic abilities needed to learn about related subjects.
Understand public health in communities. Understand systems of pathology, anatomy,
and pharmacology needed for intravascular administration of contrast agents and lower
gastrointestinal tract examinations.

Scientific basics
of health, medicalcare, welfare;radiation scienceand techniques

15

Acquire basic knowledge about science, technology, and information science inhealth, medical care, and welfare. Increase comprehension abilities. Acquire basic
knowledge needed to safely use radiation in health, medical care, and welfare. Increase
comprehension, observation, and decision-making abilities.

17

Understand the structure, operating principles, and methods of maintenance andmanagement of equipment for X-ray imaging, X-ray CT, magnetic resonance imaging(MRI), ultrasound imaging, and other examinations. Acquire the knowledge and skills
needed for photography and imaging, and learn about analyzing and evaluating theresults. Acquire basic abilities for dealing with patients.

7

Understand the principles of radioisotope examinations, and the structure, operating
principles, and methods of maintenance and management of gamma cameras, SPECT,
PET, cyclotrons, and other equipment. Acquire the knowledge and skills needed forradioisotope examinations; learn about the analysis and evaluation of nuclear medicine
images and examination results; learn about evaluating doses and other aspects ofradiation exposure.

Radiation therapy
techniques

7

Understand the principles of radiation therapy, as well as the structure, operating
principles, and methods of maintenance and management of equipment. Acquire theknowledge and skills needed for radiation therapy; learn about analyzing and evaluating
treatment plans; learn about quality management and dose evaluation with advanced
radiation therapy technology and radiation therapy.

Medical image
information

6

Understand the principles of image information needed to construct medical images.
Learn about the analysis, evaluation, and processing of medical images, and about
medical information systems.

Radiation safety
management

4

Learn how to safely handle radiation and other tools, understand the related regulations,and acquire knowledge and techniques related to safety management in the healthcare
field. Increase problem-solving abilities.

Medical safety
management

2

Understand an RTʼs responsibilities and scope of practice. Learn the skills needed toperform examinations appropriately, such as administration of contrast agents, withrespect to infection control and medical safety. Understand the risk factors associatedwith administration of contrast agents, particularly how to appropriately address
anaphylaxis and other serious complications. Learn how to quickly contact a doctor
or obtain other assistance, and how to properly provide basic life support (BLS). Learn
about regulations on medical devices and other tools; acquire basic knowledge andskills related to medical safety; understand the causes of medical accidents and how todeal with them.

Diagnostic
imaging5

Acquire knowledge needed for diagnosing and interpreting images as part of an RTʼsduties. Understand the pathophysiology and clinical anatomy associated with diagnostic
imaging.

15

Acquire the basic practical abilities of an RT, and the knowledge and analytical abilities
related to managing a radiology department at a medical institution. Learn how todeal with subjects and patients. Learn the appropriate responses to matters involving
medical safety and infection control. Acquire the ability to fulfill oneʼs responsibilities androle in team medical care.

Basics of scientificthinking
Humans and life

Medical imaging
techniquesRadioisotope
examination
techniques

Clinical training

Total

Credits Educational targets

105

34 ◆ Journal of JART English edition 2018

Toward revision of the designation regulations for radiological technologist training schools(4) The acts should be things that students are
permitted to experience by their final year ofclinical training. Standards should be set basedon educational considerations using rough estimates of the degree of physical invasivenessto the patient.
Because the objectives, means, and methodsof these acts are accepted by society, even if

they are performed by students without RT
qualifications, they may not be construed asillegal if they can be performed with the same
degree of safety as when performed by an RT.
That is, these acts could be legally justified if(1) they are performed with the consent ofpatients and their families, (2) their purpose
is legitimate for the education of an RT, andTable 4 Examples of basic acts allowed under certain conditions
Standard I

Standard II

Standard III

Acts students can perform on theirown under the advice, instruction of a
trainer*1

Acts students can perform under the
instruction, supervision of a trainer(clinical training instructor, etc.)*2

Acts students are not allowed toperform on their own, in principle.
Students can observe a trainer (clinicaltraining instructor, etc.)*2

X-ray imaging (assist*3)
Fluoroscopy (assist)
X-ray CT (assist)
MRI (assist)
Radioisotope exam (assist)
Ultrasound exam (assist)
Bone mineral measurement (assist)
Non-mydriatic fundus photography(assist)
Medical device servicing
Image monitor servicing

Angiography (assist)
External radiation therapy (assist)
X-ray imaging
Fluoroscopy
X-ray CT
MRIRadioisotope exam
Ultrasound exam
Bone mineral measurement
Non-mydriatic fundus photography
Safety management of radiation
sources
Explanations and consultations forradiation examinations
CT simulator imaging, creation ofanchors
Radiotherapy planning
Quality management for radiotherapy(verification tasks)
Measurement of radiation leakage
Quality management for medical
devices
Quality management for image
monitors

Examinations that inject contrast agent
R e m o v i n g n e e d l e s f ro m v e n o u sroutes, hemostasis
Angiography
Image guided therapy (IVR)
External radiation therapy
Brachytherapy
Internal use therapy
Preparing radiopharmaceuticals
Image Interpretation (detection of abnormal findings)
Imaging, other surgical support*1 A trainer is someone with at least 5 years of work experience as an RT and sufficient training skills.
*2 A trainer (clinical training instructor, etc.) is someone who has been certified by JART as a clinical training instructor or
has completed the Foundation for Promotion of Medical Trainingʼs course for training institute instructors.
*3 Assistance includes positioning.

Table 5 Subjects and number of questions on the national RT exam
Subject

No. of questions

General medical basics

30

Basic radiology (radiation biology, radiation physics, radiometry)

30

Medical imaging devices

20

Medical imaging examinations (including X-ray imaging techniques)

40

Medical image information

20

Radioisotope examination techniques (including radiochemistry)

30

Radiation therapy techniques

30

Radiation safety management

10

Medical safety management

10

Diagnostic imaging

20

Special Feature ◆ 35

(3) they are performed with the appropriate
means and methods. Moreover, if the objectives of these acts (4) are seen as having relatively little risk of injury (balance with legal
protections) and (5) are seen as being highly
necessary (need), and they have legitimate
purpose for RT education and their means are
acceptable, then these requirements can beseen as fulfilled.
Table 4 shows examples of basic acts allowed under certain conditions in the clinicaltraining of RTs. Only students who pass OSCE
and CBT will be allowed to participate in clinical training. JART and the National Council of
RT Training Institutes plan to consider installing CBT servers, OSCE protocols, and a certification system for medical facilities that canperform OSCE.
Table 5 shows the subjects and number ofquestions for the national RT exam.

5. Process following compilation of
the “Report from the committee
on statutes and clinical trainingof RTs”
Table 6 shows the process that followed thecompilation of the “Report from the commit-

tee on statutes and clinical training of RTs.”
After the “Report from the committee on
statutes and clinical training of RTs ” wascompiled, it was submitted to the Ministryof Health, Labour and Welfare on March 15,
2016.7) Then, a letter dated March 25 was sent
to the National Council of RT Training Institutes,8) asking the council to allow JART to
explain the main points of the report at thecouncilʼs 61st annual meeting. On April 15,
each school was sent documents describing
the process of compiling the “Report from thecommittee on statutes and clinical training ofRTs.”9) On May 16, the National Council of
RT Training Institutes invited JART to explain
the “Report from the committee on statutes
and clinical training of RTs” at its 61st annual
meeting. The JART chairperson, director in
charge, and secretary-general attended the61st annual meeting of the National Councilof RT Training Institutes on June 17, where
they explained and answered questions about
the “Report from the committee on statutes
and clinical training of RTs.” The assistantchief of the medical section of the Ministryof Health, Labour and Welfareʼs Health Policy
Bureau also attended the councilʼs 61st annual
meeting. After this, the board of the National

Table 6 Process following the compilation of the “Report from the committee on statutes and clinical trainingof RTs”
Mar. 15, 2016 “Report from the committee on statutes and clinical training of RTs” submitted to the Ministry of Health,Labour and Welfare
Apr. 15, 2016

Documents on the process of compiling the “Report from the committee on statutes and clinical training ofRTs” sent to each school

Jun. 17, 2016 61st annual meeting of the National Council of RT Training Institutes
The JART chairperson, director in charge, and secretary-general attended the meeting to explain the “Reportfrom the committee on statutes and clinical training of RTs.” The assistant chief of the medical section of the
Ministry of Health, Labour and Welfareʼs Health Policy Bureau also attended.
Jun. 30, 2016 Expanded board meeting of the National Council of RT Training Institutes
The National Council of RT Training Institutes (chaired by Kyoto College of Medical Science) proposed
making major revisions to the report on statutes and clinical training for RT, which was compiled jointly by
JART and the council.
Jul. 28, 2016

Expanded board meeting of the National Council of RT Training Institutes
Recommended 97 credits and replacing “Diagnostic imaging” with “Diagnostic imaging techniques.”

Aug. 29, 2016 Expanded board meeting of the National Council of RT Training Institutes
National Council of RT Training Institutes proposal drafted.
Sep. 30, 2016 National Council of RT Training Institutes proposal approved.

36 ◆ Journal of JART English edition 2018

Toward revision of the designation regulations for radiological technologist training schools

Council of RT Training Institutes decided toconvene an expanded board of directors to
study the “Report from the committee on statutes and clinical training for RTs.” However,the council did not officially communicate
with JART, despite the fact that the committeeʼs report was compiled jointly by JART andthe council.
On June 30, the expanded board of the
National Council of RT Training Institutes(chaired by Kyoto College of Medical Science)
discussed making major revisions to the “Report on statutes and clinical training of RTs,”
which was compiled jointly by JART and thecouncil. On July 23, the councilʼs expandedboard met to discuss drawing up a proposal
from the council. On August 29, the expanded board compiled the council ʼ s proposal,
which recommended 97 credits and replacing“Diagnostic imaging” with “Diagnostic imaging
techniques.” On September 30, the council approved the proposal.10)

6. National Council of RT Training
Institutes proposal
Table 7 compares the various numbers ofcredits for the attached table No. 1 of the des-ignation regulations for RT schools, including
those from the proposal of the National Council of RT Training Institutes.
The committeeʼs report recommends a totalof 105 credits, including 5 additional credits
of clinical training. However, the National
Council of RT Training Institutes proposal recommends 97 credits, a 2-credit increase. Yet,a report from a committee created by the Ministry of Health, Labour and Welfare in fiscal
2016 on improving the curriculums and otheraspects of judo therapist training institutes
recommended increasing the total numberof credits in the designation regulations forthese institutes by 14, from 85 to 99 credits.11)
Similarly, a report by a committee created by
the Ministry of Health, Labour and Welfare
on improving the curriculums at training institutes for massage therapists, acupuncturists,
and moxibustion practitioners recommended
the total number of credits in the designation
regulations for these institutes be increased
by 7, from 93 to 100 credits.12) While the total
number of credits for both national certifications, which are mainly obtained through3-year vocational schools, are slated to be
increased considerably, the National Councilof RT Training Institutes proposal only recom-

Table 7 Comparisons of attached table No. 1 of the designation regulations for RT schools
Educational content

Credits
Current

Committee National
reportcouncil
proposal

Basic fields

Basics of scientific thinking
Humans and life

14

14

14

Specialized basic fields

Structures, functions, and diseases of the body
Scientific basics of health, medical care, welfare;radiation science and techniques

13
18

13
15

13
18

Specialized fields

Medical imaging techniquesRadioisotope examination techniques
Radiation therapy techniques
Medical image information
Radiation safety management
Medical safety management
Diagnostic imaging
Diagnostic imaging techniques
Clinical training

17
6
6
6
4
1

17
7
7
6
4
2
5

17
6
6
6
4
1

Total

̶
̶

̶

10

̶

15

2
10

95

105

97

Special Feature ◆ 37

mended a 2-credit increase up to 97 credits.
It is extremely unfortunate that after 15 years
and compared to these other national certifications, institutes that train RTs have statedthat an increase of only 2 credits is sufficient.
For the sake of future RTs, we hope that all
instructors will go back to basics and thinkcarefully about what kind of education should
be provided.

7. Conclusion
Discussions should proceed based on the“ Report by the committee on statutes andclinical training of RTs,” which was compiled
jointly by both groups. In particular, to improve the quality of RTs and increase theirstandard of education, we believe the Ministryof Health, Labour and Welfare and Ministry of
Education, Culture, Sports, Science and Technology need to create a committee to stipulate
standards regarding which basic acts can be
performed under certain conditions as part ofthe clinical training RT schools are entrusted
with, the same as is done for doctors, dentists,
nurses, and other professions. The survey
conducted by JART to determine whether toestablish a committee to study how clinicaltraining should be carried out in the education of RT, showed that a variety of requests
were made of medical facilities as part of theclinical training of RT and that there was agreat deal of variation between schools. Further, most schools (85%) wanted standards
on the medical acts that are permitted undercertain conditions during clinical training.
Schools also desired criteria for certifying clinical trainers. Because some of the designation
regulations for RT schools cover clinical training, how clinical training should be conducted
needs to be discussed when revising the overall designation regulations.
Starting in 2023, university medical programs will be evaluated to determine whether they meet international standards.13) The

38 ◆ Journal of JART English edition 2018

purpose of this is to train doctors who canthrive on the global stage. After receiving a
notice from the U.S. Educational Commission
for Foreign Medical Graduates (ECFMG), theAssociation of Japanese Medical Colleges(AJMC) met in September 2011 to create acommittee on assessments in medical school
education and begin discussing a certification
system. In May 2013, the Japan Accreditation
Council for Medical Education (JACME) wasestablished under AJMC, and in July 2013 assessment criteria for different fields of medical education were published in Japanese,
based on the World Federation of Medical
Education (WFME) Global Standards, and trial assessments were started.14) From a viewpoint of cultivating comprehensive medical
abilities, progress is being made on qualitativeand quantitative initiatives regarding participation-based clinical training; increasing theperiod of clinical training in Japan from 52
weeks to the world standard of 72 weeks; creating curriculums with specific themes, suchas medical care for elderly people or in depopulated communities; making modifications
to the education of comprehensive medical
abilities. Going forward, a number of issues
need to be addressed, including improving
clinical training for Foundation Doctors (FD);securing and improving outside educational
hospitals for clinical training; sharing, coordinating with, and agreeing on educational content and plans with outside educational hospitals for clinical training; improving simulations
and other forms of pre-education.15) Education
based on these kinds of global standards is
expected to spread to other medical professions. Therefore, RT training must be able toadapt to globalization. The committee on statutes and clinical training for RTs, described
here, represents a desire to improve education so it moves from an observational model
to a participatory model for clinical training.
In Japan, RTs undergo about ten weeks ofclinical training. According to a 2012 survey

Toward revision of the designation regulations for radiological technologist training schools

by the International Society of Radiographers& Radiological Technologists (ISRRT), clinicaltraining lasts 55 weeks in Britain, 52 weeks inAustralia, and 45 weeks in Canada. Even Thailand provides 16 weeks of training, showingthat other countries offer more robust clinicaltraining programs than Japan. Going forward,
a committee established within the Ministryof Health, Labour and Welfare should discussthese issues further based on the “Report by
the committee on statutes and clinical training of RTs.” We hope the members of JART
will understand the developments describedabove, and agree that the designation regulations for RT schools should be revised.

References
1） Mitsuomi Matsumoto. Trends in radiological technologist education – report No.2 curriculum outline andeducational targets. Japanese Journal of RadiologicalTechnology, 57 (2) p. 185-189, 2001.
2） Ministry of Health, Labour and Welfare Health Policy
Bureau Chief Notice. Promoting team medical carethrough cooperation and collaboration between medical staff. Health Policy Bureau 0430.1 (April 30, 2010),
2010.
3） Ministry of Health, Labour and Welfare 2014 fiscal
year scientific research funding. Research on the expanding scope of practice of medical professionals(chief investigator: Kiyoshi Kitamura), 2014.
4） Japan Association of Radiological Technologists notice No.388. Regarding the establishment of a committee to study how clinical training should be carriedout in the education of RT (July 25, 2014), 2014.
5） Japan Medical Imaging and Radiological Systems Industries Association. Retrieved from: http://www.jiranet.or.jp/information/file2/20131205_topics_02.pdf

6） Japan Association of Radiological Technologists notice No.287. Regarding the establishment of a committee to study how clinical training should be carriedout in the education of RT (April 20, 2015), 2015.
7） Japan Association of Radiological Technologists notice No.175. Submission of a report by the committee
on statutes and clinical practice for radiological technologists (March 15, 2016), 2016.
8） Japan Association of Radiological Technologists notice No.179. Regarding explanations to the 61st annual
meeting of the national council of radiological technologist training institutes (March 28, 2016), 2016.
9） Committee on statutes and clinical practice for radiological technologists. Process of compiling the reportby the committee on statutes and clinical practice forradiological technologists (April 25, 2016), 2016.
10）National council of radiological technologist training
institutes. On statutes and clinical practice for radiological technologists (council proposal August 29,2016), 2016.
11）Committee on improving the curriculums and otheraspects of judo therapist training institutes. Reportby the committee on improving the curriculums andother aspects of judo therapist training institutes (October 31, 2016), 2016.
12）Committee on improving the curriculums at training
institutes for massage therapists, acupuncturists, andmoxibustion practitioners. Report by the committee
on improving the curriculums at training institutes formassage therapists, acupuncturists, and moxibustion
practitioners (October 31, 2016), 2016.
13）Ministry of Education, Culture, Sports, Science andTechnology, High Education Bureau, Medical Education Department. On the state of medical education(March 15, 2012), 2012.
14）Japan Accreditation Council for Medical Education.
Assessment criteria for different fields of medical
education, Japanese edition 2.1, based on the World
Federation of Medical Education 2015 Global Standards (June 24, 2016), 2016.
15）Association of Japanese Medical Colleges. Formulating standards on medical acts by medical students forparticipation-based clinical training (July 2014), 2014.

