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Professional Practice
Practice Standards, Glossary & Advisory Opinion Statements

The ASRT Practice Standards for Medical Imaging and Radiation Therapy define the practice and establish general and specific criteria to determine compliance. The document includes a number of professional practice resources.

Practice standards are authoritative statements established by the profession for judging the quality of practice, service and education. Professional practice constantly changes as a result of a number of factors including technological advances, market and economic forces, and statutory and regulatory mandates.

Scopes of practice delineate the parameters of practice, identify the boundaries for practice and typically are formatted as lists of tasks that are appropriate to include as part of the work of an individual who is educationally prepared and clinically competent for that profession.

Each scope of practice is limited to that which the law allows for specific education, experience and demonstrated competency. Many states have laws, licensing bodies and regulations that describe requirements for education and training and define scopes of practice for professions.

Advisory opinion statements are interpretations of the practice standards. They are intended for clarification and guidance for specific practice issues.

These statements allow the organization to address practice specific issues that are not addressed in practice standards or scopes of practice. An example of an issue requiring an advisory opinion statement was the administration of medications by medical imaging and radiation therapy professionals.

Even though the practice standards indicate that administering medications is within the scope of practice for individuals who are educationally prepared and clinically competent, when the task is performed, it is often questioned. The decision was made to provide an opinion statement with evidentiary documentation that supports the performance of this task. The strength of the documentation is indicated by the GRADE assigned to it (see below).

For all medical imaging and radiation therapy professionals, aspects of professional practice can vary throughout the United States. Community custom, state statute or regulation may dictate local practice parameters. Wherever there is a conflict between these standards and state or local statutes and regulations, the state or local statutes and regulations supersede these standards. Recognizing this, the profession has adopted standards that are purposely broad in nature.

Practice standards and scopes of practice can be the documents that states, institutions and legal advisors use when questions arise about the practice of specific professionals.

Take a look at this 10 minute video that will give you an overview of the standards.

Grading of Recommendations Assessment, Development and Evaluation (GRADE)

The ASRT recognizes the use of Grading of Recommendations Assessment, Development and Evaluation (GRADE) for measuring the quality of evidence and strength in recommendations for the development of advisory opinion statements and significant changes to scopes of practice for medical imaging and radiation therapy professionals.

The use of a standardized method for grading the quality of evidence and strength of recommendation assists in minimizing bias and ensuring that recommendations made by the Practice Standards Council are based on review of adequate and appropriate evidentiary documentation.

  • Quality of Evidence

    For the purposes of recommendations made by the ASRT Practice Standards Council, the definition of “quality of evidence” is confidence in the quantity and quality of evidentiary documentation used to make a recommendation.

    The GRADE working group provided the following guidance in assigning a measure of quality in evidence for decisions and/or opinions on provision of healthcare. The following guidance, as adapted from GRADE Working Group, should be used by the Practice Standards Council in assigning a measure of quality in evidence for all resources used in formulating advisory opinion statements:

    High = further research is very unlikely to change our confidence in the estimate of effect;

    Moderate = further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate;

    Low = further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate;

    Very low = any estimate of effect is very uncertain.1


    Strength of Recommendation

    For the purposes of recommendations made by the ASRT Practice Standards Council, the definition of “strength in recommendation” is recommendations to perform, or not perform, a task, should be based on the tradeoffs between benefits on the one hand, and risks, burden and, potentially, costs on the other as supported by evidentiary documentation such as current literature, curriculum, position statements, scopes of practice, laws and federal and state regulations. If benefits outweigh risks and burden as supported by evidentiary documentation, the Practice Standards Council will recommend that medical imaging and radiation therapy professionals are qualified to perform a task. The uncertainty associated with the tradeoff between the benefits and risks and burdens, as supported by evidentiary documentation, will determine the “strength of recommendations”.

