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Forty Years Later, Times are Forty Years Later, Times are Changing - Or Are They?Changing - Or Are They?
Melissa C. Martin, MS, FACR, FAAPM, FACMPMelissa C. Martin, MS, FACR, FAAPM, FACMP
Therapy Physics Inc., Gardena, CA Therapy Physics Inc., Gardena, CA
40th Annual CRCPD Meeting 40th Annual CRCPD Meeting
Greensboro, NC Greensboro, NC
May 19, 2008May 19, 2008
PersonalPersonal Perspective – Perspective – 35 Years Ago35 Years Ago
State of Regulatory Compliance State of Regulatory Compliance Enforcement Procedures:Enforcement Procedures:
““Beware of the State Inspector - Stay on Beware of the State Inspector - Stay on their good side if at all possible”their good side if at all possible”
- Advice from my first supervising - Advice from my first supervising medical physicistmedical physicist
Expertise of Regulatory Staff – Expertise of Regulatory Staff – HistoricallyHistorically
Most of the Regulatory Staff who Most of the Regulatory Staff who performed healthcare facility performed healthcare facility inspections had several years of inspections had several years of experience in the medical environment experience in the medical environment
Well acquainted with the operation of Well acquainted with the operation of most of the diagnostic imaging and most of the diagnostic imaging and radiation therapy equipment.radiation therapy equipment.
Basic understanding of radiation safety Basic understanding of radiation safety principles and practice.principles and practice.
Expertise of Medical Physicists - Expertise of Medical Physicists - HistoricallyHistorically
Individuals performing medical Individuals performing medical physics services in medical facilities physics services in medical facilities came from a variety of backgrounds came from a variety of backgrounds and educational training. and educational training.
““Medical Physics” programs were in Medical Physics” programs were in early stages of clinical training.early stages of clinical training.
Medical Physicists were trained in all Medical Physicists were trained in all subspecialties of the field.subspecialties of the field.
Training Resources - ThenTraining Resources - Then
AEC/NRC provided training for AEC/NRC provided training for Agreement State personnelAgreement State personnel
BRH provided training for Regulatory BRH provided training for Regulatory PersonnelPersonnel
BRH provided stipends for medical BRH provided stipends for medical physics graduate studentsphysics graduate students
*AEC: Atomic Energy Commission/Nuclear Regulatory Commission*AEC: Atomic Energy Commission/Nuclear Regulatory Commission
*BRH: Bureau of Radiological Health*BRH: Bureau of Radiological Health
Training Resources - NowTraining Resources - Now
Limited NRC training of Agreement State Limited NRC training of Agreement State PersonnelPersonnel
Limited FDA training for NEXT surveys Limited FDA training for NEXT surveys and Mammography Personneland Mammography Personnel
Medical Physics programs are self-Medical Physics programs are self-funded training programs - limited funded training programs - limited funding for medical physics residencies funding for medical physics residencies through CMS and other professional through CMS and other professional organizationsorganizations
Training Resources - NowTraining Resources - Now
AAPM training:AAPM training:– At CRCPD annual meetingsAt CRCPD annual meetings
– AAPM Members provide:AAPM Members provide:» state-specific requested trainingstate-specific requested training
» Training for FDA personnel as requestedTraining for FDA personnel as requested
– Captured and placed in the AAPM Captured and placed in the AAPM Virtual Library and is available to non-Virtual Library and is available to non-AAPM membersAAPM members
AAPM Virtual LibraryAAPM Virtual Library
AAPM Virtual LibraryAAPM Virtual Library
AAPM Virtual LibraryAAPM Virtual Library
Professional Expertise Professional Expertise ChallengesChallenges
Personnel with limited scientific Personnel with limited scientific education and medical experience are education and medical experience are being hired to fill vacanciesbeing hired to fill vacancies
More reliance and time spent on in-More reliance and time spent on in-house traininghouse training
Unable to keep the pipeline filled with Unable to keep the pipeline filled with qualified personnel to address the qualified personnel to address the security and health needs of the nationsecurity and health needs of the nation
Manpower SpectrumManpower Spectrum
Will the future workforce have Will the future workforce have the appropriate training and the appropriate training and knowledge to understand knowledge to understand what the readings or what the readings or measurements really mean?measurements really mean?