Special Feature ◆ 39

The 33rd Japan Conference of Radiological Technologists

Invited lecture

Current Situation and Future Perspective of
Education for Radiographers and Radiologic
Interpretations by Radiographers in Europe
Dr. Håkon H. Hjemly
European Federation of Radiographer Societies, President

Chair Person, Nakazawa:

The current presenter, Dr. Håkon Hjemly,is from the European Federation of Radiographer Societies. Dr. Håkon Hjemly is the manager of policy at the European Federation ofRadiographer Societies. His main responsibilities for the society are related to the professional development of radiographers and critical issues in human health. After presenting
in several radiology departments in Norway,
he challenged international conferences, andstarted to present abroad. His presentations
talked about the current situation of radiographers, the future purpose expected in education for radiographers, and radiographic
interpretation by European radiographers. Dr.
Håkon Hjemly, please start.
Dr. Hjemly:Thank you very much for the nice introduction and for the invitation to this congress. I
am going to speak about the current situationand future perspective of education for radiologists as well as radiology experienced byradiographers in Europe. I do this on behalfof the European Federation of Radiographer
Societies. I will initially explain to you why
we have such an organization as the EFRS, asthat will be related to the topic I will discusslater. I will talk about our aims and what wehave achieved because this is very much in

40 ◆ Journal of JART English edition 2018

Dr. Håkon Hjemlyline with the topic. I will then show you someresults from surveys that we have conducted
regarding this topic and a few of our publications. At the end of my lecture, I will also discuss a very important project for us, called theEuropean Congress of Radiology. This is also
very much related to the research activities forradiographers, their education, and their roledevelopment.
I want to discuss the Federation: I have verystrong support; you can see me here in Chicago because I had a very warm coat on. I camefrom Norway. Our Vice President, Jonathan, isfrom Ireland, and we have a treasurer comingfrom Greece. We have a board member from
Malta and another board member from theUK. We have also hired a staff CEO, Dorien,
who is from the Netherlands. This helps youunderstand that we are spread throughout Europe (Fig.1).
We were actually founded only ten years
ago. During those ten years, we have blossomed into having 39 national societies. Thatmeans almost every country in Europe is now
represented in the EFRS, so we no longer
have much growth to come from that aspectof our membership. We now have a total
membership of over 100,000 radiographers.
However, we also have an educational wing
within our organization and it is constantly
increasing in number. I think there are now
61 universities from 33 different countries
that are currently members in the EFRS. Thismeans that there are also 800,000 students ofradiography who are also members.
Subsequently, we now have a growing listof experts from all professional fields related
to our organization. We also now have threedifferent subcommittees that support our
work: we have one in Medical Imaging, one
in Radiotherapy and one in Nuclear Medicine.
The role of EFRS is to represent, promote,and develop the profession of radiography inEurope within the entire range of medical imaging, nuclear medicine, and radiotherapy. In
addition, we are also involved with everythingthat is directly or indirectly related to radiography. Ten years ago, before we were funded,
nobody performed this role. We had the ISRT,
which is a worldwide organization. In Europe,
however, there was little they could do. There
are many countries in Europe, and very little
was organized before the EFRS. There wasa big need for our organization to be established.
One of the first things we had to establish
was agreement on a definition of our profession because that remains to be very important. In Europe, there are over 40 countries. I
donʼt think I over-exaggerate when I say that
there are 30 or 35 different definitions of our
profession. We had to make one European
definition, and also include the terms peculiar
to certain countries. However, when we speak
about the radiographer in Europe, we have adefinition that they are medical imaging andradiotherapy experts who are professionallyaccountable to the patientsʼ physical and psychological well-being before, during, and after
examination or therapy. Further, we take anactive role in the justification and optimizationof medical imaging and radiotherapeutic procedures. Moreover, we are the key persons
in the radiation safety of patients and third
persons in accordance with ALARA law, principle, and recommended legislature (Fig.2).

EFRS Definition of a Radiographer (2011)

EFRS - Executive Board

PresidentHåkon Hjemly (Norway)

Vice President
Jonathan McNulty (Ireland)

Treasurer
Vasilis Syrgiamiotis (Greece)

Board Member
Paul Bezzina (Malta)

Board Member
Charlotte Beardmore (UK-England)

CEO
Dorien Pronk-Larive (Netherlands)
www.efrs.eu

www.efrs.eu

Fig.1

Fig.2
Special Feature ◆ 41

We now possess a more detailed definition ofwhat entails being a diagnostic radiographer
or therapeutic radiographer.
The key aim of EFRS has always been andwill always be to promote patient safety andradiation protection. Before we could establish EFRS code of ethics, however, there wasa very important document we needed to formulate, during the infancy of our society.
Developing European standards in professional practices was a top priority in the firstyears of the EFRS because we didnʼt have previous European standards to follow. I will talkmuch more about these standards soon. Promoting evidence-based practice was also oneof our priorities. We also sought to promote
the harmonization of initial and post-graduate
education because there were and are huge
differences from country to country. Even
different hospitals within the same country
had major differences among themselves, especially concerning what they believed a radiographer was and what they did regarding
education. The status of our profession was
low in big countries like Germany and Spain;
this enabled countries like the Netherlands,
the UK, and Portugal to be at the top level interms of education.
We also wanted to facilitate the free movement of radiographers. Both the European
commission and European politics aim forworkers and patients to move freely from one
country to another to work or to get treatment. We also believe it is also very importantthat a radiographer possess this freedom.
We cooperate with other organizations withsimilar objectives. I would like to mention theEuropean Society of Radiology (ESR) in particular, and I will also talk further about themlater. We also work together with the European Association of Nuclear Medicine. I will ac-

42 ◆ Journal of JART English edition 2018tually be at their European congress in three
weeks. We will have a stand and hand out
flyers for the nuclear medicine radiographers.
We try to be visible where we can.
We also work very well with the European
Federation of Organizations for Medical Physicists and also with the ISRT. We have a general understanding with the ISRT. We donʼt use
interpreters because of this, as they can sometimes misinterpret what we mean.
We also have collaborations with several
other organizations, such as the European
commission, and with related societies likethe society for MRI vendors, for radiotherapy,
for national relations with tech regulators, the
IREA, the World Health Organization (WHO),and many others.
I mentioned that we had to produce a few
important documents and statements during
our first years. We were successful, and here,
I will list a few of the most important ones
(Fig.3). They are all accessible at our website
at EFRS.eu, and on many other websites aswell. I chose these ones because they were
the first ones that we focused on. We had one
statement on radiography education in Europe that was published in 2012 (Fig.4). We
also had one about the radiographersʼ role

From Aims to Achievements• EFRS Radiographer Code of Ethics (2010)• European Definition of a Radiographer (2011)• EFRS EQF level 6 Benchmark document (2013)(Bachelor Degree)• EFRS EQF level 7 Benchmark document (2016)• Surveys of member societies on their organisation and policies
and on radiographer education, including clinical education(2010,2013,2015, 2017)• Full partner in EU projects (EMAN, MEDRAPET, PiDRL, MESTRA)• EFRS policy statementswww.efrs.eu

Fig.3

Current Situation and Future Perspective of Education for Radiographers and Radiologic Interpretations by Radiographers in Europe

development as well as a statement on roledevelopment that I will expound upon later.
We also had a statement on CPD - Continuous Professional Development. I also had
the pleasure of attending a seminar yesterday
where different leaders of patient and radiological societies spoke about their education
system. Many of them mentioned that they
have CPD systems. I think that is very good
because they could learn a lot from many of
those societies in Europe.
We had also called for the implementationof evidence-based practice in undergraduate
radiography curricula. One of our newest
statements is regarding radiographer researchin Europe.
We need to be able to obtain data to createsuch a document so we did and do surveys
on our members. We do this every other year.
Thus, we survey all the national societies andwe survey all the universities to constantly get
the data we need to create the first editions ofthese documents and statements, and we also
survey regularly to have timely revisions.
This is one result from a survey we did in2015 on education（Fig.5); it will highlightthe differences from one program to another. Most of the programs are combined. This

Laying the base for the future!

means that when you graduate, you will havea certain amount of education on medical
imaging, nuclear medicine, and radiography.
It doesnʼt mean, however, that you are fully qualified to work in any of those fields.
Different programs focus on different areas.
There are also certain programs that focus
only on medical imaging. There are also otherprograms that offer three alternatives: a program that only focuses on radiotherapy, onethat only focuses on nuclear medicine, anda combination program that focuses on both
medical imaging and radiotherapy.
Here you can also see the differences inlength. Most of the programs are three-year
programs. There are also quite a lot of programs here that are four-year programs. However, there are shorter programs as well. Somecountries even have two-year programs.
We call the study points ECTS（Fig.6). Bothterms are interchangeable. Most of these programs with four years have 240 study points,
and the three-year programs normally have180. So, one study year is basically 60 study
points. However, a study point in one country
is not necessarily the same as a study point inanother country. It could be that one university demands 30 hours of education for one
study point in England but another university

Educational Programme TypeEFRS Education Survey 2015

www.efrs.eu

www.efrs.eu

Fig.4

Fig.5
Special Feature ◆ 43

requires only 25 hours in another country to
get the same study point. You cannot directlycompare the programs from one country toanother, even if they have the same numberof study points. Itʼs complicated.

6, which is where the EFRS acts. We have this
supported by European recommendations.
It is the level where the radiographer title isgranted. You can then take the Masterʼs degree and then normally be at level 7.

The European Qualification Framework(EQF)( Fig.7 ), however, does not focus on
study points. It tests a bachelorsʼ degree, butwhatʼs more important is that it focuses on thelearning of the programʼs concepts. It focuseson oneʼs ability, knowledge, competencies,
and skills. This will help the member states,
educational institutions, and the employers tocompare qualifications across the European
Unionʼs diverse education and training systems. Further, the core of EQF is eight levels,
which I will describe in some detail. I willshow you a table of these eight levels in thenext slide (Fig.8). This will illuminate what
the possibilities are for the student as well as
illustrate complications related to the EQF.

Whatʼs very important in such a system isthe terminology used. The wording is very
critical in order to understand what we needregarding knowledge skills and competencies. Here you see an example of the generic learning outcomes related to knowledge
skills and competencies (Fig.9). You will notice that when we used the term “advanced
knowledge” we mean “critical understanding
regarding skills. ” We also used “ advanced
skills,” and this is what we say when you
must demonstrate a “mastery in innovation” in

EQF also makes it possible to compare alltypes of education, training and qualifications,
whether professional and vocational. Everything is basically harmonized. Moreover, this
implementation is coordinated at the national
and European level.
You can see that I highlighted the EQF level

What is the EQF?
• The EQF will help Member States, education institutions, employers
and individuals compare qualifications across the EU’s diverse
education and training systems.
• The core of the EQF are eight common European reference levels,
which are described in learning outcomes: knowledge, skills andcompetences.
• This makes it more understandable what a learner with aqualification related to the EQF knows, understands and is able todo.
• This approach also makes it possible to compare all types of
education, training and qualifications, from school education toacademic, professional and vocational at each of its levels.
• Implementation is coordinated at national and European level.

www.efrs.eu

Fig.7

Programme duration and ECTS

EQF Levels•

All of the institutions who indicatedthat their programme was 4 years inlength (n=12) also indicated that the
total credits for their programme was
240 ECTS.
• All of the institutions who indicatedthat their programme was 3.5 years inlength (n=6) also indicated that the
total credits for their programme was
210 ECTS.
• One institution indicated that their 3
year programme was 240 ECTS while
one other institution indicated thatthey did not use ECTS.

EFRS Education Survey 2015
www.efrs.eu

www.efrs.eu

Fig.6

44 ◆ Journal of JART English edition 2018

Fig.8

Current Situation and Future Perspective of Education for Radiographers and Radiologic Interpretations by Radiographers in Europe

and these competencies systems.

solving complex and unpredictable problems
in a specialized field of study. Furthermore,“ competence ” means the ability to manage
complex technical or professional activities or
projects and take responsibility for decision
making. I will show you this for level 6.
You can see the same generic learning
outcomes for level 7 (Fig.10), but we moved
up one step in regard to the learning outcomes: here we talk about highly specialized
knowledge. We deal now with the forefrontof knowledge, original thinking, or research;
and we say, “critical awareness of knowledge”
which pertains to specialized problem-solving
skills. You can see, we also expect that thoseat level 7 will be able to manage and transform work or study contexts. You will findmaybe 50 or 60 different detailed learning
outcomes underneath these knowledge skills

We surveyed EQF Level 7 radiographers
after asking our societies and our members
whether or not they supported research to bedone on a doctorate level. A high percentage
said yes. Level 7 would be normally where
the researchers are. 70 percent said yes tothis survey two years ago and the percentage
increased with the latest survey (Fig.11). The
results, however, are not yet ready for presentation.
We also obtained data from our members as
to why this affects them and they say that oneof the benefits in introducing this level at theuniversities is that it will lead to more formal
recognition of the radiographers who have

EQF Level 7 Bachelor Generic Learning
Outcomes
Knowledge

SkillsCompetenceHighly specialised
knowledge some of which
is at the forefront ofknowledge in a field ofwork or study, as the basis
for original thinking and/or
research.

Critical awareness ofknowledge issues in a field
and at the interface
between different fields.

Manage and transformwork or study contexts thatare complex, unpredictable
and require new strategic
approaches.

Specialised problem
solving skills required inresearch and/or
innovation in order todevelop new knowledge
and procedures and tointegrate knowledge fromdifferent fields.

Take responsibility forcontributing toprofessional knowledge
and practice and/or
reviewing the strategic
performance of teams.

www.efrs.eu

Fig.10EQF Level 6 Bachelor Generic Learning
Outcomes
Knowledge

SkillsCompetence

Advanced knowledge of afield of work or study,
involving a criticalunderstanding of theories
and principles.

Advanced skills,
demonstrating mastery andinnovation, required tosolve complex and
unpredictable problems ina specialised field of workor study.

Manage complex technicalor professional activities or
projects, take responsibility
for decision making in
unpredictable work or
study contexts, takeresponsibility for managing
professional developmentof individuals and groups.

www.efrs.eu

EQF Level 7 Radiographers
Benefits:• An aid to Level 7 programme development, introduction and formal
recognition.
• Role development ↑• Autonomy ↑• Radiographer research ↑www.efrs.eu

Fig.9

Fig.11
Special Feature ◆ 45

taken a lot of abuse. It will help with theirrole development and promote an increasein the economy as well as the amount of research done by radiographers.
We also asked our members about role development, and 90% were in favor of this afew years ago. The 10 percent belonged tocountries that are terribly resistant to role development for radiographers for many reasons(Fig.12). Most important among these were
the radiologistsʼ perspective. It could be dueto the countries ʼ general labor market andtheir economy.
After collaborating with experts, we prepared a statement on role development.
I am sorry for all the text: I thought you
would be very interested in the details of thisstatement. Please forgive me. I can, however,read it for you. The background says:
Increasingly, radiographers are performing
duties which were previously performed byother health professionals such as radiologists. This development of the radiographerʼsadvanced role has become an integral part ofmodern imaging and radiotherapy treatment.
Some of these advanced roles are to be foundwithin the areas of ultrasound, mammogra-

Radiographersroledevelopmentwww.efrs.eu

Fig.1246 ◆ Journal of JART English edition 2018

phy, and musculoskeletal image reporting.
More and more countries are relying on theseadvanced radiographer roles to develop andimprove service development and delivery.
Recently, the interest shown in these roles byhealth professionals and management has increased across Europe.
There are a few obvious benefits to this.
Further, advanced practices can aid in the
progression from EQF level 6 to EQF level
7. At EQF level 7, practitioners would havedeveloped expert knowledge and skills in
relation to the delivery of care in diagnostics
or in therapeutics. Formal post-graduate university education is essential for radiographers
to learn the skills and overall competencies
required to take on these roles. National societies will continue to promote and developthese new roles and encourage universities tocarry out the education required to underpin
them.
Thereʼs a very strong focus here on the education required to be able to take on responsibilities stemming from this advanced role. According to research, radiographers working at
this level have increased job satisfaction. This
aids staff retention and enables radiologists todeal with more complex procedures. After all,quite a few countries struggle to get enoughradiologists. Having the possibility of career
progression increases the job satisfaction andalso increases the interest toward becoming aradiographer.
Today, the advanced practitioner has an
essential role in enabling the advancement ofinnovative practice where improvements inservice delivery and quality patient care canoccur. We conclude this with saying that theadvanced practitioner is an integral part of theimaging and radiotherapy treatment team andencourages a multi-disciplinary approach bothat local departmental level and in the wider

Current Situation and Future Perspective of Education for Radiographers and Radiologic Interpretations by Radiographers in Europe

health care environment. There are some very
important references also shown here (Fig.13).
I mentioned education as the important factor of being qualified to take on the role as ahealth practitioner. We had to survey regarding the possibilities of getting that education,
because otherwise, our survey would havedealt with the lack of opportunities. There
are, however, opportunities. Many of ouruniversities offer prospects in post-graduate
education, which include certificates and diplomas. Many of them even offer Masters andDoctorates.
The majority support the CPD ( Fig.14 ),which is also very important if you have an
advanced practitioner role. You need to maintain your skills. In almost half of the countries
in Europe, this is mandatory. Unfortunately,
however, it is not in Norway and in the other
Scandinavian countries, but we are working
very hard to change that. I work for the national societies in data and geographies and I
am on a crusade to convince our politicians toapprove mandatory CPD.
These are some samples from the UK( Fig.15 ). The reason for me to show samples from UK is that they started very earlyin their role development for radiographersand other professionals. I will not go into detail about their special system, but I will tell
you a little bit about the drivers behind this.
I do not think this is special to the UK as wehave a similar situation in Norway where we
notice that people are getting older and alsothat there are more people living in the same
country. There is thus an increasing pressure
for diagnostic imaging and also for cancer
treatment. The number of radiologic exams
being done in the UK for basically all mortalities has increased with every survey.
A few countries also struggle with getting
enough staff. Here you can see different
groups. I have a red box around the most
relevant ones (Fig.16). There is a 50 percent
shortage of radiologists in the UK. There is an

