DOCUMENT RESUME - ERIC · future developments, ... Although trends and schools of thought ... perhaps reflecting the present lack of definition in the field.

DOCUMENT RESUME

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TITLE Development of Career Opportunities for T:chniciansin the Nuclear Medicine Field, Phase I. InterimReport Number 1: Survey of Job Characteristics,Manpower Needs and Training Resources, July 1969.

INSTITUTION Technical Education Research Center, Cambridge, Mass.SPONS AGENCY Office of Education (DREW) , Washington, D.C.PUB DATE Aug 69NJTE 290p.

EDRS PRICEDESCRIPTORS

EDRS Price MF-$1.25 HC-$14.60*Career Opportunities, Educational Needs,Educational Programs, *Health Occupations, *JobDevelopment, Manpower Development, *Manpower Needs,Occupational Information, *Radioloqic Technologists,Task Analysis, Training

ABSTRACTPhase I of a multiphase research prograN in progress

at the Technical Education Research Center, Inc., was conducted toanalyze needs and resources ih terms cf job performance tasks, careeropportunities, and training requirements for nuclear medicaltechnicians. Data were gathered through personal interviews with 203persons, mostly physicians, and from 151 questionnaire respondents.Major findings were: (1) Nuclear medicine has grown rapidly, but moremoney, better equipment, and improved instructional programs fortechnicians would speed the growth, (2) Diagnosis is the majorconcern of every nuclear medicine department surveyed, although mostare involved in some radiotherapy work, (3) The technician's taskscenter upon scanning and the related activities ofradiopharmaceutical preparation and oral administration to thepatient, (4) Standardization of preparatory programs andcertification requirements is needed, and (5) Need was expressed fora standard textbook written especially for the technician and formore careful instruction in clinical procedure, use of instruments,mathematics, and radiation physics. (SB)

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INTERIM RESEARCH REPORT

Development of Career OpportunitiesFor Technicians in the Nuclear Medical Field

Phase I

August 1969

Technical Education Research Center, Inc.44A Drattle Street

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PREFACE

This Research Report describes Phase I of the "NMTProgram", a multiphase research program being carried onat Technical Education Reaearch Center, Inc. (MC) as apart of TERC's program to develop generalizable educa-tional programs in several emerging technologies.

The overall objectives of the NMT Program are toassist both public and private institutions to plan,design and/or evaluate programs in nuclear medical tech-nology that are keyed to identified needs, and anticipatefuture developments, in the field. The purpose of thePhase I study was to analyze the needs and resources ofthe field in terms of the job performance tasks, thecareer opportunities, and training requirements fornuclear medicine technicians. The purpose of Phase IIwin be to design end evaluate responsive instructionalprograms based on task analysis and pJrformence criteria.

TLRC is a non-profit research organization that iswholly devoted to the improvement of occupational andtechnical education throughout the U.S. The critiques ofthe report (Appendix I) by several well known experts inthe practice of nuclear medicine reflect TERC's interestin receiving feedback bpth favorable and unfavorable,which will allow us to improve the quality of our work.We will welcome any comments you might have on the sub-stance of the report or its format which would allow usto perform a better service to young people choosingcareers as Nuclear Medical Technicians, to the institu-tions that train them, and to the public and privateinstitutions that employ them.

The research reported herein was performed pursuantto a grant with the Office of Education, U.S. Departmentof Health, Education, and Welfare. Contractors uader..taking such projects under Government sponsnrship areencouraged to express freely their professional judgmentin the conduct of the project. Points of view oropinions stated do not, therefore, necessarily representofficial Office of Education position or policy.

Table of Contents

12.S9e

I. Introduction 1

II. The Growth, Place, and Practice ofNuclear Medicine 5

The Development of Nuclear Medicinein Hospital Departments 5

Trends in Nuclear Medicine 8

Factors Affecting the Growth ofNuclear Medicine 9

Nuclear Medical Tests and Equipment 10

III. The Nuclear Medicine Technician (NM):Occupational Information 13

Profile of the "Average" NuclearMedicine Technician 13

Tasks of the Nuclear MedicineTechnician 14

NMI' Working Conditions 23

Communications on the Job 24

Manpower Needs 25

Salary 26

IV. Preparation of Nuclear Medicine Technicians 31

Summary of Findings 31

Fxisting Collaborative Programs 32

Additional Existing Programs 33

Other Background Faotors 33

Certification 34

Possibility of Collaborative Programs 36

'Table of Contents - continued Page

Some Program Descriptions 38

Curriculum Development Approaches 42

Instructional Materials 44

V. Mailed Questionnaire 47

Response 47

Findings 47

VI. Summary of Conclusions 50

The Growth, Place, and Practiceof Nuclear Medicine 50

The Nuclear Medicine Technician:Occupational 'nformation 51

Preparatory Pnograms for NuclearMedicine Technicians 52

Tables

1. Numbers of Technicians in DepartrientsWhere Nuclear Medicine Operations Olcur

2. Organizational Patterns in Nuclear Medicine

3. Frequency of Tasks Performed by NMT's inNuclear Medicine Departments, withEmphasis on hverage Technician

4. Demand for Nuclear Medicine Technicians

5

8

16

26

5. Preferences and Salary Offered to NMTCandidates 29

6. Mean Salaries (by City) Offered toPeople Concluding Two-Year NuclearMedicine Programs

7. Organizations Which Respondents WouldLike to Approve Curriculum forNew Preparatory Programs

8. Comparison Between Mailed and InterviewSamples

9. Comparison of Number of Nuclear MedicineTechnicians in Nailed vs. InterviewSample

30

35

48

49

Graphs

Page

1. The Establishment of Nuclear MedicalFacilities 6

2. Demand for Nuclear Medicine Technicians 27

Appendices

A. The Questionnaire Instrument 54

B. Manpower Estimates 97

C. Certification Requirements 116

D. Preparation for Nuclear MedicineTechnicians 120

E. Essentials of an Accredited Program inNuclear Medicine Technology (AMA) 161

F. Existing Films, Books, and Materials onNuclear Medicine, by A. Bertrand Brill, M.D. 168

G. "Radiopharmaceuticals and Instrumentation,"Chapter I from Clinical Nuclear Medicine,by C. Douglas Maynard,M.D. 212

H. Hospitals Participating in Survey 235

I. Reviewers' Comments on First Draft of Report 247

J. Duke University Medical Canter Job Specificationsfor Nuclear Medical Technicians and Technologists 267

K. Task Frequency Data and Statistical Analysis 279

I. Introduction

This report, completed as Project Number 7-0313 for theBureau of Research of the United States Office of Education,concerns the career opportunities for young people as NuclearMedicine Technicians (NMTs). Although the NMT has providedthe focal point for research and occupies center stage inthis report, the background for the technician is the pre-sent and futuro state of the field of nuclear medicine. Thusthe report of necessity includes our findings concerning thefield of nuclear medicine as well as the technician's placewithin it.

The survey has grown during the past year from prelimi-nary planning conferences to the rough identification ofbehavioral objectives of an NMT, then to the design of asurvey questionnaire instrument, and finally to the collec-tion and analysis of information on the technician and nuclearmedicine. There have been five specific objectives whichhave provided structure to the survey and which dictate thesubstance of this report. The five objectives are:

1. to provide an estimate of the number of NMTs nowemployed, the number now needed, and the numberlikely to be needed by 1975 in the United Status;

2. to identify the performance objectives of an NMT,and from them to derive job descriptions for theNMT;

3. to discover the nature and extent of existingpreparatory programs for NMTs;

4. to explore the feasibility of NMT preparatoryprograms involving cooperation among hospitals"Ind educational institutions;

3. to consider what new instructional materials ornew programs, if any, will be required to meetemployment needs.

The outline of the report (exclusive of the appendices)tends to follow these objectives. An additional section hasbeen added on the field of nuclear medicine as we have foundit in our investigations. Because the survey has providedwhat amounts to a current picture of nuclear medicine, acomprehensive history of the development to this point intime is neither possible nor particularly useful. From theinformation we have gathered, howriver, we have attempted toidentify the dynamic factors at work and their implicationsfor the growth and direction of the field.

Several impressions have become clear as the investiga-tions have proceeded. Nuclear medicine is a vigorous, dy-namic activity, and although physicians and NMTs frequentlydisagreed on many subjects within the field, there was aconsensus that the rate of growth of nuclear medicine hasbeen unique. At the same time, ironically, a difficultyexists in defining exactly what nuclear medicine is a whereit should be practiced in hospitals. The ectablishei defini-tion of nuclear medicine is as follows:

Nuclear Medicine is the scientific and clinicaldiscipline concerned with the diagnostic, thera-peutic (exclusive of sealed radiation sources),and investigative use of radionuclides. (Journalof Nuclear Medicine, Page 901, December, '967)

The field overall Deems to be fragmented, however, withnuclear medicine being conducted in departments of radiology,pathology, internal medicine, and independent nuclear medi-cine departments. Although trends and schools of thoughtare fairly clear, the exact direction of nuclear medicineseems uncertain. The activity of a nuclear medicine servicein a particular hospital seems to bear a direct relation tothe.initiative, energy, and dynamism of the physicians,nologists, and physicists involved. Although we have developedterminal performance tasks for the to'Lal range of activitiesin which most Nuclear Medicine Technicians are engaged, theconception of what an NHT is or should be has varied widely,perhaps reflecting the present lack of definition in thefield.

Besides identifying tasks and working conditions of theNMT, we have attempted to project the requirements for newWe over the next five years. Irdications are that thefield is growing not only in tests performed and equipmentpurchased, but in manpower needs as well. The preparatoryprograms for these technicians, like the entire field itself,appear to be uncoordinated. Existing programs, certifica-tion standards, and instructional needs constitute anothersection of the report.

A brief note of explanation concerning the terminologyused in this report is necessary since many differences existin the field. We have used the title "Nuclear MedicineTechnician"(NMT) consistently throughout the report to de-scribe the person who works as an assistant to a physicianin performing nuclear medicine tests and operations in hos-pitals. The titles such persons presently hold vary con-siderably but frequently incorporate the term 'technologist"rather than "technician." Where registries or organisationsuse the former term, we have tried to follow their usage.We understand "technologist" to imply, however, four years

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of higher education, with a baccalaureate degree. In select-ing the title of "Nuclear Medicine Technician," we haveassumed that two years of higher education and probably anassociate degree would more accurately describe the educa-tional qualifications of technicians involved in and requiredfor nuclear.medical work. A general agreement on the defini-tion and use of these terms does not exist.

Among educators and others concerned with educationthere is a lack of agreement on terminology parallel to thatwithin the health professions. In this report, rather thanuse "training" or "education" to modify "programs" designedfor persons going into nuclear medicine technology, we havechosen the adjectives "preparatory" and "instructional".We define "preparatory programs" as including (in some un-specified ratio which may vary from case to case) both train-ing for particular skills and education in the sense of broadunderlying knowledge and individual fulfillment. "Training"has been used only where it was clearly so intended byreapondents.

We have made every effort to refine the body of thereport itself as much as possible. Consequently, much of thedetailed information and substantive material have beenplaced in the apperA!.ces where they may be referred to readily.The report is intended to be as useful as possible to thoseconcerned with nuclear medicine technology. Rather than tofurnish only nulobers and statistics, the report seeks toprovide the physician who hires or instructs Nuclear Medi-cine Technicians with practical information. Also it shouldfurnish a valuable framework to those interested or presentlyinvolved in establishing more formal preparatory programsfor NMTs. Hopefully the report will reflect some sense ofwhere the field stands at the moment and where it may beheading. Thus, by casting the report in a utilitarian mold,we hope that the survey objectives will provide helpfulinformation.

The data on which this report is based were gatheredin personal interviews and by mail. A single basic ques-tionnaire instrument was developed over a period of severalmoths and gradually refined by critical examination andpractical experience in the field. A longer version pro-vided the foundation for personal interviews, conducted byten interviewers in twenty major cities over a period ofthree weeks in June, 1969. An abridged version of aboutone-half the full length was used in a mailed sample, sentto a random sample of hospitals listed by the Journal ofthe American Hospital Association as having nuaTiFiFearcinefacilities. As we conducted interviews and as we have un-dertaken the analysis of the data obtained, a number of flaws

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in the questionnaire have become apparent. Undoubtedlyit is always difficult to design a questionnaire that issimultaneously fully comprehensive, entirely clear inintent, and completely efficient in format. This ques-tionnaire sought varieties of information which a singlerespondent was not always capable of giving. Indeed wesought information frequently requiring the respondentto be physician, technologist, administrator, educationspecialist, ane medical prognosticator and visionary rolledinto onel A full copy of the questionnaire along with amore detailed critique of the instrument and its use iscontained in Appendix A.

The majority of those interviewed were physicians withbaokgrounds representing radiology, pathogy, and internalmedicine.* Nuclear Medicine Technicians and physicists werealso among the 203 interview respondents. The mailedquestionnaires were sent to 618 hospitals in every stateexcept Alaska. There were 151 replies and the data theycontain have been integrated and/or compared with theinterview data.

