Nuclear Medicine Technologist Training Looking Down the Road Kent Hutchings, MS, CNMT VA Palo Alto...

Nuclear Medicine Technologist Training

Looking Down the RoadKent Hutchings, MS, CNMT

VA Palo Alto Health Care SystemJune, 2008; VAPAHCS PET/CT Symposium

2016

2013

2010

2008

Technological Advancements

PET scan volume more PET scan volume more than doubled from than doubled from 2004 to 2007 and is 2004 to 2007 and is forecast to triple by forecast to triple by 20102010

Clinical introduction Clinical introduction of SPECT in the of SPECT in the 1980s1980s

PET/CT Hybrids and PET/CT Hybrids and the increasing the increasing importance of importance of fusion imaging fusion imaging technologies technologies

History Programs Problems Bachelors NMAP History Programs Problems Bachelors NMAP

Evolution of Nuclear Medicine

Major Revisions Incoming Outgoing Radioimmunoassay (RIA)Radioimmunoassay (RIA)

Digital Imaging/ProcessingDigital Imaging/Processing

Heathcare InformaticsHeathcare Informatics

Shift toward specialists careShift toward specialists care

Dedicated PETDedicated PET

PET/CT and SPECT/CTPET/CT and SPECT/CT

Molecular Imaging/TherapyMolecular Imaging/Therapy

PEM & PET/MRI (anticipated)PEM & PET/MRI (anticipated)


Concerns

• “When asked [about] issues facing NMT education programs in the near future, program directors overwhelmingly cited fitting new content into an already crowded curriculum as their main concern.”

SNM 2005 Program Director Survey

http://tech.snmjournals.org/cgi/content/full/36/1/55


NMT Program Demographics

~30% Universities~30% Universities– 35% of these award

a bachelor’s degree (usually 4 years in length)

~30% Community / ~30% Community / Junior collegesJunior colleges– 53% of these award

an associates degree (Most are 2 year programs)

~40% Hospital-based~40% Hospital-based– One-year certificate

program. Intended for health care professionals who wish to specialize in another allied health field

SNM Program Director’s Survey – http://tech.snmjournals.org/cgi/content/full/36/1/55


JRCNMT

– Nationally recognized accrediting agency for NMT Nationally recognized accrediting agency for NMT educational programs educational programs

– The The EssentialsEssentials– Accredited Programs in the USAccredited Programs in the US– Regional AccreditationRegional Accreditation

Joint Review Committee on Educational Programs in Nuclear Medicine Technology

www.jrcnmt.org


Problem #1: Variable Education

NM Technologist Training Programs ClinicalClinical

• 59% require more than 1,200 hours of clinical practicum • 10% of NMT programs required fewer than 1,000 hours

– 22% of these were community college programs

Didactic (Overall average = 44.7 credit hours) Didactic (Overall average = 44.7 credit hours) • Programs in academic medical centers (60 hours)• Universities or four-year colleges (46.6 hours)• Hospitals with university affiliation (45.2 hours)• Community/junior colleges (39.7 hours)• "Other" settings (44.7 hours)

SNM Program Director’s Survey -- tech.snmjournals.org/cgi/content/full/36/1/55


NMT Program Award LevelNMT Program Award Level

http://interactive.snm.org/docs/Nuclear_Medicine_Technologist_Report_2005.pdfhttp://tech.snmjournals.org/cgi/content/full/28/4/280/F2

Variable NMT Education

2005200520002000


http://tech.snmjournals.org/content/vol28/issue4/images/large/jnmt01610002x.jpeg

Variable Education (continued)

Many NMT possess a degree upon entry– 2005 NM Technologist (Overall Education)2005 NM Technologist (Overall Education)

Findings from a 2005 SNM Survey of Nuclear Medicine Technologists


Problem #2: Staffing

• Aging WorkforceAging Workforce

http://interactive.snm.org/docs/Nuclear_Medicine_Technologist_Report_2005.pdfhttp://tech.snmjournals.org/cgi/content/full/28/4/280/F2

2000: Mean = 48 years 2005: Mean = 43.5 years


http://tech.snmjournals.org/content/vol28/issue4/images/large/jnmt01610004x.jpeg

Problem #2: Staffing

• Technologist ShortageTechnologist Shortage– Faster-than-average job growth is Faster-than-average job growth is

anticipated through 2016anticipated through 2016• Technological innovations will increase the Technological innovations will increase the

diagnostic uses of nuclear medicine diagnostic uses of nuclear medicine • The development of new nuclear medicine The development of new nuclear medicine

treatmentstreatments• An increase in the number of middle-aged and An increase in the number of middle-aged and

older persons, who are the primary users of older persons, who are the primary users of diagnostic procedures. diagnostic procedures.

http://science.education.nih.gov


Problem #3: New Technologies Outpaced Curriculum Revisions

Updating today’s NM Technologist Training Programs– Most NMT programs (~93%) now offer clinical and didactic Most NMT programs (~93%) now offer clinical and didactic