CPD for radiographers

www.efrs.eu

Fig.14

Conclusion• The advanced practitioner is an integral part of the imaging[5] and radiotherapy treatment team [6] and encourages amulti‐disciplinary approach both at local departmental level
and in the wider health care environment.
•
•
•
•
•
•
•

References
Challen V. A European perspective on the role of radiographers in imaging departments. Imaging Management
2011;11(3):14‐17.
European Federation of Radiographer Societies(EFRS) Development of the Radiographer Role: EFRS GuidanceDocument 2011.
McKenzie GA, Mathers SA, Graham DT, Chesson RA (1998) An investigation of radiographers performing barium
enemas. Radiography 1998;4:17‐22.
Snaith B. Radiographer –led discharge in accident and emergency – The results of a pilot project. Radiography
2007;13: 13‐17.
The Royal College of Radiologists and Society and College if Radiographers. Team Working in Clinical Imaging.
London: The Royal College of Radiologists and Society and College of Radiographers.2012
Price R et al. Scope of Radiographic Practice 2008. London: The Society and College of Radiographers (UK) 2008

SCoR Scope of Practice deﬁnition• ‘A member of the professional workforce can develop
his or her own scope of practice as he or she
determines, provided that he or she is adequately
educated and trained and competent to practice’•https://www.sor.org/learning/document-library/scope-practice-2013/3-deﬁning-individual-scope-practicewww.efrs.eu

www.efrs.eu

Fig.13

Fig.15Special Feature ◆ 47

11 percent shortage of radiographers. Thereis also a 22 or 23 percent shortage of sonographers. There are not enough people in theradiology department and this leads to longer
waiting times for patients, and nobody wants
that. The department thus tries to recruit moreradiographers and properly educate them sothat they could take on more responsibilities from the radiologists and also from othergroups. I will show you the wide scope of
this in a moment.
They have legislation that allows them to do
this. They state that a member of the professional workforce can develop his or her own
scope of practice as he or she determines it,
provided that he or she is adequately educated, trained, and competent. This is reallyneeded due to the increase of the imaging
exams being done in the UK, but this is also
happening in many other European countries. Here you see that about 54 percent of
all exams in the UK are being reported on byradiologists (Fig.17). These, however, are thereporting radiographers. They are increasing
in number and they are taking more responsibility from the consultant radiologists. They
now report on 10 percent of exams. The radiographers report on 21 percent of all theexams being done in the UK now. Imagine,
if you took away this box, they would havehuge problems.
Here you can see the wide scope of practice of the reporting radiographers or thoseworking with advanced education (Fig.18).
Although it started with simple skeletal exams, they are not limited to only those. They
gradually proceeded to the axial skeleton.
When they saw that this worked excellently,
the dedicated radiographers with proper education and training continued to report on

www.efrs.eu

Fig.17
Radiographers report across a whole range of diagnostic
imaging examinations.
Some departments indicate that they have reportingradiographers in training = workforce challenge, back fill,cost of training etc.
Where providers utilise reporting radiographers it isgenerally across multiple areas of practice.
Some providers still do not utilise reporting radiographers.

Workforce challenges
Scope of
Practice 2015
advancedpractitioners/
reportingradiographers

www.efrs.eu

www.efrs.eu

Fig.16

Fig.1848 ◆ Journal of JART English edition 2018

Current Situation and Future Perspective of Education for Radiographers and Radiologic Interpretations by Radiographers in Europe

exams. This was introduced into all the fields
that needed this extra service. You can thus
find these reporting radiographers within allareas of the UK.
What distinguishes the reporting radiographers from the consulting radiologists is thatthese radiographers work in a narrower area.
They become experts in a small area, arevery good at it, and are aware of their limits(Fig.19). They are not taking over the radiologistʼs role.
This is not the situation in many othercountries, but we are slowly arriving whenit comes to role development. In the Nordic
countries, there is definitely a strong drive forthis. In Norway and Denmark, we now provide education for reporting radiographers.
Sweden is also planning for role developmentin their country. Moreover, countries like theNetherlands have had this for a long time. I
know that in Finland, radiographers have afour-year program that includes sonography,
so when they graduate they can work independently in sonography. More and morecountries are introducing advanced education
for radiographers.
However, there are also countries that are

Distribution of consultant radiographer
practice by practice area

5%

5%
breast imaging

5%• 30% of those with
consultant
practitioners havethem in more than
one area ofpractice

5%

33%

4%

I mentioned that we cooperate with otherorganizations and this is something that wehave to do in the European level if we wantto have the success that we are aiming for on
the national level as this sets an example forthe other national societies. If we can solvea problem in the European level, it will bemuch easier for us to solve the same problem
on the national level. We do not have a project related to role development of radiographers for the ESR, but I hope that will comesometime soon. We did, however, actually
have a section last year at the European Congress of Radiology that dealt with radiographers and ultrasound. It was quite controversial in many European countries. At least we
introduced it a little bit.
We have a very strong memorandum of
understanding with the ESR. Here you cansee me signing the new agreement last year
( Fig.20 ). The agreement has basically twoparts: the first deals with common issues thatboth of us need to solve together, and the

EFRS and ESR

Scope of Practice 2015:
Consultant Radiographers• 23% of responding
providers employ
consultant
radiographers

really against this. We will see what the future
brings. If this is a success in more and morecountries, I think we will see this in the wholeof Europe within a few years.

EFRS signed a 2nd MoU with
ESR for 2017-2020 related to
the European Congress ofRadiology (ECR) and otherareas of mutual interest.

ultrasoundgeneral radiography
education
Dexa
CT
GI

19%

Interventional
24%

www.efrs.eu

Fig.19www.efrs.eu

Fig.20The breadth of practice for consultant radiographers
continues to develop.

Special Feature ◆ 49

second one deals with the European Congressof Radiology. One of our projects is the European Diploma in Radiography. The radiology
society has had a European diploma for many
years and that diploma is very popular. Currently, thousands are taking the exam for thiscertification on a yearly basis. EFRS suggested that we should perhaps create somethingsimilar for radiographers. We liked this idea alot. We surveyed this with our members andthey agreed with us. We now have a working group looking into this. This will not be
happening next year, but it could be introduced for radiographers two years from now.
We also think this will have some individual
benefits. It may contribute to your CV, it may
differentiate you from others for a job, and it
is also an international certification of yourradiographer knowledge. It is a personal andprofessional development opportunity.
We also believe that it will also help raise
the profile of radiography as a profession withradiologists and physicists and with fields likenuclear medicine, physics, and radiotherapy.
It is a step forward in the harmonization of radiography standards in the profession.
It is also an aim towards the improved mobility of the workforce. Successful completion of the diploma will certify a standard ofradiography knowledge deemed appropriate

50 ◆ Journal of JART English edition 2018by our benchmark documents. The European congress is growing every year and it is
the biggest congress in Europe. Itʼs probably
among the top five radiology congresses in
the world. We had 26,829 people attending
from 141 countries this year. We also have
had a lot of people attending from theirhomes, online. All the presentations are being streamed and you can watch them when
you have the time. I am happy to say that thishas become a very successful congress for radiographers as well. We managed to have thebiggest radiographer program this year. It was
the first year we had a session dedicated toradiographers at any point in time across thewhole week. We had 19 sessions in total.
We have held this annual meeting of radiographers in New York. This is the EFRS official
congress. It is a great opportunity for CPD,
and for networking with colleagues all over
Europe and also all over the world. You canstill send an abstract as the deadline is October 10th. If you do that, there are a couple ofprograms that you should be aware of: one is
the “shape your skills” program. I left some ofthese flyers at the table by the entrance of theother building. You should bring some withyou. The other one is the “invest in the youth”
program. If you qualify for one of these two
programs for radiographers, you may besponsored for the congress fee and for the
hotel stay in Vienna. You should really look at
those and see if you qualify.
One criterion is that the applicant be member of EFRS. It costs 11 euros per year, so it
is actually a no-brainer: for 11 euros, you canattend these programs if you are selected. You
will have a heavily discounted fee, and it will
be easier to physically attend the congress.
However, members will also have the accessto watch the congress electronically and on
demand. Members can even watch past congresses, because there is a huge databaseCurrent Situation and Future Perspective of Education for Radiographers and Radiologic Interpretations by Radiographers in Europe

called Education on Demand that is part ofthe membership package (Fig.21). We have
had radiographers working on Education of
Demand for a year now. It took some time
because we possess close to 700 different
lectures; however, we have a working group
looking at them and targeting those presentations that we think are most relevant forradiographers. This is a great opportunity fore-learning and for getting your CPD.
I mentioned the “ shape your skills” program. You can take a flyer with you at theother building and read more about it. Herewww.efrs.eu

Fig.21The ESR ʼ s new e-Learning platform Education on
Demandʼ contains.
➢260+ eLearning Modules➢360 eCME points available

are some nice numbers about attendants. As
you can see, Japan is up there. It is number
six among the countries that send the mostradiographers to ECR ( Fig.22 ). On top, ofcourse, the host country, Austria. My country
is number second. That is something I amvery proud of because there are fewer radiographers in Norway. Almost 10 percent of them
go to ECR each year, which is very good.
We also have the electronic poster numbers. I remember that in 2015, Japan was on
top and the same occurred in 2016 (Fig.23). I
didnʼt bring the numbers for 2017 but I think
you are still number one when it comes tosending electronic posters and getting them
accepted, and I thank you very much for that.
I hope you continue to send in abstracts because it is very important to show others thatradiographers worldwide are involved in research.
We now introduced an honor to those sending in abstracts and those sending in electronic posters in the form of awards. We havethree new awards for radiographers. Theseawards had already existed for radiologists,
but we also now have them for radiographers.
We have a paper abstract award, a poster
award, and the “best radiographer student” abstract award. There are some nice prizes, too,

NEW: R level for radiographers!

-71 from Japan!
-Total 1393
-215 from outside
EuropeECR-16EPOS:

CountryJAPAN
ITALY
UNITED KINGDOM

www.efrs.eu

Fig.22

Rejected
Abstracts
46
4
8

Submitted
Abstracts (TOTAL)
14
8
3

60
12
11

KOREA, Republic of

6

3

9

NORWAYCHINA
RUSSIAN FEDERATION

3
3
2

4
2
3

7
5
5

DENMARKSPAIN
SWITZERLAND

4
2
1

0
1
2

4
3
3

FINLANDGREECESLOVENIA
AUSTRALIABRAZIL
BULGARIA
IRAN, Islamic Republic of

1
2
2
1
0
1
0

1
0
0
0
1
0
1

2
2
2
1
1
1
1

IRELANDNETHERLANDS

1
1

0
0

1
1

PORTUGALSERBIASINGAPORE

1
0
1

0
1
0

1
1
1

TUNISIAwww.efrs.eu

Accepted
Abstracts

1

0

1

91

44

135

Fig.23Special Feature ◆ 51

if you win one of these.
We have made an agreement with the scientific journal called Radiography (Fig.24).
This is rated as the number one international
journal for our profession. It is led by an index cloud and it is the official journal of EFRS.
We see submissions from basically all over theworld but they mostly come from European
countries. However, I would really like to see
more articles coming from Japan. The latest
issue deals with education in Europe, which isalso a part of my topic here. I encourage you
to have a look at this. It is online now and thelink is displayed here. There are around ten
articles related to education of radiographersin Europe in its latest issue.
To summarize, I made some bullet points,
which I named The European Radiographer
Today. Radiography practice is now widening.
We see that more radiographers are sub-specialized. We see that more radiographers are
moving toward constant practice. We seemore radiographers being involved in new imaging dualities, hybrids and other modalities.
We also see radiographers cooperating more
directly with non-radiologist professions in ahigher rate than before. It was mentioned by
the previous speaker that big data and artificial intelligence is coming and I think this will

Developing & promoting radiographer‐led research• Radiography is now the official journal of the EFRS
• No. 1 international journal for our
profession, Medline indexed.
• We want to see more article
submissions from Japan!

www.efrs.eu

Fig.2452 ◆ Journal of JART English edition 2018

have a big effect on my last bullet point here.
Education is improving and expanding allover Europe. We see that the educational programs are getting more and more in line with
us and they are also more in line with thebenchmark document we spoke about earlier.
We see that there is currently an increase in
the Masters and PhD programs, and there are
more English language programs as well, so
you can easily go to another country, not onlyin England. Further, we see post-graduate
education in sonography, diagnostic reporting, mammography, and colon exams among
many others.
Thereʼ s currently an increase in research
activity, publications and submissions of abstracts. It will be a great sign of increasing research activity.
The congress starts on February 28th andends on March 4th.
I hope to see you in Vienna and I thankyou for your attention. Again, I thank you forthe invitation and I congratulate the JTRC congress. I wish you well in the coming days. If
there are any questions then I am available.
Chair Person:

OK. Thank you for your presentation. Now
for questions. Are there none?
Dr. Nakanishi:

My name is Satoshi Nakanishi of Shizuoka
University of Medical Science. Please forgive
my poor English and lack of knowledge.
Thank you very much for your excellent presentation. I have a question. You mentionedthat in the definition of a radiographer, justification belongs to the radiographer. In Japan,
the justification of a worker, both medical
doctors and radiographers, is optimization.
Japanese radiographers cannot take a radiograph without an order from a medical doctor.

Current Situation and Future Perspective of Education for Radiographers and Radiologic Interpretations by Radiographers in Europe

Dr. Satoshi Nakanishi :Shizuoka University of Medical Science

My question is, in Europe, can a radiographer
take a radiograph without any instruction
from a medical doctor?
Dr. Hjemly:Thank you. I fully understand your question. As you know, Europe is not one coun-try so I cannot say yes or no to that, but insome parts of Europe, radiographers are very
involved in the whole chain of action andjustification. Both accept the orders of examination from the physicists checking that everything is OK. They can also say that something is clearly missing here, so they say thatthey could not do this exam, or simply refuse.
That is the situation in quite a few countries,
including Norway. However, the normal thing
to do would be of course for radiographers to
consult with a colleague or with the radiologist if there is uncertainty and then make thedecision together. That would be the practical
way to do this.
Itʼs a very hot topic and many countries are
discussing the meaning of this now. Itʼs also
becoming common for the European commission to link responsibilities.

Special Feature ◆ 53

Special
FeatureThe 32nd Japan Conference ofRadiological Technologists
Symposium 1(Disaster Countermeasure Committee)

Response to the Kumamoto Earthquakes andFuture Earthquake Countermeasures
Chairman: Akihiro Kitagawa（Chairman, Disaster Countermeasure Committee; Director, The Japan Association of RadiologicalTechnologists / Nippon Kokan Fukuyama Hospital）

Kinya Ono （Member, Disaster Countermeasure Committee / Kawasaki Municipal Hospital）
Report from the Disaster Countermeasure Committee“Survey Team for the Union of Kansai Governments”
Akihiro Kitagawa （Chairman, Disaster Countermeasure Committee）

Symposium

1．Report on the Kumamoto Earthquakes

Yasuhiro Hiai （President, Kumamoto Association of Radiological Technologists / Teikyo University Fukuoka Medical
Technology Department）

2．Report from Hospitals Impacted by the Disaster
Nobuaki Anai （Aso Medical Center）

3．Operational support dispatched from JART

Hiroshi Kuwahara （Vice President of the Oita Association of Radiological Technologists/Sekiaikai Saganoseki Hospital）

4．Activities of the Japanese Red Cross Association of RadiologicalTechnologists
Masaaki Nakata （Japanese Red Cross Kobe Hospital）

5．Activities of the National Hospital Association of RadiologicalTechnologists
Eiichiro Konishi （Disaster Medical Center）

The 32nd Japan Conference of Radiological Technologists
Symposium 1 (Disaster Countermeasure Committee)

Response to the Kumamoto Earthquakes
and Future Earthquake Countermeasures
Chairman: Akihiro Kitagawa（Chairman, Disaster Countermeasure Committee; Director, The Japan Association of Radiological Technologists /Nippon Kokan Fukuyama Hospital）

Kinya Ono

（Member, Disaster Countermeasure Committee / Kawasaki Municipal Hospital）

Report fromthe Disaster
Countermeasure
Committee(Chairman) Kitagawa: My name is Kitagawa,(Chairman) Ono: I am Ono from Kawasaki

and I am Director of the Japan Association ofRadiological Technologists (JART). I would
now like to open Symposium 1 of the Disaster Countermeasure Committee on the theme,“Response to the Kumamoto Earthquakes andFuture Earthquake Countermeasures.” I thankyou all for your participation.

Municipal Hospital, and I would also like tothank everyone for joining us today.
(Chairman) Kitagawa: Before we get started on
todayʼs theme of earthquake countermeasures,
I would like to take a few moments to delivera brief report from the Disaster Countermeasure Committee.

“Survey Team for the Union of Kansai
Governments”
Akihiro Kitagawa （Chairman, Disaster Countermeasure Committee）(Chairman) Kitagawa: I will begin with a sim-ple explanation of the Union of Kansai Governments and the Disaster Countermeasure
Committee report. The “ Agreement on thePrevention of Radiation Exposure during Nuclear Disasters” was accepted by the Union of
Kansai Governments on August 17, 2015.
The Union of Kansai Governments includes
the prefectures of Kyoto, Osaka, Hyogo,
Wakayama, and Shiga, as well as Tottori Prefecture in the Chugoku district, Tokushima
Prefecture in Shikoku, and Fukui Prefecture,

for a total of eight prefectures. Over a period
of about a year, we visited each prefecture,received the approval of prefectural governors
and heads of municipalities, and concluded
the agreement.
I would particularly like to draw your attention to the fact that when the regional union
received the request for this agreement, notonly did it promptly seek to coordinate withother prefectures, create a relief plan using
established aid allocations, and notify both
the recipient and donor prefectures, it also
Special Feature ◆ 55

sought assistance from the Japan Associationof Radiological Technologists and prefecturalradiological technologist associations, as wellas coordination between prefectural groups.
Moving on to what is most important: “In theevent that a member of the Japan Associationof Radiological Technologists is injured, contracts a disease, or dies while conducting business under the conditions of this agreement,
the prefectural government shall compensate
the damage in accordance with the provisionsof said prefecture except in the following cases.”
Until now, it wasn ʼ t always feasible for
JART itself to do this; however, as one might
expect, associating with a prefectural administration allows us to treat our activities as work

Symposiast①

rather than as volunteering, which is an important distinction. It has, as a result, becomemuch easier to call on each one of you here
today.
As described earlier, Shimane Prefecture
joined JART in 2013, and recently entered into
the Union of Kansai Governments. Once you
return home to your prefecture, we encourage you to discuss the idea of membershipwith your people, since you are, of course,
also eligible to receive compensation when
you accept this agreement as members. WhileI donʼt have specific numbers for the amounts
to expect, we humbly encourage you to participate.
That concludes our brief report. Thank you,everyone.