The assistance and cooperation of all respondents wasrewarding and the level of enthusiasn for nuclear medicineand this survey has been high. Many physicians interruptedbusy schedules to give generously of their time and insight.Those docitors who mentioned the number of questionnairesthey received were often the most generous with their time.This report owes no small debt to the many respondents whoseinterest and assistance have made its completion possible.

*For exact breakdown, see Appendix A, page 96

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II. The Growth, Place, and Practice of Nuclear Medicine

The Development of Nuclear Medicine in Hospital Departments

Radioactive isotopes have been the subject of researchthroughout most of the twentieth century. It has only beensince the end of World War II, however, that they have beenused extensively as a research tool. The use of nuclearradiation in medical diagnosis and therapy - called "nuclearmedicine" - has also grown since the end of the War, and hasbecome established in many hospitals.

In the 203 hospitals from which interview data weregathered, about five nuclear medicine facilities wereestablishes' per year in the early 1950's. By 1953 thisnumber rose to about ten departments per year, a growthpattern indicated in Graph 1 on the following page. Thedecline in numbers of new departments following 1965 isprobably not characteristic of hospitals throughout thecountry, but reflects the types of hospitals we visited.In most cases we surveyed only well established nuclearmedicine departments, since our interview sample was basedon hospitals listed in the 1966 American Hospital AssociationGuide as having radioisotopii-TWHITETIFT

Nearly all nuclear medicine departments are quite smallin terms of personnel. In only 24 cases (12%) were more than4 technicians employed. In over thirty-seven percent (37%)of the hospitals only one (1) technician was employed.

Table 1

Numbers of Technicians in Departments Where Nuclear17dielair-le-Operations Occur (n = 197)

70

60

Number ofHospitals "In

AO

20

10

0

(74)

( 50)

(33)

3 4 5 6 7 8 9 10

Number of NMTs

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In most cases (62%) nuclear medical operations beganin departments of radiology and in only thirteen percent(13%) of the cases was nuclear medicine originally estab-lished as a separate and independent department. Elevenpercent (11%) of the departments were initially a branch ofpathology and seven percent (7%) a branch of intexnal medi-cine; the remaining departments, notably in Veterans Admin-istration hospitals, usually began as a part of researchdepartments. Currently the same percentage of departmentsis subordinate to radiology, but an additional nine percent(9%) have become independent of pathology and internal medi-cine, bringing the number of independent departments totwenty-two percent (22%) of our sample.

Although a principal purpose of nuclear medicine is toprovide a diagnostic aid for a variety of medical specialties,and several of the tests correspond to work in pathology,nuclear medicine has been and continues to be most closelylinked to radiology. This affinity is evidenced by the per-centage of departments subordinate to radiology, the factthat most Nuclear Medicine Technicians have come to theirposition by way of X-ray technology, and the fact that muchof nuclear medical work concerns scanning or anatomic imag-ing. Many radiologists indicated that they thought theirdepartment was the appropriate place in the hospital organ-ization for nuclear medicine.

In sixty percent (60%) of the hospitals which haveeither an independent department or one subordinate to path-ology, all of the hospital's nuclear medical tests and opera-tions are performed within that department. For these hos-pitals, laboratory tests associated with nuclear medicine(T-3 tests, blood volumes, etc.) tend to be performed by thesame individuals who do the scanning. Where nuclear medicineis associated with radiology, however, only thirty-sever; per-cent (37%) of the units performed all the tests, the majoritysharing the work with pathology and other departments.

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Table 2

Organizational Patterns in Nuclear Medicine

110berStatus of Number Sharing Performing AllNuclear Medicine Number of Nuclear Medical Nuclear MedicalDepartment Departments Operations Operations

Independent 44 19 (44%) 25 (56%)

Under Pathology 11 3 (27%) 8 (73%)

nder Radiology 120 76 (63%) 44 (37%)

other 20 5 (25%) 15 (75%)4

Trends in Nuclear Medicine

If past trends continue, the number of independentdepartments of nuclear medicine will probably grow slowlyover the next few years, most separating themselves frompathology and internal medicine. Departments of radiologywill undoubtedly continue to sponsor nuclear medicine opera-tions during the next few years; their interest in nuclearmedicihe operations remains positive and strong. We see somesigns, however, that after a few years nuclear medicine maybegin to, branch from radiology as it has done from otherdepartments. Some respondents indicated a desire to sepa-rate from radiology into an independent department. Therecognition of nuclear medicine, as a specialty rather thana subspecialty by the American Medical Association (AMA)would provide strong impetus for independent status. Ifphysicians find their primary interest in the practice ofnuclear medicine, some of the presently strong ties toradiology may be loosened. Several interview respondentssuggested that the parallels between nuclear medicine andradiology are more apparent than real. Furthermore, some ofthe trends in instrumentation and technique foreseen by anumber of those interviewed may have the effect of movingnuclear medicine farther from radiology. One trend istoward an increased number of dynamic function studies bymeans of such instruments as the scintillation camera. Theapplication of computers to the scintillation camera and todata processing in general would seem to indicate a greaterdegree of complexity and specialization than has heretoforecharacterized nuclear medicine.

The preceding paragraph is not intended to be a certainprediction that departments of nuclear medicine will becomeseparate from radiology. There are other signs that existing

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connections will be maintained. In smaller hospitals thepresent volume cf nuclear medicine tests may require thepart-time assistance of X-Ray Technologists. Indeed the prep-aration required by a Nuclear Medicine Technician and anX-Ray Technologist has a common base in anatomy and radi-ation physics. Also, a prccedure used in a few of thehospitals surveyed combines X-Ray pictures with dynamicfunotion studies in a sort of "overlay" fashion to give,physicians a more comprehensive diagnostic tool.

The Source of much of the energy and dynamism in nuclearmedicine often appears to be in university hospitals andmedical schools. Where respondents were asked with whom theywould prefer to collaborate if a preparatory program for.NMT'swere established, many named university medical centers. Be-cause of the prestige of these centers, and the fact thatextensive research and development work is carried on there,staff physicians in surrounding hospitals tend to look touniversities for leadership in nuclear medicine.

Factors Affecting the Growth of Nuclear Medicine

Reipondents were asked to list the factors they thoughtwould slow or limit the growth of nuclear medicine, and con-versely, the factors which might speed its growth. Theresponses tended to fall into several categories. One factormentioned as constraining growth was money for equipment,personnel and the necessary hospital space. The initial cost,technical sophistication, and the rapid obsolescence of equip-ment were cited by a number of respondents. . More than aquarter of those surveyed also mentioned the poor quality ofinstructional programa for technicians, the inadequate formalpreparation in nuclear medicine for physicians, and the generallack of familiarity of doctors with the potential of nuclearmedicine.. In many oaces health insurance plans do notcover nuclear medicine tests on an out-patient basis, thusplacing a burdensome cost on the individual. Althoughanother significant factor. mentioned was the bureaucratic"red tape"' required by the Atomic Energy Commission (AEC)and the Food and Drug Administration for use of radionuclidesand radiopharmaceuticals, some respondents felt that theseregulations are essential to prevent the use of nuclearmedicine by incompetent persons. Fear of nuclear radiationby the public was also cited as a consideration in the growthof nuclear medicine.

In speeding the growth of nuclear medicine, more money,better equipment, and improved preparation for NMT's andmedical doctors were cited as significant factors. A numberalso felt more uniform certification standards and strongerorganizations for NMT's would permit the growth of the field.A few respondents noted that nuclear medicine would grow as it.became freed of its subordinate status to other departments.

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A few felt that recognition of nuclear medicine. as aspecialty by the AMA might significantly speed its growth.*About ten percent (100 of our respondents cited increasedavailability, shorter half-life, and ease in the use of newand improved radiopharmaceuticals as factors that would speedthe field's.growth. A subsequent section will discuss inmore detail anticipated innovations in equipment and radio-pharmaceutical use.

A feeling expressed by many was that the nuclearmedicine field could benefit from better public relations inseveral ways. They felt that the general public should bemade aware of the fact that nuclear medicine tests are quitesafe and that the patient usually receives even less radiationexposure than in a normal X-ray. At the same timed radio-pharmaceuticals make possible teats enabling the physicianto diagnose many patient ills he would not be able to diag-nose otherwise. The popular idea of radioactivity is prob-ably most commonly associated with nuclear weapons and warand these.populs fears are not limited to patients alone.Hospital staff, including doctors and nurses, frequentlylack an understanding of the functions of the nuclearmedicine department in their hospital. As a result of thismisunderstanding, some departments provide lectures and toursfor new hospital staff who have to relate to patients or per-sonnel involved in nuclear medicine.

Another feeling of concern to many, one which relatesto the fear of radioactivity, is that many people outsidethe field consider it to be esoteric. Several respondentscited the need to develop counseling and student recruitmentmaterials at the secondary school level for potential NuclearMedicine Technicians. Apparently many counselors view thefield as being extremely difficult and would only think ofrecommending a career in nuclear medicine to the "brightest"students. Needless to say, this type of student usuallygoes into a four-year degree program. The professionalsocieties with interests in developing this field might con-sider how to dispel the fear among the.general public and,at the same time, stimulate interest among young persons whomight consider employment opportunities in nuclear medicine.

Nuclear Medicine Tests and Equipment

Most, departments of nuclear medicine are primarily con-cerned with diagnostic work. The basic nuclear medicine in-struments- -- detector probe, scaler, well counter, monitor,rectilinear scanner, and automatic film developing facilities-- are designed to meet two major diagnostic objectives:

*See comment by C. Craig Harris, Appendix I, pages 262-263.

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the description and localization of medical or organicdisorders.* Interviews showed that a scaler andstationary detector probe were often the first major purchasesof new departments of nuclear medicine, followed by arectilinear scanner.

For the purpose of observing trends that may affectthe NMT's role, the diagnostic work of most departments,allowing for some overlapping, can be classified intothree categories: static studies, dynamic function studies,and in vitro tests. Static studies, which may also bedescinorarill "anatomic imaging," primarily include imageor localization studies, commonly called "scans." Theyare usually done with a scanner, taking from thirtyminutes to two hours or done with a camera in considerablyless time. Rapid uptakes (e.g. renograms) and slow uptakes(e.g. thyroids) are examples of dynamic function studies andare usually done by a stationary probe. Nuclear medicinedepartments may combine the single measurement of a thy-roid function with a scan of the thyroid, a brief operation.The renogram ta:zes more time, whether scanned or probed,than a thyroid. In vitro tests can be done ten or moretimes as quickly as a scan. These three classes of proceduresaccount for 54% of the number of tests performed in theaverage department, although there is a wide range intheir frequency. Roughly 40% of the work time of the averagenuclear medicine department of our survey is devoted toscanning.

Other dynamic function studies currently form asmall proportion of the typical nuclear medicine department'swork but many doctors reported.that they expect to do moresuch studies in the future. Inhalation studies, brainblood flow, and cardiac blood flow were the areas of interestmost often mentioned by these physicians. Dynamic functionstudies may be done by the scintillation camera with orwithout computers, as well as by the stationary detect-or probe. Many departments have this equipment now(49%) and many have cameras on order (9%) or anticipateeventual acquisition.

When nuclear medicine is independent or subordinateto radiology, in vitro tests are often performed in the

*See Appendix G for a more thorough discussion ofinstrumentation.

department of pathology (see Table 2, page 8). Manyseparate nuclear medicine department, however, wouldlike to assume responsibility for laboratory tests.These tests include T-3 and T-4 tests, absorption andexcretion tests (e.g. Schilling, fat tests) and bloodvolume tests. In vitro work does riot usually demandthe amount of train-Fig-and experience which distinguishesa separate technology. Medical Technologists easilypick up the nuclear medical in vitro techniques withouta subspeciality occurring in-DIM-Yanks.

Therapy is also a part of the work of most departmentswhere nuclear medicine is practiced. Radiopharmaceuticaltherapy is performed in seven-eight percent (78%) of thedepartments interviewed; it almost aiwaye involves 1311.Other forms of therapy, including other radionuclides,brachytherapy, and teletherapy are conducted less fre-quently. These forms of therapy do not change theorganization, training, technique, or equipment requiredby the department. Nuclear Medicine. Technicians are onlyoccasionally involved in radiopharmaceutical therapy sincethe procedures are ordinarily performed by a physician.

Many respondents expected to be using new equipmentand procedures in the near future. They mentionedcomputer applications for the scintillation camera andwhole-body scanner, time sharing computers, inhalationstudies, and the area of radioimmunoassay. These opera-tions are now being performed in a few hospitals. Othertrends mentioned in the development of nuclear medicineincluded the introduction of ultrasonic scanners, infra-red scanners, and joint tests with electro-encephalographsand electrocardiographs. We have little information onthese developments, since the practices are limited tovery few hospitals and occur infrequently.

