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!