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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?

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

  • Forty Years Later, Times are Changing - Or Are They? Melissa C. Martin, MS, FACR, FAAPM, FACMP Therapy Physics Inc., Gardena, CA 40th Annual CRCPD Meeting Greensboro, NC May 19, 2008
  • Personal Perspective – 35 Years Ago
    • State of Regulatory Compliance Enforcement Procedures:
    • “ Beware of the State Inspector - Stay on their good side if at all possible”
    • - Advice from my first supervising medical physicist
  • Expertise of Regulatory Staff – Historically
    • Most of the Regulatory Staff who performed healthcare facility inspections had several years of experience in the medical environment
    • Well acquainted with the operation of most of the diagnostic imaging and radiation therapy equipment.
    • Basic understanding of radiation safety principles and practice.
  • Expertise of Medical Physicists - Historically
    • Individuals performing medical physics services in medical facilities came from a variety of backgrounds and educational training.
    • “ Medical Physics” programs were in early stages of clinical training.
    • Medical Physicists were trained in all subspecialties of the field.
  • Training Resources - Then
    • AEC/NRC provided training for Agreement State personnel
    • BRH provided training for Regulatory Personnel
    • BRH provided stipends for medical physics graduate students
    • *AEC: Atomic Energy Commission/Nuclear Regulatory Commission
    • *BRH: Bureau of Radiological Health
  • Training Resources - Now
    • Limited NRC training of Agreement State Personnel
    • Limited FDA training for NEXT surveys and Mammography Personnel
    • Medical Physics programs are self-funded training programs - limited funding for medical physics residencies through CMS and other professional organizations
  • Training Resources - Now
    • AAPM training:
      • At CRCPD annual meetings
      • AAPM Members provide:
        • state-specific requested training
        • Training for FDA personnel as requested
      • Captured and placed in the AAPM Virtual Library and is available to non-AAPM members
  • AAPM Virtual Library
  • AAPM Virtual Library
  • AAPM Virtual Library
  • Professional Expertise Challenges
    • Personnel with limited scientific education and medical experience are being hired to fill vacancies
    • More reliance and time spent on in-house training
    • Unable to keep the pipeline filled with qualified personnel to address the security and health needs of the nation
  • Manpower Spectrum
    • Will the future workforce have the appropriate training and knowledge to understand what the readings or measurements really mean?
  • State Programs
    • 32% of all FTE’s devoted to Radioactive Material licensing & inspection
    • CRCPD Criteria For An Adequate Radiation Control Program
    • Many states understaffed in Radioactive Material licensing and inspection
    • Ref: HPS - Human Capital Crisis Task Force Report (July 2004)
  • State Programs- continued
    • Specialized education or training requirements
      • 93% of licensing and inspection positions desired 4 yr degree in health physics or equivalent field
      • 55% of licensing and inspection positions possess a 4 yr degree in health physics or equivalent field
    • Ref: HPS - Human Capital Crisis Task Force Report (July 2004)
  • Medical Physicist Staffing
    • Over 3,000 hospitals have diagnostic imaging and radioisotope facilities
    • Over 1,200 hospitals have radiation therapy facilities - plus 1,500 freestanding centers
    • Ref: AHA Hospital Statistics
  • Where are Medical Physicist’s Employed?
  • Professional Credentials of Medical Physicists
    • Education
    • Certification
    • Maintenance of Certification
    • Licensure
    • Hospital Privileging/Credentials
  • Pathways into Medical Physics Practicing Medical Physicists Contributed By: Dong (MD Anderson ) 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 B.S. in Physics or related field On the Job Clinical Training in Medical Physics
  • Example of Graduate Program* Requirements
    • M.S. Program
      • 34 semester hours of didactic curricula
      • Diagnostic imaging physics clinical rotation
      • Radiation therapy physics clinical rotation
      • Thesis
    • Ph.D. Program
      • M.S. Program requirements
      • 3 Research tutorials
      • Oral candidacy exam
      • Dissertation
    *(Univ. of Texas Graduate School of Biomedical Sciences, Houston) Contributed By: Hogstrom (MD Anderson)
  • Professional Credentials of Medical Physicists
    • Education : M.S. (51%) or Ph.D. (49%) in medical physics, physics, nuclear engineering, or related discipline
    • Hospital Credentials : Procedure-specific privileges
    • Professional Society Memberships
  • Professional Credentials of Medical Physicists
    • Board Certifications*
      • American Board of Radiology
      • American Board of Medical Physics
      • Canadian College of Physicists in Medicine
      • American Board of Scientists in Nuclear Medicine
    • Licensure and Registration
      • Texas (first in 1992), Florida, New York, and Hawaii
      • Licensure initiatives being considered nationally
      • Many states require board certifications
      • Many states require registration
    • *Certification by the American Board of Health Physics is an acceptable qualification for the practice of Medical Health Physics.