Report on the Kumamoto Earthquakes
Yasuhiro Hiai
（President, Kumamoto Association of Radiological Technologists / Teikyo University Fukuoka Medical Technology Department ）(Chairman) Kitagawa: Weʼll now get started on

todayʼs theme, “Response to the Kumamoto
Earthquakes and Future Earthquake Countermeasures.” We will begin with a “Report on
the Kumamoto Earthquakes” by the Presidentof the Kumamoto Association of RadiologicalTechnologists. President Hiai, thank you very
much.
Hiai: Thank you for your kind introduction. I
am Hiai, current President of the Kumamoto
Association of Radiological Technologists, andIʼd like to thank everyone for allowing me
to speak today about the Kumamoto earthquakes.
The primary characteristic of this event isthat it was actually composed of two large
quakes, a foreshock and a main shock. Al-

56 ◆ Journal of JART English edition 2018

though I say two quakes, in reality there wereover seven shocks of seismic intensity 6 orgreater. The first earthquake, on April 14, hada seismic intensity of 7; however, a quakeof magnitude 7 and seismic intensity 7.3 occurred the following night. It may seem likethere was a 20-minute break here, but theactual duration of the earthquakes was very
long; those who experienced them felt likethe shaking continued for the full 20 minutes.
In addition to what I have described, a great
many earthquakes of seismic intensity around6 were occurring.
The upper part of Fig.1 shows the situationin Mashiki Town, which remains in the same
condition to this day. The lower part shows
the damage to the hospital. Despite these cir-Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures

Fig.1

Fig.2

cumstances, we still had to accept many patients.
Fig.2 shows the state of the Kumamoto Red
Cross Hospital. Increasingly, we were doing
triage in the hallway, where we were accepting more and more patients.
A technologist association activity, the firstmeeting of the Kumamoto Earthquake Response Headquarters Assembly, was scheduled to convene in Tokyo the day after theforeshock occurred on April 14.
Because there was only minimal damage at
the time of the foreshock, it was clear what
measures would be needed, what kind of
information had to be gathered about thequake, and so on. This was in the evening,but then the main shock hit that night．
Afterward, a range of relief activities was
conducted, as the Kumamoto Earthquake Response Headquarters Assembly meeting wasconvened a second, third, and ultimately, asixth time.
As a form of support, Vice Chairman Ogawa, Director Azemoto, and Specialist Yasukawa came from JART to the Kumamoto Prefecture Disaster Response Headquarters at theprefectural office on April 22 to discuss, when
we can anything to do. They consulted widely with officials in the prefectureʼs response
headquarters.

On the 22nd, many professionals – physicaltherapists, occupational therapists, medical
technologists – gathered at the evacuation
center, as they had been dispatched fromplaces like the Nursing Association; however,
due to the nature of the work and the type ofoccupation of the radiological technologists,
it was not possible to conduct activities in theevacuation center. The Japan Association ofRadiological Technologists therefore took thelead on dispatching technologists to the Aso
Medical Center, where many patients weregathering.
I will now present a report on the resultsof a questionnaire administered to 140 institutions in Kumamoto Prefecture. We began the
project in May, with a response rate of 57%.
The questionnaire includes six items related towork and two items related to life. The items
related to work were designed to shed lighton what might be useful measures for the
future. As for the items related to daily life,
since we received relief funds on this occasion, we needed to understand certain issues
and conditions through the questionnaire, inorder to make the best use of support money,
and to cover requests like exemptions frommembership dues, and so on.
I would now like to share with you a few
excerpts from the questionnaire items.
Special Feature ◆ 57

damaged (Fig.4). From this, we could see thatdamage to MRI equipment was considerable.
With MRI equipment, even a slight deviation
makes the device incapable of producing animage.
In addition, although not in a notable position on the list, there are destroyed, high-definition monitors (Fig.5). There were many cases where high-definition monitors collapsed,
breaking the screen and rendering them unusable. Something could perhaps have been
done in advance for these monitors, such as
preparing countermeasures to prevent collapse, but it seems that nearly 30% of thehigh-definition monitors were broken.
Next, we consider hospital regulations. For

Condition of damage, by equipment
No damageLight damage

Serious damage(condition can be recovered
with minor repairs)(condition requiring
expensive repairs)

Completely
destroyed

er
O

th

g
rd
er
in

Th
er
io

n

O

ap
y

TV
ra
y
X-

Ra

di

at

An

gi

og

ra

ph
y

Many damaged and broken MRIs

G
Im en
ag er
in al
g

I will begin with the earthquake resistanceof buildings. The Aso Medical Center is aquake-absorbing structure built with grooves
that reduce the impact of tremors, and a floor
reinforced with rubber. A quake-absorbing
structure, by definition, protects equipment.
When I think of earthquake countermeasures,
earthquake-resistant construction, quake-absorbing structures and non-earthquake resistance come to mind. Earthquake resistanceis generally considered to be a good thing,and I myself did not distinguish too clearly
between seismic isolation and earthquake
resistance. In this questionnaire, seismic isolation was very low at only 7% (Fig.3), but the
Aso Medical Center is one of seismic isolation
construction. Kumamoto University Hospitalis also a seismic isolation structure, so there
was little damage to the hospitalʼs facilities orthe equipment inside; however, in the case ofearthquake-resistant buildings, the structures
themselves were fine, but the equipment was
damaged considerably.
Although two items in the questionnaire addressed damage to equipment, various inspection tools were destroyed, so no investigations
can be conducted for the time being. I therefore divided the questionnaire into generalimaging, CT, MRI, and X-ray, in order to identify the types of equipment that were actually

Fig.4

Building Structure

Broken monitors, including high-definition monitors

Unknown
15%

No Earthquake
Resistance23%
Seismic
Isolation
7%

Earthquake
Resistance55%

Damaged29%
No damage71%

Answers from 80 institutions

Fig.3

58 ◆ Journal of JART English edition 2018

Answers from 80 institutions

Fig.5

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures

staff to assemble, about 70% of institutions
had a policy in place for earthquakes rated
over 5 in seismic intensity, but about 40% of
the institutions that did not have such established, internal regulations were located in
Kumamoto. The people of Kumamoto Prefecture thought an earthquake would neveroccur there, and did not expect it at all, but inreality, there was a fault below, and this is thekind of damage that resulted – so it may bethat there was also a lack of preparation. Only
60% of hospitals had created regulations.
Let us now consider how many actually assembled. About 70% of hospitals had agreed
to assemble during an earthquake of seismic
intensity of 5 or more, but the percentage thatgathered following the foreshock was lower
than this. After the main shock two days later, everyone assembled much more quickly
than they had during the foreshock; after all,preparations had been carried out once folks
recognized the danger.
During this earthquake disaster, I think
about, what we can do.
First, because they are in clinical practice,
it is necessary to think about their work situation during the disaster and the response
preparedness of the hospital in which theywork, where things can take place within thehospital itself.
As for medical care during the disaster, thistime I went to the Kumamoto prefectural office with members of JART, but my feeling isthat we need to think about dispatching people to the hospital, as well as things we cando at the shelter.
Additionally, we need to consider what we
can do for affected members. On this occasion, we received substantial relief funding.
Moreover, there is a system referred to as
membership fee exemption. There are hospitals where the buildings have been destroyed
and shut down, but in the future, I think weshould reflect further on the issue of peopleʼs

Kumamoto Earthquake Disaster Financial
Assistance Delivery Ceremony
August 1, 2016 Kumamoto Association of Radiological Technologists

Fig.6

jobs.
These are all future measures. Although
it may be the subject of this symposium,
what we should actually do is make advance
preparations. In all honesty, the earthquake
occurred in an area where no one thought anearthquake could happen, so the response
was pressured and stressful. I understand thatholding this symposium is one form of preparation, but I would still like to encourage everyone to practice in these areas and prepare.
Last but not least, JART ʼs President Nakazawa came to Kumamoto on August 1, and weheld a financial assistance delivery ceremony for Kumamoto earthquake disaster relief(Fig.6). We received a considerable amountof money on behalf of Kumamoto Prefecture.
I would like to thank you all very much foryour support. We are planning to use thefunds to help affected members. You have mysincere thanks.
Now, as we say, “Do Your Best, Kumamoto!” I am doing my best at the Kumamoto
Association of Radiological Technologists. We
look forward to your continued support in the
future. Thank you very much for your time
today.
(Chairman) Kitagawa: President Hiai, thankyou very much.

Special Feature ◆ 59

Symposiast②

Report from Hospitals Impacted
by the Disaster
Nobuaki Anai (Aso Medical Center)(Chairman) Ono: Next, we have a “Report from

Hospitals Impacted by the Disaster.”
Anai: Thank you very much. I am Anai fromthe Aso Medical Center. During the earthquakes, everyone, including the members, really got to work. Thank you so much. I would
like to express my sincere appreciation ofyour interest in having me come to give thispresentation. Allow me to begin without delay.
Our hospital, Aso Medical Center, has 124
beds. The population of Aso is shown in thefollowing figure ( Fig.1). In the greater Aso

Asocity population: 27,372 people
阿蘇市⼈⼝︓27,372⼈
Aso district (-gun) population: 36,821
people
合計︓64,193⼈

阿蘇郡⼈⼝︓36,821⼈
Total:
64,193 people

area, there is a population of approximately
64,000 people.
The hospital was renovated two years ago,
and as discussed previously, now has seismic
isolation and earthquake-resistant construction. The equipment used is as follows. Portable items are marked with an asterisk (*),
since they represent key points later on in thepresentation (Fig.2).
This was the situation when the earthquakes hit April 14 through 16. There werealso mudslides in Aso. This is an enlarged image of the area where the mudslides occurred(Fig.3), and here is National Highway 57, themain road linking Kumamoto and Oita. The
JR line runs basically parallel to it. You cansee here that this is where it was cut across.
Because access to the main road was
blocked, patients heading to the big hospitalin Kumamoto City, among others, both fromour hospital and from the greater Aso area,
were delayed. There is another hospital in thearea, but it is being forced to shut down.
All told, there were three hospitals capa-

Fig.1

Hospital Radiology Department
当院放射線室使⽤機器
Equipment①
device (80 １台
rows) 1 unit
① CT
CT装置（80列）②
MRI equipment (1.5 T) 1 unit
② MRI装置（1.5T） １台③
Tubular imaging device (biplane) 1 unit
③ ⾎管撮影装置（バイプレーン） １台④
General imaging equipment (1 room, 2 tube
④ ⼀般撮影装置（１部屋２管球） １台

April
14, 2016 9:26 pm, Seismic
Intensity
7 (Foreshock)平成２８年４⽉１４⽇
PM９︓２６
震度７（余震）
平成２８年４⽉１６⽇
AM１︓２５
震度７（本震）
April
16, 2016 1:25 am, Seismic
Intensity
7 (Main shock)
Highway 57
国道５７号線

Aso-ohashi
Bridge collapse
阿蘇⼤橋崩落bulbs) 1 unit

⑤ FPD（フラットパネル） ３台⑤ FPD (flat panel display) 3 units⑥ ポータブル撮影装置 ２台 ＊⑥ Portable imaging device, 2 units*⑦ X線TV １台⑦ X-ray TV, 1 unit
⑧ マンモグラフィー １台⑧ Mammogram, 1 unit
⑨ ⾻密度測定装置 １台⑨ Bone density measurement device, 1 unit
⑩ 外科⽤イメージ ２台⑩ Surgical imaging device, 2 units

Fig.2

60 ◆ Journal of JART English edition 2018

R57 Resolution = dividing the Aso district and Kumamoto city
districtR57の⼨断＝阿蘇地区と熊本市内⽅⾯との分断
into separate parts.
Aso-ohashi
Bridge collapse = Isolation of Minami-Aso district
阿蘇⼤橋の崩落＝南阿蘇地区の孤⽴化

Fig.3

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures

ble of providing emergency care. There werefour, including the closed hospital, but because the other hospitals capable of providing
emergency care were damaged, patients became concentrated in our hospital during thequakes.
This shows the condition of the road near
our hospital (Fig.4). This is the worst area,
and although there are people at the end, thedestruction was so bad that there was a gapof about 2 m in the road. For an idea of thecondition of the hospital during the quakes,
this is a biplane angiography device (Fig.5).
We use whatever we can, but the axis is misaligned, so it requires some repairs.
If I can talk a little more about this, I was
made deeply aware of the importance of photos such as these, taken when disasters occur.
People may not be panicking, but everyonesays they are focused first and foremost on

returning to work, so they tend to forget totake pictures. I was keenly aware of this at
the time – the idea that I should be taking as
many photos as possible of the conditions after the disaster.
In terms of photos related to radiological
technology, we had a lot of equipment thatshould have been photographed, but we forgot, so all I have with me is this one photo of
the biplane angiography device with its misaligned axis.
This is a picture of another operating room,
which was in this condition (Fig.6).
This is the situation on April 16 (Fig.7); at
this point in time, the DMAT (Disaster Medical
Assistance Team) had arrived. At our hospital,
there is one DMAT, which includes a medical radiological technologist. This person had
already led regular training sessions, whichfacilitated setting up and quickly making

Fig.4

Fig.6

2016-4-17
DMATDMAT受け入れ
acceptance
2016-4-17

2016-4-19 DMAT
Assembly
33 Corps
2016-4-19
DMAT集結33隊

2016-4-20 Establishment
of Disaster
Response Headquarters (within Aso Medical Center)2016-4-20
災害対策本部設置（阿蘇医療センター内）
Yokohama Rosai
Hospital Emergency and横浜労災病院救命救急センター
Critical Care Center, 中森知毅医師
Doctor Nakamori Tomoki

Fig.5

Fig.7
Special Feature ◆ 61

judgements in the circumstances, especially inregard to triage.
It felt like April 17 was the first day that
DMAT Group 1 was accepted. April 19 wasMAX, but we were happy to have 33 groups
come to the hospital to provide assistance.
At our hospital, we typically handle thingsoutside of normal working hours with an oncall system, but since we were seeing a lot of
patients and also many refugees at this time,
it was necessary for someone to be constantly on duty. Even though I say “on duty,” wewere not going home when our shifts wereover; instead we were basically sleeping at
the hospital. I remember staying at the hospital for about three days straight.
It was written as e-mail, but it was very
helpful during the earthquakes. At our hospital, 1/3 people found themselves in situations that prevented them from getting towork when the disaster hit. In the immediate
aftermath, people took note of which routes
were passable, but it just kept raining. Mudslides took out some roads, so the route you
had just taken might not be accessible anymore, and information about the situation
kept changing. In order to deal with this, thehospital released an internal statement to theentire staff via our mailing list: “ These are
the roads that are currently open,” and sent
this out to everyone by email. Another thing
about these routes was that it was thanks to
information sent in by our staff that we wereable to make sense of which routes people
could take to get to work. Also, when we haddamaged equipment in need of repairs, themanufacturers came to us, and at the bottomof these emails we added information to theeffect of: “If you come using this route, youwill be able to arrive safely,” which facilitatedquick response.
Since we have an emergency generator at
our hospital, we used it the day after the disaster to take photos, and the following day
a temporary battery car came from Shikoku

62 ◆ Journal of JART English edition 2018

Electric Power. By the evening of the secondday, we had the CT and MR in operational
condition.
As mentioned earlier by President Hiai,the clinical wing of our hospital is a seismic
isolation structure, and the outpatient and administrative buildings are earthquake resistant.
The clinical wing, placed like equipment on
the front side, is a seismic isolation structure,
whereas the far side is earthquake resistant;the join of the two absorbed all of the shock,leaving it in this condition (Fig.8, upper left).
Initially, it was in much worse shape, but
this was because the floor boards, and so on,were all out of place. I think this is due to asingle area absorbing all of the shock.
This is the seismic isolation structure; there
are over 70 of them in the basement. The
black part is made of rubber, which absorbs
all of the horizontal vibrations (Fig.8, upper
right).
This is a conversation for another day, but
I heard that the company that created the design said it slid 46 cm. That is 46 cm on one
side, so it seems there was an overall dislocation of about 90 cm. Once it has abruptly
shifted sideways, it then slowly returns to its
original position.
The first wave of the earthquakes that hit
around Mashiki seems to have been a fine,horizontal vibration, but the second wave was
especially damaging, including to our hospital,

免震機構
Seismic
Isolation Structure

Fig.8

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures

because the periodic amplitude was especiallyhigh. This is why I think this seismic-isolation
function is incredibly helpful. I have said thatthe horizontal displacement was as much as
90 cm, and when I spoke with the company
that designed it, they said this was possibly arecord.
In our hospital, there also exists in-house
power generation for facilities in the medical
examination building, with electricity that lasts
for about three days. In addition, water andsewage facilities are installed. Also, a temporary battery car came to assist.
This is the number of emergency visits todate, but we saw two or three times this figure just in the month of April, immediately
after the event (Fig.9). This continued until
around May, which I figure is about the levelof increase that hospitals can expect, should
they survive the disaster intact and can accept
patients. At the time, we saw a huge increasein patients, even outside of the emergency
care center.
Director Ono and Mr. Kuwahara, both here
today, did an amazing job, along with manyothers, especially the Oita Prefecture technologistsʼ association, which came right away.
The reason for coming to help was the panic that set in at the time of the disaster. Sincepatients just kept coming, one after the other,
it was all we could do to complete the work
we were committed to, leaving us no time

