Radiography Education and Training in Saudi Arabia

During the recent past, there have been considerable advancements in the radiologic techniques in the United States and European Countries. These techniques have been considered in Saudi Arabia, to keep pace in line with the latest developments in radiologic technology. Saudi radiographers are necessarily to be more professional with updated knowledge to meet the demands of modern times in the health sector. Therefore, radiologic technology education and training programs must be built to meet the uprising technology in health care. This paper presents the present state of affairs in this field in Saudi medical Institutions and medical training centers. It is concluded that advance radiographic techniques like digital imaging should be preferred in the curriculums of education and trainings.


Introduction
Since the introduction of x-ray imaging in 1900s, radiography has evolved rapidly into more complicated practice with a great deal of responsibilities and duties.As a result, there have been significant changes in radiography education and practice during the last two decades [1].
Radiography (also called radiologic technology) includes conventional x-ray imaging as well as additional imaging modalities such as fluoroscopy, mammography, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicines (NM) and radiation therapy (RT).Radiography is an essential diagnostic tool of modern medicine.
Treatment of a patient depends on the accurate and precise production of radiographic images and successful interpretation of these images.Various injuries and conditions can be treated when the exact diagnosis is known to the physician.Therefore, a radiographer must be well educated and trained to achieve this goal.A highly quailfied and skilled radiographer is a significant member of the health care staff.He could provide appropriate services using imaging techniques, and evaluates radiographs of technical quality.
A high-quality vocational program for radiographers, which produces competent radiographers for both diagnostic and radio therapeutic working environment, is the basis for the development of a radiographer's vocation [2].With the current changes in the areas of radiology, it is necessary to enhance radiography educational standards to fulfill the needs of the health care community [3].Therefore, it is necessary to review the status of ra-diography education and training in the third world and compare it with similar programs in the developed countries.The additional responsibilities of today's radiographer make it necessary to upgrade the educational programs to sufficiently educate students without overwhelming them in the process [3].An ideal curriculum would offer multiple modalities that could be included more effectively in a baccalaureate degree programs.The future of the radiologic sciences depends to a large extent on the outcome of its education [4].During the last decade many of these two-year courses were converted into 3-year programs at the level of Intermediate Health Colleges.The main programs in these institutes and colleges were on the x-ray imaging.

Background of Radiologic Technology Education and Training
The Saudi government realized the need for qualified graduate radiographers and in 1976, the academic education and training of radiologic technology was introduced.In this year the College of Applied Medical Sciences (CAMS) was established at King Saud University.Later on, more colleges were established in other Universities.This shows that radiologic technology education has been well established in Saudi Arabia.Female students are also admitted to such educational programs.
Furthermore, the private sector has also participated in establishment of more radiographic schools and colleges under the supervision of Ministry of Higher Education (MOHE) and the Ministry of Health (MOH).Table 1 shows the number of governmental and private institutions that run radiologic technology programs and enrolled students.Presently, the total number of male and female students in radiographic schools and colleges is between 5500 and 6000.Baccalaureate and diploma students are between 2900 and 2700 respectively.

Admission and Selection Process of Interested Students
Generally, a few studies have assessed the consistency of admission standards in radiography programs [5].In the United Kingdom, the educational requirements for the radiographer have already been elevated to a baccalaureate degree [6].Although there is a great demand for higher education in radiologic technology, it far exceeds the available capacity within the country's Universities and Colleges.Thus, competition for radiologic technology programs in the Universities is really tough.

