History of the NMTCB and
Exam Development
David Perry, CNMT, PET
NMTCB Executive Director
Objectives
• Recognize the important role that the
NMTCB has in the development of
certification examinations for nuclear
...
Outline
• History – the formative years
– Birth of the NMTCB
– Those first exams
• Background – how exams are developed
– ...
In the 1970’s:
Many, if not most pioneer nuclear medicine
technologists came from a background of
radiology or medical tec...
Why Start NMTCB?
The NMTCB was established in 1977 because
the nuclear medicine technologist community
believed that two i...
First Concern:
Credentialing was being offered as a
subspecialty of radiology or medical
technology.
Second Concern
As schools in nuclear
medicine technology
were established,
neither “parent”
credentialing body
kept pace w...
So…
SNMTS National Council Meeting
– The Greater New York Chapter moves that
the new Executive Committee, to be
convened o...
Exploratory Task Force
Executive Committee
• Mark Muilenburg
• Jim Langan
• Barbara Horton
• Sue Weiss
• Jim Kellner
• Ton...
How to Get Started
The task force made the initial assumption
that “preparedness to practice” could be
determined by measu...
What Made Things Difficult
At the time the domain of nuclear medicine
job functions (tasks) had not been
completely descri...
What Made Things Difficult
No data existed
on which tasks
were the most
important in daily
practice and no
definition of
n...
Steps to First Exam
1. Perform task analysis to identify the skills
and/or knowledge required to perform nuclear
medicine ...
Steps to First Exam
4. Analyze items: check that the questions and
answers are well phrased (outside service).
5. Select w...
Task Force Recommendations
The name of the Board will be the Nuclear
Medicine Technology Certification Board
(NMTCB).
The ...
Task Force Recommendations
Eligibility requirements will include:
– Recognition of prior certification
– Graduation from a...
Next Steps
Initial task analysis was reviewed.
Initial Test Specifications Matrix
established:
– 23% Nuclear Instrumentati...
Also…
Bylaws amended and approved.
Board decided to pretest exam with recent
graduates.
Agreed that the Board “may issue a...
June 17, 1977
One year and
seven days after
the initial
resolution, the
NMTCB was
incorporated.
More Steps to the First Exam
300 items to be developed
Initial Item Writing Assignments
– Nuclear Instrumentation: J. Lang...
Pretest
Administered
February 11, 1978
100 pretesters with 25
at each of four sites
– Chicago
– Los Angeles
– New York
– B...
Pretest
Pretesters must have taken another registry
within past two years. Included some who failed
other registry.
Well o...
First Exam Sites
• Seattle
• San Francisco
• Los Angeles
• Ogden, Utah
• Phoenix
• Denver
• El Paso
• Minneapolis
• Omaha
...
First Exam
Administered September 15, 1978
– Exam fee - $30.00
– 652 Examinees, 33 no shows
– 60% (391) passed
First Exam
200 items
Maximum = 174, Mean = 117, Minimum = 56
1,674 granted reciprocal
certification because they
held curr...
Where Are They Now?
Of 2,074 individuals granted certification in
1978:
– 771 continue to be Active
– 135 hold Emeritus st...
1979 Exam
Administered September 30, 1979
• 950 applications, 27 incomplete, 26 rejected, 44
withdrew, 28 no shows
• 780 E...
1979 Exam
225 items, last 25 were pretest items
Maximum = 179, Mean = 130, Minimum = 27
941 granted reciprocal certificati...
1970’s Nuclear Medicine
Development of rectilinear scanners
reached its peak in 1972 and in 1973, 2
times as many scanners...
Fusion Imaging 70’s Style
A fusion of a rectilinear
scan using I-131 rose
Bengal with a chest X-
ray outlining the
positio...
Donald R. Bernier
• SNMTS President
1971-1972
• NMTCB Board
1977-1983
• Editor Nuclear
Medicine: Technology
and Techniques...
Founding Mission
The NMTCB was founded and dedicated to the
production of a certification examination which
truly reflecte...
Getting Into The ACT
Contract with the American College Testing
Program (ACT) for exam development and
administration serv...
Norm Referenced Exam
• A norm-referenced test / NRT is a type of test,
assessment, or evaluation which yields an
estimate ...
Criterion Referenced Exam
• A criterion-referenced test is one that provides
for translating test scores into a statement ...
Criterion Referenced Exam
The Board initially chose and has continued to
adhere to the criterion-referenced approach
becau...
Philosophy
In 1977, the purpose of the NMTCB’s
certification process was to “protect the public by
distinguishing between ...
Philosophy
The criterion-referenced NMTCB examination
was based upon a domain of knowledge and
skills that were judged to ...
Preparedness to Practice
The most important characteristic of a criterion-
referenced examination is the definition of the...
Task Analysis
• The Task Analysis contains a list of tasks,
developed by experts in the field, that are judged
to reflect ...
Next Steps
Initial task analysis was reviewed.
Initial Test Specifications Matrix
established:
– 23% Nuclear Instrumentati...
The Task Analysis:
• Is an important source of content validity
evidence for the examination.
• Provides an empirical basi...
Partial Beatles Reference
• There’s going to be an evolution.
• The examination development process is
evolutionary and mu...
Analyzing the Task Analysis
• During the spring 2009 NMTCB Board meeting,
the results of the survey were presented.
• The ...
