The frontier of medical imaging and radiotherapy

By Nisshanthan Dhanapalan

As a prominent yet understated profession in the allied medical field, radiography has made huge contributions in the development of imaging techniques, the diagnosis of diseases and treatment of cancer.

What are radiographers?

Radiographers are often confused for radiologists who are medical doctors that specialise in diagnosing and treating diseases and injuries based on images produced by medical imaging technology.

On the other hand, radiographers are allied health professionals and they can be generalised into two categories: diagnostic radiographers and therapeutic radiographers.

Diagnostic radiographers or medical imaging technologists, use medical imaging technology to produce images such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), ultrasound and others. They then acquire the images and pass them to a radiologist for interpretation and diagnosis.

On the other hand, therapeutic radiographers or known as radiation therapists, use a wide range of therapeutic and cancer therapy equipment to plan and deliver accurate radiation for treatment of tumours and cancers. Oncologists and medical physicists work closely with therapeutic radiographers to provide treatment and cancer care.

Chan Lai Kuan, honorary advisor for the Malaysian Society of Radiographers and lecturer at University Malaya says that radiography is an integral aspect of medical healthcare and is the backbone to the field of medicine.

“Both diagnostic and therapeutic radiographers provide essential services every year to millions of people. Without detailed and high quality images, physicians will be lost and have significant difficulty in diagnosing what is happening within the human body. Treatment will not be as effective and valuable time will be lost,” she says.

“In addition, with the increasing number of reported cancer cases, therapeutic radiographers are required to plan course versus cost of treatment and delivery as well as the daily care and support to the patient,” she adds.

Both the public and private medical sectors need radiographers. Radiographers who have just completed their undergraduate studies can apply for a job through the Ministry of Health who will then decide on their postings to public hospitals and clinics.

In the private sector, radiographers may be required to undergo further training upon hire as they will have a wider range of duties they are required to perform.

“Radiographers can also diversify into other fields which is still related to health. For example, you can be sales representative in a medical devices company, health insurance company and much more,” says Chan.

There are many myths and misconceptions regarding the field and profession of radiography. Radiographers are often mistaken as administrative staff, nurses or attendants but radiographers have their own department with their own hierarchy -- a separate division from both the administrative and medical staff.

Another myth in radiography is that it is a highly dangerous job due to concerns of radiation exposure from X-ray and CT equipment. Radiographers are trained to handle medical imaging or radiotherapy equipment thanks to guideline and safety protocols drafted by international bodies such as the International Atomic Energy Agency and local bodies such as the Department of Standards Malaysia and the Ministry of Health.

The field sees continuos advancement of medical technology, radiographers must constantly be up to date on the latest findings and innovations in the field. The demand for radiographers is plentiful with the growing number of healthcare institutions that are embracing more sophisticated diagnostic and radiotherapy technology.

Where to study Radiography?

Studying radiography requires STPM, foundation in science or A-Levels to enrol in a degree program. However, a 3 years diploma in the field is considered a minimum requirement to start a career. Students of radiography is can further their studies by doing a bachelor’s degree followed by a master’s degree and doctorate.

The Ministry of Health offers a full scholarship for a three-year diploma programme under the Allied Health Sciences College in Johor Baru  for diagnostic radiography training course and the Allied Health Sciences College in Sungai Buloh for the radiotherapy training.

Institutions offering radiography related education:

• Private institutions:
  • Asia Metropolitan University (AMU): Diploma in Medical Imaging, Bachelor of Medical Imaging and Radiotherapy (Hons)
  • KPJ Healthcare University College, Diploma in Medical Imaging, Bachelor of Medical Imaging (Hons)
  • Management & Science University (MSU), Diploma in Diagnostic Imaging (Radiography)
  • MAHSA University, Diploma in Medical Imaging, Bachelor of Medical Imaging (Hons)
  • Kuala Lumpur Metropolitan University College (KLMUC), Diploma in Medical Imaging
  • Universiti Kuala Lumpur (UniKL), Diploma in Radiography
  • Universiti Selangor (UNISEL), Diploma in Medical Imaging
• Public institutions:
  • Universiti Sains Malaysia (USM), Bachelor of Health Science (Medical Radiation)
  • Universiti Kebangsaan Malaysia (UKM), Bachelor of Diagnostic Imaging and Radiotherapy (Hons)
  • Universiti Teknologi Mara (UiTM), Diploma in Medical Imaging, Bachelor in Medical Imaging (Hons)
  • Universiti Sultan Zainal Abidin, Diploma in Radiography
  • International Islamic University of Malaysia (IIUM), Bachelor of Radiography and Diagnostic Imaging (Honours)

The early years

It is important to understand how the different subjects taught in schools can indirectly inspire students to pursue a course in radiography. By continuous support from parents and educators, students will then perform better in these subjects if they understand its relevance in the field.

