Decoding the Alphabet Title Soup: An Overview of the Licensures and Credentials of Cardiac Cath Lab and Interventional Radiology Technologists

Cardiac catheterization (often referred to as a cardiac cath lab, cath lab or just CCL) and interventional radiology (also called special procedures or just IR) are two distinct medical specialties.  However, the core skill sets of technologists working in both fields share commonalities in terms of procedures and techniques. There are a multitude of credentials and licenses associated with these professions, making it essential to understand their distinctions. This guide provides an overview of the relationships between Cardiac Cath Lab and IR, the key differences in the Technologist role, imaging modalities, overlapping procedures, and the varying licensures, certifications and credentials within these fields.

• Common Techniques: Both cardiac catheterization and interventional radiology use catheters (thin, flexible tubes) to access the interior of the body for diagnostic or therapeutic purposes. In both fields, these catheters are guided using imaging technology to visualize and navigate inside the body.
• Imaging Modalities: Both specialties heavily rely on imaging modalities to guide their procedures. In cardiac catheterization, the primary imaging technique is fluoroscopy, which provides real-time X-ray images of the heart and blood vessels. In interventional radiology, a variety of imaging modalities can be used, including X-ray, CT (computed tomography), MRI (magnetic resonance imaging), and ultrasound, depending on the specific procedure.
• Overlapping Procedures: Some procedures performed in interventional radiology and the cardiac cath lab can overlap. For example, angiography is a common procedure in both fields. In cardiac catheterization, it is used to visualize coronary arteries and diagnose heart-related conditions, while in interventional radiology, it can be used for procedures such as angioplasty, embolization, or stent placement in other parts of the body.
• Different Specializations: Cardiac cath lab procedures are primarily focused on diagnosing and treating heart and blood vessel conditions, such as coronary artery disease, congenital heart defects, and valvular diseases. Interventional radiology, on the other hand, encompasses a broader range of procedures that can be performed throughout the body, including vascular and non-vascular interventions. These may include treating strokes (“neuro”), aneurysms, performing biopsies, draining abscesses, and more.

Technologists working in the Cardiac Cath Lab and IR Lab have various options for credentialing, licensing, and certification. It’s crucial to understand the distinction between licensure, which legally allows individuals to perform specific tasks, and credentials or certifications, which demonstrate the successful completion of a comprehensive examination in a particular area of expertise. For example, a fluoroscopy license allows an RT to operate the X-ray machine, while the RCIS certification does not grant this privilege.

Cath Lab Technologists

In the cardiac catheterization lab, there are three “levels” for cath lab technologists:

• Radiologic Technologist (RT) – holds a fluoroscopy license (may even hold the ARRT(CI))
• Registered Cardiovascular Invasive Specialist (RCIS) – A certification covering a broad range of cardiovascular topics, including cardiac catheterization, vascular procedures, and electrophysiology studies. It is recognized as a comprehensive certification in the cardiovascular field.
• Cardiovascular technician (CVT) – Does not hold a fluoroscopy license or RCIS certification and is typically trained on the job

The roles that a cardiac cath lab technologist can perform include scrubbing (assisting the cardiologist by providing wires and catheters), monitoring (recording vitals and procedure timeline in medical records, often done by nurses or technologists), and X-Ray/Panning (operating the X-ray machine, requires a fluoroscopy license).

Key Note: Very often a hospital will be able to use a travel  RCIS instead of an RT if they plan to use the traveler primarily to scrub.  The current department staffing must have enough RTs currently available – at least one for every procedure room.   This isn’t the case all the time, but it’s worth a question because an RCIS with 20 years of experience is more helpful in the scrub position than an RT with 6-8 years.

Interventional Radiology Technologists

In the Interventional Radiology lab, there is no specialized test equivalent to the RCIS for non-fluoro licensed professionals.  However, oftentimes only a “scrub tech” is needed because  the imaging modalities used in interventional radiology vary widely and often use equipment with dedicated personnel (such as CT).

• Radiologic Technologist (RT) – Has a fluoroscopy license (may even hold the ARRT(VI))
• IR Tech  – Does not hold a fluoro license, though may hold an RCIS certification.  This position is similar to a CVT for cath lab, where the technologist is mainly responsible for scrubbing (no license required).

RCIS Overview

It can be held by a nurse, technologist, technician, those with fluoro, those without… because it is a test of invasive heart knowledge covering all aspects of cardiac interventional procedures.  There are other credentials that cover cardiac knowledge, however those exams are not universally available like the RCIS.  For example, Radiologic Technologists have the option of pursuing the Cardiac Intervention or the Vascular Intervention credential from the American Registry of Radiologic Technologists, however that is limited to RTs and focuses on the application of Radiologic Technology in the fields..  

When the RCIS was introduced, there was a period where technicians were able to be “grandfathered” into the entrance requirements if they had extensive invasive heart experience.  Later updates to the program only allowed students who graduated from cardiovascular technology programs to register.

Electrophysiology – The Wild West

In the cath lab, team roles have been defined by licensure for decades, with nurses often assuming the circulating role and radiologic technologists handling the panning and scrubbing. In the EP lab, technological advancements have changed these traditional roles. Cardiac mapping technology, which doesn’t always require licensure, has reduced the significance of roles defined by licensing.

In the EP lab, roles are determined more by knowledge and ability than licensure. The terms used in the cath lab, such as circulating, scrubbing, and panning, are replaced with EP-specific terms like stimulating, recording, and mapping, which do not require a license. Nevertheless, the administration of medications remains the responsibility of nurses, and operating the X-ray machine (if used) is typically handled by radiologic technologists.

The RCES (Registered Cardiac Electrophysiology Specialist) credential is recognized as the industry standard for electrophysiology knowledge due to its comprehensive cardiac content, accessibility, and affordability. Two other challenging exams, the CCDS (Certified Cardiac Device Specialist) and CEPS (Certified Electrophysiology Specialist), are administered by the International Board of Heart Rhythm Examiners:

• CCDS (Certified Cardiac Device Specialist) – This certification is designed for healthcare professionals who work with cardiac implantable electronic devices (CIEDs), such as pacemakers and defibrillators. CCDS certification indicates expertise in the management and programming of these devices.
• CEPS (Certified Electrophysiology Specialist) – The CEPS certification is intended for individuals who work in electrophysiology labs, assisting in procedures such as ablations and device implantations. This certification signifies a high level of expertise in electrophysiology procedures and is recognized as a standard of excellence in the field.