| Literature DB >> 30338913 |
Jessica B Clements1, Christopher T Baird2, Steven F de Boer3, Lynne A Fairobent4, Tyler Fisher5, James H Goodwin6, Dustin A Gress7, Jennifer Lynn Johnson8, Kathryn L Kolsky9, Gig S Mageras10, Rebecca M Marsh11, Melissa C Martin5, Brent Parker12, Daniel C Pavord13, Michael C Schell14, J Anthony Seibert15, Donna M Stevens16, Russell B Tarver17, Christopher G Waite-Jones18, Nicholai Wingreen19.
Abstract
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline (MPPG) represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiation requires specific training, skills, and techniques as described in each document. As the review of the previous version of AAPM Professional Policy (PP)-17 (Scope of Practice) progressed, the writing group focused on one of the main goals: to have this document accepted by regulatory and accrediting bodies. After much discussion, it was decided that this goal would be better served through a MPPG. To further advance this goal, the text was updated to reflect the rationale and processes by which the activities in the scope of practice were identified and categorized. Lastly, the AAPM Professional Council believes that this document has benefitted from public comment which is part of the MPPG process but not the AAPM Professional Policy approval process. The following terms are used in the AAPM's MPPGs: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.Entities:
Mesh:
Year: 2018 PMID: 30338913 PMCID: PMC6236822 DOI: 10.1002/acm2.12469
Source DB: PubMed Journal: J Appl Clin Med Phys ISSN: 1526-9914 Impact factor: 2.102
Administrative Tasks — may be applicable to all subspecialties
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards. |
|---|---|---|---|---|
| Participates in operations management (e.g., establish client expectations, allocate personnel, ensure expectations are met) | x | 1, 2 | ||
| Participates in staffing and budget discussions and decisions that impact clinical medical physics services | x | 1, 2 | ||
| Participates in initial and ongoing facility planning (e.g., facility layout optimization, life cycle management of imaging equipment) | x | 1, 2, 3 | ||
| Consults on selection of new equipment prior to purchase, including review and comparison of equipment specifications and performance | x | 3 | ||
| Supervises medical physics staff, including physicists, medical physicist assistants, medical physics residents, and medical physics students in compliance with all relevant regulatory requirements and appropriate professional documents (e.g., AAPM reports) | x | 1, 2, 4 | ||
| Ensures that all local and national regulations and accreditation requirements as relating to medical physics are met and maintained | x | |||
| Oversees quality assurance and quality control programs to meet local and national regulations, accreditation organization(s) standards, and national recommendations | x | 10, 11, 12, 13, 14, 15, 16 | ||
| Establishes training and competency requirements and monitors maintenance of competencies for clinical medical physics tasks | x | 9 | ||
| For activities that require supervision by a QMP, identifies the educational background and competencies required by those delegated to perform these duties | x | 10, 11, 12, 13, 14, 15, 16 | ||
| Provides institutional consultation on the development of clinical programs that utilize medical physics | x | |||
| Participates in Coding/Billing (documentation) | x | |||
| Provides technical oversight of personnel (including, but not limited to, radiation therapists, technologists, dosimetrists, and service engineers) | x | 3 | ||
| Serves as the radiation safety officer for the facility | x | 17 | ||
| Serves as a member of the institution's Radiation Safety Committee | x | 17 | ||
| Develops procedures for the initial and continuing evaluation of radiation protection equipment and procedures | x | 18, 19 | ||
| Acts as the facility's MR Safety Expert or MR Safety Officer | x | 20 | ||
| Develops an MRI safety program | x | 10, 12 |
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards |
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| Develops procedures for initial acceptance testing and ongoing equipment testing (e.g., annual testing, postservice testing), including who performs the test, the frequency of testing, tolerance levels, and what to do if the test is out of tolerance | x | 1, 2, 3 | ||
| Ensures that measurement equipment is calibrated according to manufacturer recommendations and regulatory guidelines | x (general) | 5, 6, 7, 8 | ||
| Maintains appropriate documentation of all quality assurance and calibration results | x (general) | |||
| Participates in research and development either individually or as part of a broader clinical team including support for clinical trials | x | 3, 4 | ||
| Participates in the development of products and procedures relevant to medical physics through collaboration with equipment manufacturers and Research and Development scientists | x | 10 | ||
| Participates in evaluation of emerging technologies and incorporating technology innovations into clinical practice | x | 3 | ||
| Reviews service activities (e.g., software updates) that may impact dose or image quality and determines if further medical physics follow‐up is required | x (general) | |||
| Develops and oversees processes to authorize release of clinical equipment after service | x | |||