    The GRADE working group provided the following guidance in assigning a strength of recommendation for decisions and/or opinions on provision of healthcare. The following guidance, as adapted from GRADE Working Group, should be used by the Practice Standards Council in assigning a strength of recommendation for all advisory opinions:

    Strong = Based on the available evidence, if the Practice Standards Council is very certain that benefits do, or do not, outweigh risks and burdens they will make a strong recommendation.

    Weak = Based on the available evidence, if the Practice Standards Council believes that benefits and risks and burdens are finely balanced, or appreciable uncertainty exists about the magnitude of benefits and risks, they must offer a weak recommendation. When, across the range of potential scenarios in which the task will be performed, fully informed medical imaging or radiation therapy professionals or the institutions these professional work for are liable to make different choices, the Practice Standards Council should offer weak recommendations. 1

    Grading under any system is complex, and the Practice Standards Program manager has taken measures to learn the GRADE process and to help with this process. Although we do not expect you to grade recommendations yourselves, we expect that you will need to interact with the Practice Standards Program manager to work through questions that arise about the appropriate grades for the recommendations made by the Practice Standards Council.

    As you work with the Practice Standards Program Manager on grading, please keep the following in mind:

    1. The Practice Standards Council should always make a recommendation about the issue brought forward. Just as a consultant’s note would never conclude “given the lack of data from trials I can make no recommendation about how to treat this patient” similarly the Practice Standards Council should never fail to make a recommendation just because there is no high quality evidence. As a knowledgeable author of the topic, you have more expertise on which to base such a decision than the reader.
    2. A weak recommendation is still a recommendation. If there is concern whether a recommendation should be strong or weak, it is better to err on the side of making it a weak recommendation.
    3. Grade High quality in evidence will be uncommon for most things the Practice Standards Council recommends. Observational evidence is nearly always grade very low unless the estimates of effect are very large. For instance, if a recommendation is made based on the practice at one facility in one state, it should be given a grade very low for quality in evidence.

    References:

    1. GRADE working group FAQs. 2009. Available at gradeworkinggroup.org
    2. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations BMJ 2008;336:924-926 (26 April). Available at http://www.bmj.com/cgi/content/full/336/7650/924

The ASRT Practice Standards for Medical Imaging and Radiation Therapy define the practice and establish general and specific criteria to determine compliance. Practice standards are authoritative statements established by the profession for judging the quality of practice, service and education. Professional practice constantly changes as a result of a number of factors including technological advances, market and economic forces, and statutory and regulatory mandates.

For all medical imaging and radiation therapy professionals, aspects of professional practice can vary throughout the United States. Community custom, state statute or regulation may dictate local practice parameters. Wherever there is a conflict between these standards and state or local statutes and regulations, the state or local statutes and regulations supersede these standards. Recognizing this, the profession has adopted standards that are purposely broad in nature.

Practice standards and scopes of practice can be the documents that states, institutions and legal advisors use when questions arise about the practice of specific professionals.

Scopes of Practice


Scopes of practice delineate the parameters of practice, identify the boundaries for practice and typically are formatted as lists of tasks that are appropriate to include as part of the work of an individual who is educationally prepared and clinically competent for that profession.

Each scope of practice is limited to that which the law allows for specific education, experience and demonstrated competency. Many states have laws, licensing bodies and regulations that describe requirements for education and training and define scopes of practice for professions.

It is important to note that even though scopes of practice are often lists of tasks, they should be worded broadly. A scope of practice may include the statement: Starting and maintaining intravenous (IV) access. This is a broad statement and does not say how to do the task or which devices to use. Those specifics may be determined by the institutional policy and may vary from facility to facility.

If the ASRT House of Delegates decides there is a need for further clarification about a specific type of IV access, then an advisory opinion statement can be developed.

Glossary

An alphabetical list of terms or words specifically found in the ASRT Practice Standards; with a definition. The terms or words have meaning that is not general knowledge.

The definition is formulated using evidentiary documentation and put into place following extensive review and subsequent approval.

Glossary