An understanding of physics will take a student far in his or her career as a radiographer. Imaging and radiotherapy technology uses extensive knowledge in both managing radiation for diagnostic purposes, and mechanical and electronic knowledge for the operation of diagnostic devices.

Other than physics, radiographers must be well-versed with biology and most importantly, human anatomy. Radiography students are also taught physiology and pathology in their undergraduate studies so a strong foundation in biology is essential.

A lot of medical imaging equipment uses nuclear or radioactive substances to emit rays and waves to produce scanned images. Hence and understanding of these materials and how to handle them is necessary for all radiographers. Radiography students also are thought basic pharmacology.

Paired with physics, mathematics also plays a role in equipment operations and management. Furthermore, mathematics is used in radiography for equipment calibration and maintenance as well as measurements in images produced.

In an era of digitisation, almost all radiography equipment now come with computers assisted technology to produce digital images and data. Students who are computer literate and tech savvy will find it easier to handle the current and next generation medical imaging and radiotherapy equipment.

Careers in radiography

As technology advances, the field of radiography continues to become even more diverse. This of course offers an opportunity for regular radiographers to specialise in areas in radiography and handle specific equipment.

Here are some specialised areas where diagnostic radiographers can expand their career pathway in.

• Angiography: used to visualise blood vessels and circulatory system by injecting a radio-opaque dye under a fluoroscope.
• Animal radiography: the use of radiography techniques in the field of veterinary science
• Basic X-ray: emitting X-ray beams to produce images of bones and dense tissues in the body.
• Bone Densitometry: an enhanced form of X-ray technology, bone densitometry is used to measure bone loss and is used with patience who are suspected or diagnosed with osteoporosis.
• Computer tomography (CT)/Computerised axial tomography (CAT): CT or CAT is a digitised version of the X-ray and can be used to produce cross-sectional images or even generate a three-dimensional image of tissues being scanned.
• Dental imaging: used in the field of dentistry especially the sub-specialisation of orthodontics.
• Fluoroscopy: the emission of X-rays to produce moving images in real time like a video or movie.
• Magnetic Resonance Imaging (MRI): MRI uses a magnetic field and radio wave pulses to produces imaged of tissues and organs in the body.
• Mammography: scanning of breast tissues for abnormalities or cancer.
• Paediatric imaging: sub-area of imaging techniques catered for children.
• Sonography or Ultrasound: high frequency sound waves are used to produce images organs, soft tissues, blood flow and even foetuses.
• Trauma imaging: used in the trauma department of medical facilities for quick diagnosis.

Additionally, here are some careers for therapeutic radiographers:

• Advance practitioner: expert knowledge and skills in relation to the delivery of care in diagnostic imaging or radiotherapy and oncology.
• Medical dosimetry: Dosimetrists create radiation plans for cancer patients by working with physicists and radiation oncologists.
• Medical physicists: Medical physicists work with oncologists through clinical service and consultation, research and development as well as teaching.
• Modality experts: Radiation therapists who have undergone specific training for advanced cancer therapies and trains new staff members.
• Systems experts: Radiation therapists who are trained and accredited to be experts in the oncology information system.

Entry requirements:

Minimum qualifications to study diploma:

SPM or equivalent with credit in:

• Bahasa Malaysia
• English
• Mathematics
• one science subject (either  biology / physics / chemistry / general science)
• and any other subject to make up a total of 5 credits.

O-levels or equivalent with credit in:

• English
• Mathematics
• one science subject (either  biology / physics / chemistry / general science)
• and any other two subjects to make up a total of 5 credits.

Minimum qualification for a Bachelor’s degree:

• Pass in STPM/matriculation / A- level / pre-University program or equivalent with minimum:
  • CGPA of 2.5 in biology / physics and chemistry
  • 5 credits or equivalent at the SPM levels, 3 of which in the following subject: biology, physics, mathematics, chemistry and English.
• A diploma from a recognised institution with:
  • CGPA of 2.75 of a related diploma or,
  • CGPA below than 2.75 and a minimum of 3 years working experience.