AAPM PRESIDENT-ELECT'S REPORT Bruce Thomadsen, PhD, Madison, WI

Physics Summit on Imaging Physics

The situation with imaging physicists is becoming critical. Or maybe not. We wish we knew. There are indications that there may not be enough imaging medical physicists coming into the workforce. Some hospitals and consulting groups cannot find board certified imaging physicists to fill positions. To assess the situation, AAPM President Melissa Martin convened a Physics Summit, with representatives of the American Board of Radiology, the American Board of Medical Physics, the Commission on the Accreditation of Medical Physics Education Programs (CAMPEP), the American College of Radiology, and the Society of Directors of Academic Medical Physics Programs. For AAPM, in addition to the members of the Executive Committee, Jim Dobbins of the Education Council and Joann Prisciandaro, Chair of the Education and Training of Medical Physicists Committee (ETC) participated.

An important part of this situation plays out through the tandem limits to entry: the requirement by the ABR that candidates complete a residency and the limited number of imaging residencies available. Currently, there are 15 CAMPEP accredited imaging residencies and seven more in the process of applying for accreditation. The existing programs graduate about 20 residents per year, and it looks as if those programs in the application process should produce approximately another 10. So, how does that match the need? Aside from the anecdotal comments about the difficulty in finding imaging physicists, we have no real data on the issue. To address the question, the ETC will study the supply and projected need for imaging physicists and CAMPEP will have graduate programs and residencies provide more data on what graduates do after leaving the programs. Funding for the existing imaging residencies remains precarious, sometimes depending on grants.

Regardless of the uncertainty on the supply and demand sides of the equation for imaging physicists, the future of imaging physics is very much more uncertain than the issues discussed at the summit. Many states do require, through regulation, the quality testing of x-ray equipment by qualified medical physicists and federal regulations require medical physics evaluations for mammography units. Aside from such requirements, for those modalities that ACR accredits, qualified medical physicists are responsible for commissioning the equipment and establishing the quality program and reviewing the results. The frequency of review may only be annually, which coincides with most state required QA. Other than this testing and review, further interactions between the medical physicist and the facility depends on the largess of its director since there is no identifiable revenue stream for imaging physics as there is for therapy. And this is a big loss for the facility, the patients, and the medical physicist.

Another indication of the invisibility of imaging physics comes, for example, with the ACGME Program Requirements for Graduate Medical Education, for example, in Interventional Radiology. Those requirements include that residents must learn diagnostic physics, but there is no requirement that a medical physicist teach the course. The requirements dictate that the program takes place in a large institution to allow for a good number and distribution of cases and to provide meaningful interactions between the residents and other relevant persons, and specifies that the program must have a qualified interventional radiology technologist and a nurse qualified to administer moderate sedation. A medical physicist is not mentioned. The writers of the standard apparently have no understanding or appreciation of the valuable contributions medical physicists make in imaging other than the annual performance checks on the equipment.

Imaging physicists played a more direct role in patient care and improving quality in individual departments in days gone by. Funding for an expanded role of the medical physicists in diagnostic and nuclear medicine facilities will only come if accreditation and education standards call for it. If that were to become the standard, programs to educate and train imaging physicists would have to grow to supply the need. AAPM needs to publicize the role of imaging physicists so both graduate students and the radiological community appreciate the value. Our voice alone will not lead to necessary changes. Medical physics has strong allies in the Radiological Society of North America and the American College of Radiology and we need (there was a word missing here. is “need” the right word?) to work with them to affect change.

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