State ProgramsState Programs
32% of all FTE’s devoted to Radioactive 32% of all FTE’s devoted to Radioactive Material licensing & inspectionMaterial licensing & inspection
CRCPD Criteria For An Adequate CRCPD Criteria For An Adequate Radiation Control ProgramRadiation Control Program
Many states understaffed in Radioactive Many states understaffed in Radioactive Material licensing and inspectionMaterial licensing and inspection
Ref: HPS - Human Capital Crisis Task Force Report (July Ref: HPS - Human Capital Crisis Task Force Report (July 2004)2004)
State Programs- continuedState Programs- continued
Specialized education or training Specialized education or training requirementsrequirements– 93% of licensing and inspection 93% of licensing and inspection
positions positions desireddesired 4 yr degree in health 4 yr degree in health physics or equivalent fieldphysics or equivalent field
– 55% of licensing and inspection 55% of licensing and inspection positions positions possesspossess a 4 yr degree in a 4 yr degree in health physics or equivalent fieldhealth physics or equivalent field
Ref: HPS - Human Capital Crisis Task Force Report (July 2004)Ref: HPS - Human Capital Crisis Task Force Report (July 2004)
Medical Physicist StaffingMedical Physicist Staffing
Over 3,000 hospitals have diagnostic Over 3,000 hospitals have diagnostic imaging and radioisotope facilitiesimaging and radioisotope facilities
Over 1,200 hospitals have radiation Over 1,200 hospitals have radiation therapy facilities - plus 1,500 therapy facilities - plus 1,500 freestanding centersfreestanding centers
Ref: AHA Hospital StatisticsRef: AHA Hospital Statistics
Where are Medical Physicist’s Where are Medical Physicist’s Employed?Employed?
36%
1%
29%
2%
2%
9%
8%
5%8% Private Hospital
Government Hospital
University Hospital
University
Government
Physicist's Service Group
Physician's Service Group
Industry
Cancer Center
Professional Credentials of Professional Credentials of Medical PhysicistsMedical Physicists
EducationEducation
CertificationCertification
Maintenance of CertificationMaintenance of Certification
LicensureLicensure
Hospital Privileging/CredentialsHospital Privileging/Credentials
M.S. or Ph.D. in Medical Physics
M.S. or Ph.D. in Physicsor related field
Medical PhysicsResidency Program
Medical PhysicsPostdoctoral Training
Practicing Medical Physicists
Contributed By: Dong (MD Anderson)
B.S. in Physicsor related field
On the Job Clinical Training in Medical Physics
Pathways into Medical PhysicsPathways into Medical Physics
Example of Graduate Program* Example of Graduate Program* RequirementsRequirements
M.S. ProgramM.S. Program– 34 semester hours of didactic curricula34 semester hours of didactic curricula
– Diagnostic imaging physics clinical rotationDiagnostic imaging physics clinical rotation
– Radiation therapy physics clinical rotationRadiation therapy physics clinical rotation
– ThesisThesis
Ph.D. ProgramPh.D. Program– M.S. Program requirementsM.S. Program requirements
– 3 Research tutorials3 Research tutorials
– Oral candidacy examOral candidacy exam
– DissertationDissertation *(Univ. of Texas Graduate School of *(Univ. of Texas Graduate School of Biomedical Sciences, Houston)Biomedical Sciences, Houston)
Contributed By: Hogstrom (MD Anderson)Contributed By: Hogstrom (MD Anderson)
Professional Credentials of Professional Credentials of Medical PhysicistsMedical Physicists
EducationEducation: M.S. (51%) or Ph.D. (49%) in : M.S. (51%) or Ph.D. (49%) in medical physics, physics, nuclear medical physics, physics, nuclear engineering, or related disciplineengineering, or related discipline
Hospital CredentialsHospital Credentials: Procedure-: Procedure-specific privilegesspecific privileges
Professional Society MembershipsProfessional Society Memberships
Professional Credentials of Professional Credentials of Medical PhysicistsMedical Physicists
Board Certifications*Board Certifications*– American Board of RadiologyAmerican Board of Radiology– American Board of Medical PhysicsAmerican Board of Medical Physics– Canadian College of Physicists in Medicine Canadian College of Physicists in Medicine – American Board of Scientists in Nuclear MedicineAmerican Board of Scientists in Nuclear Medicine
Licensure and RegistrationLicensure and Registration– Texas (first in 1992), Florida, New York, and HawaiiTexas (first in 1992), Florida, New York, and Hawaii– Licensure initiatives being considered nationally Licensure initiatives being considered nationally – Many states require board certificationsMany states require board certifications– Many states require registrationMany states require registration
*Certification by the American Board of Health Physics is an acceptable *Certification by the American Board of Health Physics is an acceptable qualification for the practice of Medical Health Physics. qualification for the practice of Medical Health Physics.