The major trends in nuclear medicine which mayaffect technicians over the next two or three yearsinclude scanning with faster scanners and cameras,an increased.number of time dependent observations,the development of radionuclides of shorter half-life,greater use of prepackaged pharmaceuticals and materials,and more automated data handling. Most respondentsanticipated a greatly expanded use of radionuclides ofshorter half-life; this practice would increase the im-portance of chemical preparation of radiopharmaceuticals.In some ways these changes will simplify the tasks of thetechnician since there will be fewer steps to some routines.In other ways, however, tasks will become more complex,with more routines, tests, pieces of equipment, and radio-active materials. This dynamic character of nuclear medi-cine explains the premium now placed on intelligent peoplemotivated to learn new techniques.

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III. The Nuclear Medicine Technician: OccupationalIn ormat on

Profile of the "Average" Nuclear Medicine Technician

The questionnaire used in the performance of this surveyemphasized the "average" Nuclear Medicine Technician. The useof this term caused semantic difficulties. It was not the in-tent of the investigators to describe this "average" in thesense of a mathematical mean; rather, to employ it in its morecolloquial usage as "common" or "ordinary". For example, thedecision was made to largely exclude tasks performed by highlyskilled Chief Technicians, since these tasks would hardly beassigned to those newly graduated from Associate Degree programsof the two-year variety. However, once having defined thisrestriction, the objective was to compile a list of tasksrepresenting the total range within which such an entry-levelNMT would operate, within the first year or two from hisgraduating date.

However, in some cases, departments had only a single,all-purpose NMT, while in other instances there was no cleardividing line between the "chief" technician and others workingwith him. In still other replies, it was apparent that therespondents were not describing their actual "average" techni-cians, but an average technician which world be "ideal" (i.e.,for their situations), were he available. This introduced aconfusion with the following item in the questionnaire, whichdid request this information. The latter, however, was theninterpreted as some kind of a "super-ideal", not tied to therespondent's own institutional situation, necessarily.

Recognizing these difficulties, we have attempted in thissection to delineate, the profile of the "average" NMT now work-ing in American hospitals. This profile is based upon analysisof the data and upon our collective impressions of the viewsexpressed in the interviews. A fuller discussion of this pro-file and variations of it are contained in the followingsections.

The 'average" technician now working in hospitals doesnot always hold the title of "Nuclear Medicine Technician,"although that name is common. "Technologist" may be preferredsince it connotes a baccalaureate degree. Another fairlycommon title is "Radioisotope Technician," and where X-RayTechnologists perform double-duty with operations in nuclearmedicine, they frevently maintain their title of "X-Ray" or"Rddiologic Technologist."

Although the amounts of preparation technicians havereceived bary, the average NMT has had between two and threeyears of formal preparation, most of it as an X-Ray Technolo-gist, or, in a few cases, in laboratory work. The average

-13-

NMT has usually learned nuclear medicine in an on-the-jobsituation from physicians or, as commonly, from other NuclearMedicine Technicians. Besides on-the-job experience, theaverage technician has received some formal instruction inshort seminars or special programs of perhaps a week'sduration.

The Average NMT has certification from the AmericanRegistry of Radiologic Technologists as a Registercd Tech-nologist (R.T.) usually in X-ray technology but occasionallyin nuclear medicine technology. The salary received by tech-nicians varies considerably, but the average is about $6,300.

The average NMT works in a department with two other.technicians, although he may spend considerable time workingby himself. The tasks he routinely performs are many, buthe spends about forty percent (40%) of his time engaged inthe operation of a rectilinear scanner for conventional scan-ning. In connection with this work, he makes simple dosecalculations for in vivo studies. He also receives, posi-tions, and attends to patients, besides abstracting simpledata from their records. The average technician is alsoconcerned with safety, and has responsibility for the dis-posal of radioactive waste, safe storage of radioactivematerial, and the inventory and control of radiopharmaceuticals.

Most of the Nuclear Medicine Technicians we talked toreported that they found their work varied and interesting,and it is probably safe to say that the average techniciandoes not suffer from boredom. When technicians do leavetheir jobs, the most common reasons are marriage, pregnancy,or a better paying position elsewhere.

Tasks of the Nuclear Medicine Technician

On a gross level, it may be sufficient to state that, in'carrying out the diagnostic tasks of the nuclear medicine de-partment, the average Nuclear Medicine Technician is primarilyoccupied with scanning and related activities. However, sincea basic premise of this report is that curriculum design forpreparatory programs for any occupation must be based on thecurrent and expected activities of people in that occupation,all NNW tasks must be thus identified in nasonably sure fashion.mg part of the questionnaire which began this complicated taskmay be seen on pp. 58-59.

See pages 42-44.

-14-

0

In explanation of the task frequency table which appearson the next two pages (and in Appendix A), several pointsshould be noted. First, the term "job description" can haveseveral legitimate definitions, depending upon the purposeof the investigator. If one desires an overall profile ofgeneral characteristics, for informational or comparative pur-poses, the format employed indlahaDictionary of OccupationalTitles is useful. If, on the other hand, the intent is todescribe progressive levels of preparation and responsibility,as for rating or certification purposes, a scheme such as thatdevised by the Duke University Medical Center is appropriate.However, if the descriptive materials are intended for directuse in developing instructional materials, a much more detailedanalysis must be undertaken.

Second, in the latter case, the initial step is to developa complete and verified listing of all tasks (i.e., operationaloutcomes) which the worker is, or may be, expected to perform.Successively, the task analyst determines task frequency, rela-tive importance, relationships among tasks or a task hierarchy,skill and knowledge inputs, conditions under which the tasksare performed (e.g., degree of supervision), and socio-personalconcomittants, among others. The resulting task network canthen be superimposed on the certification-type job description,thus affording the investigator the benefits of both types.

Third, this survey has attempted systematically only thefirst two steps in the task analysis sequence described above:task frequency and relative importance. Unfortunately, repliesconcerning the latter were not in a form which permitted thesame kind of tabulation as the frequency. The same is true ofinformation regarding tasks which an average NMT might reason-ably be expected to perform in the future. Consequently, whiletask gusquency results are reproduced in tabular form, below,the questions of task importance and future task developmentsare reported in narrative form, throughout the text.

Finally, it should be noted that task frequency does notnecessarily correspond to task importance. However, in mostinstances in this study, this correspondence existed. Importantcases which deviated from the norm are noted in the text. Also,Table 3 sum/ain't data from personal interviews, only. Forvarious reasons, the validity of responses to this particularitem (1.1) in the mailed responses was questionable. However,numerous spot checks were made and the mailed responses indi-cated very similar frequency patterns to those in the table.

To facilitate calculations, somewhat arbitrary values wereassigned to the letter codes described on page 63. This doesnot significantly distort the relative frequencies since theabsolute frequency ranges of the original letter codes could,the. -elves, be open to debate. To avoid confusion, the equi-valent values and code meanings are stated, as follows:

-15-

. 0 = task not performed in department (value assigned: 0)

a = task performed in department, but not by an avera etechnician in that department (value assigns : 1)

b = 1-3 times per month (value assigned; 2)

c = 4-10 times per month (value assigned: 3)

d = 11 or more times per month (value assigned: 4)

Table 3

Fre uenc of Tasks Performed by NMTs InNuc ear Medicine Departments,

with h-Eii3Siils on Average TecHICian.

Preparation Mean S.D.1. Chemically prepare short-life isotopes:

a) elutihg the column 2.7 1.82. b) chemical preparation 1.0 1.53. c) sterilize 0.6 1.34. Calibrate isotopes against a standard 3.1 1.55. Prepare oral dose: measure from manufacturer's

bottle 2.6 1.76. Preparo oral dose: mix, dilute to measure 2.1 1.87. Propare injections: measure dose 3.7 1.08. Prepare injections: sterilize dose 0.7 1.49. Set up instruments for operation: a) in vivo

studies 3.6 1.010. Set up instruments for operation: b) in vitro

studies 3.0 1.6

Tests & Patients1771EiralUiFrsotopes to patients: a) orally 3.6 1.012. Administer isotopes to patients: b) by injection 2.5 1.613. Receive patients, explain tests to them and allay

their fears 3.9 0.614. Position patient with respect to nuclear medical

equipment 3.9 0.515. Superficial and specialized examination of

patients16. Attend to patient's comfort before and during

MD MI 1111 ohm:.

scan . 3.9 0.617. Understand operating room procedure 111

Data Handling18. Abstract simple data from patient's chart 3.0 1.419. Make simple dose calculations for a) in vivo

examinations 3.6 1.020. Make simple dose calculations for b) in vitro

examinations 2.8 1.621. Make simple dose calculations for c) tracer

examinations 3.5 1.122. Accumulate and process data for MD's interpre-

tation 3.6 1.023. Examine scan test results for general credibility 3.7 0.924. Perform preliminary interpretations of observa-

tions for MD 1.9 1.6

-16-

Table 3 (cont'd)

Mean S.D.Equipment25. Operate a rectilinear scanner for conventional

scanning 3.7 0.926. Operate a autofluorescope for static studies 0.1 0.427. Operate a scintillation camera for static

studies 1.7 1.928. Operate an autofluorescope for fast dynamic

studies (under one minute scan) 0.1 0.629. Operate a scintillation camera for fast dynamic

studies 1.3 1.730. Operate a scanner for slow dynamic studies

(over one minute scan) 1.9 1.831. Operate an autofluoroscope for slow dynamic

studies 0.1 0.632. Operate a scintillation camera for slow

dynamic studies 1.5 1.833. Calibrate nuclear medical instruments 3.0 1.434. Check performance of existing and new nuclear

medical instruments against manufacturer'sspecifications 1.9 1.3

35. Determine if a nuclear medical instrument isin need of major repair 2.6 1.3

36. Perform minor maintenance on nuclear medicalinstrument 1.9 1.2

37. Evaluate nuclear medical instruments frommanufacturer's literature tnd specify andrank those instruments that satisfy doctors'requirements 1.2 0.9

38. Advise doctors on the technicalities and proce-dures involved in operating a nuclear medicalinstrument 2.2 1.3

Safety39. Check monitoring instruments 2.5 1.340. Monitor personnel in compliance.with hospita2

regulations 2.2 1.4

41. Monitor space in compliance with hospitalregulations 2.5 1.2

42. Handle and store radioisotopes safely 3.8 0.743. Assay wet chemical solutions for activity and

contaminants 2.3 1.744. Safely dispose of radioactive wastes 3.4: 0.9

Clerical137-Male secretarial work: appointments, type

reports 2.8 1.446. Routinely check incoming equipment 2.2 1.347. inventory and order radiopharmaceuticals and

materials 3.3 1.048. Keep accounts of hospital licensing and isotope

procurement 2.6 1.5

-17-

Frequency data contributing to the calculation of meansin Table 3, plus parallel data from the mailed questionnaire,are shown more fully in Appendix J.

Other major points of interest regarding the averageNMT's performance tasks are as follows:

Wherever the patient load justifies the cost, hospitalshave obtained their own radionuclide generator. Techniciansoperate these generators, but so far little chemical prepara-tion of the resulting radioactive material is performed.Chemical work is becoming simplified by kits for many proce-dures, although certain procedures continue to require somewet-lab skill and attention. Radionuclides and pharmaceuti-cals prepared by commercial firms usually are sterile and asa result sterilization is almost never done by NMTs. Techni-cians do calibrate radiopharmaceuticals against a standard,and some doses are calculated and diluted to measure; otherscome pre-measured by the manufacturer. Technicians usuallyset up their own instruments on a daily basis, checkingvoltages, concentrations, radiation levels, etc.

The techoician usually administers oral doses to thepatient. Many technicians draw blood, and in about fortypercent (40%) of the hospitals surveyed, they also administerinjections. Some MDs prefer to give injections themselvesbecause of their responsibility and risk to the patientinvolved. Some MDs have expressed interest in knowing moreabout legal restrictions or insuranco possibilities for tech-nicians who would be eligible to administer injections.

Technicians, as well as doctors, find it beneficial toestablish rapport with patients before and during the scan,which may last two hours or more. Ordinarily techniciansread the patient's chart and abstract data from it. NMTsreceive patients, explain the tests to them, allay theirfears and tend to their comfort during a long scan. Theymay sometimes work in a recovery room, but instances ofparticipation in surgery are rare.

Nuclear Medicine Technicians do not diagnose disordersor interpret results of tests, but some may point out anarea of interest on a scan to the doctor. Most are capableof judging the quality of their roans, and in general exer-cise quality control over their work. Some physicians checktheir calculations or share this work with them, each check-ing the other's calculations. Slide rules and desk calcula-tors are used in figuring such problems as half-life, butthere is a trend toward more electronic calculation. Time-sharing computer terminals currently are operated by a few

-18-

physicists or MDs who often are seeking technicians capableof using this type of equipment.

Nuclear Medicine Technicians operate rectilinear scan-ners, detector probes, well counters, scalers-ands scintil-lation cameras for static and dynamic studies. Although insome instaAces (usually in hospitals without cameras) iswas felt that sophisticated studies involving the scintilla-tion camera required an exceptional technician, the averageNMT generally handles this task adequately. The NMT isnot involved in any major maintenance of equipment, althoughhe may perform minor maintenance, such as changing a fuseon a tracking motor or replacing a knob. He may also checkthe performance of instruments against manufacturer'sspecifications, and may decide when the repairman must becalled. NMTs demonstrate nuclear medical instruments andprocednres to doctors, often residents, and to students inradiologic technology and nuclear medicine.