  • Florida and Georgia
  • Mission Statement of a Certifying Board
    • American Board of Radiology:
      • To serve the public and the medical profession
        • by certifying that its diplomates have
          • acquired, demonstrated, and maintained
        • a requisite standard of
          • knowledge, skill, and understanding
        • essential to the practice of radiology, radiation oncology, and radiologic physics.
  • Who is a Qualified Medical Physicist ?
    • An individual who is competent to practice independently in one or more of the subfields in medical physics.
      • Certification and continuing education (to demonstrate competence)
      • Trained to be familiar with the principles of physics used in the equipment and instruments
      • Familiar with government regulations and laws
      • Familiar with performance specifications of equipment
      • Familiar with physical limitations of instruments, calibration procedures, and computer algorithms
  • Medical Physics Disciplines
    • Therapeutic Radiological Physics
    • Diagnostic Imaging Physics
    • Medical Nuclear Physics
    • Medical Health Physics
  • Therapeutic Radiological Physics
    • The therapeutic applications of x-ray, gamma ray, neutron, electron, and charged-particle beams, and radiation from sealed radionuclide sources.
    • The equipment associated with their production, use, measurement, and evaluation.
    • The quality of images resulting from their production and use.
    • Medical health physics associated with this subfield.
  • Cell Killing by Ionizing Radiation
  • Diagnostic Radiological Physics
    • The diagnostic applications of x-rays, gamma rays from sealed sources, ultrasonic radiation, and radio frequency radiation and magnetic fields
    • The equipment association with their production, use, measurement and evaluation
    • The quality of images resulting from their production and use
    • Medical health physics associated with this subfield
  • Discovery of X-rays On 8 Nov 1895, Wilhelm Conrad Roentgen (accidentally) discovered an image cast from his cathode ray generator.
  • Medical Nuclear Physics
    • The therapeutic and diagnostic applications of radionuclides in unsealed sources
    • The equipment association with their production, use, measurement, and evaluation
    • The quality of images resulting from their production and use
    • Medical health physics associated with this subfield
  • Emergency Management of Radiation Casualties CAUTION February 9, 2005, version 1.0
  • What is the Medical Physicist’s Primary Discipline?
  • What is the Medical Physicist’s Primary Responsibility?
  • General Areas of Responsibility of the Medical Physicist
    • Clinical
    • Research
    • Education
    • Regulatory Compliance
  • Clinical Responsibilities of the Medical Physicist
    • Daily clinical support
    • Equipment acquisitions
    • Site planning
    • Quality assurance
    • Dose calculations
    • Liaison between other medical professionals, manufacturers, and regulatory agencies
  • Research & Development Opportunities for the Medical Physicist
    • Basic scientific research
    • Develop new therapeutic or diagnostic procedures
    • Implement and/or integrate new equipment into clinical use
    • Establish, investigate and/or evaluate therapeutic or diagnostic outcomes/performance
    • Collaborate with the Regulatory Authorities to ensure a framework for clinical practice
  • The Regulatory Environment - 40 Years Later
    • Active Non-Agreement States regulating NARM
    • 35 Agreement States today
    • Some states weighing the “benefit” of becoming agreement
    • Agreements have been “given back”
    • There are still inconsistencies between state and federal regulations
  • Inconsistency
    • Forty years of effort developing Suggested States Regulations, partnerships with the NRC to “ensure” compatibility of regulations across the board and we still have significant variations in many areas.
  • Current Federal Agencies Involved in Radiation Protection
    • NRC
    • EPA
    • DOE/NNSA
    • DHS/FEMA
    • DOT
    • Department of Commerce/NIST
    • Department of Labor/OSHA
    • Department of Agriculture
  • Future Opportunities for Collaboration
    • Together we must:
      • Optimize use of Personnel, Time and Equipment
      • Ensure fiscal responsibility
      • Regulations should be written to be performance-based
      • Medical community/professional should develop standards that address the prescriptiveness of the application
  • Future Opportunities for Collaboration
    • Regulatory Community and Medical Physicists must work together to develop a regulatory environment that recognizes the expertise and credentials of both sides
    • While maintaining adequate protection of the public health, safety and security of radioactive materials
    • While delivering quality healthcare to the patient!