Florida and GeorgiaFlorida and Georgia
Mission Statement of a Mission Statement of a Certifying BoardCertifying Board
American Board of Radiology:American Board of Radiology:– To serve the public and the medical To serve the public and the medical
profession profession
» by certifying that its diplomates have by certifying that its diplomates have acquired, demonstrated, and acquired, demonstrated, and
maintained maintained
» a requisite standard of a requisite standard of knowledge, skill, and understandingknowledge, skill, and understanding
» essential to the practice of radiology, essential to the practice of radiology, radiation oncology, and radiologic radiation oncology, and radiologic physics.physics.
Who is a Qualified MedicalWho is a Qualified Medical PhysicistPhysicist??
An individual who An individual who is competent is competent to practice to practice independentlyindependently in one or more of the in one or more of the subfields in medical physics.subfields in medical physics.– Certification and continuing education (to Certification and continuing education (to
demonstrate competence)demonstrate competence)
– Trained to be familiar with the principles of Trained to be familiar with the principles of physics used in the equipment and instrumentsphysics used in the equipment and instruments
– Familiar with government regulations and lawsFamiliar with government regulations and laws
– Familiar with performance specifications of Familiar with performance specifications of equipmentequipment
– Familiar with physical limitations of Familiar with physical limitations of instruments, calibration procedures, and instruments, calibration procedures, and computer algorithmscomputer algorithms
Medical Physics DisciplinesMedical Physics Disciplines
Therapeutic Radiological Therapeutic Radiological PhysicsPhysics
Diagnostic Imaging PhysicsDiagnostic Imaging Physics Medical Nuclear PhysicsMedical Nuclear Physics Medical Health PhysicsMedical Health Physics
Therapeutic Radiological PhysicsTherapeutic Radiological Physics
The therapeutic applications of x-ray, gamma The therapeutic applications of x-ray, gamma ray, neutron, electron, and charged-particle ray, neutron, electron, and charged-particle beams, and radiation from sealed radionuclide beams, and radiation from sealed radionuclide sources.sources.
The equipment associated with their production, The equipment associated with their production, use, measurement, and evaluation.use, measurement, and evaluation.
The quality of images resulting from their The quality of images resulting from their production and use.production and use.
Medical health physics associated with this Medical health physics associated with this subfield.subfield.
Cell Killing by Ionizing RadiationCell Killing by Ionizing Radiation
Diagnostic Radiological PhysicsDiagnostic Radiological Physics
The diagnostic applications of x-rays, gamma The diagnostic applications of x-rays, gamma rays from sealed sources, ultrasonic radiation, rays from sealed sources, ultrasonic radiation, and radio frequency radiation and magnetic and radio frequency radiation and magnetic fieldsfields
The equipment association with their The equipment association with their production, use, measurement and evaluationproduction, use, measurement and evaluation
The quality of images resulting from their The quality of images resulting from their production and useproduction and use
Medical health physics associated with this Medical health physics associated with this subfieldsubfield
Discovery of X-raysDiscovery of X-rays
On 8 Nov 1895, Wilhelm Conrad Roentgen (accidentally) discovered an image cast from his cathode ray generator.
Medical Nuclear PhysicsMedical Nuclear Physics
The therapeutic and diagnostic applications The therapeutic and diagnostic applications of radionuclides in unsealed sourcesof radionuclides in unsealed sources
The equipment association with their The equipment association with their production, use, measurement, and production, use, measurement, and evaluationevaluation
The quality of images resulting from their The quality of images resulting from their production and useproduction and use
Medical health physics associated with this Medical health physics associated with this subfieldsubfield
Emergency Management of Emergency Management of Radiation CasualtiesRadiation Casualties
CAUTION
February 9, 2005, version 1.0February 9, 2005, version 1.0
What is the Medical Physicist’s What is the Medical Physicist’s Primary Discipline?Primary Discipline?