Analyzing the Task Analysis
• During the spring 2009 NMTCB Board meeting,
the results of the survey were presented.
• The ...
2008 Task Analysis
Items that will be removed from the entry-level
examination include: hemocytometer, wet film,
venogram,...
2008 Task Analysis
At the fall 2009 NMTCB Board meeting the task
analysis data was reviewed again. Final
changes were disc...
2008 Task Analysis
Items to be added to the examination content
were in the area of computed tomography (CT).
Since the ex...
2008 Task Analysis
The foremost of these is obviously CT.
Based on the responses given via the task
analysis survey roughl...
2008 Task Analysis
Many of these are low-dose CT scans, being
used solely for attenuation correction or
localization in co...
2008 Task Analysis
To remain relevant we must be inventive and
adapt to contemporary trends. As an
organization, the NMTCB...
Another Pie Chart
Back to the Past
• NMTCB began the transition from paper & pencil
exam to one administered on computer in 1992.
• This wou...
History of Adaptive Testing
It has always been recognized that giving a test
that is much too easy for the candidates is l...
History of Adaptive Testing
On the other hand, questions that are much too
hard, also produce generally uninformative test...
History of Adaptive Testing
Alfred Binet (1905) achieved the major advance
in this area with his intelligence tests.
He re...
History of Adaptive Testing
If the candidate succeeded, Binet proceeded to
give successively harder item subsets until the...
History of Adaptive Testing
From this information, Binet could estimate the
candidate's ability level.
Binet's procedure i...
Transition to CAT
• Reckase (1974) is an early example of this
methodology of computer adaptive testing
(CAT).
• In March ...
Computer Adaptive Testing
On July 15, 1996, the NMTCB began offering a
computer adaptive test (CAT) for classification in
...
More CAT
Each item in the item pool is associated with:
– information on its difficulty (the proportion of
examinees answe...
More CAT
An item that has a difficulty level at or near the
passing score and has good discrimination will
be a better ite...
Classification CAT
Unlike Benet’s early work, for the NMTCB
classification CAT, the type of items that are
administered to...
Classification CAT
The test will adapt by test length rather than by
item difficulty.
Each examinee answers a total of 50 ...
NMTCB CAT
Items for the classification CAT are selected in
the following approximate proportions for each
of four content ...
1977
• First personal computer introduced – Commodore PET.
• Apple was incorporated – Apple II introduced.
• Snow fell in ...
déjà vu?
March 25, 2000 – Board discussion regarding an
advanced specialty exam for nuclear cardiology
was tabled pending ...
déjà vu?
September 3, 2000 – NMTCB Board meets and
the following motion is approved:
The Exam Committee recommends the
for...
And We’re Off…
A group of ten subject matter experts (SME)
identified the critical abilities related to the practice
and d...
Subject Matter Experts
Ad Hoc Committee
• Gary Dillehay
• Tony Knight
• Vivian S. Loveless
• Kathleen Murphy
• Patricia We...
NCT Exam Development
• The SME group developed test specifications for
the specialty exam, which included the item
format,...
NCT Exam Development
The test included one hundred scored and 21
pre-test items of multiple-choice format with four
possib...
Putting It All Together
Candidates were given a total time of two hours
to complete the test.
The ad hoc committee members...
Putting It All Together
After the pilot, the ad hoc committee members,
SME experts and members of the NMTCB
worked togethe...
The First NCT Exam
The first administration of the nuclear cardiology
exam was June 23, 2001.
Sixty-eight examinees sat fo...
NCT Specialty Exams
• Board determined that since this was a specialty
exam and because the field can change
dramatically ...
PET?
March 25, 2000 - An in depth discussion
regarding an advanced practice exam for PET
was held during the NMTCB Board m...
PET?
The Board contacted the Institute for Clinical
PET (ICP) to determine:
– level of interest by the PET technologist co...
We’re Off …Again
Action items include:
– Preparing a content outline (utilizing the
expertise of the PET community)
– Revi...
PET-CT Consensus Conference
• ACR
• Arizona Board of Medical
Radiologic Technology
• ARRT
• ASRT
• CPS Innovations
• CTI M...
PET/CT Consensus
Any registered radiographer with the
credential R.T.(R), registered radiation
therapist with the credenti...
PET/CT Consensus
• Ideally, technologists operating a hybrid PET-CT
unit would be a hybrid themselves, credentialed
in bot...
False Start
March 22, 2003 – After 2nd consensus meeting
in Albuquerque, Board approved motion to
create two exams:
– PET ...
Qualifications to Sit for PET
• CNMT, CAMRT or ARRT(N):
– 700 hours of clinical experience in PET as validated
by the sign...
First PET Exam Results
First exam administered September 24, 2004.
– 226 registered for exam
– 203 sat for exam
– 105 (51....
New Career Path for NMTs
• A Nuclear Medicine Advanced Associate (NMAA) is an
advanced-level nuclear medicine technologist...
Advanced Imaging Practitioner
A first-of-its-kind master’s level degree program
is now being offered to provide nuclear me...
NMAA Program
• The program is currently offered through a
consortium of three universities: the University of
Arkansas for...
A New Certification Exam
Nuclear Medicine Advanced Associate
– Spring 2009 – NMTCB committed to
developing an NMAA certifi...
NMAA Exam
• Multiple choice; ~200 questions; delivered by
paper & pencil at SNM Annual Meeting in San
Antonio, June 2011.
...