PET instruction. PET instruction. – Almost half provide some clinical and didactic instruction in CT.Almost half provide some clinical and didactic instruction in CT.– 50% offer didactic instruction in cross sectional anatomy (but 50% offer didactic instruction in cross sectional anatomy (but

very few offer clinical correlation).very few offer clinical correlation).– Only one-sixth offered clinical instruction in MRIOnly one-sixth offered clinical instruction in MRI

Findings from a 2006 SNM Survey of NMT Education Program Directors


SNM Revised Scope of Practice SNMTS Presidential Task Force Practice Standards:

1. Diagnostic CT when performed on SPECT/CT or PET/CT camera*

2. Administration of oral and IV contrast (requires education in CT)* 3. Operation of scanners with x-ray tubes for bone density studies*

4. Administer therapeutic radionuclides, radiopharmaceuticals, and pharmaceutical agents by oral and/or intravenous routes*

5. Assist in NM cardiac stress testing procedures*

6. Insertion of peripheral intravenous catheters

7. Administer non-radiopharmaceutical agents*

* Under the direction of a physician

http://tech.snmjournals.org/cgi/content/full/35/3/15A


Incorporating CT into the Curriculum

• To stay current with the market, many programs are incorporating sectional anatomy and CT into their programs.

http://interactive.snm.org/index.cfm?PageID=2760

2004 the ASRT/SNMTS 2004 the ASRT/SNMTS PET/CT CurriculumPET/CT Curriculum


Additional Curriculum Requirements

• Multi-modality curriculum should include MRI

• Health care management: Reimbursement, billing, coding, etc

• Research: Evidence-based patient outcomes

• Advanced nuclear cardiology including ACLS certification

• Molecular and biochemical medicine & radiotherapeutics

• Digital Imaging: PACS, software, hardware, troubleshooting

October 2004, the PET-CT Task Force of the SNMTS


Problem #4: Credentialing

Which Board Exam Should I Take?

88.2% are CNMT certified88.2% are CNMT certified 50.1% are RT(N) certification50.1% are RT(N) certification

37.7% are licensed 37.7% are licensed in another allied in another allied health field:health field:

Findings from a 2005 SNM Survey of Nuclear Medicine Technologists

39% have both


The Future of Nuclear Medicine

Baccalaureate degree for entry level NMT by 2015

Education and credentialing standards via state licensure

The Nuclear Medicine Advanced Practitioner

Baccalaureate Degree Standard by 2015

• By 2015, all graduates from nuclear medicine programs should have a baccalaureate degree.

• Hospital-Based Programs have 2 options:1) Recruit from a population of applicants who already

possess a baccalaureate degree

2) Affiliate with a university to secure the necessary college credit

Society of Nuclear Medicine Technologist Section (SNMTS)


Baccalaureate Degree Criticisms

• A university education is expensive.A university education is expensive.

• Certificate program closures will create workforce shortages.Certificate program closures will create workforce shortages.

• Many universities are not interested in such affiliations.Many universities are not interested in such affiliations.

• Didactic education is prioritized over practical experience.Didactic education is prioritized over practical experience.

• Nursing and radiation therapy continue to recognize non-Nursing and radiation therapy continue to recognize non-baccalaureate entry level professionals.baccalaureate entry level professionals.

• Obsolescence of current certificate & A.S. degrees holdersObsolescence of current certificate & A.S. degrees holders



C.A.R.E. Act

• The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE) Legislation– The act sets education and credentialing The act sets education and credentialing

standards by requiring state licensure for all standards by requiring state licensure for all technologists who administer radiation.technologists who administer radiation.

– How do we ensure that states will adopt good How do we ensure that states will adopt good standards?standards?

https://www.asrt.org/content/GovernmentRelations/CAREBill/faq_legislative.aspx


Advanced Practitioner

• A Master’s Candidate who demonstrates a high level of autonomy, technical sophistication, advanced clinical knowledge and strong critical thinking

– Could assume certain physician tasks under the discretion of Could assume certain physician tasks under the discretion of the attending physicianthe attending physician

– Credentialed by the NMTCB and/or ARRT. Credentialed by the NMTCB and/or ARRT. – The six graduate-level competency domains are Patient Care, The six graduate-level competency domains are Patient Care,

Clinical Nuclear Medicine, Interpersonal and Communication Clinical Nuclear Medicine, Interpersonal and Communication Skills, Evidence-based Decision Making, Professionalism, and Skills, Evidence-based Decision Making, Professionalism, and Systems-Based Practice.Systems-Based Practice.

SNMTS Advanced Practice Task Force, 2007


Advanced Practitioner

The six graduate-level competency domainsThe six graduate-level competency domains::1) Patient Care

2) Clinical Nuclear Medicine

3) Interpersonal/Communication

4) Evidence-based Decision Making

5) Professionalism

6) Systems-Based Practice

SNMTS Advanced Practice Task Force, 2007


Advanced Practitioner Questions

• Will administration support an FTE for an NMAP?

• What criteria should be used to select candidates?

• Many states don’t recognize radiologist extenders.

• Will Medicare or private payors reimburse?



Thank You

Slides available at: Slides available at:

www.nucmedschool.com/education.pptwww.nucmedschool.com/education.ppt

Nuclear Medicine Technologist Training Looking Down the Road Kent Hutchings, MS, CNMT VA Palo Alto...

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