| Evaluates technical and clinical physics issues related to patient care and determines if further medical physics follow‐up is required | x | |||
| Communicates with and educates patients, including discussions of risk | x | |||
| Consults with other healthcare professionals regarding patient radiation dose and associated risks | x | |||
| Performs radiation dose estimates from diagnostic and nuclear medicine exams, including peak skin dose estimates, individual patient dose estimates, and fetal dose estimates, to be reported to the health care team and patient | x | 11, 12, 13, 14, 15 | ||
| Performs individual patient dosimetry for therapies involving radiopharmaceuticals | x | |||
| Performs calculations to determine the release status of patients receiving treatment with radiopharmaceuticals | x | 46 | ||
| Participates in or oversees the safe use of radiopharmaceuticals or radionuclides during therapeutic procedures (e.g. Y‐90) | x | 47 | ||
| Provides consultation regarding patient safety in MRI, such as SAR considerations, prevention of patient burns, implanted devices, etc. | x | |||
| Provides consultation regarding patient safety in ultrasound, such as thermal and mechanical index considerations | x | |||
| Evaluates appropriate imaging protocols for diagnostic and interventional imaging and simulation and image‐guided radiotherapy | x | 16, 17, 18, 19 | ||
| Ensures the safe and appropriate implementation and use of imaging procedures and equipment as they pertain to diagnostic and interventional equipment and radiotherapy (simulation, treatment planning, and treatment delivery) | x | 6, 22, 23, 24, 25, 26, 27, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45 | ||
| Participates in developing policies and procedures related to the appropriate therapeutic use of radiation | x | 29, 30, 31 | ||
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| Approves radiation oncology technical procedures prior to clinical use | x | 29, 30, 21 | ||
| Works with the medical practitioner to develop the dosimetric component of treatment plans. Reviews radiation oncology dosimetry information noted in patient records | x | 31, 32, 33, 34, 35 | ||
| Provides written reports as needed to assure accurate and appropriate choice of dose delivery for radiation therapy | x | |||
| Is involved with the development and delivery of special radiotherapy procedures | x (direct) | |||
Education Tasks — may be applicable to all QMP subspecialties
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards |
|---|---|---|---|---|
| Participates in clinical education and training programs as needed to provide appropriate clinical training and supervision required for students. | x | 1 | ||
| Provides MRI safety training to health care team members and emergency responders | x | |||
| Provides formal and informal radiation physics training for all members of the care team necessary for safe and effective care of patients and employee safety | x | 2 |
Informatics Tasks — may be applicable to all QMP subspecialties
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards |
|---|---|---|---|---|
| Participates in informatics technology resource management | x | 1 | ||
| Participates in developing policies and procedures for electronic medical information security and privacy | x | 1, 2, 3, 4, 5 | ||
| Develops and manages a quality assurance program for data transfer between clinical systems in radiation oncology | x | 1, 6, 7 |
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards. |
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| Performs EPE for primary interpretation displays and modality displays, excluding displays used in mammography | 1, 2, 3, 4, 5, 6, 7 | |||
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| Performs EPE for primary interpretation displays and modality displays used in mammography | 1, 5, 6 | |||
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| Performs EPE for dental x‐ray systems (Excluding dental CT) | 8, 9 | |||
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| Performs EPE for general x‐ray systems, including computed radiography and digital radiography systems | 8, 10, 11 | |||
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| Performs EPE for fluoroscopy systems including general fluoroscopy, mobile C‐arms, and interventional angiography systems | 8, 12, 13, 14, 15 | |||
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| Performs EPE for cone‐beam CT systems, including those used for dental imaging and as part of an interventional fluoroscopy system | 2 | |||
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| Performs EPE for mammography systems | 1, 20, 21, 22 | |||
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| Performs EPE for ultrasound systems | 1, 2, 3, 4, 23, 24 | |||
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| 1, 2, 3, 4, 30, 31 | |||
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| Performs EPE for PET systems | 1, 2, 3, 4, 32, 33 | |||
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| Performs EPE for nonimaging nuclear medicine equipment (e.g., dose calibrators, uptake probes, well counters) | 1, 2, 3, 4, 34 | |||
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| Performs EPE for equipment used for external beam therapy, brachytherapy, simulation, image guidance, treatment planning, radiation measurement, including associated computer systems, algorithms, data and output | 35, 36, 37, 38, 39 | |||
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| x (general) | |||
