October 18, 2018

Article Emphasizes Essential Roles of Medical Physicists

An analysis in the October Radiographics [38(6):1665-1671] finds that medical physicists have become the “go-to” experts for medical imaging safety and quality in addition to their traditional roles in equipment acceptance testing, regulatory compliance, dose measurement and medical physics training.

Author Mahadevappa Mahesh, MS, PhD, chief physicist at Johns Hopkins Hospital, noted medical physicists play indispensable roles in ensuring their radiology departments and medical imaging equipment comply with all safety and performance requirements.

Federal and state regulations and voluntary guidelines have increased the amount of authority accorded to medical physicists. They have also broadened the physicist’s reach to wherever medical equipment involving human exposure to ionizing radiation is operating and to nearly all types of medical specialists who employ X-ray and advanced medical imaging in their practices.

The Mammography Quality Standards Act (MQSA) of 1992 established a template defining the roles assigned to medical physicists in the late 20th and early 21st centuries, Mahesh wrote. They include imaging modality acceptance testing, evaluations to ensure compliance with various regulations and accreditation requirements and reviews of equipment performance after major repairs and service.

Medical physicists are not alone in fulfilling these responsibilities. They collaborate with radiologists and radiologic technologists to assure that mammography systems, general X-ray, fluoroscopic, CT, MR and other advanced imaging modalities are precisely calibrated and closely monitored to perform safely and effectively.

Mahesh wrote that the Medicare Improvement for Patients and Providers Act (MIPPA) of 2008 created compulsory roles for medical physicists when it required outpatient imaging centers to undergo accreditation for advanced imaging services to qualify for Medicare and Medicaid reimbursement. The Joint Commission further expanded the scope of the MIPPA mandates to acute care hospitals by requiring the medical physicist involvement with imaging modalities at the time of installation, during annual inspections and after major repairs and service.

In particular, Mahesh noted the Joint Commission requires medical physicists to annually evaluate all CT scanners within their purview for scanner performance, radiation dose measurements, dose display accuracy and periodic protocol review. Commission guidelines for interventional fluoroscopy govern patient dose monitoring quality control to identify individual instances of high radiation exposure and to determine when the facility’s sentinel event policy should be applied. Here again, the medical physicist’s skills come into play through the daily monitoring of patient dose and reviews of interventional procedures, not only for radiology, but for cardiology, vascular surgery and other areas of the hospital as well.

State regulations defined by the Suggested State Regulations for Control of Regulations (SSRCRs) of the Conference of Radiation Control Program Directors (CRCPD) have also established state-specific certification standards that need medical physicist expertise to fulfill. They are considered qualified experts for assuring compliance with U.S. Nuclear Regulatory Commission regulations governing the transportation, storage and handling of radioactive materials used in nuclear medicine, nuclear cardiology and vascular and interventional applications.

“Generally, the following rings true,” Mahesh wrote as he quoted an anonymous source, “’If everything is going well, no one knows who the medical physicist is in the radiology department, but if something goes wrong, then everybody knows who the medical physicist is.’”

That’s because the recent evolution of medical practice and its regulation have made them essential in many ways.