77%
14%
3% 2% 3% 1% 0%Radiation Oncology
Diagnostic Radiology
Nuclear Medic ine
Magnetic Resonance
Rad. Safety/Health PhysicsEngineering
Administrative
What is the Medical Physicist’s What is the Medical Physicist’s Primary Responsibility?Primary Responsibility?
77%
11%
4%3% 5% 0% Clinical
Academic
Administrative
Regulatory & StandardsResearch, Development & ManagementApplication Spec ialist
General Areas of Responsibility General Areas of Responsibility of the Medical Physicistof the Medical Physicist
ClinicalClinical
ResearchResearch
EducationEducation
Regulatory ComplianceRegulatory Compliance
Clinical Responsibilities of the Clinical Responsibilities of the Medical PhysicistMedical Physicist
Daily clinical supportDaily clinical support
Equipment acquisitionsEquipment acquisitions
Site planningSite planning
Quality assuranceQuality assurance
Dose calculationsDose calculations
Liaison between other medical Liaison between other medical professionals, manufacturers, and professionals, manufacturers, and regulatory agenciesregulatory agencies
Research & Development Research & Development Opportunities for the Medical PhysicistOpportunities for the Medical Physicist
Basic scientific research Basic scientific research
Develop new therapeutic or diagnostic Develop new therapeutic or diagnostic proceduresprocedures
Implement and/or integrate new equipment into Implement and/or integrate new equipment into clinical useclinical use
Establish, investigate and/or evaluate Establish, investigate and/or evaluate therapeutic or diagnostic outcomes/performancetherapeutic or diagnostic outcomes/performance
Collaborate with the Regulatory Authorities to Collaborate with the Regulatory Authorities to ensure a framework for clinical practiceensure a framework for clinical practice
The Regulatory Environment - The Regulatory Environment - 40 Years Later40 Years Later
Active Non-Agreement States Active Non-Agreement States regulating NARMregulating NARM
35 Agreement States today 35 Agreement States today
Some states weighing the “benefit” of Some states weighing the “benefit” of becoming agreementbecoming agreement
Agreements have been “given back”Agreements have been “given back”
There are still inconsistencies between There are still inconsistencies between state and federal regulationsstate and federal regulations
InconsistencyInconsistency
Forty years of effort developing Forty years of effort developing Suggested States Regulations, Suggested States Regulations, partnerships with the NRC to “ensure” partnerships with the NRC to “ensure” compatibility of regulations across the compatibility of regulations across the board and we still have significant board and we still have significant variations in many areas.variations in many areas.
Current Federal Agencies Current Federal Agencies Involved in Radiation ProtectionInvolved in Radiation Protection
NRCNRC
HHS/FDA/CDC/NIOSHHHS/FDA/CDC/NIOSH
EPAEPA
DOE/NNSADOE/NNSA
DHS/FEMADHS/FEMA
DOTDOT
Department of Commerce/NISTDepartment of Commerce/NIST
Department of Labor/OSHADepartment of Labor/OSHA
Department of AgricultureDepartment of Agriculture
Future Opportunities for Future Opportunities for CollaborationCollaboration
Together we must:Together we must:– Optimize use of Personnel, Time and Optimize use of Personnel, Time and
Equipment Equipment
– Ensure fiscal responsibility Ensure fiscal responsibility
– Regulations should be written to be Regulations should be written to be performance-basedperformance-based
– Medical community/professional should Medical community/professional should develop standards that address the develop standards that address the prescriptiveness of the applicationprescriptiveness of the application
Future Opportunities for Future Opportunities for CollaborationCollaboration
Regulatory Community and Medical Regulatory Community and Medical Physicists must work together to Physicists must work together to develop a regulatory environment that develop a regulatory environment that recognizes the expertise and credentials recognizes the expertise and credentials of both sidesof both sides
While maintaining adequate protection of While maintaining adequate protection of the public health, safety and security of the public health, safety and security of radioactive materialsradioactive materials
While delivering quality healthcare to the While delivering quality healthcare to the patient! patient!