Appendix B - Sample Application for Medical Staff Privileges


Medical Staff Credentials and Privileges for a Medical Radiation Physicist Department of Radiology or Radiation Oncology

CREDENTIALS

    1. M.S. or Ph.D. in a physical science, plus four years experience in a medical environment,

    and

    2. Certification by the American Board of Radiology or equivalent board in diagnostic, and/or therapeutic, and/or nuclear medicine medical physics required,

    and

    3. Appropriate state license (in states where applicable).

    These and any other evidence of qualification must be approved by the radiology department prior to submission to the Medical Staff Executive Committee and the governing body of the hospital.

PRIVILEGES

Please check the privileges being requested and for which you are qualified.

RADIATION ONCOLOGY

  1. Calibrate therapy machines and sources.
  2. Provide treatment planning consultations.
  3. Provide radiation dose calculations and measurements.
  4. Establish review quality assurance programs.
  5. Review therapy charts. Make chart entries as required.
  6. Be responsible for intracavitary dosimetry.
  7. Insert and/or remove after loading sealed radiation sources for intracavitary and interstitial treatments when requested by the radiation oncologist.
  8. Document patients' hospital charts, the conditions and times of radiation source insertions and removals.
  9. Train medical and hospital staff in above areas.