Number of 救急車受け入れ件数
ambulances accepted

⽀援要請までの流れ
Flowchart
for support request

200

各⽀援要請病院
Hospitalrequesting support

172

180
160
140

125

120
100
80
60

66

71

65

71

72

82
67

70
57

40
20
0

Fig.9

74

77

73
61

to think about what to do afterwards. When
Director Ono, who had come from DMAT, letslip the word “request,” it was the first time
I realized such a thing was possible, so wemade some adjustments beginning the next
day and had Mr. Kuwahara come. After that,members of the Oita Association of Radiological Technologists started to arrive, and that
was a big help.
At our hospital, we had an on-call standby
system in place for Sundays and holidays, etc.,
but switching from on-call standby to a rotating watch system created a strain, because of
the number of people involved. Having additional support arrive was very helpful. I want
to express my heartfelt thanks to everyone
who came out to help.
In addition, Kumamoto City Hospital also
suffered serious damage, and we got a lot of
support for that.
One thing Iʼd like to mention is that until
then, the idea of “support” was not something
we considered much, but since we were able
to receive it this time, I would like to remind
everyone that they can get support from theJapan Association of Radiological Technologists (Fig.10).
As previously mentioned, I would like toencourage everyone in their daily preparations at hospitals and radiology departments
to participate in disaster drills.
Additionally, while the phone will not al-

61↓↓
災害対策本部
Disaster Response Headquarters
↓
↓
各県医師会
Prefectural Medical Association↓↓
Medical医師会
Association
↓
↓
JART
JART

Fig.10Special Feature ◆ 63

ways be connected during a disaster, it is still
possible to communicate using e-mail, which
I think is a good idea for helping the neighborhood prepare as well.
I also felt a need for satellite phones. And
with around the clock shifts, I think that hospitals should prepare stockpiles of clothes andbedding.
As for the radiology department, throughthe drafting of an “operations manual,” we can
explain to engineers who come to offer support that “I am using such and such a device
at our hospital,” so that they can provide assistance based on that information. Moreover,I think that if we can get some of the people
who regularly use the equipment into thegroup of engineers that offers aid at the outset, we could greatly improve the speed of assistance. By creating and distributing a manualwith photos, we could facilitate the efficient
reception of assistance.
If we could send a request to the Japan Association of Radiological Technologists andmanufacturers to establish some kind of mailing list, at least for the Kumamoto Associationof Radiological Technologists, our support

64 ◆ Journal of JART English edition 2018

network would be expanded, and we could
better provide, according to the needs.
Where the road was blocked, we received a
lot of support from the Oita people in the opposite direction, so instead of thinking that weneed to request the technologistsʼ association,
I suggest that in future a system is created torequest support from nearby districts and prefectures.
In regard to manufacturers, a troubling issue
came to light when I put a portable generator
in the general imaging room at the time ofthe emergency to take a picture of a patient,and the vacuum tube of the general imaging
device kept getting in the way. Because thepower was off, I could not move the vacuum tube. I think that it would be good to ask
manufacturers to add an off-lock function, if
possible – a release measure that allows you
to move the vacuum tube at the last minute, and take a picture of the patient on thestretcher.
Thatʼs all I have. Thank you very much.
(Chairman) Ono: Mr. Anai, thank you verymuch.

The 32nd Japan Conference of Radiological Technologists
Symposium 1 (Disaster Countermeasure Committee)

Response to the Kumamoto Earthquakes andFuture Earthquake Countermeasures: Part 2
Chairman: Akihiro Kitagawa（Chairman, Disaster Countermeasure Committee; Director, The Japan Association of Radiological Technologists /Nippon Kokan Fukuyama Hospital）

Kinya Ono

（Member, Disaster Countermeasure Committee / Kawasaki Municipal Hospital）

Symposiast③

Operational support dispatched from JART
Hiroshi Kuwahara（Vice President of the Oita Association of Radiological Technologists/Sekiaikai Saganoseki Hospital）(Chairman) Ono: As Mr. Anai mentioned in

his presentation, instead of requesting support from within Kumamoto Prefecture, I assumed it would be easier to get support fromneighboring Oita Prefecture, even though that
prefecture was also affected. That is why I
phoned Mr. Kuwahara.
I invited Mr. Kuwahara to speak today sothat we can ask him about that time. He ʼ shere to talk about how JART can provide operational support. Thank you for coming.
Kuwahara: Iʼm Kuwahara from The Oita Association of Radiological Technologists. I workat Saganoseki Hospital in Oita Prefecture.
Iʼd like to report on two items. I did headout to Kumamoto as part of a DMAT (Disaster
Medical Assistance Team), and so I would liketo talk about that and the dispatch of technologists to provide support during disasters.
There was a large main shock at 1:25 a.m.
on April 16. I was sent as part of the secondary DMAT. First, the assembly point/hospital

was the Japanese Red Cross Kumamoto Hospital, but the roads were impassable̶plus,
there was major congestion in Aso City. There
was no way to get to the assembly point. That
was when I heard on the radio, “Minamiaso
village is almost completely destroyed andthere is no support at all.” I quickly contacted
headquarters and asked if I could go to Minamiaso.
I headed to Minamiaso and worked in aplace called the Chouyou Village Office. At
that time, there were one or two local publichealth nurses there as well, but everyone wasin a state of panic, and one or two people
were not nearly enough to handle the work.
When we arrived and announced that wewere a “DMAT,” they were really happy.
This is a photograph of the village office. As
you can see, there was no time even to tidyup (Fig.1).
First, the public health nurses asked us totake care of the dialysis patients. There wasSpecial Feature ◆ 65

Fig.1

Fig.2

no hospital near Aso that could perform dialysis. We werenʼt sure that the Aso Medical Center could accept patients, so we transferred
our patients to Oita Prefecture. Later, we weretold that there was “a pregnant woman who
may go into preterm labor,” so we transferred
her to Oita Prefecture too.
There were some patients with minor injuries. Public health nurses were unable toget those patients accepted at surrounding
hospitals, but once we contacted them, they
responded by saying, “we will do what wecan,” and we were able to get several patients
accepted. We also arranged with the hospitals
to transfer patients who required stiches anda patient who was suspected of having a fractured right humerus.
In terms of communication, all we had was
my company cell phone, which was our lifeline. We contacted the logistical support teamusing SNSs, such as LINE, in response to eachsituation.
As part of our DMAT activities, I wanted tostart working as a radiological technologist,
but realistically, DMATʼs mission was to sendpatients in serious condition to medical facilities as fast as possible. It was difficult to doboth jobs at the same time.
But I am aware that we, as radiological
technologists, have many opportunities towork directly with emergency patients, alongside physicians and nurses. I think our skills
are extremely useful.
This was Fukushima after the Great East Japan Earthquake of March 11, 2011 (Fig.2). It
was quite an experience to observe the stateof panic at the time. During this time, we ran
out of supplies as well.
When I arrived at Minamiaso during this disaster, it was late afternoon. Without water or
power, everyone became very stressed, andsome of the local people were verbally attacking the public health nurses with questions
such as, “when will we get some water?”
We tried to intervene, explaining that we
couldnʼt provide water “until we have enoughwater for everyone. ” We apologized, andasked for “more patience.”
Next, letʼs talk about the activities that dispatched technologists undertake during disasters.
Technologists are dispatched to provide
support during disasters. The guidelines callfor radiological technologists to be sent from
JART when medical facilities in areas affected by a disaster lack radiological technology
manpower. The cost of such travel is coveredby JART.
These guidelines have always been in place,but personally, I always used to wonder, “what66 ◆ Journal of JART English edition 2018

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasuresdisaster support is OK ?” and “whether anyone
can do it.” I was not sure that we would be
able to provide support from outside the affected prefecture when there was insufficient
medical support in the affected site. The lackof manpower might mean that disaster basehospitals didnʼt have enough technologists. If
so, those hospitals could not suddenly accommodate devices and electronic files. Of course,
we could use paper files, if staff members
were overwhelmed by the need to handle
electronic files. Given the situation, I assumed
that it would be difficult to send technologists. However, I was the first technologist togo, as I will explain. The Hospital Director
Kai, Director Ono, and Mr. Anai discussed the
Aso Medical Center outpatient department,
which had received double the normal number of patients. The technologists there were
exhausted and overwhelmed. I was therefore
sent to the Aso Medical Center on a temporary
basis, as a part of the first team, to arrange thedispatch dates (Fig.3).
The purpose of this trip was not to examination, but to reduce the load on the Aso
Medical Center staff. In short, we went toprovide continued and stable medical care. It
does make a big difference to have a radiological technologist on site. We went there
understanding that the purpose of dispatching

technologists was to provide stable medicalcare. Between April 20 and May 8, the Oita
Association of Radiological Technologists,
Kumamoto Association of Radiological Technologists, Fukuoka Association of RadiologicalTechnologists, and Saga Association of Radiological Technologists all took turns sending
one technologist each to the Center.
This is a summary of the dispatch statusof radiological technologists, based on documents provided by Chairman Eto (Fig.4 ).
You can see that the numbers fluctuate. Immediately after the disaster, there were cases of DVT and takotsubo cardiomyopathy.
Subsequently, the stress people experienced
because they had to live in shelters for a longtime, while managing various physical burdens, made it impossible to know when alarge number of patients might crowd into thehospital. Under these circumstances, sending
technologists to provide stable medical care atmedical facilities was an effective strategy.
It has already been discussed, but the futurechallenge is to clarify the nature of such support systems before another disaster happens,
and to inform each municipality.
It is important to clarify the ways in which
support should be requested. It is not sufficiently clear whether affected facilities should
submit a request to JART through the prefec-

Radiological work at the Aso Medical Center afterradiological technologists were sent to provide support.

GeneralImaging

Fig.3

Fig.4
Special Feature ◆ 67

tureʼs technological association or submit a request to the prefectureʼs technological association through JART. We are not sure how therequest documents should be prepared. The
document mentioned in the report was drawn
up as a trip report and request for travel costs,
but the process could be simplified. There isalso the issue of travel costs. Since we cannot
rely on public transportation, medical support
staff will need to use cars. This restriction
complicates JARTʼs procedure for requesting
travel expenses. These points must all be clarified.
In summary, earthquake disasters can strikeanytime anywhere. When I was part of a
DMAT, the first thing we were asked to do by

Symposiast④

the local public health nurses was to manage
dialysis patients.
We also need to examine ways to handle an
emergency situation in which the lifelines are
cut off in our own facilities.
I believe that JARTʼs dispatch of technologists during this disaster represented an extremely rare case. In future, we will need tocooperate with the government, clarify theroles of technologists during a disaster response, and advertise our work more widely.
My most sincere condolences to those who
were affected by this disaster. I also would
like to thank everyone who helped us provide
support on site. Thank you for listening.
(Chairman) Ono: Thank you, Mr. Kuwahara.

Activities of the Japanese Red Cross
Association of Radiological Technologists
Masaaki Nakata （Japanese Red Cross Kobe Hospital）(Chairman) Ono: It is quite difficult to provide

operational support, and there is an ongoingargument about whether or not it is necessary.
Mr. Nakata, who will present next, has given
a lot of thought to this issue, over many years.
Mr. Nakata works at a hospital run by theJapanese Red Cross Society, and has done extensive work in disasters. I hope he can teachus about the activities of the Japanese Red
Cross Society.
Nakata: Hello, Iʼm Masaaki Nakata from theJapanese Red Cross Kobe Hospital.
As Mr. Kuwahara and Mr. Ono have mentioned, I have been part of a DMAT from the
beginning. I was also part of the relief team of
the Japanese Red Cross Society, and a member of the JICA Japan Disaster Relief medical
team. I have been involved with disaster relief

68 ◆ Journal of JART English edition 2018

for dozens of years, and have discussed theneed for radiological technologists during disasters and additional preparations at hospitals
involved with radiology with everyone here.
Thank you for organizing this symposium atsuch a big venue.
During this disaster, I entered the site asa member of the Red Cross relief team, andworked on behalf of the Association of Radiological Technologists of the Japanese Red
Cross Society. Iʼd like to report on that.
During the Great East Japan Earthquake, weat the disaster medicine support departmentof the Japanese Red Cross Association of Radiological Technologists cooperated with device manufacturers and were able to provide
crucial devices. During the Kumamoto Earthquake, Association technologists provided

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures

support from April 16th, when the main shock
occurred.
In this report, I will compare what we wereable to do during the Great East Japan Earthquake, and what we were able to do during
the Kumamoto Earthquake, based on previous
experience. I will evaluate the progress madein providing such support, and will then outline future challenges.
First, Iʼd like to review activities during theGreat East Japan Earthquake.
Immediately after the Great East Japan
Earthquake, our technologists ʼ association
requested rental support from device manufacturers via the disaster medicine support
department. We secured the devices shown in
Fig.1.
Where were these devices used? I wasworking as a DMAT member immediately after the Great East Japan Earthquake. After I
returned to Hyogo Prefecture, about 10 days
after the quake, I informed medical staff at theaffected site that an X-ray device was available, and asked whether any facility needed
one. We contacted the medical headquartersof the government of the affected prefecture,
the medical supervisor of the Japan Red Cross
Society, and the Japan DMAT supervisor. In
response to the requests we received, we discussed details further with local supervisors.

[Results 1] the Great East Japan Earthquake <securing the X-ray device>.
[Mobile X-ray device] + [CR system]

Hitachi Medical
Corporation[Portable X-ray device] + [FPD system]

Canon Marketing Japan

Fuji Film“Japanese Red Cross Association of Radiological Technologists: disastermedical support department” asked to provide a rented X-ray device,supplied by the manufacturer, immediately after the disaster.

Fig.1

During the Great East Japan Earthquake,such arrangements were made by gathering
information from outside the affected site. As
a result, we provided device support in threelocations in Iwate Prefecture and two locations in Miyagi Prefecture.
We were able to provide one device about
two weeks after the quake, and two more devices two months after the quake.
Approximately a year and six months later,
we analyzed whether this support was effective in six locations in Iwate Prefecture andthree locations in Miyagi Prefecture.
The assessment showed that the device
support was extremely effective, and that thearrangements were reasonable.
While working to provide support, we realized that, in order to meet the support needsof each site affected by the disaster, we had tolook at the situation from the perspective of
those affected.
We learned from this survey that human
support is also necessary. It was clear that
staff members like us needed to go in person
to provide support to hospitals in the affectedareas. There are many challenges associated with this issue. We must raise awarenessof the urgent need and build an operational
structure for this essential support system.
Next, let me discuss our activities during the
Kumamoto Earthquake.
Hitachi, Ltd., which provided support
during the Great East Japan Earthquake, offered to lend X-ray devices to medical centers
on April 16th. Initially, we were able to obtaina portable device (a tiara with a wireless flat
panel detector).
I arrived at the Joint Adjustment Office ofthe headquarters of the Japanese Red Cross
Societyʼs Kumamoto Office on April 16th, tosee whether they needed an X-ray device.
After two days, an evacuation shelter was set
up in the gymnasium in Mashiki Town anda field medical unit, known as a Red Cross
dERU, was set up. It was determined that anSpecial Feature ◆ 69

X-ray device should be installed and operated
at this first-aid station. Therefore, during the
Kumamoto Earthquake, information was gathered at the affected sites and arrangements
were made on site.
This was the Mashiki Town gymnasium. At
first, we carried out medical work in a small
space of about 10 ㎡, part of the 20 ㎡ spacewithin the gymnasium (Fig.2).
This shelter was opened on April 14th, when
there was a foreshock. After the main shockon the 16th, it was determined that medical activities could no longer be carried out in thisspace. A field clinic would be set up outside
the gymnasium in the affected area. On the
19th, a dERU was opened outside the gymna-

The Japanese Red Cross Societyʼs first aid station in the Mashiki Town gymnasiumsium; this became the first-aid area (Fig.3). At
the back of this area, we set up an X-ray imaging area and an imaging space. On the 22nd,
the X-ray device arrived from Hitachi. Imaging
began as soon as this device was installed in
the dERU (Fig.4).
Chronologically, the main quake occurredon April 16th, and our needs were clarified
two days later. Six days later, on the 22 nd,
the installation of the device began. It wasremoved on the 27th. I think it was quite anachievement that a device could be installed
in an emergency situation during the disasterso that imaging could begin.
In terms of sending radiological technologists, the relief team that was sent on April
18th included a radiological technologist. Imaging was performed in the evacuation shelter
we had just set up (dERU). The supervisor ofthis Red Cross relief team came from the Chugoku-Shikoku block; thus, the supervisor of
the Association of Radiological Technologists
in the Chugoku-Shikoku block created a planand submitted it to the headquarters of theJapanese Red Cross Society. The Red Cross
HQ contacted Chugoku-Shikoku in Hiroshima, which passed on requests to each block.
Ultimately, a request was sent to the directorof each hospital that ultimately sent a technologist. In total, five radiology technologists

Fig.2

April 19 (Tuesday) setting up the dERU

April 22 (Friday)
The arrival of the X-ray device

Japanese Red Cross Kobe HospitalFig.3

70 ◆ Journal of JART English edition 2018

Fig.4

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures

were sent.
As for supporting hospitals in the affected
area, we contacted the Japanese Red Cross
Kumamoto Hospital on the day of the main
quake to see if they needed human resources
support. They did not need any support inthat area.
This is a picture of the imaging area, inside
the first-aid station. We began our work on
April 22nd and were finished on the 27th. We
had a team of five technologists, and there
were 17 patients who needed imaging (Fig.5).
We were able to provide support during theacute phase because we secured the device
quickly, by relying on a good and cooperative
relationship with the manufacturer, establishedduring the Great East Japan Earthquake. We
gained quick support with the X-ray device by
surveying the imaging needs of the affectedsite at the beginning of the emergency.
To support the radiological technologists,
the Japanese Red Cross Society HQ, which
managed the relief team, connected quickly
with our association of technologists, ensuringthat a radiological technologist was includedin the relief team. This cooperation allowed
technologists to be dispatched.
In the end, only 17 patients needed imaging, but I think there was quite a bit of needduring the four-day period between the 18th,

April 22 (Saturday)
The operation began
April 27 (Wednesday)
The operation finishedSupport provided by 5 radiological
technologists
Imaging patients: 17
Japanese Red Cross Kobe Hospital

Fig.5

when needs were confirmed, and the 22nd,
when the device arrived. The short activity
period of six days resulted in a small numberof patients.
The reason the activity period only lasted
six days was that the first-aid station changed
from a 24-hour operation into a clinic thatclosed at 22:00, which made night-time management of the X-ray device difficult. This led
to its earlier removal.
In a field clinic, devices that can be easily
moved are essential. The Japanese Red Cross
Association of Radiological Technologists has
its own portable Canon X-ray devices; initial
response teams should always use such devices. In areas that need continuous imaging,portable devices provided by manufacturers
should be used to set up a good imaging system.
In summary, during the Kumamoto Earthquake, building on our experience during theGreat East Japan Earthquake, we were able toprovide an X-ray device and human resources
support during the acute phase of the emergency. However, it was challenging to manage the X-ray device in the field clinic.
We did not have a clear operational system
to provide human resources, but we were sufficiently fluid to respond to the earthquake.
In future, it will be important to build detailed
procedures for dispatching staff, including human resources to support hospitals in affectedareas.
I would like to take this opportunity tothank Hitachi for their cooperation in providing X-ray devices.
Disaster medicine in present-day Japan began with the Great Hanshin-Awaji Earthquake
on January 17, 1995. Our understanding ofwhat we, as radiological technologists, can offer during disasters and how we can respondbegan with Kobe. By building on our experiences in Kumamoto, and working together
̶you as JART and we as the Japanese Red
Cross Society ʼ s Association of RadiologicalSpecial Feature ◆ 71

Technologists̶we can reach higher and develop a support system.