Organizational Involvement
• SNMTS
– National Council of Representatives
– Advocacy (Government Relations) Committee
– Edu...
Organizational Diversity
• The Board of Directors consists of eighteen (18)
individuals.
– Physician member of the SNM
– P...
Members of the NMTCB Board
Michele Beauvais, RPh, BCNP
Angela Bruner, PhD, DABR
Jimel Carpenter, CNMT, NCT
Anne Fisher, CN...
NMTCB Chairs
• Mark I. Muilenburg
• James J. Kellner
• John J. Kozar
• Sheila Rosenfeld
• George W. Alexander
• Nancy M. B...
NMTCB Chairs
• Ellen A. Thomas
• Anthony W. Knight
• Kristen Waterstram-
Rich
• Kathleen H. Murphy
• Kathleen S. Thomas
• ...
Executive Directors
• Barbara Horton, CNMT
• Dennis Park
• James Greene, PhD
• Bhaskar Dawadi, PhD
• Stanley Kalisch, PhD
...
Director Application Form
Online Item Submission
The Simpsons Reference
Matt Groening made his first professional cartoon sale to the avant-
garde Wet magazine in 1978.
Th...
Also in 1977…
Later renamed to Star Wars
IV: A New Hope
1979
Jaguar posted a 1.75
petaflop/s
performance speed
running the Linpack
benchmark. One
petaflop/s refers to
one quadril...
History of the NMTCB and Exam Development
History of the NMTCB and Exam Development
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History of the NMTCB and Exam Development

  1. 1. History of the NMTCB and Exam Development David Perry, CNMT, PET NMTCB Executive Director
  2. 2. Objectives • Recognize the important role that the NMTCB has in the development of certification examinations for nuclear medicine technologists. • Understand the history of the NMTCB and how the organization interacts with other professional organizations.
  3. 3. Outline • History – the formative years – Birth of the NMTCB – Those first exams • Background – how exams are developed – Types of exams – Validation – Adaptive Testing • Recent History • Part of the nuclear medicine community
  4. 4. In the 1970’s: Many, if not most pioneer nuclear medicine technologists came from a background of radiology or medical technology. It became apparent that the knowledge and skills necessary in this new field required different background and training than either radiographer or medical technologist.
  5. 5. Why Start NMTCB? The NMTCB was established in 1977 because the nuclear medicine technologist community believed that two important concerns were not being satisfied by the credentialing mechanisms available at the time.
  6. 6. First Concern: Credentialing was being offered as a subspecialty of radiology or medical technology.
  7. 7. Second Concern As schools in nuclear medicine technology were established, neither “parent” credentialing body kept pace with the scope of practice and requisite knowledge and skills of the nuclear medicine technologist.
  8. 8. So… SNMTS National Council Meeting – The Greater New York Chapter moves that the new Executive Committee, to be convened on June 10, 1976, in Dallas, Texas, appoint a committee to explore fully the implementation of an Independent Nuclear Medicine Technology Examination Board. This committee shall be required to report back to the National Council Meeting to be held in Las Vegas, Nevada, in January of 1977. Minutes of the SNMTS National Council, June 10, 1976
  9. 9. Exploratory Task Force Executive Committee • Mark Muilenburg • Jim Langan • Barbara Horton • Sue Weiss • Jim Kellner • Tony Mazzola National Council • Vi Custer • George Alexander • Joan Herbst • Glenn Moran • Susan Hemmingway
  10. 10. How to Get Started The task force made the initial assumption that “preparedness to practice” could be determined by measuring the application of knowledge and skills on selected job functions.
  11. 11. What Made Things Difficult At the time the domain of nuclear medicine job functions (tasks) had not been completely described.
  12. 12. What Made Things Difficult No data existed on which tasks were the most important in daily practice and no definition of nuclear medicine technology competency had been developed.
  13. 13. Steps to First Exam 1. Perform task analysis to identify the skills and/or knowledge required to perform nuclear medicine procedures. 2. Determine of actual examination content. 3. Develop “items”: questions and both correct and incorrect (distractors) answers. Minutes of the NMT Certification Task Force, September 21-22, 1976
  14. 14. Steps to First Exam 4. Analyze items: check that the questions and answers are well phrased (outside service). 5. Select which questions and how many are to be administered in an exam. 6. Determine pass/fail point. Minutes of the NMT Certification Task Force, September 21-22, 1976
  15. 15. Task Force Recommendations The name of the Board will be the Nuclear Medicine Technology Certification Board (NMTCB). The NMTCB will be formed as soon as possible. The eleven members of the task force plus one physician appointed by the SNM will serve as the initial Board members. Minutes of the SNMTS National Council, January 25, 1977
  16. 16. Task Force Recommendations Eligibility requirements will include: – Recognition of prior certification – Graduation from an AMA approved school – A mechanism will be established for persons trained on the job Minutes of the SNMTS National Council, January 25, 1977
  17. 17. Next Steps Initial task analysis was reviewed. Initial Test Specifications Matrix established: – 23% Nuclear Instrumentation – 10% Dose Calibration and Administration – 24% Imaging Procedures – 10% Radiopharmacy – 10% Radiation Protection – 23% Non-Imaging Procedures Minutes of the NMT Certification Task Force, March 16, 1977
  18. 18. Also… Bylaws amended and approved. Board decided to pretest exam with recent graduates. Agreed that the Board “may issue a certificate to any applicant holding current certification in Nuclear Medicine Technology with the ARRT and/or ASCP which was issued prior to the initial examination.” Minutes of the NMT Certification Task Force, March 16, 1977
  19. 19. June 17, 1977 One year and seven days after the initial resolution, the NMTCB was incorporated.
