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Forty Years Later, Times are Changing - Or Are They?
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Forty Years Later, Times are Changing - Or Are They?

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  • This morning Chuck Hardin spoke about the climate at the time of the “birth” of the CRCPD. Now let’s see if there has been true progress 40 years later.
    We now have active non-agreement states regulating NARM since the passage of the Energy Policy Act of 2005; we still have states becoming agreement, we still have states considering becoming agreement
    We have had states give back the agreement
    There is still no consistency in states following the SSRs
  • Chuck spoke of the number of federal agencies forty years ago having a role in regulating the use of radiation and radioactive material, he mentioned at least 9 federal agencies, are we better off today?
  • Transcript

    • 1. Forty Years Later, Times areForty 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, CATherapy Physics Inc., Gardena, CA 40th Annual CRCPD Meeting40th Annual CRCPD Meeting Greensboro, NCGreensboro, NC May 19, 2008May 19, 2008
    • 2. PersonalPersonal Perspective –Perspective – 35 Years Ago35 Years Ago State of Regulatory ComplianceState of Regulatory Compliance Enforcement Procedures:Enforcement Procedures: ““Beware of the State Inspector - Stay onBeware 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
    • 3. Expertise of Regulatory Staff –Expertise of Regulatory Staff – HistoricallyHistorically Most of the Regulatory Staff whoMost of the Regulatory Staff who performed healthcare facilityperformed healthcare facility inspections had several years ofinspections had several years of experience in the medical environmentexperience in the medical environment Well acquainted with the operation ofWell acquainted with the operation of most of the diagnostic imaging andmost of the diagnostic imaging and radiation therapy equipment.radiation therapy equipment. Basic understanding of radiationBasic understanding of radiation safety principles and practice.safety principles and practice.
    • 4. Expertise of Medical Physicists -Expertise of Medical Physicists - HistoricallyHistorically Individuals performing medicalIndividuals performing medical physics services in medical facilitiesphysics services in medical facilities came from a variety of backgroundscame from a variety of backgrounds and educational training.and educational training. ““Medical Physics” programs were inMedical Physics” programs were in early stages of clinical training.early stages of clinical training. Medical Physicists were trained in allMedical Physicists were trained in all subspecialties of the field.subspecialties of the field.
    • 5. Training Resources - ThenTraining Resources - Then AEC/NRC provided training forAEC/NRC provided training for Agreement State personnelAgreement State personnel BRH provided training for RegulatoryBRH provided training for Regulatory PersonnelPersonnel BRH provided stipends for medicalBRH 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
    • 6. Training Resources - NowTraining Resources - Now Limited NRC training of Agreement StateLimited NRC training of Agreement State PersonnelPersonnel Limited FDA training for NEXT surveysLimited FDA training for NEXT surveys and Mammography Personneland Mammography Personnel Medical Physics programs are self-Medical Physics programs are self- funded training programs - limitedfunded training programs - limited funding for medical physics residenciesfunding for medical physics residencies through CMS and other professionalthrough CMS and other professional organizationsorganizations
    • 7. 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 AAPMCaptured and placed in the AAPM Virtual Library and is available to non-Virtual Library and is available to non- AAPM membersAAPM members
    • 8. AAPM Virtual LibraryAAPM Virtual Library
    • 9. AAPM Virtual LibraryAAPM Virtual Library
    • 10. AAPM Virtual LibraryAAPM Virtual Library
    • 11. Professional ExpertiseProfessional Expertise ChallengesChallenges Personnel with limited scientificPersonnel with limited scientific education and medical experience areeducation 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 withUnable to keep the pipeline filled with qualified personnel to address thequalified personnel to address the security and health needs of the nationsecurity and health needs of the nation
    • 12. Manpower SpectrumManpower Spectrum Will the future workforce haveWill the future workforce have the appropriate training andthe appropriate training and knowledge to understandknowledge to understand what the readings orwhat the readings or measurements really mean?measurements really mean?