Radiation safety responsibilities are often sharedwith a Radiation Safety Officer (M.D. or Ph.D. physicist)or with a Chief Nuclear Medicine Technician. Basic know-ledge in handling, storing and disposing of radionuclidesand cleaning lab ware is essential. Technicians routinelyuse monitoring instruments, film and ring badges, and arefamiliar with regulations and techniques for monitoringpersons and hospital space.

The amount of clerical work done by the average NMTvaries depending upon whether or not a department has itsown secretary. It may include keeping of records of doses,dose calculations, and treatments, as well as the filingof scans. NMTs often inventory and order radiopharmaceu-ticals, routinely check incoming equipment and materialsand handle appointments. Since NMTs often work unsuper-vised in the course of a day, they must be capable of plan-ning and completing work on their own.

The discussion, thus far, of the tasks of the NuclearMedicine Technician has been largely in terms of an "average"technician. These are the tasks which were reported aspresently being performed by Nuclear Medicine Techniciansin hospital departments. In other questions, respondentsindicated for what task performance they believed a techni-cian should he prepared, and what tasks he should be ableto peFEFFE: In short, we received a range 51Wressionsof what a Nuclear Medicine Technician should be, focusingboth on their actual and desired abilities.

The expectations respondents had of the NMT's jobvaried considerably. However, we had the general impres-sion upon completion of the interviews that there were,in effect, three types of technicians - the "knob turner,"the "two-year person," and the "chief tech." The first wouldperform most of the mechanics of nuclear medicine testsand operations under close supervision, but would not knowmuch about the theoretical or conceptual background of thetasks he performed. Preparation for this individual wouldbe minimal, usually on-the-job, and would follow directlyfrom high school. The princip' requisite qualificationwould be a willingness and ability to perform, with compe-tence,tasks which are routine and repetitive.

The "chief tech" described for us by many respondentsmore commonly was termed a Nuclear Medicine "Technologist,"especially qualified for the field by a full four-yearcollege program. In contrast to the first type, this NuclearMedicine Technologist would have a firm grasp of the concep-tual background of nuclear medicine, besides competence toperform the mechanics of tests and operations. In addition,such a person might have supervisory and instructionalresponsibilities.

A description of the tasks of the "two-year" NuclearMedicine Technician would fail between these poles. Thisperson would most commonly have completed a two-year pro-gram in an area other than - but related to - nuclear medi-cine (usually radiologic technology,) followed by a shortformal or on-the-job preparatory program.

We believe that these three modal impressions reflecta desire for several levels of an NMT. :ertainly paths foradvancement should be considered for career-oriented persons,and different levels of preparation, experience, competence,and responsibility could provide an appropriate career ladder.However, as has been previously emphasized in this report,this type of job description must ultimately come fromagreement within the field. This agreement does not currentlyexist. Furthermore, for the purposes of developing instruc-tional materials rather than immediately hypothesizing a"papers curriculum, the task performance analysis approachis more relevant and has been the foundation of this report.

Nevertheless, since this report will hopefully be usedby schools which are faced with the immediate problem ofdeveloping a curriculum outline for a specific kind or levelof technician, we are including one of the better, locallydeveloped, set of job level descriptions in the field. Thisparticular one was developed by the Duke University Medical

-20-

Center's Division of Nuclear Medicine. Since these des-criptions presumably are based on the Medical Center's ownmanpower organization and needs, they are understandablymore detailed than our own conclusions of this type, whichare not only peripheral to our purpose at this stage, butalso reflect the lact of clear national agreement previouslynoted.

Contrary to Duke's experience, our survey did not findthat the lowest level technician is nearly as well preparedas their "NMT-I". However, with this single tentative quali-fication, we feel that the Duke classification scheme shouldhe a useful guide in providing a prototype career ladderfor the Nuclear Medicine Technician. Adjustments can bemade in it, by prospective users, in order to reflect theirown local conditions.

While the entire Duke classification can be found inthis report's Appendix K (including nature of work, skillsand abilities, and training and experience), only the firstof these categories is placed in the body of the report,below, as a convenient aid to those readers who may wisha quick overview to determine the full scheme's possibleusefulness.

The Duke job descriptions are as follows:

Nuclear Medicine Technician 1*

A technician in this classification performs entry-level work as a trainee in nuclear medicine procedures.These tasks are carried out under the direction and guid-ance of higher level personnel. The individual is respon-sible for performing a limited number of procedures accurately,or assisting in setting up procedures, and for recordingpertinent data. Assignments may be in specialized areas,such ass scanning, in vitro studies, or other areas asdetermined by the patron-are needs of the service orthe aptitude of the technician trainee. Duties are per-formed under direct supervision of both senior technologistsand physicians, although some phases may be performed with-out repeated instruction. The work is evaluated by obser-vation.

Employment in a position of this classification pro-vides, over an appropriate interval of instruction andexperience, training to lead to certification as a Regis-tered Nuclear Medicine Technologist.

-21-

Nuclear Medicine Technician Ht.Nuclear Mianine Technologist II

A technician or technologist in this classificationperforms routine technical work related to nuclear medicineprocedures using radioactive tracers and instrumentationpertaining to the measurement thereof. The level of perform-ance is above that of an entry-level technician, but doesnot call for completely unsupervised performance. The in-dividual is responsible for performing a large number ofprocedures accurately, for setting up procedures and forrecording pertinent data. Assignments may be in any areaof the nuclear medicine laboratory, e.g. assignment torectilinear scanneru, thyroid uptake area, or in vitrostudies. Supervision is of a general nature ea' Frm-ance is evaluated by observation, both by senior technolo-gists and by physicians.

Nuclear Medicine Technician III,Nuclear Medicine Technologist III

A technician or technologist in this classification iscapable of performing any of the udual procedures in theclinical nuclear medicine laboratory with only minimal oroccasional supervisory guidance. This classification iden-tifies the technician or technologist as a senior technicianor technologist, and ansumes that the individual is of aresponsible nature, having had intensive training and ade-quate experience. The individual is responsible for per-forming a large number and variety of procedures accurately,to develop and evaluate new procedures and should 1.06 capableof developing optimal means for recording pertinent data.As a senior technician or technologist, assignments may beto perform or to supervise in any area of the nuclear medi-cine laboratory, including scanning, in vitro studies andradiopharmaceutical preparation. The warri performedunder general supervision and is evaluated by observation.

Nuclear Medicine Technologist IV

A technologist in this classification carries out thesupervisory responsibilities of an overall chief technolo-gxst. This position carries the responsibility of organi-sing the technologic staff of the Division of Nuclear Medi-cine and devising and maintaining an orderly approach to the

-22-

completion of each day's work load. This work is.accom,-plished with.the advice and guidance of the Instructor andin coordination with the clinicians and other faculty mem-bers responsible for the clinical service of nuclear medicine.

(end of Duke University material)

NMT Working Conditions

The tasks of the Nuclear Medicine Technician and thehospital environment shape the NMT's working conditions.The tasks, tests, and equipment involving the technicianhave already been discussed. The hospital environment inwhich the technician works necessitates that he be able torelate to MDs, physicists, technicians, nurses, otherhospital personnel, and last, but by no means least, thepatient. Ideally, the NMT must function as a part of thehealth care team of the hospital. Several respondents notedthat the NMT occupied a position of unusual responsibilityand importance and should enjoy an associate relationshipwith the physician. Others noted that a "bedside manner"was every bit as important to the NMT as to the doctor.

Formal and informal instruction in hospitals alsoinfluences the NMT's working conditions, especially thosenew on the job. Some doctors prefer a "black box" approachin training technicians to operate the instruments; theirconcern is for reliable, uniform technical performancebased on routine. This approach requires only a relativelyshort training time, and an individual of average intelli-gence and high reliability. It recognizes the high turn-over rate of NMTs that some areas have experienced. Otherdoctors prefer an in-depth understanding of the radio-pharmaceutical-physiological-physics-instrumentation aspectsof what is being done. Their concern is for reliablo per-formance plus ability to handle unusual situations end tolearn new techniques with a minimum of supervisory instruc-tion. This approach requires an individual of higher in-telligence, initiative, interest in the work, possibly alonger preparatory program, and perhaps higher salaries andmore than average career challenge and opportunity.

Most NMTs at present are prepared informally on thejob, one.or two people at a time, by the doctor in chargeof nuclear medicine at the hospital. The physician's mostimportant criterion for hiring a person as an NMT is in-telligence enough to learn the work quickly. Many MDsinstruct their technicians closely for awhile, checking

-23-

their work and supervising them until they are confident oftheir ability. In the larger hospitals with long-establishednuclear medicine departments there are commonly severaltechnicians who are supervised directly by a chief NMT, whoin turn is supervised by a doctor. In the smaller hospitalshe is more likely to be on his own and there his role dependsvery much on the attitude of the MD and the responsibi.litiesentrusted to him.

Communications on the Job

Many NMTs work without close supervision once theirpreparation is completed. Most of the procedures areroutine and require little on-the-spot communication.Often there is an informal net of people who provide assis-tance as it is needed, such as moving a patient, explain-ing a point of technique, etc. The more involved commu-nications can usually be deferred until it is convenient,such as discussions on background, theory, new products,and techniques. The record keeping is standardized, oftenin ledgers devised by the NMT to meet doctors', hospital,and AEC requirements. The NMT may write a note or fill outa form for the patient's chart describing the work done anddose given. On occasion a short report of the procedure andfindings, with unusual items noted, is required,

Communications with nurses in wards is usually to conveyroutine messages about pre- and post-scan attention and care,to ensure that the message is fully understood, and to en-courage the nurses to observe every detail. Many floornurses are totally unfamiliar with nuclear medicine and itspre- and post-scan requirements. This process is a combina-tion of informing, impressing others with the need to carryout all instructions, and occasional checking up. It maybe done by mimeographed instructions, phone calls, and face-to-face conversations.

Communication with patients is to explain the need toremain immobile, to allay fears (sometimes extreme in theaged or those unfamiliar with medical aspects of radiation),to bolster morale, and to explain pre- and post -teat pro-cedures, such as avoiding high-iodine foods, vitamin pillsand medicines before a thyroid scan. During tests, NMTshave to establish rapport with the patient to securetheir. total cooperation.

Communication with drug and instrument manufacturersis by telephone and personal contact for orders and repairsand for information on new products. Technicians often con-tinue to read medical texts and booklets on procedures and

-24-

to attend discussions and lectures. For a senior or chieftechnician, an ability to understand written technical materi-al is essential. Conferences and review sessions are some-times organized by NMTs to refresh and stimulate interestin the field. In some cities, NMTs organize preparationsessions for the certification examinations.

NMTs interviewed were appreciative of the responsibilitythey were entrusted with, the newness of the field, theskill required to obtain good results, and the mutual con-fidence and regard between doctors and technicians, especi-ally in the area of new information and techniques. Tech-nicians generally were pleased with their work situation.They desired better preparatory programs and more continu-ing instruction, especially for those NMTs who are workingnearly full time. Technicians were piqued where they senseda lack of interest by their hospital or department head inthe nuclearmedicine unit (when nuclear medicine was not anindependent department and the chief of the department wasnot nuclear medicine-oriented). Other concerns were lackof space, need for another technician, a concern to showothers in the hospital what nuclear medicine could do, anda desire for more equipment and better procedures.

Manpower Needs

Estimating future manpower needs in any field is alwaysa hazardous undertaking. Such estimates are not only afunction of present data, but are also dependent on futureoccurrences which may be unforeseeable. Whenever calculationsare presented for manpower needs, they should be coupledwith the assumptions on which they are based. Wherever avariety of assumptions is reasonable, more than one set ofestimates is required.

For the field of nuclear medicine, respondents generallywere of the opinion that the next decade would be a periodof rapid expansion (although even this was not unanimous:two or three people felt that nuclear medicine would becompletely obsolete by 1980, having been replaced by ther-mography, ultrasonics or other procedures). From the datacompiled, we have attempted to isolate the most reasonableassumptions concerning future growth and relate them to theexpected needs for Nuclear Medicine Technicians.

(The most basic premise of this method is that thedemand for an occupation will be the major factor in deter-mining the supply of people in that occupation. The recentemergence of the position of the NMT and the predominanceof on-the-job instruction are both major reasons to believethat this premise is a valid one.)

-25-

The techniques used were not complicated, consistingessentially of multiplying values of "average number of NMTsper hospital" by "number of hospitals." To obtain thevalues used, however, numerous assumptions were made, eachof which is incorporated into the explanation of that tech-nique in Appendix B.

The results are summarized in Graph 2. The shaded areaof the graph represents the range within which the need forNuclear Medicine Technicians for any given year is mostlikely to fall. The circled results are our best estimatesbased on the assumptions which appear to be most reasonable.

From a present base of 4,000 - 4,600 NMTs, Table 4summarizes in different form the future demand for NuclearMedicine Technicians.