  20. 20. More Steps to the First Exam 300 items to be developed Initial Item Writing Assignments – Nuclear Instrumentation: J. Langan, M. Muilenburg – Dose Calibration: J. Herbst – Imaging Procedures: S. Weiss, D. Bernier, B. Horton – Radiopharmacy: S. Hemingway – Radiation Protection: J. Kellner – Non-Imaging Procedures: F. Kontzen, V. Custer, T. Mazzola – Medical Advisor: J. Conway, MD Minutes of the Nuclear Medicine Technology Certification Board, June 24, 1977
  21. 21. Pretest Administered February 11, 1978 100 pretesters with 25 at each of four sites – Chicago – Los Angeles – New York – Birmingham
  22. 22. Pretest Pretesters must have taken another registry within past two years. Included some who failed other registry. Well over 200 items identified as statistically strong.
  23. 23. First Exam Sites • Seattle • San Francisco • Los Angeles • Ogden, Utah • Phoenix • Denver • El Paso • Minneapolis • Omaha • Chicago • St. Louis • Oklahoma City • Houston • Birmingham • Tampa • Charlotte • Boston • New York • Philadelphia • Toledo • Puerto Rico • Hawaii
  24. 24. First Exam Administered September 15, 1978 – Exam fee - $30.00 – 652 Examinees, 33 no shows – 60% (391) passed
  25. 25. First Exam 200 items Maximum = 174, Mean = 117, Minimum = 56 1,674 granted reciprocal certification because they held current certification in Nuclear Medicine Technology with the ARRT and/or ASCP which was issued prior to the initial examination.
  26. 26. Where Are They Now? Of 2,074 individuals granted certification in 1978: – 771 continue to be Active – 135 hold Emeritus status – 158 hold Retired status – 142 are Inactive – 798 let certification lapse – 63 are deceased – 7 had their certification revoked • All were for failure to comply with the NMTCB CE Policy that was implemented January 1, 2006.
  27. 27. 1979 Exam Administered September 30, 1979 • 950 applications, 27 incomplete, 26 rejected, 44 withdrew, 28 no shows • 780 Examinees • 69% (538) passed
  28. 28. 1979 Exam 225 items, last 25 were pretest items Maximum = 179, Mean = 130, Minimum = 27 941 granted reciprocal certification because they held current certification in Nuclear Medicine Technology with the ARRT and/or ASCP which was issued prior to the initial examination. Of 1,479 certified in 1979, 682 are still active.
  29. 29. 1970’s Nuclear Medicine Development of rectilinear scanners reached its peak in 1972 and in 1973, 2 times as many scanners in the field as gamma cameras. William and Harris, “The Decline and Fall of the Rectilinear Scanner: Nuclear Medicine Instrumentation 1970-1995” JNMT 23.4S (1995) 16S-20S It wasn’t until the introduction of the 40-cm detector in 1975 that gamma cameras emerged as the preferred imaging device.
  30. 30. Fusion Imaging 70’s Style A fusion of a rectilinear scan using I-131 rose Bengal with a chest X- ray outlining the position of the diaphragm was used to diagnose subphrenic abscess before the availability of CT scanning and ultrasound.
  31. 31. Donald R. Bernier • SNMTS President 1971-1972 • NMTCB Board 1977-1983 • Editor Nuclear Medicine: Technology and Techniques 1st through 5th editions • Trained me to become a nuclear medicine technologist.
  32. 32. Founding Mission The NMTCB was founded and dedicated to the production of a certification examination which truly reflected both current practice and the entire scope of practice of nuclear medicine technology. The NMTCB promotes quality healthcare by certifying individuals through psychometrically sound examinations to practice and advance in Nuclear Medicine and Molecular Imaging.
  33. 33. Getting Into The ACT Contract with the American College Testing Program (ACT) for exam development and administration services. Determine the type of examination that would best serve the purpose of the NMTCB.
  34. 34. Norm Referenced Exam • A norm-referenced test / NRT is a type of test, assessment, or evaluation which yields an estimate of the position of the tested individual in a predefined population, with respect to the trait being measured. This estimate is derived from the analysis of test scores and possibly other relevant data from a sample drawn from the population. • The term normative assessment refers to the process of comparing one test-taker to his or her peers.
  35. 35. Criterion Referenced Exam • A criterion-referenced test is one that provides for translating test scores into a statement about the behavior to be expected of a person with that score or their relationship to a specified subject matter. • Most tests and quizzes written by school teachers are criterion-referenced tests. • The objective is simply to see whether or not the student has learned the material. WIKIPEDIA The Free Encyclopedia
  36. 36. Criterion Referenced Exam The Board initially chose and has continued to adhere to the criterion-referenced approach because it was more consistent with the intent of the certification program which is to define and measure “preparedness to practice” or competency at career entry-level.
  37. 37. Philosophy In 1977, the purpose of the NMTCB’s certification process was to “protect the public by distinguishing between those candidates who are prepared to practice and those who are not.” By “prepared to practice”, the Board meant those capabilities or competencies that were recognized by the nuclear medicine technology profession and identified by the Board as necessary for adequate preparation as an entry- level practitioner.