Radiologic Technology Curriculum
Rapid technological changes have made it increasingly difficult to define a common structure of education for the profession.In any curriculum, it is important to give students a solid foundation of traditional core knowledge besides providing opportunities to develop skills in various areas of radiologic technology.However, the knowledge and skills should provide students with all the core subjects required to meet the health professions body standards.
In Saudi Arabia, there are two types of radiologic technology programs: Baccalaureate-degree program, which lasts for 4 -5 years and diploma-degree program, which lasts for two years.The radiography curriculum varies slight among the Saudi Universities.In this study, the curriculum of King Saud University will be reviewed being a founding University running such programs.
In general, the radiography curriculum of baccalaureate program consists of two major areas: general education and professional education.General education and training in radiography (35 -40 hours) includes English language, culture, chemistry, organic chemistry, physics, biostatistics and zoology.General education and training requires one and half year full time study.It is designed to provide students with the basic knowledge for radiologic technology in addition to English language skills.
The curriculum of the professional education and training (95 -100 hours) is shown in Table 2.The initial phase of the curriculum focuses on the basic sciences of diagnostic imaging, followed by concurrent clinical internships and class room lectures.The American Society of Radiologic Technologists (ASRT) sponsored a national educational consensus conference in radiologic sciences to define the roles and responsibilities of radiologic technologists at various educational levels [7].Curricular content was suggested for the certificate or associate degree level which was designated for the technical/entry level and for the baccalaureate level which was designated the professional level (National Educational Consensus Conference, 1996).For the purpose of comparison, Table 3 shows the curriculum produced by the American Society of Radiologic Technologists (ASRT).The headline syllabus of contents of ASRT has been illustrated so that it can be compared with the average content of Saudi college's curriculum.This is because sometimes two contents may have different titles but identical syllabus.
It is obvious that radiologic technology education and Professional education and training are designed to provide students with the knowledge base and environment to develop into radiologic technology field.Professional education and training in radiography are a combination of lectures, practical demonstration, procedural simulation, and actual clinical practice.The last two years of the curriculum are directed mostly toward the clinical practice.With the presence of qualified radiologists and radiographers, students will progress from observing to assisting and subsequently to conducting radiographic examinations.In this manner, they will immediately utilize the theories and concepts presented in the classroom.The clinical experience associated with the professional education and training portion of the program is conducted in the radiology departments of the hospitals where training is carried out.Supervised clinical education and training are essential part of the curriculum of all radiography programs.The integration between the clinical and basic sciences is progressive and proceeds with direct patient contact early in the curriculum.
Most of colleges are provided with laboratories equipped with modern equipments in physics, chemistry, anatomy, ultrasound, x-ray and fluoroscopy machines, image processing equipments and gamma camera.However, due to limited number of large hospitals in major cities, there is a difficulty in training and following up students individually.Diploma Institutions are equipped only with an x-ray machines and small physics and chemistry labs.
There are no Institutions specialized in the education and training of imaging modalities apart from x-ray imaging.Therefore, Saudi radiographers lack advanced education and skill in other imaging modalities such as: CT, MRI, nuclear medicine and radiation therapy.However, competence in modalities such as MRI, CT and nuclear medicine is obtained via on job training opportunities proided by employers as done in other countries [8].v partnership with local and international institutions.
Introducing and implementing postgraduate programmers for the purpose of increasing the quality of health care professionals in the Kingdom is a major goal and responsibility of the Saudi Commission for Health Specialties (SCFHS).SCFHS has adopted new regulations for the purpose of training and examinations in their programmers to reach that goal.SCFHS has also created specific regulations for accrediting training centres.This regulation plays an important role in measuring the level of government hospitals, private hospitals, and training centres' capacity to host programmers.

Certification and Employment Opportunities
Radiography programs at Saudi Universities offer two types of certifications: A baccalaureate degree or a diploma degree in Radiography.The baccalaureate degree is awarded when students complete 135 hours course work successfully.The diploma degree is awarded when students complete 68 hours course work successfully.Upon successful completion of the degree requirements, students are eligible to apply for a job corresponding to the type of their degree.
As a result of technological advances and the shortage of healthcare specialists in Saudi Arabia, employment opportunities for radiographers are on demand.Job opportunities are good due to the shortage of radiographers.Radiographers can choose to work in hospitals, clinics, primary health care centers and other medical or Industrial facilities running radiographic examinations.Career advancement opportunities exist in education, administration, and research and sales representatives.Furthermore, salaries for radiographers are competitive with other professionals with similar levels of education.Radiographers usually work independently or interact with other members of the health care team such as radiologists, surgeons, emergency medicine physicians, cardiologists, and nurses.Nevertheless, as in the United States and Norway, radiographers have struggled with the idea of serving as both assistant to the radiologist and patient advocate [9].
Careers of radiographers in the field of US, CT, MRI, CIT, nuclear medicines or radiation therapy is promising.Upon completion of a bachelor's degree, opportunities exist to continue education and obtain a master's degree.Such graduates in one of the radiologic technologies are desirable for supervisory, administrative or teaching positions.

Conclusion
The radiography curriculum in Saudi Arabia is at par with the curriculum produced by ASRT.It is also following the curriculum taught in many Universities in USA and Europe.Yet, digital imaging and radiation protection should be taught more thoroughly.Although there is a great demand for radiographers, hospital training availability should be considered.More emphasis should be given to CT, MRI and nuclear medicines.Education-ists must reform teaching strategies, techniques and clinical training.Instructional delivery systems must be changed to accommodate the cultural diversity and different learning styles of the present day students [10].

Table 3 . Radiography curriculum produced by the American Society of Radiologic Technologists (ASRT) in 2007.
Radiographer and Health Care Team, Attitudes and Communication, Patient/Radiographer Interactions, Safety and Transfer Positioning, Evaluating Physical Needs, Infection Control, Medical Emergencies, Unique Situations and Trauma, Contrast Studies, Tubes, Catheters, Lines and Collection Devices, Mobile and Surgical Radiography

Table 4 .
It focuses on x-ray imaging only.However, there is a need to develop those radiographers with higher level skill basic radiography.The teachers on radiologic technology education and training programs in Saudi Arabia were from different countries such as, India, Pakistan, Egypt, Sudan, Jordan.Nowadays, most of them are Saudis, who had got there higher education in Canada, United States, Germany and United Kingdom.