Table 4

Demand for Nuclear Medicine Technicians

Year Range Best Estimate

1970 4,600 - 5,800 5,500 - 5,700

1972 6,300 -10,300 8,000 - 8,500

1975 10,000 -17,000 11,300 -12,300

Finally, the number of people who should be prepared tofill positions as NMTs is somewhat larger than the yearlyincrease due to deaths, retirement, pregnancies, and othercauses which reduce the existing stock. Incorporating thesefactors we have concluded that there will be a need to prepareabout 1,300 people per year to fill available positions asNuclear Medicine Technicians,

Salary

Dissemination of information concerning the wage struc-ture of an occupation is an essential process if marketforces are to regulate effectively the supply and demandfor people with that occupation. Nuclear Medicine Techniciansare unfortunately under the same constraint as many hospi-tal occupations in that demand is greater than supply, andyet salaries remain low. We have attempted in this surveyto obtain data on present salaries under the assumption thatsuch information would be useful to a person contemplatingentering this field.

-26-

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Nuclear Medicine Technicians in the U. S. with oneyear of experience are presently being paid anywhere from$4,000 to $12,000 with an average salary of $6,300 per year.These figures, unfortunately, are of little value becausethey include people with such a wide variety of backgrounds(our expectation that it would be possible to differentiatesalaries based on the possession or nonpossession of "certi-fication" proved to be impractical due to the many inter-pretations of the term).

Respondents were also presented with a description ofpossible candidates for a position as an NMT in their de-partment and asked: a) to rank them in order of preferenceand, b) to suggest the salaries they would be willing topay each individual. As indicated in Table 5, their firstchoice was for people with two years of nuclear medicinepreparation, with or without an internship. A somewhatsurprising finding, since most present NMTs have followedthis route, is the relatively low ranking accorded topeople with preparation in radiologic technology.

Respondents' answers to whether they would wish to hirean individual with four years of formal education (eithera college science or a medical technologist program) ex-hibited the greatest variety; some refused even to consideranyone else; others felt that it was too unrealistic toexpect someone with such high-level credentials to seek ajob as a Nuclear Medicine Technician. The latter contentionis further supported by the starting salaries respondentswere willing to offer people with four-year backgrounds.Means were less than $7,000 and only $300-$400 more thansalaries offered to.those completing a 'two-year nuclearmedicine program. Aggregating the data in this manner tendsto conceal certain regional or other patterns; nevertheless,it is a highly exceptional hospital which offers competitivesalaries to people with a B.S. degree.

The variety of responses to the above question waspartly a function of the lack of standardization of cer-tification requirements and instructional programs. Start-ing salaries offered NMTs with two years formal preparationrange from less than $5,000 to more than $10,000. Thevariety was also due to real city-to-city differences, asshown by Table 6 which lists the mean salaries respondentsin each city would offer people who have concluded "a two-year Nuclear Medicine Technician program involving hospitalexperience over several semesters" (this was first or secondchoice in all cities). It should be noted that respondentswere often not responsible for the establishment of salarylevels; the variety of figures within nearly every citysuggests that their reliability is questionable. .

-28-

Table 5

Preferences and Salary Offered to NMT Candidates

Comparison factors:Candidate hasCompleted

PreferredRanking

ProportionRanked inTop 4

Salary Offered

Median Range Mean

(a) no post-secondarypreparation orexperience

10 10 4,750-5,250 $5140

(b) two years of on-the-job prepara-tion in hospitalmedical labora-tories other thanin radiation

9 9 5,250-5,750 $5610

(c) two years of on-the-job preparationin a nuclear medi-cine department

3 3 5,750 -6,250 $6270

EITTTW6-year X-RayTechnician programinvolving hospitalexperience overseveral semesters

6 6 5,750-6,250 $6040

(e) same as (d) plussix-month hospitalinternship program

7 7 5,750-6,250 $6200

-TIT-a two-year nuclearmedicine technicianprogram involvinghospital experienceover severalsemesters

2 1 6,250 -6,750 $6560

-1-0 same program as (f)

plus six-month hos-pital internshipprogram

1

'-----8

2

8

6,750-7,250

6,250-6,750

$6680

$6250(h) a registered nurseprogram

-TI) a four-year collegedegree program inbiology/chemistry/physics

5 5 6,750 -7,250 $6820

-Urlour-year MedicalTechnologist Programincluding hospitalexperience overseveral semesters

4 4 6,750-7,250 $6980

-29-

Table 6

Mean Salaries (b Cit Offered to Peo le Concludin Two-Yearuo =ar e ne rogram

City

New York

Miami

Salary City

$8,050 Baltimore

$7,600 Cleveland

Minneapolis-St. Paul $7,100 St. Louis

Los Angeles $7,100 Denver

San Francisco $7,100 Washington

Boston $6,950 Atlanta

Chicago , $6,850 Kansas City

Dallas -Fort Worth $6,700 Philadelphia

Seattle $6,650 New Orleans

Salary

$6,600

$6,500

$6,400

$6,050

$6,000

$6,000

$6,000

$5,750

$5,350

The reasons people leave positions as Nuclear MedicineTechnicians is a useful guide to the problems of the job.Eighteen percent (18%) of the hospitals replied that theirtechnicians left because the department could not offersufficient opportunities for advancement. An additionaleleven percent (11%) cited an inadequate salary scheduleas the prime cause for leaving, although seventeen percent(17%) considered it an important cause. (For example, inone very large county hospital, the respondent assertedthat he needed and would hire three competent NMTs at thatmoment, except that their pay scale, established by CivilSerVice, was not competitive. As a result, he could findno technicians to employ.) Less than five percent (5%)reported that technicians left because of lack of interest,supporting the frequently expressed idea that the NuclearMedicine Technician's job is in general varied and interesting.

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IV. Preparation of Nuclear Medicine Technicians

Summary of Findings

The report thus far has considered the growth andpractice of nuclear .aedicine, and occupational informationabout the Nuclear Medicine Technician. The major objectivesof this survey have also included the identification of theways NMTs are presently being prepared and certified, andthe need and feasibility for collaborative instructionalprcgrams. This section of the report focuses on our find-ings and impressions concerning certification and instruc-tional programs for the technician.

We have indicated earlier in the report that the fieldof nuclear medicine is highly fragmented. This fact was nomore apparent than in the answers to our inquiries concern-ing preparation and certification for Nuclear Medicine Tech-nicians. Most technicians have entered nuclear medicine byway of an X-ray background or previous experience in someaspect of medical technology. It is thus not surprisingthat the majority of the survey respondents (53%) reportedthat their Nuclear Medicine Technicians are instructed infor-mally on-the-job at the hospital, since this instructionis to alter the tasks of an existing employee. Thisarrangement can amount to an inefficient over-preparationfor NMTs, since other technicians, also in short supply,must be replaced. Furthermore, the newly prepared NMTmay not use all the instruction gained in other technolo-gies.

It was difficult to determine exactly what constitutedthese informal instructional programs, but it was clear thatthey varied greatly both quantitatively and qualitatively.In a few cases, respondents maintained that as many as ahalf-dozen or more NMTs were prepared informally, on-the-job each year. On the other hand, most informal programsappeared at best to be makeshift, catch-as-catch-can opera-tions, preparing one or two students per year.

Over one-fourth of the hospitals surveyed provide aformal preparation program for their Nuclear Medicine Tech-nicians, although these also seemed to vary considerably.About sixteen percent (16%) have a program of their own,and another thirteen percent (13%) are involved in someform of collaborative program with other hospitals or schools.Of those who claimed to have some kind of formal program,collaborative or not, sixty-seven percent (67%) reportedpreparing fewer than three students per year. Again it is

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impossible to give an adequate descriptive breakdown ofthese programs in anything but the grossest terms of size,length, etc., since no uniform standards exist and we coulddetermine none to act as a standard for comparison.

The distinction between a "formal" and an "informal"program is often a rather uncertain one. Regardless of thecategory in which they were reported, most programs empha-size on-the-job experience. This aspect of the technician'spreparation is interspersed with formal classwork, occa-sional conferences and short courses. The essential dif-ference between a "formal" and an "informal" program seemsto revolve around the question of whether or not theseaspects of the prcgram are regularly scheduled. Qualita-tively, it is difficult to believe in many cases that animportant difference exists.

As there seemed to be some controversy over the valueof an internship as part of (or appended to) a preparatoryprogram for NMTs, we attempted to obtain respondents'opinions on this topic. An internship was defined as aperiod of time (at least several weeks) spent wholly in ahospital, usually for little or no pay. A clinicalexperience consisted of spending (on a regular basis)gaREriday (or week) in a hospital, while continuing todo course work. Of those who expressed an opinion only onthe idea of an internship (63), two-thirds favored it.When compared with a clinical experience, however, the over-whelming opinion favored the latter. About one-third ofall respondents thought that an internship should be partof the preparatory program,,but, close to half felt that itwas of little importance. Some were vehemently opposed toit, with one respondent referring to an internship as"slave labor". A clinical experience was considered to bean essential part of any program by about eighty percent(80%) and of little importance by less than ten percent(10%) of all respondents.,

Existing Collaborative Programs

A relatively small number of the hospitals we visitedare involved in collaborative instructional programs withother hospitals and/or educational institutions. Of thetwenty-three hospitals that are so involved, fifteen partici-pate in a full-time educational program (regular intervalsof in-hoipital clinical work alternating with regular in-tervals of classroom instruction at the educational insti-tution) without an internship. Three have full-time pro-grams with a following internship as part of the total pro-gram. There are a few hospitals which are involved inpart-time school-based courses for employees who are either

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in a different medical field or who are already in thefield of nuclear medicine.

Although the majority of these collaborative programsdo not include an internship as part of the total program,many of them do involve clinical experience over the periodof preparation. In fact, eighty-five percent (85%) of therespondents connected with various collaborative programsbelieved that clinical experience is of great importance insuch programs. Although most of our respondents saw theutility of an internship, they nevertheless felt that clinicalexperience interspersed with course work throughout theinstructional period is more expedient and relevant.

There is no standardized length of preparation forcollaborative programs. Class work ranges from a few weeksto a full year while clinical work may by a few months towell over a year. Variation is such that no average figurehas any validity.

Besides finding the type and length of existing col-laborative programs, we were also interested in trying tounderstand some of the organizational problems involved insuch cooperative efforts. We suggested six possibilities(question 4.19) and asked the respondent to indicate thedegree of importance of each factor in establishing theircollaborative program. Those that were considered to beof greatest importance were, in order: 1) that the programinclude on-the-job (clinical) experience over several semes-ters; 2) that the AMA or another professional associationapprove the curriculum; and 3) that the hospital's depart-ment of nuclear medicine be represented on an active ad-visory board to the educational program.

Additional Existing Programs

Thirty hospitals reported that they have a formal in-structional program for NMTs which does not involve collabo-ration with any other, institution. The duration and typeof such programs vary too much for aggregate figures to bemeaningful. The vast majority (84%) of hospitals withformal instructional programs reported that they preparedonly one to three persons per year.

Other Background Factors

Persons who are prepared to be Nuclear Medicine Tech-nicians have a variety of backgrounds, including X-RayTechnology, Medical Technology, laboratory assistant work,high school, nurse training, and college degrees in science.From 1967-69, more than half of the students were originally

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X-Ray Technologists. An additional one-fifth of the NMTsprepared came directly to their program from high school.Medical Technologists accounted for about one-tenth ofnuclear medicine students.

Our survey questionnaire did not specifically requestthe sex and age of technicians, but an impression is thatthe average Nuclear Medicine Technician is female, and prob-ably in her middle to late twenties. Respondents were asked,however, whether they preferred males or females as NuclearMedicine Technicians. More than half had no preference, and,of the remainder, males Were preferred slightly over females.Some wanted to have at least one NMT of each sex because ofthe need to deal with patients' idiosyncracies. Reasonsfor preferring females were that they tended to be moreaccurate, more easily instructed, better with patients, lesstrouble and more willing to accept lower salaries. Maleswere preferred because they could work at odd hours, werebetter with equipment, were more career oriented, tended tostay longer, could lift heavy items, were faster, moredependable, and,in the colorful terminology of one res-pondent, weren't "bitchy".

Certification

It is difficillt to say for sure how the average NuclearMedicine Technician is certified since the definition of"certification" is as ambiguous as the adjective "average"applied to an NMT. Probably a majority of technicians havecertification of one type or another, most of them in aspecialty other than nuclear medicine. Although data werenot obtained in the survey, it is our impression that aplurality of Nuclear Medicine Technicians are certified asRadiologic Technologists by the American Registry of Radio-logic Technologists (ARRT).

A national total of between 600 and 700 people arepresently certified as "Nuclear Medicine Technologists".The two organizations providing certification are the ARRTand the Registry of Medical Technologists (American Societyof Clinical Pathologists), with most certified techni-cians registered with the former group. Certification aoesnot, however, imply uniformity of formal preparation orexperien,:e since basic eligibility requirements vary con-siderably.*

*See Appendix C for ARRT and RMT eligibility requirements.