  38. 38. Philosophy The criterion-referenced NMTCB examination was based upon a domain of knowledge and skills that were judged to be important for entry- level practice in nuclear medicine technology. An individual’s performance is judged relative to the level of knowledge that has been determined to be sufficient and necessary for practice.
  39. 39. Preparedness to Practice The most important characteristic of a criterion- referenced examination is the definition of the domain of knowledge and skills to be tested. The NMTCB has devoted a great deal of effort in defining (and redefining) what will be tested in the examination by conducting periodic task analyses of the nuclear medicine technology profession.
  40. 40. Task Analysis • The Task Analysis contains a list of tasks, developed by experts in the field, that are judged to reflect important entry-level skills. • Task Analysis Surveys are then sent to a large, diverse and wide-spread group of practicing technologists who are asked to evaluate the importance, frequency performed, criticality and relevance of each task to the entry-level worker. • The Survey is statistically analyzed and results translated into the test blueprint or test specifications matrix, which define tasks to be included and emphasis each is to receive on the exam.
  41. 41. Next Steps Initial task analysis was reviewed. Initial Test Specifications Matrix established: – 23% Nuclear Instrumentation – 10% Dose Calibration and Administration – 24% Imaging Procedures – 10% Radiopharmacy – 10% Radiation Protection – 23% Non-Imaging Procedures Minutes of the NMT Certification Task Force, March 16, 1977
  42. 42. The Task Analysis: • Is an important source of content validity evidence for the examination. • Provides an empirical basis for determining which tasks will be included in the examination. • Is used to create the test specification matrix, which helps to guide the entire examination development process both in item writing and in test assembly. • Also supports the interpretations made of the test scores.
  43. 43. Partial Beatles Reference • There’s going to be an evolution. • The examination development process is evolutionary and must evolve with the profession to ensure that the exam continues to reflect current practice and the tasks that are important for entry-level practice. • Task Analyses continue to be conducted on a regular basis and the examination is frequently updated/revised to reflect the current state of nuclear medicine technology.
  44. 44. Analyzing the Task Analysis • During the spring 2009 NMTCB Board meeting, the results of the survey were presented. • The task analysis committee relied on a combination of numerical parameters to identify items to be considered for modification. • Items on the current examination falling below 15% frequency on the survey were reviewed for their criticality in current practice of nuclear medicine technology. • Items not currently on the examination that scored above 15% were taken into consideration for addition to the examination. NMTCB Task Analysis Report May 2009
  45. 45. Analyzing the Task Analysis • During the spring 2009 NMTCB Board meeting, the results of the survey were presented. • The task analysis committee relied on a combination of numerical parameters to identify items to be considered for modification. • Items on the current examination falling below 15% frequency on the survey were reviewed for their criticality in current practice of nuclear medicine technology. • Items not currently on the examination that scored above 15% were taken into consideration for addition to the examination. NMTCB Task Analysis Report May 2009
  46. 46. 2008 Task Analysis Items that will be removed from the entry-level examination include: hemocytometer, wet film, venogram, schillings test, I125 serum albumin/RISA, I125 Iothalamate. Among the active items falling below 15% frequency were the dose calibrator geometry test, red cell mass, and plasma volume studies. It was decided based on criticality that these items would remain on the exam. NMTCB Task Analysis Report May 2009
  47. 47. 2008 Task Analysis At the fall 2009 NMTCB Board meeting the task analysis data was reviewed again. Final changes were discussed, including the deletion of several items that are no longer available. The following items have been added to the list of items to be deleted since the spring 2009 publication: P32 chromic phosphate colloid, P32 sodium phosphate, B12, and Tc99m gluceptate. NMTCB Task Analysis Report Supplement December 2009
  48. 48. 2008 Task Analysis Items to be added to the examination content were in the area of computed tomography (CT). Since the explosion of the hybrid/fusion imaging technology, our field has become increasingly intertwined with other modalities. NMTCB Task Analysis Report May 2009
  49. 49. 2008 Task Analysis The foremost of these is obviously CT. Based on the responses given via the task analysis survey roughly 25% of nuclear medicine technologists surveyed are already performing CT examinations. NMTCB Task Analysis Report May 2009
  50. 50. 2008 Task Analysis Many of these are low-dose CT scans, being used solely for attenuation correction or localization in conjunction with a PET or SPECT nuclear medicine imaging system. There are however a significant number of nuclear medicine technologists already performing diagnostic quality CT examinations that may involve the use of contrast agents. NMTCB Task Analysis Report May 2009
  51. 51. 2008 Task Analysis To remain relevant we must be inventive and adapt to contemporary trends. As an organization, the NMTCB remains committed to the challenge of keeping pace with changes that affect the knowledge and skill requirements for technologists entering the field. Educators preparing students for the examination are being given a one-year notice of the new material to be incorporated into examination content. Prospective certificants can expect to see the proposed new content on the examination beginning January 1, 2011. NMTCB Task Analysis Report Supplement December 2009
  52. 52. Another Pie Chart