Symposiast⑤

Thank you.
(Chairman) Ono: Thank you very much.

Activities of the National Hospital Associationof Radiological Technologists
Eiichiro Konishi （Disaster Medical Center）(Chairman) Ono: Building a network day by

day is important, but there is another organization, the National Hospital Organization Association of Radiological Technologists, which
also has a nationwide network. There is also abase hospital, called the Disaster Medical Center, that works to alleviate disasters. I would
like to hear their experience with this particular disaster. So, here is Mr. Konishi from theDisaster Medical Center.
Konishi: Hello, Iʼm Konishi from the Disaster
Medical Center.
I will be reporting on the activities of radiological technologists working for the National
Hospital Organization.
First, let me introduce the National Hospital.
The whole country is divided into six groups,
with 143 hospitals in operation. For radiological technologists, there is a national networkof approximately 1,500 radiological technologists. The National Hospital Organization is a
designated public institution under the Basic
Act on Disaster Control Measures. It is therefore ready to dispatch a first-response medical
team whenever a disaster occurs. Radiological
technologists are not officially registered withthe medical team, but are able to participate.
The National Hospital Organization of Radiological Technologists provides an organization for technologists. Originally, it was the
National Hospitalʼs association of radiological
technologists, but it separated from the hos-72 ◆ Journal of JART English edition 2018

pital and became independent. Today, it has
a total of 170 facilities and about 1,690 members, including the National Hospital Organization, the National Centers for Advanced andSpecialized Medical Care, the National Hansenʼs Disease Sanatoria, and the Hospital of
the Imperial Household.
I reviewed the staff members dispatchedfrom the National Hospital Organization before the Kumamoto Earthquake. During the1999 Tokaimura JCO Criticality Accident,
radiological technologists from the National Hospital were sent to survey facilities in
Ibaraki Prefecture. Then in 2011, during theGreat East Japan Earthquake, we were sent
as support members to a facility in Ibaraki
Prefecture. Technologists were also sent in tosurvey the Fukushima Daiichi Nuclear Power
accident.
During the Great East Japan Earthquake,
we conducted many questionnaire surveys.
Earlier, as was mentioned in the case of the
Aso Medical Center, many hospitals increased
staff numbers to accommodate emergency situations. During that time, the number of staff
members increased, especially as there was aneed to provide additional emergency treatment for radiation exposure. Since their own
homes were damaged, there were many staff
members who could not go home.
These were the situations in two hospitals during the Great East Japan Earthquake

Response to the Kumamoto Earthquakes and Future Earthquake Countermeasures(Fig.1). A facility in Ibaraki Prefecture needed
to combine emergency treatment for radiation
exposure with other types of medical care;thus, they requested technologists. A technologist was sent for five days (Fig.2).
Given the situation, organizations began
to examine the need to send technologists toprovide emergency support.
When there is a disaster, public facilities
and roads are shut down, and patients may
not be able to reach their own hospitals. The
National Hospital Organization does transfer
staff members; many people do not live locally. Thus, if possible, staff should be sent tonearby facilities to provide support. That was
the beginning.
Thinking about the emergency situations

Two hospitals during
the Great East Japan Earthquake
Hospital A・The majority of staff members who were working on the day of thedisaster stayed at the hospital (22 out of 27 worked into the earlymorning hours), repairing equipment, and providing an emergency
response and emergency exposure medical treatment. Some of thesestaff members could not go home for five days.

Hospital B・Ten or more staff members stayed at the hospital from the day of thedisaster, repairing equipment and providing an emergency response
and emergency treatment for radiation exposure. Staff members were
finally able to go home on March 20.

The 33nd Japan Conference of Radiological Technologists

from this perspective makes it clear that there
are four challenges: standards for dispatch requests; methods of requesting support; costs,
payments, and compensation; and issues related to different types of facilities, such as
national specialized medical research centers
and the Hansenʼs disease sanatoria (Fig.3).
As National Hospital technologists, tasked
with establishing a more extensive support
system during the disaster, we submitted to
the Council of Directors a proposal to enhance disaster countermeasures. Since theheadquarters has radiology professionals, we
argued that they should be used to enhancethe disaster response system. To provide disaster training at our hospital, we perform dispatch simulations for technologists, to clarify
and explain the issues. Professionals from the
National Centers for Advanced and Specialized Medical Care take part in these simulations.
The Kumamoto Earthquake took place inthis context. There are four national hospitals
̶or five, if you include the Hansenʼs Disease
Sanatorium̶in Kumamoto Prefecture, but theepicenter was near the hospitals and caused
much damage. Staff members could not reachthe hospitals, and on-call staff could not takeany breaks, as more manpower was needed.
As working staff members became exhausted,

Fig.1

Dispatching technologists during
the Great East Japan Earthquake
Hospital B
Date

From

To

Details

17-MarEvening

Hospital B
Hospital director

Kanshin GroupRadiological technologist
Dispatch request

18-Mar
9:20

Kanshin district
Organization headquarters
Facility supervisingradiological professionals
technologist

18-MarOrganization headquarters Hospital B
Dispatch staff determinedradiological professionals Supervising technologist and notified

March 18−22 −−The 33nd Japan Conference of Radiological Technologists

Fig.2

Dispatch staff recruiting

Radiological technologist
dispatched

IssuesStandard for dispatch requests
Method of requesting a dispatch
Cost coverage and compensation
Facility style
The 33nd Japan Conference of Radiological Technologists

Fig.3
Special Feature ◆ 73

Hospital C in Kumamoto Prefecture requested
additional technologists.
To meet this request, the facility put out acall for technologists through the director of
the Kyushu group and radiological professionals. This led to the dispatching of two
technologists between April 19th and 22nd. One
was working at Hospital C until March, while
the other was selected because he/she had
experience of disaster medicine. Since the first
technologist had worked at Hospital C, he/she
could take over specialized tasks, including
CT scans and radiation treatment.
Staff members and their families in the disaster-affected area were also victims, andsome were staying in shelters in Kumamoto
City. Others were actually living in their cars.
Many facilities set up self-regulated attendance, but medical professionals tend to be
responsible, and many of them did come towork. Many people also wanted to manage
the situation in their own hospitals. This led
to exhaustion and stress, making management
difficult. In the future, we hope to alleviate
such situations by offering support and delineating possibilities.
Another thing I thought about during thisearthquake was that hospitals in affected areas
must keep their staff on call, or increase thenumber of staff members, in order to manage. For example, in the case of Kumamoto,groups in Kyushu dispatched technologists.
Nearby groups could fill the hole by dispatching a replacement technologist. There could
thus be a two-stage support system.
In this way, we must develop a system oflong-term dispatch. The need has been discussed, but usable devices are limited; thus,
manuals and equipment must be prepared inadvance.
Two hospitals outside the Kumamoto Prefecture organization requested radiological
technologists. When we consulted with theheadquarters of the organization for radiology
professionals, we were told: “if the request

74 ◆ Journal of JART English edition 2018

comes from an appropriate source, the organization can respond.”
Although it did not happen during the present disaster, we now know that the National
Hospital Organization can respond; we therefore hope to propose a new style of support
for future disasters.
When the National Hospital Organization
provides operational support, it makes routine transfers. For this reason, as happenedin the case of the technologist who was dispatched to Hospital C, technologists who
have previous experience of working at aparticular facility can be dispatched to that facility. There are routine lectures and seminars
within groups; thus, face-to-face relationships
are cultivated, to a certain degree. Since technologists can be dispatched as a part of theirprofessional work, the cost of these transfers
should be covered.
JART insurance guarantees the income oftechnologists; in addition, the National Hospital Organization provides insurance formembers of its Association of RadiologicalTechnologists. We have confirmed that thisinsurance provider will cover radiologicalwork in the National Hospital Organization,
radiological work at other medical facilities,
and radiological work in emergency medical
facilities.

Summary

Review of past cases
Building a cross-sectional dispatch system
Developing a dispatch system

The 33nd Japan Conference of Radiological Technologists

Fig.4

Response to the Kumamoto Earthquakes and Future Earthquake CountermeasuresThus, two out of the four issues are mostly
resolved. However, we need to continue examining the issues related to facilities, such as
the standards for requesting a dispatch, how
and when technologists should be dispatched,
and when people can request support.
In summary, there is a system at the National Hospital Organization for sending technologists to provide support when full-time
staff members are on sick leave or vacation

leave. This system can also be applied during
disasters. Having been given this opportunity,
I hope to build a dispatch system in cooperation with the Japanese Red Cross Societyʼs
Association of Radiological Technologists and
JART. I would like to be able to inform municipal organizations that such a system has
been set up (Fig.4)．
(Chairman) Ono: Thank you.

Q&A
(Chairman) Ono: We donʼ t have much timeleft, but letʼs have a Q&A session. If you havea question, please state your affiliation and
name.
Takeda: Iʼm Takeda from the Center Hospitalof the National Center for Global Health andMedicine.
In terms of the future, I would like to hearfrom the National Hospital Organization, Japan Red Cross Society, JART, other radiological technologists, and all of you, in regard to
how we should share information and build
relationships.
(Chairman) Ono: Thank you. Let me go first.
In the Committee on Disasters at JART, weplanned this symposium. I think this is where
we can build the network. There are alreadymany networks out there. If we could nurturecross-sectional connections between these
networks, we should be able to develop alarge network relatively easily. We have actually been trying to make that happen. However, since this is an association of radiological
technologists, as Director Kitagawa mentioned
in his introduction, we are always instructed
to: “first prioritize the response to radiation
disasters and nuclear power disasters.” By“holding conversations on operation support

relating to these issues,” we are just startingto build the network. Cross-sectional connections are so important. I think we should havesuch connections outside of disasters. What isyour opinion Mr. Nakata?
Nakata: In response to the points made by
Chairman Ono, the situation is complex, andthere are various roles in various frameworks.
So, building immediate cross-sectional connections will be difficult, as I think those who
worked on site are painfully aware. Basically,
there are face-to-face relationships, as wellas the support from cross-sectional connections. I believe that people can be rescued
through connections among people. If I startwith a clearer effort based on my experience,
the annual workshop on disaster support fortechnologists, hosted by the technological association, can lead to horizontal connections
between people who actually work on site.
Sharing education, a common language, andcommon knowledge can, in turn, lead to connections beyond the framework.
(Chairman) Ono: Mr. Konishi, how about you?
Konishi: I had the opportunity to be partof the Arrangements for Medical Assistance
Headquarters in Kumamoto Prefecture, andwas able to work in Kumamoto. The generalSpecial Feature ◆ 75

opinion was that “there arenʼt enough radiological technologists or lab technicians. We
need more support.” JART was the first organization to be contacted. We were informedthat we should first contact the associations ofradiological technologists and laboratory technicians. As emergency SOS information usually reaches JART first, workshops like those
proposed by Mr. Nakata could build horizontal connections, making operations run moresmoothly.
(Chairman) Ono: Thank you. In terms of support requests, Mr. Konishi just mentioned that
there was a request for support. Chairman
Hiai, was there a prediction that Kumamoto
City would have more problems than anyone
expected? Did you learn anything specific?
Was there a request for support̶anything ofthat sort?
Hiai: I think the problem was that there wasno network to bring in support staff. I got a
lot of information from my technologist colleagues and friends who were DMAT members. I did hear that there was support from76 ◆ Journal of JART English edition 2018

Hitachi, but we had no idea what the level of
support was.
There was some information about support
during this disaster, but we could not figureout which organizations or how many organizations were working in Kumamoto. Therewas just sporadic information: there was support here, there was support there. It is therefore important to clarify the situation on site.
JART should play a role in connecting thesebodies.
(Chairman) Ono: Thank you. I think we needto discuss this more, but there isnʼt enoughtime. As Mr. Anai mentioned, we did hearfrom hospitals during the Great East Japan
Earthquake that “ they did not expect any
support.” I would therefore like to provide aproper summary of future disaster countermeasures established by JART.
This concludes the Disaster Countermeasure
Committee Symposium. Thank you for yourtime.
(Chairman) Kitagawa: Thank you.

Arts and Sciencesmaterial

A follow-up system of radiograph interpretation
reports by the remote diagnostic reading doctor
at our hospital
Asuka Ishii1）, Tomoyuki Hasegawa1）, Yoshitaka Nemoto1）, Takahisa Araki1）,
Yoshiyuki Kawasaki1）, Yoshiyuki Seya1）
1）Department of Radiology, Radiological Technologist, Hitachinaka General Hospital

Key words: follow-up system, remote diagnostic reading doctor, remote medical system【Abstract】

In our hospital, two diagnostic reading doctors (one on-site, one remote) read CT and MRI images. When theyencounter acute findings or evidence of infectious diseases, or when important findings are overlooked, a remotediagnostic reading doctor, unlike an on-site doctor, cannot contact the attending physician immediately. Therefore,
the radiological technologists and medical clerks developed a system in June 2012 through which follow-up withattending physicians was made possible. We report the details of this system and the results of the first two years ofuse.

1. Background
1.1 Remote diagnostic imaging

Recent advances and specialization in medical care have led to major improvements andadvances in the diagnostic capabilities of computed tomography (CT) and magnetic resonance imaging (MRI) and to increasing demand
for radiodiagnosis of medical images by diagnostic radiologists. However, there are only
5,000 diagnostic radiologists in Japan; the percentage of diagnostic radiologists in the Japanese population is approximately one-thirdthat in the West1).
The situation described above has increased
the expectations for remote diagnostic imaging. Remote diagnostic imaging takes advantage of developments in telecommunications
infrastructure and information technology tosend medical CT images, MRI scans, and othermedical images to a diagnostic radiologist at aremote location, enabling the radiologist to
support diagnostic imaging at medical facilities
with no diagnostic radiologist. By creating

more opportunities to receive diagnoses fromdiagnostic radiologists, who are experts in diagnostic imaging, this system is anticipated to
improve the quality of medical care and lead toa reduction in the temporal, physical, and financial burdens on patients2), 3).
1.2 Current status of diagnostic imaging at our
hospital

Our hospital is a smaller general hospitalwith 302 beds and 31 departments (internal
medicine, nephrology, cardiology, neurology,
respiratory medicine, gastroenterology, hematology, rheumatology, surgery, plastic surgery,orthopedic surgery, neurosurgery, pediatrics,
pediatric neuropsychiatric development, obstetrics and gynecology, ophthalmology,
otorhinolaryngology, urology, dermatology,
clinical laboratory, anesthesiology, pathology,
oral and maxillofacial surgery, radiology, radiotherapy, chemotherapy, palliative care, rehabilitation, emergency/general medicine, homecare, and health management). Diagnostic imaging at our hospital is conducted using two
Arts and Sciences ◆ 77

CT systems (a 16-row system and a 64-row system) and one MRI system (1.5 T). From April to
October 2014, an average of 38 ± 6.9 CT scans
and 16 ± 2.8 MRI scans were conducted perday; these images were interpreted by an onsite doctor and a remote doctor. The on-site
doctor conducts imaging diagnosis for inpatients and emergency patients; the remote doctor conducts imaging diagnosis for first-timepatients. This division of labor allows our hospital to manage the increasing demand for diagnostic imaging.
In this system, when the radiograph interpretation reveals acute findings or infectious disease, or when important findings are determined not to have been reflected in the examination, the on-site doctor can inform the attending physician directly using the personal
handyphone system or the electronic medical
record system. However, the remote reading
doctor does not have access to this correspondence network. Consequently, the treatment of acute phase patients or patients with
infectious diseases may be delayed.
Therefore, our hospital has enacted a system
to enable reliable sharing of information withthe attending physician in cases in which remote radiograph interpretation reports containthe findings described above.

2. Objective
In June 2012, with the cooperation of a medical clerk, our hospital initiated a system to follow up remote radiograph interpretation reports by a radiological technologist. We report
the details of this follow-up system and theresults, approximately 2 years after initiation.