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A substantial number of NMTs work with no formalcertification, either in nuclear medicine or in an alliedfield. Without implying that their competence is any lessthan their certified colleagues, many respondents feltthat standardization of certification requirements wouldassist the development of the field.

To a major extent, this lack of standardized certifi-cation requirements is responsible for the wide variety ofinstructional programs cited above. Respondents were askedto name the organization(s) they would like to see establishstandards for proposed collaborative programs. Their repliessuggest the continuing fragmentation of the field (seeTable 7), although it should be noted that forty percent(40%) of the respondents favored some form of collaborationof organizations to establish standards (either by listingmore than one organization or by citing the AMA as thestandard-setting group).

Table 7

Organizations Which Respondents Would Like to ApproveCurriculum for New Preparatory Programs

Organization %*

American Medical Association 35%

Society of Nuclear Medicine 51%

American Registry of Radiologic Technologists 19%

American College of Radiology 15%

American Society of Clinical Pathologists 1%

Registry of Medical Technologists 4%

Society of Nuclear Medical Technologists 2%

Others .7%

*Total is greater than 100% because many respondentscited two or more organizations.

At the American Medical Association convention, onJuly 15, 1969, the House of Delegates took a large steptoward establishing standards for programs for Nuclear Medi-cine Technicians. The House approved a paper entitled:"Essentials of an Accredited Education Program in NuclearMedicine Technology". These Essentials provide for a Board

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of Schools of Nuclear Medicine Technology representing thetechnological groups and medical specialties with interestsin nuclear medicine. The Board of Schools is charged inthe Essentials with the evaluation of educational programsfor Nuclear Medicine Technicians, the maintenance of highstandards of education, and the development of new teach-ing programs. The Essentials are included in full inAppendix E.*

Possibility of Collaborative Programs

Most of the hospitals surveyed were not involved incollaborative nuclear medicine programs with other hospitalsand/or educational institutions. Respondents in these hos-pitals were asked if they would consider establishing sometype of collaborative effort; eighty-six percent (86%) res-ponded affirmatively. Their responses, however, were markedby varying degrees of enthusiasm and interest. Some felta need for collaborative programs to prepare more tech-nicians, and some welcomed the idea although they did notthink that with their facilities and personnel they coulddo much to help start a program.

Respondents were asked to rank their preference forworking with various institutions if their department wereconsidering establishing a collaborative educational program.The kinds of institutions chosen for collaboration were, inorder of preference, 1) other hospitals and a universitymedical school; 2) other hospitals and a community collegeor technical institute; 3) a university medical school;4) a community college or a two-year technical instituteand 5) other hospitals only. Ninety-five percent (95%)of those who did not list collaboration with a communitycollege or technical institute as their first choice never-theless indicated in answering another question their will-ingness to work with such institutions.

As with the established collaborative programs, wepresented a table of factors (question 4.28) and asked therespondent to indicate how important each would be for theirparticipation in a collaborative program. First, there wasconsiderable agreement (75%) concerning the inclusion ofon-the-job experience. Second, there was nearly equal im-portance attached to the approval of the curriculum by theAMA (or another recognized professional organization) and

*The survey interviews were conducted prior to theAMA's adoption of these Essentials. As a result the Boardof Schools was not mentioned as'an alternative to approvecurriculum for preparatory programs. For a funer des-cription of this issue, see also the comment by C. CraigHarris in Appendix I.

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the representation of the nuclear medicine department on anactive advisory board to the program. Third, almost halfof the respondents attached great importance to havingcontrol over the specialized content of the curriculum.It is interesting to note that, in the case of hospitalspresently involved in collaborative programs, the importanceattached to this factor was not as great. The great ma-jority of respondents favored a collaborative program con-sisting of a full-time educational program with regularintervals of in-hospital clinical work alternating with theclassroom instruction. A program of upgrading the skillsof present employees appeared to be relatively unattractive.

As is true of present instructional programs, thelength desired of collaborative programs varied consider-ably. The difference, however, was that respondents tendedto prefer longer periods of preparation in a proposed col-laborative program than in presently existing ones, whethercollaborative or non-collaborative. Thus, while about athird of all currently existing programs are between sixand twelve months long, more than half (52%) of the respon-dents preferred collaborative programs that are eighteen totwenty-four months long.

The overwhelming acceptance by respondents of the ideaof collaboration is an accurate reflection of the demandfor future preparatory programs. With the field of nuclearmedicine presently fragmented, and with an apparent presentand future need for increased numbers of NMTs, collaborativeprograms seem essential to the supply of well-prepared com-petent technicians. Programs with collaborative arrange-ments among hospitals, colleges, university hospitals andmedical schools, offer the possibility of increased effici-ency in the use of expensive equipment and valuable pro-fessional talent. Collaborative programs also will facili-tate the placement of graduates, easing employment burdensfor both employer and employee.

Collaborative arrangements seem central to the elaergingconcept of the "health team" and recent ideas on educationfor the health professions. The college or institutesetting is perhaps the best place for didactic, classroominstruction, and clinical experience is best obtained inthe appropriate hospital setting. Course and clinical workcan be at least partially credited toward degree require-ments when a college is involved, encouraging partir' ationin health fields by individuals also desiring the au vantagesof a college program.

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Some Program Descriptions

The evolution of preparatory programs for NuclearMedicine Technicians has followed the growth of nuclearmedicine. With its expansion into new hospitals duringthe last decade or more, technicians in related medicalspecialties have, largely in on-the-job situations, gainednew skills to perform the tasks of the NMT. The initiationof formal instructional programs seems to have lagged some-what behind the need for well prepared technicians. Eventoday most Nuclear Medicine Technicians receive their in-struction primarily in an on-the-job, clinical setting.Undoubtedly many physicians practicing nuclear medicineprefer to instruct X-Ray Technologists or other experiencedtechnicians to perform the specific tasks chey desire.

The fact that wide concern exists regarding standardi-zation of Nuclear Medicine Technician preparation and cer-tification, and that formal and collaborative programshave recently begun or are presently being initiated, in-dicates that informal methods of instruction are no longerconsidered sufficient to meet the needs of the field.

Existing formal preparatory programs for NuclearMedicine Technicians exhibit a great variability in almostany dimension. A useful, if arbitrary, categorizationscheme might describe the types of programs by their pur-pose, student background, and length. Using these dimen-sions, the following pattern emerges.

There are essentially three types of formal prepara-tory programs: 1) In the first, present NMTs attend veryshort refresher courses or presentations of new techniques.Such programs are sponsored privately, by universities, orby professional organizations, and last from several daysto a maximum of a month. A common variation is a semester-long single course given by an educational institution.Programs of this nature may be more correctly termed im-provement rather than fully developed instructional programs;as such, they are not within the scope of this report. 2)

The most common type of formal preparatory program is in-tended to turn Radiologic or Medical Technologists (orothers with A significant scientific and/or medical back-ground) into Nuclear Medicine Technicians. Such programsneed not be comprehensive since the students have alreadyhad instruction in related areas. These six-to-twelvemonth programs tend to be offered either by an educationalinstitution in conjunction with one or more hospitals orby .a university hospital. 3) A third type of formal pre-paratory program for NMTE, differs from the others in thatits students usually have little or no background in medi-cine. Most come directly from high school. These programs

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are often collaborative programs involving an educationalinstitution and one or more hospitals, and most commonlylast about two years.*

A number of programs exist which fall into the lattertwo. categories. Several will be described to provide ar(Ifsrence point for further comments on curriculum andmaterials. Exclusion from this discussion is not intendedto imply criticism of an existing program since the infor-mation gathered in the survey did not emphasize the problemsof preparation raised in this section. We did not visithospitals or institutions primarily to evaluate the train-ing programs they were condu:ting, nor did we ask our re-spondents to specify course content or evaluation criteriaused in their programs. Wherever formal programs were con-ducted, however, we requested any written material availabledescribing the program. As a result, we have compiled anumber of papers on a variety of existing programs. Thesesummaries outline, but in no way judge, the content orexcellence of these programs.

The moat common type of formal program conforms withthe requirements established by the American Society ofRadiologic Technologists (ASRT). This is a twelve-monthprogram, and usually represents the student's third yearof formal preparation. To be eligible for such a program,the potential student:

"1. Must be a graduate of AMA Approved School ofX-Ray Technology or

2. Registered Technician (ARRT) or

3. Medical Technologist, (AEU certified), (see NOTE),or

4. Registered Nurse with two years of college creditsor with a baccalaureate degree, or

5. Bachelor of Science degree with a major in Biology,Cheristry or Physics, (see NOTE).

NOTE: 7n addition, applicants under section 3 and 5must have completed a basic course in human

. anatomy and physiology of at least 60 clockhours."**

*Formal programs with three or more students areoutlined in Appendix D.

**ASRT requriemente.

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This curriculum allocates a total of 295 hours to thirteendifferent topics, adding that "all remaining hours shouldbe devoted to experience in performing clinical radioiso-topic procedures..*. The role of theory in this curriculumis deemphasized; for example, a full 130 of the specifiedhours (44%) are devoted to "specific procedures" while lessthan sixty hours (20%) are concerned with the physics ofradiation.

Numerous institutions run programs which generally con-form with these requirements, while varying somewhat inspecifics. To illustrate this curriculum approach, we haveincluded in Appendix D the curriculum outlines both of theAmerican Society of Radiologic Technologists and of theRadioisotope Technology program of the Indiana UniversityMedical Center. Many other programs exist which vary some-what differently from the ASRT requirements.

The Nuclear Medicine Institute (NMI) in Clevelandconducts one of the largest programs in the country forpreparing NMTs. Its one-year courses are open to registeredtechnologists (ARRT or ASCP), registered nurses, or thosewith a B.S. degree in biology, chemistry, or physics. Theprogram is divided into three phases: twelve weeks ofdidactic and clinical training at NYI, thirty-eight weeksof internship at an affiliated hospital, and two weeks ofreview.

The preparatory program conducted at the NationalNaval Medical Center in Bethesda, Maryland, lasts for sixmonths, yet is far more intense than ASRT programs. Moststudents in this program are naval medical corpsmen, althoughsome other students are also accepted. Over 750 classroomhours are scheduled, and emphasis is placed far more onchemistry and physics than in ASRT programs.

Programs to prepare high school graduates to becomeNMI'S are largely in the formative stages. Two promisingcollaborative efforts are expected to begin operations inthe Fall of 1969, one in Colorado at the Denver CommunityCollege and one in Florida at Miami Dade Junior College.Both are two-year programs leading to an Associate:Degreeand both enroll high school graduates (although an optionexists for X-Ray Technologists or others with a relatedmedical and/or scientific background to enter the programsat the beginning of the second year).

INEMNIIMINIMION.M011111.111111

* ASRT requirements.

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Many other similarities exist between the Denver andMiami programs. Both have found it essential to emphasize,continually, cooperation between the educational institutionsand the collaborating hospitals. Advisory bodies consistingof both medical and educational personnel have helped es-tablish each program and aid in continuing promotion. Ineach case there is a relatively large slumber of hospitalsinvolved (at last count, 10 in Denver and 6 in Miami).Each program includes, in addition to classwork at thecollege, both a summer internship and clinical experienceat the cooperating hospitals throughout the school year.

The content of both programs builds upon the existingcourses offered in the colleges. At Miami Dade there is agreater number of courses created specifically for NMTs,whereas at Denver a core program is emphasized, in whichstudents in nuclear medicine begin with some of the coursesprovided for allied health occupations. Outlines of theprograms of study and descriptions of their course offer-ings are presented in Appendix D.

Similar programs, although apparently with less of acollaborative emphasis, exist or are being developed atLos Angeles City College, Chicago City College, and theBritish Columbia Institute of Technology. In Harrisburg,Pennsylvania, a unique collaborative effort exists invol-ving the Harrisburg Hospital, the Pennsylvania JuniorCollege of Medical Arts and the Harrisburg Area CommunityCollege. The curriculum for this program is based on theASRT requirements and its graduates are eligible for cer-tification as Registered Technologists. It differs fromother programs in that it lasts only twelve months and yetis intended for students with no previous medical experience.

The only four-year training program for Nuclear MedicalTechnologists of which we are aware is located at the Uni-versity of Cincinnati. Developed with the assistance ofthe Bureau of Radiological Health U. S. Public HealthService) the program leads to a degree of Bachelor of Sciencein Medical Technology with a Nuclear Medicine Option. Gradu-ates are eligible for certification by the Registry of Medi-cal Technologists. Three of the four years are spent atthe university with the student following a normal didacticprogram. The senior year consists of a twelve-month intern-ship at the Cincinnati General Hospital, where a combinationof didactic training, laboratory exercises and practical .

training prepares the student for his future occupation.An outline of this curriculum and a description of its tech-nical courses are presented in Appendix D.