  53. 53. Back to the Past • NMTCB began the transition from paper & pencil exam to one administered on computer in 1992. • This would allow testing more often than twice per year and provide opportunity to incorporate more images into the exam. • Raised concerns about exam security. • Determined that best approach would be “Computerized Adaptive Testing” or “CAT”
  54. 54. History of Adaptive Testing It has always been recognized that giving a test that is much too easy for the candidates is likely to be a waste of time, provoking usually unwanted candidate behavior such as careless mistakes or deliberately choosing incorrect answers that might be the answers to "trick questions". Computer-Adaptive Testing: A Methodology Whose Time Has Come. John Michael Linacre, Ph.D. MESA Psychometric Laboratory, University of Chicago (2000)
  55. 55. History of Adaptive Testing On the other hand, questions that are much too hard, also produce generally uninformative test results, because candidates cease to seriously attempt to answer the questions, resorting to guessing, response sets and other forms of unwanted behavior. Computer-Adaptive Testing: A Methodology Whose Time Has Come. John Michael Linacre, Ph.D. MESA Psychometric Laboratory, University of Chicago (2000)
  56. 56. History of Adaptive Testing Alfred Binet (1905) achieved the major advance in this area with his intelligence tests. He realized he could tailor the test to the individual by a simple stratagem - rank ordering the items in terms of difficulty. He would then start testing the candidate at what he deemed to be a subset of items targeted at his guess at the level of the candidate's ability. Computer-Adaptive Testing: A Methodology Whose Time Has Come. John Michael Linacre, Ph.D. MESA Psychometric Laboratory, University of Chicago (2000)
  57. 57. History of Adaptive Testing If the candidate succeeded, Binet proceeded to give successively harder item subsets until the candidate failed frequently. If the candidate failed the initial item subset, then Binet would administer successively easier item subsets until the candidate succeeded frequently. Computer-Adaptive Testing: A Methodology Whose Time Has Come. John Michael Linacre, Ph.D. MESA Psychometric Laboratory, University of Chicago (2000)
  58. 58. History of Adaptive Testing From this information, Binet could estimate the candidate's ability level. Binet's procedure is easy to implement with a computer. Computer-Adaptive Testing: A Methodology Whose Time Has Come. John Michael Linacre, Ph.D. MESA Psychometric Laboratory, University of Chicago (2000)
  59. 59. Transition to CAT • Reckase (1974) is an early example of this methodology of computer adaptive testing (CAT). • In March of 1986 the Chicago Sun-Times reported that the "standardized testing of college-level skills recently began its long- awaited shift into the realm of computers.“ • Nov 15, 1993 - Educational Testing Service begins phasing out paper & pencil testing by offering a "computer adaptive test" (CAT) to about 30,000 of their students at about 150 sites, most of them Sylvan Test Centers.
  60. 60. Computer Adaptive Testing On July 15, 1996, the NMTCB began offering a computer adaptive test (CAT) for classification in association with ACT, Inc. that was designed to render a pass/fail decision. In order to administer a CAT for classification, the items themselves are ranked at the decision point on the score scale according to their ability to classify accurately and quickly.
  61. 61. More CAT Each item in the item pool is associated with: – information on its difficulty (the proportion of examinees answering an item correctly) – discrimination levels (the ability of an item to distinguish between passing and failing individuals)
  62. 62. More CAT An item that has a difficulty level at or near the passing score and has good discrimination will be a better item for decision-making than another item that is too difficult or too easy or has little ability to discriminate between those examinees who should pass and those who should fail.
  63. 63. Classification CAT Unlike Benet’s early work, for the NMTCB classification CAT, the type of items that are administered to each and every candidate are the same: there are no "difficult items for better candidates" or "easier items for poorer candidates." Our "classification" CAT is still adaptive in that those examinees whose abilities are far from the passing score (in either direction) will require fewer test items for classification than those whose ability is at or near the passing score.
  64. 64. Classification CAT The test will adapt by test length rather than by item difficulty. Each examinee answers a total of 50 to 75 operational items, and the items are different for each examinee. Then each candidate answers 15 (for a 75-item exam) to 30 pretest items (for a 50- item exam).
  65. 65. NMTCB CAT Items for the classification CAT are selected in the following approximate proportions for each of four content domains of nuclear medicine technology. – Radiation safety (15%) – Instrumentation (20%) – Clinical procedures (45%) – Radiopharmacy (20%)
  66. 66. 1977 • First personal computer introduced – Commodore PET. • Apple was incorporated – Apple II introduced. • Snow fell in Miami – only time in recorded history. • Optical fiber is first used to carry live telephone traffic. • Elvis Presley’s last concert in Indianapolis. • Space shuttle Enterprise make first test free-flight. • Voyager 1 is launched. • Porsche 928 debuts. • Last natural smallpox case discovered. • TCP/IP test succeeds connecting 3 ARPANET nodes (of 111), in what eventually becomes the Internet protocol.
  67. 67. déjà vu? March 25, 2000 – Board discussion regarding an advanced specialty exam for nuclear cardiology was tabled pending a task analysis assessment for nuclear cardiology. May 26, 2000 – SNMTS formally requested that the NMTCB consider the possibility of developing a specialty examination in Nuclear Cardiology.
  68. 68. déjà vu? September 3, 2000 – NMTCB Board meets and the following motion is approved: The Exam Committee recommends the formation of an Ad Hoc Board committee, and designation of funds of $15,000 for item writing, content meetings, printing of exam applications and test booklets, and administrative expenses, to create a nuclear cardiac specialty examination. October 13, 2000 – Letter to SNMTS committing to offer first NCT exam at SNM Annual Meeting in June 2001 in Toronto.
