AAPM medical physics practice guideline 10.a.: Scope of practice for clinical medical physics

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.

Task Group 174 Report: Utilization of [18F]Fluorodeoxyglucose Positron Emission Tomography ([18F]FDG‐PET) in Radiation Therapy

“… Acceptance testing for PET portion of PET/CT should at least: (a) include NEMA NU 2‐2012 performance measures; (b) pass tests on ACR flangeless PET phantom SUV parameters and resolution and/or pass European standards, such as provided by EARL; (c) have acceptable alignment (no offsets or skews) between the PET and CT image sets of the ACR flangeless phantom. Where appropriate, tests from TG‐126 (PET/CT Acceptance Testing and Quality Assurance) should be incorporated that either have more stringent criteria than those specified in this report, or do not exist in this report. Compliance with the test specifications used for ACR accreditation or EARL accreditation (EU) is recommended (for acceptance and for subsequent annual QA). Annual QA tests should be performed on the ACR flangeless phantom corresponding to SUV parameters and resolutions (as in ACR accreditation or as in EARL accreditation), and PET/CT alignment. Monthly QA tests should be performed for uniformity, quantification, scatter correction and randoms rejection, resolution, and PET/CT alignment. All tests in 1–4, above, should be performed by a Qualified Medical Physicist (QMP) (refer to American Association of Physicists in Medicine (AAPM) “Definition of a Qualified Medical Physicist”), as appropriate, or individuals working under the general supervision of a QMP (“general supervision” as defined in the AAPM Medical Physics Practice Guideline). The Qualified Medical Physicist should review and approve via countersignature all tests performed by the individual under their supervision. Patient scanning protocol should ensure consistency of patient parameters, radiopharmaceutical activity and administration, immobilization and imaging parameters, as in Table . Reporting in literature should include key patient and scanning parameters, as in Table . Treatment planning systems should include: (a) conversion of PET image to SUV and testing of accuracy of SUV calculation; (b) delineation of tumor using SUV cutoff/relative (%) thresholding for target definition/other sophisticated PET segmentation algorithms, as well as mapping of SUV distribution to radiotherapy inverse planning objectives for dose painting; and (c) support for fusing of multiple FDG‐PET datasets (pre, during, posttreatment) and analysis of changes. Rigid registration is recommended when translating information from PET images to CT images used for planning purposes. …”

“…The procedures outlined in this report are meant to be performed by a Qualified Medical Physicist (QMP) (refer to American Association of Physicists in Medicine (AAPM) “Definition of a Qualified Medical Physicist”), as appropriate, or individuals working under the general supervision of a QMP (“general supervision” as defined in the AAPM Medical Physics Practice Guideline). The documentation of work should be signed by all individuals performing the work, including the supervising QMP.…”

Diffusion of innovation in radiation oncology in the United States

“…Historically, there is great variation in MPs involvement in patient positioning and setup reproducibility, with some MPs being very involved, and some MPs being absent in the simulation process. 15 The introduction of mandatory MP residencies is closing this gap. The increase in hypofractionated treatments has also changed this dynamic, as discussed in the 2014 AAPM summer school on “safely and accurately delivering high precision, hypofractionated treatments” and AAPM reports.…”

Telecommuting: A viable option for medical physicists amid the COVID‐19 outbreak and beyond

“…The medical physicist's scope of practice categorizes their activities into administrative, clinical services, education, Informatics, equipment performance evaluation, quality, and safety. 17 Physicists in clinical service provide support to clinicians in various scenarios, for example, acceptance and commissioning of new equipment, dosimetry services, planning, patient's chart review, documentation, radiation safety, and various levels of quality assurance (QA) etc. All of these tasks require teamwork, crosschecking, direct and indirect supervision, and at times providing consultation and face-toface patient interactions.…”