Radiologist Assistant

The radiologist assistant’s education, knowledge, and standards allow him or her to perform many radiologic exams—including technically advanced, time-intensive procedures—that previously were performed by radiologists.

They are advanced-level radiographers who serve as radiologist extenders. However, the radiologist assistant is not a physician substitute. Their role does not intrude into medical practice. They work under the supervision of a radiologist to provide patient care.

Radiologist AssistantAs a radiologist extender in the diagnostic imaging environment, radiologist assistants have three major areas of responsibility. First, they take a leading role in patient management and assessment. Duties in this area might include determining whether a patient has been appropriately prepared for a procedure, obtaining patient consent prior to beginning the procedure, answering questions from the patient and his or her family, and adapting exam protocols to improve diagnostic quality. The radiologist assistant also is expected to serve as a patient advocate, ensuring that each patient receives quality care while in the radiology department or clinic.

Second, the radiologist assistant performs selected radiology examinations and procedures under the supervision of a radiologist. Although each radiologist assistant’s responsibilities will vary, a few of the procedures include assisting radiologists with invasive procedures, performing fluoroscopy for noninvasive procedures under direct supervision of the radiologist, placing nasoenteric and oroenteric feeding tubes in uncomplicated patients, and performing selected peripheral venous diagnostic procedures. The level of radiologist supervision varies, depending on the type of examination.

And third, the radiologist assistant may be responsible for evaluating image quality, making initial image observations, and forwarding those observations to the supervising radiologist. The supervising radiologist remains responsible for providing a final written report, interpretation, or diagnosis.


Radiologist assistants complete an advanced-level education that includes a radiologist-directed clinical preceptorship. The first class of radiologist assistants graduated in 2005, and there currently are six educational programs housed in universities throughout the country, with two more programs in development.

Graduates of radiologist assistant programs must earn a minimum of a bachelor’s degree. Of the six operational RA programs, three award a baccalaureate, one awards a post-baccalaureate certificate, and two award master’s degrees.

The curriculum for radiologist assistants was drafted by an advisory panel of representatives from the American Society of Radiologic Technologists, American Registry of Radiologic Technologists, American College of Radiology, and state regulatory agencies, as well as educators and Radiology Practitioner Assistants. The ASRT, which has more than 50 years of experience in curriculum design, produced the final radiologist assistant curriculum document.

Recognizing that a team approach to health care is in the best interests of the patient, the curriculum contains many cross-discipline elements. Model curricula from educational programs for nurse practitioners, emergency medical service, physician assistants, and radiology residents were reviewed in designing the curricula. The six educational institutions that sponsor radiologist assistant programs offer students the opportunity to promote relationships across disciplines that strengthen the concept of advanced practice radiography and the role of the radiologist extender.

Professional Certification

The American Registry of Radiologic Technologists has developed a certification program for graduates of radiologist assistant programs. Candidates may earn the professional designation of “Registered Radiologist Assistant,” abbreviated as “R.R.A.(ARRT).” The R.R.A. credential may be used along with the individual’s Registered Technologist credential, e.g., John Smith, R.R.A., R.T.(R)(ARRT).

Candidates seeking ARRT certification must satisfy the following eligibility criteria:

  • Must be an ARRT-registered radiologic technologist.
  • Must be a graduate of an educational program that satisfies the ARRT requirements for program recognition; or, qualify under a temporary eligibility pathway for RPAs.
  • Must possess a minimum baccalaureate degree.
  • Must present a record of clinical experiences and evaluations in the form of a “Clinical Portfolio” consisting of clinical experience documentation and competence assessments, professional activities and accomplishments record, case studies and RA Summative Evaluation Rating (RASER) scales; or, qualify under a temporary eligibility pathway for RPAs.

Continuing Education and Recertification

The ARRT requires Registered Radiologist Assistants to obtain 50 CE credits per biennium, a minimum of 70 percent of which must be discipline—or specialty—specific to the R.R.A.’s area of practice, with at least half earned through activities intended for the physician extender or physician. CE requirements for R.R.A.s are integrated into the requirements needed to maintain the R.T. designation. That is, qualifying CE credits may be applied to both the R.T. and R.R.A. requirements, and the biennium schedule for documenting CE will be maintained. Individuals must renew their registration annually. After 10 years have passed, R.R.A.s will be required to meet additional requirements to retain registration. Those requirements are currently under development.

Licensing and Regulation

Radiologist assistants are licensed by the state in which they practice, similar to licensing programs for radiologic technologists. Currently, radiologist assistants are licensed in Arkansas, Iowa, Mississippi, Montana, New Mexico, New York, and Tennessee, and are regulated in Oregon; additional licensure laws are pending in Florida, Illinois, and Ohio.

The ASRT and ACR are working with every state to enact licensure laws for radiologist assistants. The ASRT has developed model legislation and regulations to act as a guide in establishing licensure.

The Future of Clinical Practice

Registered Radiologist Assistants are employed in practices that serve patients in general diagnostic departments as well as interventional imaging suites. Radiologist assistants not only heighten the continuity of patient care in the diagnostic imaging environment, they also contribute to the growth of the technical staff as well as contributing to the growth and well-being of the radiology practice.

The future for advanced practitioners in the imaging sciences is great. The addition of radiologist assistants to the health care team will relieve the workload burden of radiologists, increase productivity, and cut costs. It also will help improve patients’ access to timely, high-quality radiologic care.

For more information about radiologist assistants, visit the ASRT web site at or the ARRT web site at

Last updated: June 2006