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| Performs EPE for CT systems used only for radiation therapy simulations or as part of an image‐guided radiotherapy system, including CT‐on‐rails, fan‐beam megavoltage CT, and kilovoltage CT | 16 | |||
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| Performs EPE for diagnostic CT systems, including the CT portion of PET/CT scanners that are used to obtain a diagnostic CT scan | 1, 2, 3, 4, 17, 18, 19 | |||
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| x (general) | |||
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| Performs EPE for MRI systems, including systems used for radiation therapy treatment planning | 1, 2, 3, 4, 25, 26, 27, 28, 29 | |||
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| x (direct) | |||
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| x (general) | |||
Quality Tasks — may be applicable to all QMP subspecialties
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards. |
|---|---|---|---|---|
| Ensures all medical physics tasks and duties are in compliance with all applicable regulations related to the use of ionizing and nonionizing radiation | x | |||
| Is involved with the recommended action and patient health effects analysis from radiation medical events or near misses | x | 1, 2 | ||
| Participates in an ongoing peer‐to‐peer review program. This may be performed with another QMP within the practitioner's institution or an extramural QMP | x | 3, 4, 5 | ||
| Serves on institutional committees (e.g., Risk Management, Quality Assurance, and Professional Staff) as needed to provide relevant information related to medical physics | x | 6, 7, 8, 9, 10 | ||
| Consults in developing policies and procedures related to the appropriate clinical use of radiation for imaging purposes (e.g., advantages and disadvantages of various imaging techniques) | x | |||
| Provides imaging protocol consultation with radiologists and other health care providers | x | 11, 12, 13 | ||
| Works with radiologists and technologists to optimize imaging protocols, including technical scan parameters and appropriate use of dose‐optimization features available on equipment (e.g., automatic tube current modulation, iterative reconstruction, pulsed fluoroscopy, etc.) | x | |||
| Works with technologists and radiologists to establish reference levels for monitoring radiation dose in general radiography, fluoroscopy, and CT‐guided interventions | x (direct) | 11, 12, 16 | ||
| Works with technologists and radiologists to set dose alert levels for diagnostic imaging procedures | x (direct) | 12 | ||
| Analyzes dose indices of aggregate data to guide imaging optimization efforts | x | |||
| Oversees or participates in evaluation, maintenance, and utilization of radiation dose index monitoring software | x (general) | |||
| Quality Tasks — applicable to therapy medical physics QMP subspecialty | ||||
| Develops and manages a comprehensive Quality Management Program that monitors, evaluates, and optimizes radiation oncology processes | x | 1, 14, 15 | ||
| Description of practice | Activity must be performed by a QMP | Activity must be performed or supervised by a QMP | Activity should include a QMP | Existing standards or guidelines related to the task. The position of the AAPM may be different than the referenced reports and standards. |
|---|---|---|---|---|
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| Plans and specifies thickness, material, and placement of shielding needed to protect patients, workers, the general public, and the environment from radiation produced incident to diagnosis or treatment in consultation with the architect and facility representatives | x | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 | ||
| Verifies and documents that the required shielding was properly installed and that the shielding design goals were met | x | 1, 2 | ||
| Participates in radiation disaster planning and recovery | x | |||
| Performs safety assessments (Failure Mode Effects Analysis, etc.) for process improvement | x | |||
| Establishes and oversees radiation and/or MR safety programs to meet local and national regulations, accrediting organizations' standards, and national recommendations | x | 13, 14 | ||
| Provides radiation safety training to physicians, technologists, nurses, and other hospital staff | x | |||
| Develops specifications for personnel and patient radiation protection equipment | x | 15, 16 | ||
| Oversees radiation protection, policies and procedures, regulatory compliance, accreditation requirements, and adherence to national recommendations | x | |||
| Provides ongoing education and training to technologists and other personnel in the safe handling of radioactive materials | x | |||
| Participates in personnel exposure monitoring | x | |||
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| Provides guidance regarding controlled access to MRI areas | x | |||
| Ensures the safety of the MRI environment | x | 14 | ||
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| Develops and oversees processes for the proper receipt, handling, storage, and disposal of radioactive materials within the hospital | x | |||
| Acts as an Authorized Medical Physicist for radioactive materials | x | |||
| Manages and maintains hot labs used for storage and preparation of radioactive materials | x | |||
| Develops facility procedures to address and manage responses to radioactive spills | x | |||