Idaho is one of just six states with no training or certification requirements for those who run X-rays on medical patients, from simple pictures to CT scans and other complicated imagery.
Yet legislation introduced this year to start licensing those technicians in the state is languishing in the Idaho Senate, where it hasn't received a hearing.
"In Idaho, the people that are using radiation don't have to go to school," says Mike Gurr, chairman of the Idaho Society of Radiologic Technologists. "And that's scary when you realize what we do for the medical community."
All of Idaho's neighboring states have standards for X-ray techs or radiologic technologists. Typically, an associate's degree level of training is required. The only states that lack any rules, other than Idaho, are Alabama, Alaska, Missouri, South Dakota and North Carolina.
Washington has a separate category for those who take only the simplest X-rays under a professional's supervision. They need only register, and have no training requirements. Other states typically refer to those as "limited scope" practitioners. But Idaho makes no distinction and requires no training for any level of practice.
Gurr says patients could be endangered if a technician doesn't position them and shield them properly, or administers too large a dose of radiation. Plus, he says, "An X-ray that's done improperly won't show a fracture, it won't show a blood clot, it won't show a tiny tumor - it won't show a big tumor if it's done poorly. When that happens, you have delay in treatment, you have additional injury in suffering, and you have a huge increase in the cost in treating someone."
Gurr's association worked with Sen. Lee Heider, R-Twin Falls, chairman of the Senate Health and Welfare Committee, to introduce a licensing bill this year, SB 1115.
But Heider says, "I don't think it's going to come out this year. We've received a lot of information on both sides of that issue."
Heider says he's open to taking up a version of the bill in his committee next year, particularly if those on all sides of the issue can get together and work out their differences. "The radiologists like it, the hospitals seem to like it," he says. "The people that don't like it are the rural communities that don't have the facilities or the people."
Steve Millard, president of the Idaho Hospital Association, says, "We've vetted it among our members, and there are some supporting it, some saying it needs to be fixed before we could support it. The local doctor's offices, they're not taking complicated X-rays, and they can't afford a registered technician - they're fairly scarce and expensive."
Millard says his group hopes to work with the radiologists and the Idaho Medical Association over the summer on a new version of the bill that would better fit Idaho, perhaps aligning the training requirements with courses currently offered at Idaho colleges like Lewis-Clark State College and the College of Southern Idaho. He also wants to see a stronger grandfather clause to let existing, experienced operators continue working.
The bill as is, he says, is "way too prescriptive - it even requires the state to develop its own exam, and there's a national exam that most states use."
Gurr says Idaho's X-ray techs have long pushed for licensing and standards. "We've actually been proposing bills off and on since I believe 1992," he says.
In Idaho, 50 percent of all facilities that have registered X-ray machines don't exclusively use trained or certified X-ray techs, Gurr says. "In other words, some of 'em may have a couple of X-ray techs on board. Most of them have none, because they're small facilities."
He says he's particularly concerned about the proliferation of small outpatient surgery centers, and a lack of trained technicians at those facilities.
Rep. John Rusche, D-Lewiston, a retired pediatrician, says it "makes sense to me" to require training for X-ray techs. "The fact is that you do get bad-quality scans and you could have radiation exposure," he says. But he added, "You'll have people that are concerned about the fact that there are not enough of these trained technicians, and they're more costly than your average high school-trained office assistant."
Says Rusche, "You wouldn't want to make it so that small practices, particularly in rural areas, wouldn't be able to have imaging."
Ken McClure, lobbyist for the Idaho Medical Association, says in some small, rural practices, there may not be either enough work or enough money to employ a certified technologist. "To take six films a day, or a week even, it doesn't make sense in a very small setting," he says.
Millard says he's hopeful that in the coming months, the hospitals and medical association can "get together with the rad techs and try and craft something that we can all live with."