    • 13. State ProgramsState Programs 32% of all FTE’s devoted to Radioactive32% of all FTE’s devoted to Radioactive Material licensing & inspectionMaterial licensing & inspection CRCPD Criteria For An AdequateCRCPD Criteria For An Adequate Radiation Control ProgramRadiation Control Program Many states understaffed in RadioactiveMany states understaffed in Radioactive Material licensing and inspectionMaterial licensing and inspection Ref: HPS - Human Capital Crisis Task Force Report (JulyRef: HPS - Human Capital Crisis Task Force Report (July 2004)2004)
    • 14. State Programs- continuedState Programs- continued Specialized education or trainingSpecialized education or training requirementsrequirements – 93% of licensing and inspection93% of licensing and inspection positionspositions desireddesired 4 yr degree in health4 yr degree in health physics or equivalent fieldphysics or equivalent field – 55% of licensing and inspection55% of licensing and inspection positionspositions possesspossess a 4 yr degree ina 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)
    • 15. Medical Physicist StaffingMedical Physicist Staffing Over 3,000 hospitals have diagnosticOver 3,000 hospitals have diagnostic imaging and radioisotope facilitiesimaging and radioisotope facilities Over 1,200 hospitals have radiationOver 1,200 hospitals have radiation therapy facilities - plus 1,500therapy facilities - plus 1,500 freestanding centersfreestanding centers Ref: AHA Hospital StatisticsRef: AHA Hospital Statistics
    • 16. Where are Medical Physicist’sWhere 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
    • 17. Professional Credentials ofProfessional Credentials of Medical PhysicistsMedical Physicists EducationEducation CertificationCertification Maintenance of CertificationMaintenance of Certification LicensureLicensure Hospital Privileging/CredentialsHospital Privileging/Credentials
    • 18. M.S. or Ph.D. in Medical Physics M.S. or Ph.D. in Physics or related field Medical Physics Residency Program Medical Physics Postdoctoral Training Practicing Medical Physicists Contributed By: Dong (MD Anderson) B.S. in Physics or related field On the Job Clinical Training in Medical Physics Pathways into Medical PhysicsPathways into Medical Physics
    • 19. 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*(Univ. of Texas Graduate School of Biomedical Sciences, Houston)of Biomedical Sciences, Houston) Contributed By: Hogstrom (MD Anderson)Contributed By: Hogstrom (MD Anderson)
    • 20. Professional Credentials ofProfessional 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, nuclearmedical physics, physics, nuclear engineering, or related disciplineengineering, or related discipline Hospital CredentialsHospital Credentials: Procedure-: Procedure- specific privilegesspecific privileges Professional Society MembershipsProfessional Society Memberships
    • 21. Professional Credentials ofProfessional 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 MedicineCanadian College of Physicists in Medicine – American Board of Scientists in NuclearAmerican Board of Scientists in Nuclear MedicineMedicine Licensure and RegistrationLicensure and Registration – Texas (first in 1992), Florida, New York, andTexas (first in 1992), Florida, New York, and HawaiiHawaii – Licensure initiatives being consideredLicensure initiatives being considered nationallynationally – Many states require board certificationsMany states require board certifications – Many states require registrationMany states require registration
    • 22. Florida and GeorgiaFlorida and Georgia
    • 23. Mission Statement of aMission Statement of a Certifying BoardCertifying Board American Board of Radiology:American Board of Radiology: – To serve the public and the medicalTo serve the public and the medical professionprofession » by certifying that its diplomatesby certifying that its diplomates havehave acquired, demonstrated, andacquired, demonstrated, and maintainedmaintained » a requisite standard ofa requisite standard of knowledge, skill, and understandingknowledge, skill, and understanding » essential to the practice ofessential to the practice of radiology, radiation oncology, andradiology, radiation oncology, and radiologic physics.radiologic physics.
    • 24. Who is a Qualified MedicalWho is a Qualified Medical PhysicistPhysicist?? An individual whoAn individual who is competentis competent to practiceto practice independentlyindependently in one or more of thein one or more of the subfields in medical physics.subfields in medical physics. – Certification and continuing education (toCertification and continuing education (to demonstrate competence)demonstrate competence) – Trained to be familiar with the principles ofTrained 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 ofFamiliar with performance specifications of equipmentequipment – Familiar with physical limitations ofFamiliar with physical limitations of instruments, calibration procedures, andinstruments, calibration procedures, and computer algorithmscomputer algorithms
    • 25. Medical Physics DisciplinesMedical Physics Disciplines Therapeutic RadiologicalTherapeutic Radiological PhysicsPhysics Diagnostic Imaging PhysicsDiagnostic Imaging Physics Medical Nuclear PhysicsMedical Nuclear Physics Medical Health PhysicsMedical Health Physics
    • 26. Therapeutic Radiological PhysicsTherapeutic Radiological Physics The therapeutic applications of x-ray, gammaThe therapeutic applications of x-ray, gamma ray, neutron, electron, and charged-particleray, neutron, electron, and charged-particle beams, and radiation from sealed radionuclidebeams, 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 theirThe quality of images resulting from their production and use.production and use. Medical health physics associated with thisMedical health physics associated with this subfield.subfield.