3. Methods
3.1 Follow-up of remote radiographic interpretations
3.1.1 Steps in the follow-up system

The steps in the system, from the return of78 ◆ Journal of JART English edition 2018

Fig.1 Follow-up system of radiograph interpretation reports by the remote diagnostic
reading doctor

radiograph interpretations by the remote diagnostic reading doctor to follow-up care, areshown in Fig.1. First, most remote radiographinterpretations are returned the day after theinterpretation is requested. Once the report isreturned, it is uploaded onto the Radiology Information System (RIS), which is coordinatedwith electronic medical records to enable referencing of the reports in the medical records.
Next, the radiological technologist checks theinterpretation to confirm the patientʼs name,ensure there are no typographical errors, andcheck the content of the report. If the radiological technologist has any questions, the remotereading doctor is asked to interpret the image
again. These tasks are performed by the radiological technologists in charge of CT, MRI, andultrasonography in the morning as they conduct tests.
Upon checking the contents of the report, if
there are acute or important findings, the radiological technologist adds those findings to thelist of patients requiring follow-up. Referring tothis patient list during outpatient examination
enables the necessary treatment measures tobe taken. Interpretation reports with findings
requiring follow-up are also conveyed to theattending physician through the medical clerk
to ensure that the information is conveyedmaterial
A follow-up system of radiograph interpretation reports by the remote diagnostic reading doctor at our hospital

properly. When there are acute findings, theradiological technologist contacts the attending
physician directly to convey the information
more rapidly.

column makes it possible to confirm that thenecessary treatment has been provided in outpatient care.
3.1.3 Information in the follow-up system

3.1.2 Patient list in the follow-up system

An excerpt from an actual patient list used in
the follow-up system is shown in Table 1.
There is one follow-up system patient list foreach department that requests tests; findings
requiring follow-up are entered by the radiological technologist. This list can be viewed atany electronic medical chart terminal; therefore, the communication of interpretations by
the medical clerk and references to this list enable the necessary treatment to be performed
during outpatient examinations. When a treatment is performed for a given test result, entering “finished” in the “communication of report”

Table 1 Excerpt of a patient list in the follow-up
systemFollow-up is performed for anything classified as one of the four items shown in Table 2,
including “other parts,” “acute phase,” “infectious disease,” and “consultation day.” When areport contains information for “other sites”,
the information is entered into the patient list
and the interpretation is communicated in accordance with the follow-up system describedin section 3.1.1. When information is classified
as “acute phase” or “infectious disease,” the information is entered into the patient list andthe attending physician is contacted. When information is classified as “consultation day,”the information is entered into the patient list
and the department nurse is contacted.
3.2 Tracing survey

A tracing survey was conducted of the 6,252
CT scans and 2,673 MRI scans conducted at
our hospital from June 2012 to February 2014;
images from these scans were interpreted by
the remote diagnostic reading doctor. Electronic medical records were used to investigate thefollowing: ①number of items requiring follow-up, ②departments requesting radiologicaltests that required follow-up, ③items followed
up, and ④progress after follow-up.

Table 2 Information in the follow-up system

Arts and Sciences ◆ 79

4. Results
4.1 Number of items requiring follow-up

proximately 10% of all items followed up. In
CT, 1 case each of “infectious disease” and“consultation day” required follow-up.

Fig.2 shows the percentage of follow-up

items of all radiograph interpretations by theremote diagnostic reading doctor. A total of309 cases (CT: 274 cases, MRI: 35 cases) required follow-up, including 4% of all CT cases
and 1% of all MRI cases.
4.1.1 Departments requesting tests
Fig.3 shows the number of tests requiring

follow-up by the department that requested
the test. The department that requested themost CT tests requiring follow-up was internal
medicine/surgery, both approximately 30% of
all requests. The urology department submitted approximately 20% of requests that required follow-up. The department that requested the most MRI tests that required follow-up
was urology, which submitted approximately
half of all requests, followed by internal medicine/surgery, which submitted approximately
20% of all requests.
4.2 Items that required follow-up
Fig.4 shows a breakdown of the items thatwere followed up. For both CT and MRI, themost common item requiring follow-up was“other sites.” “Acute phase” accounted for ap-

Fig.2-1 The ratio in the CT

4.3 Progress after follow-up
Fig.5 shows the percentage of cases in which
follow-up treatment was administered of thetotal number of cases requiring follow-up;
treatment was performed for 87% of CT cases
and 74% of MRI cases.
Table 3 shows the interpretation results andthe treatments performed for cases in each follow-up item. Results of “acute phase” cases included an aneurysm increasing in size and indanger of rupturing. We informed the attending physician when the reports were returned.
For all acute phase cases, treatment on thescheduled consultation day was sufficient.
For the “infectious disease” case, the interpretation result was re-examination 3 months
later due to suspicion of tuberculosis or non-tuberculous mycobacterial infection. In this case,we again informed the attending physician
when the report was received; treatment on
the scheduled consultation day was sufficient.
In the “consultation day” case, CT was performed provide a detailed examination forhigh levels of carcinoembryonic antigen. We
interpretated the result as rectal cancer withsuspected invasion of the bladder. The case re-Fig.2-2 The ratio in the MRI

Fig.2 Percentage of cases that required follow-up, of all radiograph interpretations by theremote diagnostic reading doctor

80 ◆ Journal of JART English edition 2018material
A follow-up system of radiograph interpretation reports by the remote diagnostic reading doctor at our hospital

Fig.3-1 The details in the CT

Fig.3-2 The details in the MRI

Fig.3 Clinical departments that requested medical imaging tests

Fig.4-1 The details in the CT

Fig.4-2 The details in the MRI

Fig.4 Details of items requiring follow-up

Fig.5-1 The ratio in the CT

Fig.5-2 The ratio in the MRI

Fig.5 Percentage of recommended follow-up treatments that were administered

Table 3 Contents of follow-up treatment

Arts and Sciences ◆ 81

Fig.6-1 Details of “other parts” results of CT scans

Fig.6-2 Details of “other parts” results of MRI examinations

Fig.6 Details of “other parts” of CT and MRI results

quired follow-up, as the next scheduled examination was 2 months later. The date of theconsultation was moved forward, and treatment was initiated more than 1 month aheadof schedule.
For “other sites,” Fig.6 shows the distributionof the indicated sites. The number of cases foreach indicated site is divided into cases inwhich a detailed examination was conducted
and “malignancy” was consequently diagnosed,and cases in which “follow-up”, and cases inwhich “no detailed examination” was performed. The numbers at the top of each bar in
the graph represent the number of cases diagnosed as malignant.

5. Discussion
Our hospital initiated a system to follow upreports of radiographic interpretations andavoid delayed responses to reports received
from the remote diagnostic reading doctor. The
present study demonstrated that follow-up was
required for 4% of all CT scans and 1% of all
MRI scans for which radiographic interpretation by the remote diagnostic reading doctor
was requested. Follow-up was required for approximately 13 CT scans per month, which is afairly high number. Of all departments, the de-82 ◆ Journal of JART English edition 2018

partment of urology requested the second-highest number of tests that required follow-up in
CT, after the department of surgery, and thehighest number of tests requiring follow-up in
MRI. These results reflect the numbers of patients examined by each department and thecharacteristically high number of MRI scans requested by the department of urology at our
hospital.
More than 70% of cases requiring follow-up
received the necessary treatment; this result
suggests the importance of follow-up. In mostof the remaining nearly 30% of cases, the reasons follow-up treatment was not performed
included: follow-up treatment had alreadybeen performed at another hospital or department, treatment of another illness was a priority, or the patient did not wish to undergo adetailed examination or treatment.
When testing reveals super-acute findings,
the on-site diagnostic radiologist and the attending physician are contacted immediately
to administer the necessary treatment. In thepresent study, follow-up was required for 24“acute phase” cases and 1 “infectious disease”
case. Reading interpretation reports for follow-up is considered to help improve interpretation accuracy. In addition, effort should bemade to respond to acute findings in testing.

material
A follow-up system of radiograph interpretation reports by the remote diagnostic reading doctor at our hospital

As suitable follow-up enables early initiationof treatment and diagnosis of malignancy, we
believe our follow-up system has sufficiently
contributed to mitigation of the delays andoversights in the treatment of cases that require
follow-up. However, the following issues must
be addressed: 1) differences in standards forobjects of follow-up according to the radiological technologist who checks the radiographinterpretation and 2) standardization of thecontent to be followed up to prevent unnecessary increases in workload that result from relatively minor findings.

References
1） Japanese College of Radiology/Remote Diagnostic
Imaging Committee Working Group/ Japan Radiological Society Electronic Information Committee: Guidelines on remote diagnostic imaging. August 2009.
2） Ministry of Internal Affairs and Communications, Information and Communications Bureau, Regional
Communications Development Division: Telemedicine
model reference book. March 2011.
3） Ministry of Health, Labour and Welfare: Guidelines
on medical information system safety management.
March 2009.

Arts and Sciences ◆ 83

Arts and Sciences
the original work

The Employment Environment of RadiologicalTechnologists
Hiroe Muto1），2）, Kanae Matsuura1），2）, Satoshi Nakanishi1），2）
1）The Japan Society of Education for Radiological Technologists2）Dept. of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science

Key words: Starting salary, Demand and supply, Radiological Technologists, Job postings【Summary】

This study aimed to clarify the wage differences among Radiological Technologists (RTs) based on the type of
employment, payroll system, school career, area (prefecture), and other characteristics. The demand for RTs, especiallyfor female RTs, has been increasing steadily. However, the supply of RTs is increasing more rapidly because thenumber of schools providing RT education has increased substantially. It is clear that we should take this research
further in order to provide appropriate guidelines for the employment of RTs.

1. Background and purpose
Recently, there have been advancements inhealthcare, and many complications need tobe addressed. Additionally, there have beenchanges in the medical needs of the public.
Therefore, there have been attempts to enhance “team healthcare delivery” that is performed by various medical staffs who cooperate with and complement each other to maximally practice their specialty. As a result, thescope of work of radiological technologists(RTs) has also increased1), 2), 3), 4). RTs are being
educated in educational institutions such as afour-year university, which accounts for approximately 70% of all of institutions offeringsuch courses. Given that the establishment of
new schools for RTs has been promoted in recent years, a corresponding increase in thenumber of students who go to schools to become an RT is expected.
Meanwhile, one of the current problems is
the lack or uneven distribution of medical staff
across the country. The Japan Medical Association Committee has formulated measures5) tocorrect the lack or uneven distribution of physicians. The estimated number of nurses by84 ◆ Journal of JART English edition 20182025 is also expected to be insufficient according to a report6) presented in the conference
for the seventh projection of the estimated supply and demand of nursing personnel by the
Ministry of Health, Labour and Welfare (MHLW)
of Japan. The Japanese Nursing Association
continuously conducts surveys to understandthe supply and demand or the work situationof hospital nurses as well as to enable the retention of the nurses7). However, althoughsome reports on the supply and demand for
RTs have been presented8), 9), 10), 11), no studies
have focused on RTsʼ starting salary, conditionof female utilization, or educational background.
We therefore aimed to investigate the current
status of the supply and demand and working
conditions of RTs taking into account regional
differences, as well as discussing the prediction of the supply and demand for RTs, and thegeneral future prospects. We also discussed thechallenges to the realization of a stable supply
and demand of RTs and to improve the treatment of RTs.

the original work
The Employment Environment of Radiological Technologists

2. Subjects and methods
The present study was conducted on 707 job
postings that were sent from medical institutions to the Suzuka University of Medical Science from April 1, 2015 to March 31, 2016.
Two job postings were also sent from non-medical institutions, which were excluded from thepresent study.
The following 10 items were investigated:①receipt date of the job posting, ②location of
institution (prefecture), ③category of institution (hospital, clinic, or others [for medical
check-up]), ④employment pattern (full time,part time, fixed term, etc.), ⑤conditions of attempting the employment of women (women
only or preferred), ⑥restriction of applicationaccording to educational background, ⑦differentiated starting salary according to educational background, ⑧payroll system (monthly salary, annual salary, etc.), ⑨base salary, and⑩qualification allowance or extra allowance,
etc. (including the fixed amount of allowancegiven to those who have an RT license, excluding age-based salary, cold-district allowance,
district allowance, family allowance, home allowance, attendance bonus, commuting allowance, overtime compensation, night allowance,
holiday allowance, etc.).
The above results were analyzed to examine
the following aspects: ①employment overview, ②requirements for employment (enhanced utilization of women), ③requirements
for employment (educational background),④employment pattern, ⑤salary by payroll system, ⑥starting salary by educational background, and ⑦starting salary by region. Subsequently, we identified the number of examinees taking the national examination for RTs
from fiscal year 2006 to 2015, as well as thepass rate, to support the discussion on the supply and demand for RTs. Based on the findings, the outcomes of various statistical surveys
conducted by the MHLW, the Ministry of Internal Affairs and Communications, or the profes-

sional associations of physicians, nurses, andothers were examined. In addition, during theperiod of the present study, opinions were exchanged with managerial or female RTs working in medical institutions. The results of thisstudy were reported in the 32nd Japan Conference of Radiological Technologists (academic
conference of the Japan Society for the Education of Radiological Technologists), where
views were exchanged with the conference
participants.
Facilities which did not clearly state parts of
the items, such as their starting salary or requirements for employment, were excluded
from each analysis.
Statistical processing was performed using
IBM SPSS Statistics Ver.22, which included basic descriptive statistics, a homogeneity analysis, the Mann-Whitney U test, and the
Kruskal-Wallis test.

3. Results
3-1 The conditions of the demand for RTs
3-1-1 Number of job recruitments

The number of monthly job recruitments infiscal year 2015 has been shown in Fig.1. In
April, 32 job postings were sent, and they increased thereafter, peaking at 113 in July. The
number started to decrease from August andremained in the 50s to 60s from September toDecember, again decreasing to less than 50 af-

Fig.1 Total number of job postings/month
Arts and Sciences ◆ 85

Fig.2 Number of entities of job postings

ter January. As illustrated in Fig.1, a line graph(thin solid line) was added to represent the
number that excluded the overlapping of job
recruitment caused by obvious “additional recruitments.” The graph added then revealed
that the job postings increased owing to theadditional recruitments in the latter half of theyear. After the exclusion of the overlaps, thetotal number of job recruitments was 609. The
dashed line shown in the figure represents thenumber of monthly job openings in fiscal year
2011 and 2013 according to the report by
Muto8). Since previous studies did not include
the data for the last 2 months of these fiscal
years, the data for both years could not becompared. However, the total number of job
openings was larger in 2015 than in 2011, with
the increased job openings in 2015 noted from
April to August.
The job postings sent were then categorized
by prefecture, as shown in Fig.2. In the present
study, job postings were sent from all 47 prefectures in Japan, and they could be includedin the analysis. Many of them were sent fromthe Tokai and Kinki regions, or the areas
around Tokyo, but some postings were also
received from the Hokkaido, Kanagawa, Hiro-86 ◆ Journal of JART English edition 2018

shima, and Fukuoka prefectures, which contain the metropolitan areas with a large population.
3-1-2 Promotion of attempts to employ women

The job postings were checked for descriptions such as “recruitment of women” or “enhanced utilization of women.” The results
showed that only 36 facilities (5.9%) specified
their conditions for the enhancement of female
RT utilization, such as “women are preferred toaddress the mammography service” or “womencandidates preferred.” Other 573 facilities(94.1%) described no specific conditions.
3-1-3 Requirements for employment based on
educational background and payroll system

Since approximately 70% of the 45 training
schools for RTs are universities as of 2016 (excluding the Institute of Medical Radiology
Technologists at the Japan Self-Defense Forces
Central Hospital), most new RTs had a university degree. The job postings were checked for
restrictions on employment and differentiationof the payroll system by educational background. A total of 64 facilities (10.5%) statedthe original work
The Employment Environment of Radiological Technologiststhat students with a bachelorʼs degree (hereafter, referred to as bachelorʼs graduates) or
higher education were eligible to apply, and 2of them (0.3%) specified the distinction of the
payroll system between bachelorʼs and masterʼs graduates. Further, 239 facilities (39.2%)
did not differentiate their requirements for employment but they specified the differentiationof their payroll system by educational background. Finally, 306 (50.2%) facilities specified
no particular differentiation.
According to the type of facility (hospital,
clinic, others [for medical check-up]), 60(11.2%) of the 290 hospitals (54.3%) specified
that they wished to employ students with abachelorʼs degree or higher education, and 230
hospitals (43.0%) specified the distinction of
the base salary. Meanwhile, most of the clinics(30 [88.2%]) and health check facilities (32[78.0%]) did not differentiate the employment
requirements or salary package.

who were particularly employed in facilities
such as university or prefectural hospitals.
3-2 Conditions of the supply of RTs (the numberof examinees and pass rate for the national

The employment pattern of RTs included
permanent full-time staff (579 facilities [95.7%]),
fixed-term staff (20 [3.3%]), and part-time staff(10 [1.6%]). This indicates that more than 95%
of RTs were currently employed as permanent
full-time staff. However, approximately 5%
were employed as fixed-term or part-time staff,

examination for RTs)
To discuss the conditions of RT supply, thechanges in the number of examinees appearing for the national examination for RTs after
fiscal year 200612) was examined (Fig.3). In
2006, the number of examinees was 2,821,
which decreased to the 2,400s during 2007 to
2012. Due to the establishment of new training
institutions for RTs, in 2013, the number increased by approximately 500, to 2,907, and it
crossed 3,000 in 2015. In addition, if the increase in the number of examinees would beequivalent to the student quota of these new
institutions (2 schools were established in 2013
and 2 in 2014) in 2016 and 2017, the number
would have increased by more than 100 eachyear. Thus, 3,236 and 3,346 examinees are expected to take the examination in 2016 and2017, respectively, indicating an approximately
1.3 times larger number of examinees than that
10 years ago.
The pass rates of the national examination
for RTs after fiscal year 2006 have been illustrated in Fig.4. Though the rate varied depending on each yearʼs examination in the last 10
years, it remained 75% on an average. Thus, if

Fig.3 Number of examinees

Fig.4 Pass rate for RT national examination

3-1-4 Employment pattern (full time, fixed term,part time, etc.)