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Curriculum Development Approaches

Except to belabor the theme of fragmentation, thecourse descriptions and certification requirements presentedabove and in Appendices C, D and E do not easily lead togeneralizable conclusions. Their variety, however, doestend to reinforce our impression that typical NMT coursesseem to "just grow". They may originally have been based ongeneral statements of what the NMT needs to know, a generalset of goals probably derived unsystematically, or fromtoo limited an analysis of the occupation. Courses may havebeen added based on interest or influence in a program.Seldom if ever has the course content been rationalized interms of the tasks the NMT actually does perform on the job.The AMA "Essentials" included in Appendix E provide an in-teresting case in point. They fail to define a NuclearMedicine Technician and to specify the proficiency levelon various tasks which graduates of a preparatory programare expected to achieve, and yet they include a breakdownof courses required as part of the program. Clearly, thewide variation in hours allowed for certain courses isindicative of this problematic method of establishing acurriculum.

We have taken the approach that the design of acurriculum for preparing NMTs must begin with a behavioralanalysis of the occupation, specifying in detail the tasks,skills and performances it contains. From these occupationalspecifications, instructional objectives can then be developedan.' expressed in terms which more readily allow measurementof the skills, knowledge and attitudes the student is ex-pected to learn and use. This survey, in outlining boththe present and expected performances required of the NMT,has provided the first step in a more rational approach tocurriculum development.

This discussion is not intended to give the impressionthat'all present NMT preparatory programs, especially theones we have considered, are of poor design and quality.Quite the contrary, we have been impressed with the calibreof elements in many programs. The emphasis given to prac-tical clinical work, the collaborative use of resources andtalents, and the emphasis placed on job performance, arerecognised ingredients of effective programs. Furthermore,we do not mean to indicate that skill "training" aimed atincreasing the MMT's ability to perform limited tasks is allthat is necessary in his preparation. This misuse of thebehavioral objective approach poses real dangers and mustbe judiciously avoided. Effective courses in fields such aspsychology and English will certainly result in improvingthe technician's competence, both as a worker and as a citi-zen, although their specific contributions are not so easilymeasured.

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We are not attempting here to develop detailed coursecontent or program evaluation instruments. These tasks orea step beyond that represented by the survey and reportundertaken thus far. A general approach and methodology,however, can be described in outline form and provide onepossible framework for designing more systematic preparatoryprograms.

A first step in such a general methodology has beentaken in this report, viz., the identification of theNuclear Medicine Technician's occupational performancetasks. These must be central to the design of a basicNMT curriculum.and/or instructional materials.

The next step is to determine the criterion behaviorswhich all students are expected to achieve by the conclusionof the preparatory program. From these, evaluative instru-ments are develored, which in turn form the basis for thepreparation of instructional objectives.

Evaluation of students' success in the program mightproceed as follows: different forms of a test involvingboth written and performance sections would be administeredprior to, immediately after, and about six months followingthe program. (Other measures, such as aptitude and in-telligence tests, should also be used to help control forvariations in student performance not resulting from theinstructional program itself.) In conjunction with thesetests, follow-up reports from NMTs prepared in the programand physicians employing them should be solicited. Fromall of these evaluative instruments, feedback would beprovided to suggest instructional topics where an individual(or, in aggregate, the program itself) is inadequate.

Advisory committees should also contribute to continu-ing evaluation, insuring that course content remains abreastof the rapid changes in the field. The entire point of thisevaluative scheme is to place emphasis on the quality ofoccupational preparation the NMT has received. The focusis the Nta's ability to perform his job competently ratherthan the titles and hours included in his instructionalprogram.

The only present means which we have discovered forevaluating the quality and effectiveness of programa seemless than ideal, although possibly providing some valid in-dicators. Programs approved by the ASRT or the AMA NEseen-tials" must include facilities such as libraries, labora-tories, etc., a competent administration, affiliation withaccredited institutions, as well as specified courses andhourly contents. The several registries certify NMTs uponthe successful completion of an examination.

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The examination and other evaluative measures which weare proposing would be more job oriented than the existingregistry exams. The primary purpose would be to specify aminimum set of competencies without which an individualwould not be qualified to act as a Nuclear Medicine TechniCian.

In the interim prior to the adoption of such an approachto curriculum development, two topics should be stressed asnecessary additions to most programs. Many respondentsmaintained that the increased involvement of NMTs in thepreparation of radiopharmaceuticals meant that more of anemphasis on chemistry was needed. Also, with computersexpected to loom larger in the future of nuclear medicine,a basic knowledge of statistics and data processing shouldbecome part of the technician's prepaiition.

Instructional Materials

With a view to the content of new preparatory programs,we asked interview respondents to identify existing instrud-tional materials which they felt could be useful. Somethirty-five to forty different books, manuals, films orother resources were mentioned in their replies. The di-versity in these recommendations is perhaps again reflectiveof the lack of standardization and the fact that a consoli-dated set of educational and technical reference materialsfor the technician is not readily available. About one-third of the respondents failed to give any answer to thisquestion or commented that they knew of nothing suitable.If anything approaches a "standard" textbook for the NMT atthe present, it seems to be Henry Wagner's Princip

frequentlyof

Nuclear Medicine. Several other texts mentioned frequtlyiiiiiDribirETERied by Bland, Quimby, and Chase and Rabinowitz.Most respondents felt, however, that these medical textbookswere too difficult for technicians.

Nearly as often as textbooks, physicians and NuclearMedicine Technicians mentioned as excellent the literature,films, and materials published by the equipment manufacturersand pharmaceutical suppliers; some respondents stated em-phatically that commercial firma produced some of the bestmaterial available for both MMTe and MDs. A more completelist of existing instructional aids is included in Appendix P.

Besides requesting information about presently availableinstructional material, we also asked respondents what newmaterials were needed. Perhaps half of those interviewedloft this question blank, or their statements were so generaland vague to be of little practical assistance. Apparentlyfew respondents had ever considered the existing literaturefrom the viewpoint of its utility for preparing their tech-nicians to perform desired tasks.

Of the responses received, the need most often expressedwas for a good standard textbook written with th instruc-tional needs of the Nuclear Medicine Technician, rather thanthe physician, in mind. Although apparently in contradictionwith some respondenf%' favorable comments on the quality ofmaterial provided by equipment manufacturers and pharma-ceutical suppliers, others stressed the need for material,programs, procedures, etc., to prepare NMTs thoroughly onthe use of specific nuclear medicine equipment (includingcalibration and maintenance of sue instruments, as well asbasic electronics). The need for cL.reful instruction inclinical procedures was also widely voiced, and a number feltthat manuals, some even of a "cookbook" format, were badlyneeded.

Other specific topics mentioned frequently were mathe-matics and nuclear physics. Most respondents felt thatthese were of central importance for the NMT and that toooften their basic preparation and background in thesesubjects has been weak. In connection with mathematics,several doctors and physicists stressed the importance ofinstruction in using the slide-rule. Safety was anotherspecific topic mentioned by a number of respondents.

Although most of the persons interviewed noted thatthere was a dearth of good resource material for the prep-aration of Nuclear Medicine Technicians, we are somewhatcautious about agreeing with this conclusion. Such a con-clusion cannot yet be based on any rigorous analysis ofavailable materials. It is equally possible that the frag-mentation and lack of communication within the field arecentring this response, rather than deficiencies in theresources themselves. The predominance of informal,on-the-job training, the variety of approaches to formalinstruction, and even the differences in job requirementsfor the NMI' may contribute to a poor knowledge of avail-able materials. However, to our present knowledge, thecomplaint that no consolidated set of reference and in-structional materials is available appears to be valid.

Our impression is that many learning resources andaids are available, but, like the field itself, are frag-mented in form and format. The greatest training require-ment may not necessarily be a new textbook for the NMT, butrather coordination, cataloging, testing, adapting, and re-testing of the many materials now in use or available foruse. Such a task would undoubtedly be sizeable, but certainlyless difficult than devising all training materials fromscratch. Furthermore, such consolidation and evaluationof existing materials must be completed before the second

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major task of identifying and developing new materials canrightfully be started.

Finally, all materials might well he packaged as"modules", so nit users might combine them in somewhatvarying configuration, according to individual needs.

These three important sequential tasks yet remain tobe undertaken.

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V. Mailed Questionnaire

The hospitals visited by interviewers were locatedwithin the major metropolitan areas of the U.S. andtended to be the leading hospitals within those areas.Therefore, in order to describe more accurately the stateof nuclear medicine throughout the nation, it was necessaryto survey hospitals in other areas as well. A number ofhospitals from each state were selected at random fromthose listed in the 1966 AHA Guide as having facilitiesfor nuclear medicine. A shorter version of the interviewschedule was sent to these hospitals.

Response

From the sample of 619 hospitals, 151 replied withinseven weeks. Of these, 104 answered the questionnaire;forty-one indicated that they had no nuclear medicine oper-ations, or that the operations were of a very restrictednature; six replied that, although a nuclear medicine depart-ment existed, they were not willing to take part in thesurvey. It was clear from an inspection of the responsesthat the instructions for a few of the questions were =big-uous. These questions were deleted.

Findings

The responses concerning the work performed indicatedthat there was little difference in the type of work doneby technicians in hospitals in the two samples. The prin--cipal differences were that technicians in the mailed sam-ple used scintillation cameras less frequently and had lessresponsibility for advising physicians and checking incomingequipment. The nuclear medicine departments in the mailedsample share many characteristics with the interview sample.The type of organizational structure seems to be essentiallythe same.

The average size of the hospitals in the mailed sample(as measured by number of beds) was about seventy percent(70%) of the average size of the hospitals in the interviewsample. This ratio reappeared several times (see Table (1)suggesting that the differences between the samples may onlybe a result of the fact that in the mailed sample the hospi-tals are some-1t smaller than in the other. Another possibleexplanation of the differences is suggested by the findingthat the average age of nuclear medicine departments in themailed sample was about two years less than that of theinterview sample (8.7 vs. 10.8 years).

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Table 8

Comparison Between Mailed and Interview Samples

Factor

aMailed(average)

bInterview(average)

500

alb-%

70%Number of Beds 350

Major Items of Equipment 2.8 4.1 68%

Number of NMTs in 1969 1.97 2.5 73%

Expected Number of NMTsin 1975 3.7 5.7 65%

Expected Number of NMTs.n 1980 5.5 7.9 70%

Possibly because the departments are in general smallerand the equipment less sophisticated, the departments in themail sample tend to employ more part-time technicians.However respondents again indicated that they would prefer toemploy individuals who have completed a two-year nuclear medi-cine program. Salaries paid tended to be rather lower thanthose in the interview sample. This finding may be explainedby the difference in proportion of hospitals in major cities,where both salaries and the cost of living tend to be some-what higher. The mean starting salary which would be offeredto a person who had completed a two-year NMT program in themailed sample was $6,420.

Since the mailed questionnaire was sent to a differentsample of hospitals with nuclear medicine operations thanthe interviews, we had expected to combine the data fromthe two samples for a manpower analysis. Unfortunately, anessential question (3.5) was not answered by enough respon-dents in the mailed sample to provide the necessary relia-bility. The questions tor which responses were adequatesuggest that the mean number of Nuclear Medicine Techniciansper hospital in the mailed sample is seventy to eightypercent (70-80%) of that in the interview sample (see Table 9).

Employing data only fro' the interview sample for themanpower analysis has probably provided an upward bias toour results. Since we have no means to gauge the extentof this bias (although it probably is not more than tenpercent (10%) ), we have not attempted to alter theconclusions.

-48-

Table 9

Comparison of Number of Nuclear Medicine Techniciansper De7157T7diiiiIiiRaiavi: Interview Sample

Year Mailed Interview

1969 (Question 3.1) 1.97 2.48

1975 (Question 3.11) 3.73 5.66

1980 (Question 3.11) 5.51 7.95

-49-

VI. Summary of Conclusions

The Growth, Place, aril Practice of Nuclear Medicine

1. Nuclear Medicine has grown rapidly since the late1950,s. In hospitals surveyed, departments of radiologyinitiated and still control over sixty percent (60%) ofsuch operations, while twenty-two percent (22%) of nuclearmedicine departments are independent. The latter figureappears likely to grow slowly depending on such factors asthe interest of other departments and the energy and ini-tiative of physicians in nuclear medicine.

2. Most respondents thought that more money, better equip-ment, and improved instructional programs for NMTs andphysicians would speed the growth of the field. A few feltthat the growth of nuclear medicine would be stimulated bya statue independent of other departments. Others consideredthat the recognition of nuclear medicine as a specialty bythe AMA also would contribute to the field. Education ofthe pUblic concerning the usefulness and safety of nuclearmedicine and less stringent AEC regulations were also consi-dered important factors in speeding the growth of the field.

3. Costs of equipment, personnel, and hospital spacewere cited as factors which could constrain the growth ofnuclear medicine. The technical sophistication of equipmentwas also mentioned along with the frequently poor qualityof instructional programs for technicians, the inadequateformal preparation of physicians, and the general lack offamiliarity of doctors with the potentials of nuclearmedicine,

4. Diagnosis is the major concern of every nuclear medi-cine department surveyed, although most are involved in someradiotherapy work (mostly 114). Diagnostic tests performedfall into three categoriest static studies (scans), dynamicfunction studies, and in vitro teats and blond volumes.Static studies and uptakes provide the bulk of the typicaldepartment's work. When nuclear medicine is subordinateto radiology, in vitro tests are often performed in thedepartment of pathology. The major trends in nuclear medi-cine which may affect technicians over the next two or threeyears include scanning with faster scanners and cameras, enincreased number of dynamic function studies, the develop-ment of radionuclides of shorter half-life, greater use ofprepackaged pharmaceuticals and materials, and more auto-mated data handling. Such trends are expected not only toaffect th8 typq of work done in nuclear medicine, but alsoto greatly TKaYease the maw of activity.