  69. 69. And We’re Off… A group of ten subject matter experts (SME) identified the critical abilities related to the practice and defined test specifications. This SME group included five members of the ad hoc committee and five professionals practicing in the nuclear cardiology field who came from different regions of the country and from different work settings.
  70. 70. Subject Matter Experts Ad Hoc Committee • Gary Dillehay • Tony Knight • Vivian S. Loveless • Kathleen Murphy • Patricia Wells NCT Professionals • Dan Basso • Wendy Bruni • Mark Hyun • April Mann • Kim Shacklett
  71. 71. NCT Exam Development • The SME group developed test specifications for the specialty exam, which included the item format, total number of items, testing time, and the proportion of items that focus on each of the identified critical abilities to be tested.
  72. 72. NCT Exam Development The test included one hundred scored and 21 pre-test items of multiple-choice format with four possible options. Guidelines for technologist training in nuclear cardiology, developed by ASNC, were used to verify and refine the content domain for the exam.
  73. 73. Putting It All Together Candidates were given a total time of two hours to complete the test. The ad hoc committee members wrote most of the items for the test. The volunteer “experts” and other members of the Board took the pilot test.
  74. 74. Putting It All Together After the pilot, the ad hoc committee members, SME experts and members of the NMTCB worked together to finalize the test. For security reasons two test forms, A and B, were developed. By scrambling the item order of form A, form B was created.
  75. 75. The First NCT Exam The first administration of the nuclear cardiology exam was June 23, 2001. Sixty-eight examinees sat for the exam. Forty-four of the 68 or 65% of the examinees passed, and twenty-four or 35% failed.
  76. 76. NCT Specialty Exams • Board determined that since this was a specialty exam and because the field can change dramatically in a relatively short period of time, the NCT Specialty Certification would expire after seven years. • In order to renew NCT certification, the candidate will have to prove continued specialty knowledge by passing the exam again. • NCT Exam offered on demand beginning February 2008. • There are currently 723 Active NCT Certificants.
  77. 77. PET? March 25, 2000 - An in depth discussion regarding an advanced practice exam for PET was held during the NMTCB Board meeting. March 25, 2000 – Board discussion regarding an advanced specialty exam for nuclear cardiology was tabled pending a task analysis assessment for nuclear cardiology.
  78. 78. PET? The Board contacted the Institute for Clinical PET (ICP) to determine: – level of interest by the PET technologist community for an advanced specialty exam – specific information to create an inclusive task analysis for the specialty of PET. March 24, 2001 - The Board agreed to move forward with the creation of the advanced competency exam in PET.
  79. 79. We’re Off …Again Action items include: – Preparing a content outline (utilizing the expertise of the PET community) – Review of the JNM and JNMT for information to enhance the content outline – Identifying 7-10 item writers – Creating 120+ exam questions – Obtaining reciprocity for CE credits for passing advanced competency exams – Proposed exam site/date: Fall ICP meeting, October 2002.
  80. 80. PET-CT Consensus Conference • ACR • Arizona Board of Medical Radiologic Technology • ARRT • ASRT • CPS Innovations • CTI Molecular Imaging, Inc. • GE Medical Systems • JRCERT • JRCNMT • NMTCB • PETNET Pharmaceuticals • Radiologic Technologist Certification Program, Florida Department of Health • Siemens Medical Solutions • SNM • SNMTS - Facilitator 27 attendees total Minutes from the PET-CT Consensus Conference, July 31, 2002, New Orleans, LA.
  81. 81. PET/CT Consensus Any registered radiographer with the credential R.T.(R), registered radiation therapist with the credential R.T.(T), or registered nuclear medicine technologist with the credentials R.T.(N) or CNMT may operate PET-CT equipment after obtaining appropriate additional education or training and demonstrating competency. Statements from the PET-CT Consensus Conference, July 31, 2002, New Orleans, LA.
  82. 82. PET/CT Consensus • Ideally, technologists operating a hybrid PET-CT unit would be a hybrid themselves, credentialed in both CT and nuclear medicine. • Less than 200, are ARRT- or NMTCB-registered nuclear medicine technologists who are also credentialed in CT through a specialty examination offered by the ARRT. • Fewer than 5,000 people nationwide are registered in radiography by the ARRT and registered in nuclear medicine technology by the ARRT or by the NMTCB. Statements from the PET-CT Consensus Conference, July 31, 2002, New Orleans, LA.
  83. 83. False Start March 22, 2003 – After 2nd consensus meeting in Albuquerque, Board approved motion to create two exams: – PET specialty exam – PET/CT exam as the priority exam for completion • PET/CT project subsequently scratched PET Exam pre-tested on February 21, 2004.
  84. 84. Qualifications to Sit for PET • CNMT, CAMRT or ARRT(N): – 700 hours of clinical experience in PET as validated by the signature of the medical director, nuclear physician, supervisor or administrator of the facility. • ARRT(R) or (T) – 700 hours of clinical experience in PET under the direct supervision of a nuclear physician and a certified, registered or licensed nuclear medicine technologist. – Additionally, the radiology technologist or therapist will be required to obtain 45 hours of didactic education (15 hours each nuclear medicine instrumentation, radiation safety and radiopharmacy).
  85. 85. First PET Exam Results First exam administered September 24, 2004. – 226 registered for exam – 203 sat for exam – 105 (51.7%) passed – 98 failed PET Exam offered on demand beginning June 2009. There are currently 618 Active Certified PET Technologists.