Arts and Sciences ◆ 87

the rate would remain at similar percentages,
the number of those who obtain an RT license
is estimated to increase in proportion to theincrease in the number of examinees.
3-3 Conditions of treatment of RTs
3-3-1 Salaries by payroll system (base salary,starting salary)

Among the 609 facilities investigated, 585(96.0%) stated their salary on the job posting.
The payroll system for RTs in those facilities
included monthly salary (576 facilities [98.5%]),annual salary (3 [0.5%]), and daily salary (6[1.0%]). The facilities adopting a daily payroll
system were recruiting part-time staff or fixedterm full-time staff. Subsequent analyses were
performed on the facilities adopting a monthly
payroll system.
A comparison of base salaries by payroll system (excluding qualification allowance or extra
allowance) has been presented in Table 1. In
the case of facilities offering different salaries
according to educational background, the salary for bachelorʼs graduates was utilized for the
analysis.
The base salary in the facilities adopting a

Table 1 Base salary for new graduates by the
payroll system for 2015 versus that for2013

monthly payroll system was 188,934 yen on anaverage, the median was 187,075 yen, the minimum was 100,000 yen, and the maximum was
280,000 yen. The base salary in the facilities
adopting a daily payroll system was 8,780 yen
on an average, the median was 8,807 yen, theminimum was 7,804 yen, and the maximum
was 9,600 yen. The base salary in those adopting an annual payroll system was 3,521,393
yen on an average, the median was 3,564,180
yen, the minimum was 3,400,000 yen, and the
maximum was 3,600,000 yen. The base salaryin facilities adopting the monthly payroll system in the present study was lower than thatreported in the 2013 survey results8) by 0.05%
on an average and by 0.7% according to themedian, with no statistically significant differences.
The starting salary calculated by the additionof extra allowance to the base salary has beenshown in Table 2. The starting salary in the facilities adopting a monthly payroll system was
201,602 yen on an average, the median was
198,330 yen, the minimum was 108,300 yen,and the maximum was 301,600 yen. The starting salary in the daily and annual payroll systems was the same as the base salary. The
starting salary in the monthly payroll system inthe present study was lower than that reported
in the 2013 survey results8) by 0.3% on an average and by 0.5% according to the median, withno statistically significant differences.
3-3-2 Salaries by educational background (starting salary)
A comparison of the starting salary by educa-

Table 2 Starting salary for new graduates by the
payroll system for 2015 versus that for2013

88 ◆ Journal of JART English edition 2018

Table 3 Differences in starting salary for new
graduates by degreethe original work
The Employment Environment of Radiological Technologists

tional background has been shown in Table 3.
The starting salary for 64 facilities that stated in
the requirements for application that theywould employ students with a bachelorʼs degree or higher education was 204,635 yen on
an average, the median was 204,066 yen, theminimum was 175,000 yen, and the maximum
was 245,400 yen. Among these facilities, 2
specified a differentiation in the starting salary
for masterʼs graduates, with an average salaryof 213,270 yen. For the 239 facilities that did
not specify the educational background for application but differentiated the starting salary
based on educational status, the starting salary
for bachelorʼs graduates was 195,959 yen on anaverage, the median was 194,200 yen, the minimum was 108,300 yen, and the maximum was
268,900 yen. The starting salary for professional school graduates was 186,503 yen on an average, the median was 184,500 yen, the minimum was 161,400 yen, and the maximum was
231,300 yen. Among these facilities, 14 described the starting salary for masterʼs graduate,
offering 208,006 yen on an average, with a median of 204,250 yen, a minimum of 191,300
yen, and a maximum of 232,800 yen. For facilities which did not particularly limit recruitment or differentiate the base salary according
to educational background, the starting salarywas 205,829 yen on an average, the medianwas 202,176 yen, the minimum was 140,000
yen, and the maximum was 301,600 yen.
In terms of statistical analysis, there was little
data on masterʼs graduates; therefore, they
were excluded from the analysis.
The results indicated that the starting salaryfor professional school graduates in facilities
differentiating the payroll system by educational status was lower than that in any othergroups (P < 0.05). The starting salary for bachelorʼs graduates in the group of facilities differentiating the payroll system according to education was lower than that in the group of facilities that required a bachelorʼs degree forapplication or those which made no differenti-

ation (P < 0.05). The facilities with different payroll systems for bachelorʼs graduates and professional school graduates differentiated thebase salary for both graduate groups, with alower starting salary for professional school
graduates than for bachelorʼs graduates.
3-3-3 Salaries by prefecture (base salary, startingsalary)The starting salary for newly graduated RTs
by prefecture has been shown in Fig.5 and Table 4. In addition to the average starting salaryfor each of the 47 prefectures, the ones in facilities employing graduates in wide-area blocks,
such as National Hospital Organization, as wellas the national average, have been presented.
For the calculation of the average starting salary in “facilities offering a different salary forbachelorʼs graduates,” the starting salary for

Table 4 Summary of the starting salary differenceby area

Arts and Sciences ◆ 89

Fig.5 Summary of the starting salary difference by area

Fig.6 Summary of the starting salary difference by area

bachelorʼs graduates was used. Facilities withan annual or a daily payroll system were excluded from the analysis. The bar graphs in
Fig.5 represent the starting salary calculated byadding qualification allowance and extra allowance to the base salary.
The names of the prefectures have been pre-90 ◆ Journal of JART English edition 2018

sented in Japanese, with the prefecture identification numbers defined by ISO 3166-2: JP (inthis report, the wide-area blocks and the national average are 00 and JP, respectively).
In addition, the starting salary for RTs in thepresent study have been presented in Table 4
and Fig.6, along with the survey results of the

the original work
The Employment Environment of Radiological Technologists

starting salary for the job types (medical andwelfare professions [excluding physician andnurse]) reported in “the 2015 Basic Survey on
Wage Structure (starting salary)13) ” conductedby the MHLW (hereafter, referred to as the2015 MHLW Wage Survey [medical and welfare]). The Basic Survey on Wage Structure isconducted annually to reveal the actual wages
by the employment pattern of workers in the
major industries nationwide. The starting salary
reported by the Basic Survey on Wage Structure is calculated by subtracting commuting allowance from a given salary (consisting of basesalary and other allowances without overtime
compensation) for new graduates completing
regular duties, representing the addition of thevarious allowances to the results of the present
research.
The base salary for newly graduated RTs byprefecture in this investigation ranged from
174,803 yen to 204,200 yen, with a differenceof approximately 29,000 yen (prefectures with
5 or less job postings that met the requirements
were excluded). The starting salary ranged
from 184,489 yen to 209,520 yen, showing a
difference of approximately 25,000 yen by prefecture. For 47 prefectures, the starting salaryof newly graduated RTs below the national average is represented by the shaded area in
Fig.4. Further, 19 prefectures had a starting salary above the national average.
The starting salary in the results of the 2015
MHLW Wage Survey (medical and welfare)
was 199,000 on an average, ranging from
160,000 yen to 220,100 yen, with a maximum
difference of 60,100 yen12). According to the2015 MHLW Wage Survey, the starting salary
exceeded the national average only in 14 prefectures.
A comparison of the starting salary in eachprefecture between RTs and the results of the2015 MHLW Wage Survey (medical and welfare) revealed a higher starting salary for RTs inas many as 35 prefectures as compared to theresults of the MHLW survey.

4. Discussion
The Vital Statistics reported by the MHLW14)
revealed that the population aged 80 years orolder would increase by 4.9 million (by 60%)
from 8.2 million in 2010 to 13.1 million in 2030.
According to the 2016 Annual Report on the
Aging Society by the Cabinet Office of Japan15),
the rate of the elderly aged 65 years or older
who had any complaints (the number of those
who had any subjective symptoms of diseaseor injury in the latest days per 1,000 population[excluding inpatients]) was 466.1 in 2013, representing nearly half of the people complaining of any subjective symptoms. Further, 258.2
individualsʼ disease or injury affected their daily life, which accounted for almost a half of
those complaining of any subjective symptoms.
In this period of total population decline, therate of population aging is increasing, with theelderly population having reached 33.92 million in 2015 and expected to peak at 38.78 million in 2042. That is to say, the demand for
healthcare professionals, including nurses who
support the elderly aged 80 years or older
prone to disease or injury, is expected to increase in the coming 20 years.
The number of job postings examined in thecurrent study will be compared to those included in a 2011 study. The last 2 months infiscal year 2011 were not investigated and were
excluded from this comparison. The job postings of the same period were compared, andthey demonstrated an increase by 20.8% from527 job postings in 2011 to 637 in 2015. In addition, the job postings were sent from the beginning of fiscal year 2015, with 95% of themintending to recruit RTs as permanent full-time
staff. This indicates a steady demand for RTs asof the time of this report. Meanwhile, 5% of the
facilities were recruiting RTs as fixed-term orpart-time staff. This suggests that despite thedemand for RTs, detailed and continuous investigation will be needed hereafter on thesetypes of employment patterns, taking into acArts and Sciences ◆ 91

count the possibilities of influences of the financial condition of hospitals or changes instrategy for treating RTs. Subsequently, we examined if the facilities stated the employment
requirements and differentiated the payroll
system by educational background. The results
showed that 10% of the facilities specified therequirements for recruitment and they preferred graduates with a bachelorʼs degree orhigher education, and 40% of them introduced
a payroll system according to educational status. Further, 3% of the facilities set a startingsalary for masterʼs graduates in their payroll
systems. These findings suggest that the demand for newly graduated RTs with higher education could increase in the future.
The present study revealed that only 6% of
all the facilities specified the enhanced utilization of female RTs in the requirements for application in the job postings. The rate was almost the same as the results8) we previously
reported. The MHLW recommends that, in thepresence of different treatment of female andmale workers, such as few women at a workplace or the majority of management positions
being occupied by men, the workplace should
engage in “positive action”. This entails the implementation of active measures necessary torealize equal treatment between men andwomen, and specifically, for example, it is performed by adding a message from senior female RTs in job postings or recruiting female
RTs. Additionally, despite the absence of discriminatory treatment between men and women in their in-company systems, some workplaces could be facing problems such as “having few women in the occupational field,” “little increase in female managers,” and thus,achieving “insufficient utilization of femalesʼ
capabilities.” In such cases, “positive action”
appears to be necessary to realize the equal
treatment of men and women, and clearly stating that it does not violate the Equal Employment Opportunity Law8), 16). During the present
study period, we had opportunities to ex-

92 ◆ Journal of JART English edition 2018change views with persons in charge of medical institutions that were recruiting employees.
On multiple occasions, we heard them commenting that they did not know about the“positive action” of their institution, and assumed that they must not specify the recruitment of women in job postings. We obtained
similar comments when we reported the results of this study in the 32nd Japan Conferenceof Radiological Technologists (academic conference of the Japan Society for the Educationof Radiological Technologists) and exchanged
opinions with the conference participants. Although they provided free comments verbally,
it was inferred that employees in actual workplaces might not be currently kept informed
about the companyʼs “positive action”. Considering the high demand for RTs at the time ofthe present study, facilities lacking female RTs
are particularly recommended to promote“positive action” in recruitment, which would
enable employers to understand the exact demands of the position and to prevent a mismatch with applicants.
As an investigation of supply and demandfor RTs, the conditions of treating RTs wereanalyzed according to their starting salary. A
field survey of RTsʼ salary was also conductedby the Japan Association of Radiological Technologists, and the results allow for the trackingof annual changes in salary, representing valuable data to examine the balance of supply
and demand for RTs, as well as to understandits background conditions related to the medical economy in Japan8), 17). In the present study,
educational background and female utilization
were added to the analysis, to investigate thesupply and demand for RTs and to discuss thechallenges to the improvement of the treatment of RTs.
The average starting salary of newly graduated RTs was as follows: 204,635 yen for bachelorʼs graduates in facilities recruiting only graduates with bachelorʼs degree or higher education, 195,959 yen for bachelorʼs graduates andthe original work
The Employment Environment of Radiological Technologists

186,503 yen for professional school graduates
in facilities differentiating their payroll systemby educational background, and 205,829 yen
for bachelorʼs graduates in facilities not differentiating their payroll system by education.
The starting salary reported in the 2015 MHLWWage Survey (medical and welfare) was
199,000 yen, which is lower than the presentsalary of RTs, which indicates that they currently receive relatively favorable treatment.
However, the starting salary in the 2015
MHLW Wage Survey (medical and welfare)
was higher than that reported in a similar survey conducted in 2013. Specifically, it was
higher by 3.2% for bachelorʼs graduates (addition of female and male salaries) and by 2.7%
for junior college and professional school
graduates. Meanwhile, the starting salary for
RTs in 2015 was higher than that in 2013 by
0.3% (addition of the results for all educational
statuses) and by 0.9% in facilities not differentiating their payroll system and employment
requirements by educational status, and lower
by 4.8% in facilities recruiting only graduateswith bachelorʼs degree or higher education.
These results imply almost no changes in thestarting salary of newly graduated RTs as awhole, as compared with the increases in thestarting salary of other healthcare personnel. In
terms of the current conditions of other kindsof occupations, a survey of the supply and demand for hospital nurses was conducted by
the Japanese Nursing Association. The resultsof the survey similarly reported that the startingsalary for newly graduated nurses had undergone little change in the past 5 years, and thatthe salary for nurses might not reflect the increased salary resulting from medical fee revisions7). These findings emphasized the needfor paying attention to future changes in thepolicy for the treatment of nurses, including
the issue of salary.
The regional supply and demand for RTs
was analyzed in terms of starting salary, whichshowed regional differences in the starting sal-ary by approximately 25,000 yen. The startingsalary for RTs in each prefecture were compared to the results of the 2015 MHLW Wage
Survey (bachelorʼs graduates), which revealed
that the present figures exceeded those reported in the 2015 MHLW Wage Survey (medical
and welfare) in as many as 35 prefectures. This
may indicate a strong demand and favorable
treatment of RTs at the time of this report, particularly in rural prefectures.
As far as the supply of RTs is concerned, thenumber of examinees taking the national examination for RTs had remained approximately
2,500 until 5 years ago, but it has been increasing significantly in recent years. The pass rate
for this examination has been around 75%, andif the rate remains at similar levels in the future, the number of newly licensed RTs is expected to increase to over 2,500 in fiscal year
2017, while it remained about 1,800 from 2007
to 2012. That is to say, the number of RTs supplied would increase on a short-term basis andit is expected to decrease in the long term dueto the declining birth rate of the country.
As the environment for healthcare professionals becomes harsher, Kodama et al.9), predicted a future decrease in the demand for RTs.
Shibuya also pointed out that the starting salary for RTs was lower than that for nurses, andless than 50% of the facilities differentiatedtheir starting salary based on educational background. He thus expressed concern that talented personnel might be no longer supplied toreal medical settings in the future unless thecurrent conditions were improved immediately10), 11). The results of the current study showedthat 10% of the facilities required newly graduated RTs to have completed a bachelorʼs degree or higher education, and 40% of them offered a starting salary that differed according to
educational background. Further, 3% of the
facilities differentiated the starting salary formasterʼs graduates. However, the treatment ofbachelorʼs graduates is still suboptimal, and it
needs to be improved.
Arts and Sciences ◆ 93

In order to ensure stable supply and demand, promotion of “positive action” is indispensable as womenʼs medical radiology technologists increase.In addition to efforts to prevent mismatches at the time of employment, inorder to continue employment while raisingchildren and care, we introduced measures
such as short-time work regular employee system, efforts towards working hours management, by taking measures to deal with diverse
ways of working, it will lead to the stable supply and demand of RTs. These measures would
allow employees with children or those involved in caregiving to continuously work at
the same workplace. This would simultaneously facilitate the provision of safe and securehigh-quality medical care. To ensure a stablesupply and demand for RTs in the future, thedemand (medical institutions) and supply(training institutions) institutions need to cooperate to appropriately improve information
sharing about employment conditions. In addition, given that Japan is set to face a population decline hereafter, it is necessary to promote measures to retain RTs by cooperating
widely with the central government; local governments; and founders of hospitals, clinics,
and healthcare centers.
The long-term estimation of the future supply and demand for RTs is considered uncertain and it may vary depending on the social
situations of the time, such as government policies or business conditions. If the healthcaredelivery system largely changes hereafter, thenew prospects of the supply and demand for
RTs will need to be discussed. The results ofthe present study can be used as reference materials for discussions on future retention of
RTs.
Additionally, in future, a more accurate prospect of the supply and demand should be formulated, and for this purpose, it is necessary tocreate methods to understand the actual de-

94 ◆ Journal of JART English edition 2018mand for RTs. For example, it would be appropriate to conduct a nationwide survey of chief
RTs on the turnover rate of full-time or newly
graduated staff, starting salary for newly graduated employees, salary for staff with an experience of 10 years, the retirement system or theextension of the retirement system, and the status of introducing a continuous employment
system. We propose that similar surveys on the
supply and demand for RTs be conducted regularly by the Japan Association of RadiologicalTechnologists, in cooperation with the Japan
Society of Education for Radiological Technologists.
This work was supported by a contract research grant for the fiscal year of 2015, awarded by the Japan Association of RadiologicalTechnologists to the Japan Society of Education for Radiological Technologists. The results
reported are the outcome of the contract study
titled “Employment environment of Radiological Technologists.”

5. Conclusion
This study revealed the current conditions ofdemand for RTs and analyzed the situation of
RTs in specific regions. The level of demandand salary for RTs seemed to remain steady at
the time of this report. Further, it was observedthat despite the demand for female RTs, theneed was not met sufficiently. The supply of
RTs has been estimated to increase on a shortterm basis. To realize a stable supply and demand for RTs in the future, it is necessary to
promote the “positive action” in recruitment aswell as to provide support to allow RTs towork continuously at their current workplaceor to have an opportunity to be employedagain. Additionally, surveys on the conditionsof supply and demand or treatment of RTs, including the issue of salary, need to be conducted continuously hereafter.

the original work
The Employment Environment of Radiological Technologists

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Arts and Sciences ◆ 95

Journal of JART–English edition 2018–

March 1, 2018
Issuer: Yasuo Nakazawa
Publisher: The Japan Association of Radiological Technologists
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・Published by The Japan Association of Radiological Technologists.
Ⓒ2018, Printed in Japan.

The Japan Association of Radiological Technologists
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