    • 27. Cell Killing by Ionizing RadiationCell Killing by Ionizing Radiation
    • 28. Diagnostic Radiological PhysicsDiagnostic Radiological Physics The diagnostic applications of x-rays, gammaThe diagnostic applications of x-rays, gamma rays from sealed sources, ultrasonic radiation,rays from sealed sources, ultrasonic radiation, and radio frequency radiation and magneticand radio frequency radiation and magnetic fieldsfields The equipment association with theirThe equipment association with their production, use, measurement and evaluationproduction, use, measurement and evaluation The quality of images resulting from theirThe quality of images resulting from their production and useproduction and use Medical health physics associated with thisMedical health physics associated with this subfieldsubfield
    • 29. Discovery of X-raysDiscovery of X-rays On 8 Nov 1895, Wilhelm Conrad Roentgen (accidentally) discovered an image cast from his cathode ray generator.
    • 30. Medical Nuclear PhysicsMedical Nuclear Physics The therapeutic and diagnostic applicationsThe therapeutic and diagnostic applications of radionuclides in unsealed sourcesof radionuclides in unsealed sources The equipment association with theirThe equipment association with their production, use, measurement, andproduction, use, measurement, and evaluationevaluation The quality of images resulting from theirThe quality of images resulting from their production and useproduction and use Medical health physics associated with thisMedical health physics associated with this subfieldsubfield
    • 31. Emergency Management ofEmergency Management of Radiation CasualtiesRadiation Casualties CAUTION February 9, 2005, version 1.0February 9, 2005, version 1.0
    • 32. What is the Medical Physicist’sWhat is the Medical Physicist’s Primary Discipline?Primary Discipline? 77% 14% 3% 2% 3%1% 0% Radiation Oncology Diagnostic Radiology Nuclear Medicine Magnetic Resonance Rad. Safety/Health Physics Engineering Administrative
    • 33. What is the Medical Physicist’sWhat is the Medical Physicist’s Primary Responsibility?Primary Responsibility? 77% 11% 4% 3% 5% 0% Clinical Academic Administrative Regulatory & Standards Research, Development & Management Application Specialist
    • 34. General Areas of ResponsibilityGeneral Areas of Responsibility of the Medical Physicistof the Medical Physicist ClinicalClinical ResearchResearch EducationEducation Regulatory ComplianceRegulatory Compliance
    • 35. Clinical Responsibilities of theClinical 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 medicalLiaison between other medical professionals, manufacturers, andprofessionals, manufacturers, and regulatory agenciesregulatory agencies
    • 36. Research & DevelopmentResearch & Development Opportunities for the Medical PhysicistOpportunities for the Medical Physicist Basic scientific researchBasic scientific research Develop new therapeutic or diagnosticDevelop new therapeutic or diagnostic proceduresprocedures Implement and/or integrate new equipment intoImplement and/or integrate new equipment into clinical useclinical use Establish, investigate and/or evaluateEstablish, investigate and/or evaluate therapeutic or diagnostic outcomes/performancetherapeutic or diagnostic outcomes/performance Collaborate with the Regulatory Authorities toCollaborate with the Regulatory Authorities to ensure a framework for clinical practiceensure a framework for clinical practice
    • 37. The Regulatory Environment -The Regulatory Environment - 40 Years Later40 Years Later Active Non-Agreement StatesActive Non-Agreement States regulating NARMregulating NARM 35 Agreement States today35 Agreement States today Some states weighing the “benefit” ofSome states weighing the “benefit” of becoming agreementbecoming agreement Agreements have been “given back”Agreements have been “given back” There are still inconsistencies betweenThere are still inconsistencies between state and federal regulationsstate and federal regulations
    • 38. InconsistencyInconsistency Forty years of effort developingForty 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 thecompatibility of regulations across the board and we still have significantboard and we still have significant variations in many areas.variations in many areas.
    • 39. Current Federal AgenciesCurrent 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
    • 40. Future Opportunities forFuture Opportunities for CollaborationCollaboration Together we must:Together we must: – Optimize use of Personnel, Time andOptimize use of Personnel, Time and EquipmentEquipment – Ensure fiscal responsibilityEnsure fiscal responsibility – Regulations should be written to beRegulations should be written to be performance-basedperformance-based – Medical community/professional shouldMedical community/professional should develop standards that address thedevelop standards that address the prescriptiveness of the applicationprescriptiveness of the application
    • 41. Future Opportunities forFuture Opportunities for CollaborationCollaboration Regulatory Community and MedicalRegulatory Community and Medical Physicists must work together toPhysicists must work together to develop a regulatory environment thatdevelop a regulatory environment that recognizes the expertise and credentialsrecognizes the expertise and credentials of both sidesof both sides While maintaining adequate protection ofWhile maintaining adequate protection of the public health, safety and security ofthe public health, safety and security of radioactive materialsradioactive materials While delivering quality healthcare to theWhile delivering quality healthcare to the patient!patient!

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