  86. 86. New Career Path for NMTs • A Nuclear Medicine Advanced Associate (NMAA) is an advanced-level nuclear medicine technologist working under the supervision of a licensed physician, who is also an authorized user of radioactive materials, to enhance patient care in the diagnostic imaging and radiotherapy environments. • The Nuclear Medicine Advanced Associate is an NMTCB- or ARRT-certified nuclear medicine technologist who has successfully completed an advanced academic program encompassing a nationally recognized NMAA curriculum and a nuclear medicine physician-, nuclear cardiologist-, or radiologist-directed clinical preceptorship. ACR ASRT Joint Policy Statement - Radiologist Assistant: Roles and Responsibilities (March 2009)
  87. 87. Advanced Imaging Practitioner A first-of-its-kind master’s level degree program is now being offered to provide nuclear medicine professionals with another career pathway for advancement in the field. The program, called the Nuclear Medicine Advanced Associate (NMAA), will help meet the growing demand for advanced imaging practitioners as new procedures are developed and as the range and utilization of imaging procedures expand. SNM Release - New Masters Program Opens Doors for Nuclear Medicine Technologists (September 2009)
  88. 88. NMAA Program • The program is currently offered through a consortium of three universities: the University of Arkansas for Medical Sciences (UAMS), Saint Louis University and the University of Missouri– Columbia. • The program runs for five semesters of full-time enrollment. Students are accepted on a rolling basis and may begin the program in the fall, spring or summer semester. • The program is designed for distance-learning and is delivered using a combination of online instruction and clinical instruction at facilities affiliated with UAMS and the consortium partners.
  89. 89. A New Certification Exam Nuclear Medicine Advanced Associate – Spring 2009 – NMTCB committed to developing an NMAA certification exam for delivery within six months of the first graduating class. – Preliminary budget, timeline and content outline approved at Spring Board meeting. – Exam ready by SNM Annual Meeting in June 2011.
  90. 90. NMAA Exam • Multiple choice; ~200 questions; delivered by paper & pencil at SNM Annual Meeting in San Antonio, June 2011. • Exam Specification Categories: – Patient Care – Clinical procedures – Diagnostic and Therapeutic Radiopharmaceuticals – Radiation Safety and Radiobiology in Clinical Practice
  91. 91. Organizational Involvement • SNMTS – National Council of Representatives – Advocacy (Government Relations) Committee – Education Committee – Various Chapters • Alliance for Quality Medical Imaging and Radiation Therapy (AQMIRT or “Alliance”) • Health Professions Network (HPN) • Council of Radiation Control Program Directors (CRCPD)
  92. 92. Organizational Diversity • The Board of Directors consists of eighteen (18) individuals. – Physician member of the SNM – Physician and/or scientist at-large (SNM Member) – A representative of the AAPM – A representative of the Specialty Council of Nuclear Pharmacy. – Twelve (12) nuclear medicine technologists certified by the NMTCB. – Two (2) are selected by the Board of Directors.
  93. 93. Members of the NMTCB Board Michele Beauvais, RPh, BCNP Angela Bruner, PhD, DABR Jimel Carpenter, CNMT, NCT Anne Fisher, CNMT Angela Foster, CNMT Deborah Gibbons, CNMT, PET David Gilmore, CNMT, NCT Leonie Gordon, M.B., Ch.B. Chad Grant, CNMT - Chair Marcia Hess Smith, CNMT Cindi Luckett-Gilbert, CNMT, PET Nancy DeLoatch, CNMT, NCT Yusuf Menda, MD Cybil Nielsen, CNMT Robert Pagnanelli, CNMT, NCT Gregory Passmore, PhD, CNMT James Patton, PhD Leesa Ross, CNMT, PET
  94. 94. NMTCB Chairs • Mark I. Muilenburg • James J. Kellner • John J. Kozar • Sheila Rosenfeld • George W. Alexander • Nancy M. Blosser • Helen M. Drew • Karen L. Blondeau • Jacqueline A. Bridges • Martha W. Pickett • Mark H. Crosthwaite • Nancy S. Sawyer • Miriam K. Miller • Daniel J. Leahey • *Nancy S. Sawyer • Daniel J. Leahey *Mark A. Richard elected but resigned prior to serving as Chair
  95. 95. NMTCB Chairs • Ellen A. Thomas • Anthony W. Knight • Kristen Waterstram- Rich • Kathleen H. Murphy • Kathleen S. Thomas • Lynnette A. Fulk • April Mann • Danny A. Basso • Anne M. Fisher • Chad M. Grant
  96. 96. Executive Directors • Barbara Horton, CNMT • Dennis Park • James Greene, PhD • Bhaskar Dawadi, PhD • Stanley Kalisch, PhD • David Perry, CNMT, PET
  97. 97. Director Application Form Online Item Submission
  98. 98. The Simpsons Reference Matt Groening made his first professional cartoon sale to the avant- garde Wet magazine in 1978. The name changed in 2007 but the cartoon is still carried in 250 weekly newspapers.
  99. 99. Also in 1977… Later renamed to Star Wars IV: A New Hope
  100. 100. 1979 Jaguar posted a 1.75 petaflop/s performance speed running the Linpack benchmark. One petaflop/s refers to one quadrillion (1015) calculations per second. Top Supercomputing Sites Report (November 2009)

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