-SO-

The Nuclear Medicine Technician; Occupational Information

1. The tasks the Nuclear Medicine Technician performscenter upon scanning and the related activities of radio-pharmaceutical preparation and administration (oral) to thepatient. The NMT does not interpret the results of scans,but some may point out areas of interest to the doctor.Besides operating the rectilinear scanner, technicians usedetector probes, well counters, scalers, and scintillationcameras for static and dynamic studies. Anything more thanvery minor maintenance on equipment is not done by the NMT,but he usually does share responsibility for radiationsafety with other technicians or physicians.

2. The tasks of the NMT and the hospital environmentshape the Nuclear Medicine Technician's working conditions.The hospital environment necessitates that he be able torelate to patients, doctors, physicists and technicians,nurses, and other hospital personnel. Formal or informalpreparation andexperisnce also define the working condi-tions of the NMT. In the larger hospitals with long-estab-lished nuclear medicine departments there are commonlyseveral technicians who are supervised directly by a chiefNuclear Medicine Technician, who in turn is supervised by adoctor. In the smaller hospitals he is likely to be moreon his own and his role depends very much on the attitudeof the MD and the responsibilities entrusted to him.

3. It is estimated that the present number of NMTs in theUnited States is between 4,000 and 4,600. Some thirtypercent (30%) of the survey respondJnts felt that theirpresent number of NMTs was insufficient for their currentlevel of operation; about half of these cited a lack ofwell-prepared technicians as the reason for this inadequacy.From 19.56-1969 the number of NMTs has been increasing byabout 800 to 900 per year. Our best estimate of the totalnumber of Nuclear Medicine Technicians needed by 1972 is8,000-8,500, and by 1975 is 11000 -12,300. There is a needto prepare about 1,300 new technicians per year.

4. Nuclear Medicine Technicians in the U.S. with one yearof experience are presently being paid anywhere from $4,000to $12,000 with an average salary of $6,300 per year. Req-pondents were also presented with a description of possiblecandidates for a position as NMT in their department andasked to rank them in their order of preference and indicatethe salaries they would be willing to pay each choice. Thefirst choice was for persons with two years of formal nuclearmedicine preparation, and the mean salary offered such aperson in his first year was $6,500.

-51-

Preparatory

1. A majority of the respondents felt that standardiza-tion of preparatory programs and certification requirementsfor NMTs was essential if the technician's position in termsof skill and salary were to be improved, Standardizationalso would help attract better persons and ensure that thedemand for technicians would be filled. At present thereare two certifying organizations for NMTs: the AmericanRegistry of Radiologic Technologists (ARRT) and the Registryof Medical Technologists. Most Nuclear Medicine Techniciansare not certified at all in nuclear medicine, a pluralityof them are certified as X-Ray Technologists (ARRT). Stillothers have no certification of any kind. Eligibilityrequirements for certification as a Nucler Medicine Tech-nologist by the above organizations vary from a high schooldiploma and on-the-job experience to a baccalaureate degree.

2. Preparatory programs for Nuclear Medicine Techniciansare at present even more diverse and fragmented than certi-fication requirements. The most common method of prepara-tion (53%) consists of informal, continuing, on-the-jobinstruction under the supervision of physicians and expe-rienced technicians. Twenty-eight percent (28%) of the hos-pitals surveyed claim to have a formal instructional programof some sort for their NMTs. The interpretation which theygive the term "formal," however, is questionable, since mostof these programs prepare only one or two people each year.About one half of these programs are in collaboration withsome other institution(s), either other hospitals, a commun-ity college, or a university medical school. In many cases,however, a hospital may be "collaborating" only to the extentof sending an individual to be prepared elsewhere.

3. When asked if they would be willing to participate incollaborative programs, most respondents (86%) replied in theaffirmative. Collaboration it. instructional programs appearsto be desirable since it would provide greater resourcesand talents, allow for their more efficient use:, and facili-tate the recruitment and placement of students. Those whoreplied in the negative to this question either feared thatsuch programs would inevitably be poor, or did not believethat NMTs needed much formal instruction. Respondents rankedcollaboration with a university medical school first,followed by collaboration with community colleges or techni-cal institutes, Very few, however, were able to name theinstitutions with which they would like to work. Fifty-two percent (52%) felt that two years would be an ar?ropriatelength for such a program. Nearly all respondents expresseda willingness to collaborate with community 'ollege ortechnical institute programz in nuclear medicine.

-52-

4. Formal prcgrams may be separated into three types.(1) In the first, present NMTs attend very short refreshercourses or presentations of new techniques. Such programsare usually sponsored pi.Lvately, by universities, or byprofessional organizations and last from several days to amaximum of a month. (2) The most common type of formal pre-paratory program is indended to turn Radiologic or MedicalTechnologists (or others with a significant scientific and/or medical background) into Nuclear Medicine Technicians.These six-to-twelve month programs tend to be offered eitherby an educational institution in conjunction with one ormore hospitals or by a university hospital. (3) A thirdtype of formal preparatory program for NMTs difl!urs from theothers in that its students usually have little or no back-ground in medicine. Most come directly from high school.These programs are often collaborative programs involvingan educational institution and one or more hospitals, andmost commonly last about two years.

5. Interview respondents were asked to identify instruc-tional materials which they felt could be useful in prepara-tory programs for NMTs. Some thirty-five to forty differentbooks, manuals, films or other resources were mentionedin their replies. If anything approaches a "standard" text-book for the NMT at the present, it seems to be Henry Wag-ner's Principles of Nuclear Medicine. Literature, films,and otEgE materlalsWne equipment and pharma-ceutical firms were also described as being generally ofexcellent quality.

6. There was considerable uncertainty among respondentsregarding new instructional materials which are presentlyneeded. Most often expressed was the need for a good stan-dard textbook written with the NMT, rather than the physi-cian, in mind. Additionally, the need was also voiced forcareful instruction in clinical procedures, use of instru-mentation, mathernetics, and radiation physics; chemistry andstatistics were also mentioned. We are somewhat cautiousin agreeing with the conclusion of many respondents thatthere is. a dearth of good resource material for the prepara-tion of NMTs. Our impression is that many learning resourcesand aids are available, but, like the field itself, arefragmented in form and format. The greatest training re-quirement may not necessarily be a new textbook for the NMT,but rather coordination, cataloging, testing, adaptingf andre-testing of the many materials now in use or availablefor use.

-53-

Appendix A: The Questionnaire Instrument

Pap

Critique 55

Copy of Questionnaire 57

Statistical Summary of Findings 80

-54-

The Survey Questionnaire: Critique

This appendix contains copies of the questionnaireinstruments used as the basis for personal interviews andthe mail survey. There were minor changes in the longerquestionnaire, the result of initial experience and revi-sion. These changes have been indicated, however, in thecopy included here, and notes of explanation Mong with abrief critical evaluation follow. After the questionnaires,a summary of the statistical tabulations is presented.

Many parts of the questionnaire were quite successfulin terms of the information they were designed to gather.The list of tasks in Question 1.1 was very helpful in de-fining the actual on-the-job performance objectives of theNuclear Medicine Technician. Question 1.7 provided a goodsupplement to the behavioral description of the NMT with acatalog of the types and frequency of equipment used. Gen-erally we found the responses to open-ended questions (e.g.3.9, 3.10, 4.30, and section 6) especially useful in deter-mining trends, verifying impressions, and corroboratingpatterns that emerged from the more structured data weobtained.

One of the general shortcomings of the interview ques-tionnaire was its formidable appearance in length and com-plexity. Long and detailed instructions (see pages 1, 4,

and 9 for examples) frequently contributed more to therespondent's confusion than clarity. The translation ofinstructions into number and letter codes to be placed incolumns or tables seemed to be the source of much of theconfusion. Several questions required a degree of discrim-ination among choices that was perhaps unreasonable. InQuestion 3.7, the respondent was asked to rank in order fromone to ten his preference for hiring Nuclear Medicine Tech-nicians. The time and difficulty initially experienced onthis question required that we seek only the top four choices.

Question 2.4 also caused a problem; it contained a tableof fifty-six blecks which the respondent had to completewith a code for the frequency of the NMTs "interaction." Inour first interviews it became clear that this question wastoo long and that some responses were unclear. A revisionsimplified the question somewhat, but terms such as "reports"and "written information" still lacked clarity and specifi-city.

Question 3.5, another table requiring completion by therespondent, also caused some confusion. The aggregation of"equivalent full-time technicians" probably contributed moreto confusion than to useful information, and the projectionof needed Nuclear Medicine Technicians in categories (A)

-55-

versus (B) frequently depended on several contingenc.ies suchas the quality of the instructional programs involved.

A real problem arose in Question.2.1, where we asked'for the salary scale now paid to NMTs. The range of salarieswas to be determined by certification and length of experience. The term "certification" was interpreted in somany ways, however, that we were unable to discriminateamong salary levels by this criterion: This probleffi of "cer-tification" is discussed more fully in the section on thepreparation of NMTs and the appendix on certificatior. re-quirements. This was not the only place in the questionnairewhere money figures were a problem. Physicians and NMTswere often unsure of the salary that should be paid forvarying levels of preparation, and frequently they statedthat the establishment of salary and stipend figures wasan administrative function.

The length of the questionnaire was certainly a liabil-ity and the average interview lasted at least an hour. Inmost cases, however, busy schedules were interrupted toaccomodate interviewers. A number of respondents remarkedthat overall the questionnaire was comprehensive and com-plete. Some others were aware of the deficiencies in thesurvey instrument and helped us by calling them to our atten-tion. Although the questionnaire was less than perfect inits form, we have been satisfied that it has provided datasufficient to accomplish the objectives of the survey.

-56-

TECHNICAL EDUCATION RESEARCH CENTER142 MT. AUBURN STREET, CAMBRIDGE, MASSACHUSETTS 02138

AREA CODE 617 547-0430

NUCLEAR MEDICAL TECHNICIANINTERVIEW SCHEDULE

Interview Number

Interviewer

Name of Hospital:

Name of department or divisionwhere nuclear medicine is practiced:

Title of Interview Respondent:

Please indicate the title you use for the technician of nuclearmedicine to whom your responses w:Lll apply:

Title of Technician:

About how many months of formal or on-the-job training beyonda high school education has this person received, or the averagetechnician in your department received?

Months of training beyond high school: months

57A Non-Profit Corporation

-1- 62.dclY

NMT INTERVIEW'

SECTION 1 The following questions concern tasks performed by the averageEFEETirains in your nuclear medical department.

1.1 Please circle in Column 1.1 how many times per month thefollowing tasks are performed by your technicians.

"Not in Hospital" means that the task is not performedin your Department.

"0 times per month" means that the task is performed inyour Department, but not by youraverage technician.

"1-3 times/month" is up to and including once a week."4-10 times/month" is weekly or semi-weakly."11+ times/month" is almost daily or more often.

1.2 Please circle in Column 1.2 the 5 or 6 most important whichyou would like to see your technicians be able to do better,or in addition to those he performs now.

1 . 1

Techsnow do

0

01

crH

ro

00

0I

4 )X

rtiGf R7 riZ E-4

Preparation

/7 1. Chemically prepare short-life isotopes:a) eluting the column

2. b) chemical preparation3. c) sterilize4. Calibrate isotopes against a standard5. Prepare oral dose: measure from manufacturer's bottle6. Prepare oral dose: mix, dilute to measure7. Prepare injections: measure dose8. Prepare injections: sterilize dose9. Set up instruments for operation: a) in vivo studies

26 10. Set up instruments for operation: b) in vitro studies

Oabcd 1

Oabcd 2

Oabcd 3

Oabcd 4

Oabcd 5

Oabcd 6

Oabcri 7

Oabcl 8

Oabcd 9

Oabcd 10

Tests & Patients

-27 11. Administer isotopes to patients a) orally12. Administer isotopes to patients b) by injection13. Receive patients, explain tests to them and allay

their fears14. Position patient with respect to nuclear medical

equipment15. Superficial and-specialized examination of patients16. Attend to patient's comfort before and during scan

3 17. Understand operating room procedures

-58-

Oabcd 11Oabcd 120 a b c Id 13

Oabcd 14Oabcd 15Oabcd 16Oabcd 17

(era 0/

'

Data Handling

11.1 f 1.z

mm0

.

Techsnow do

+

-4

'-4Mg0

i-1 40 4-) V)ri g3 40 /1)CD 'C4

I

Eiclig1

001

.c.r

re. Abstract simple data From patient's chart 1 a b c d19. Make simple dose calculations for a) in vivo examinations oabcd20. Make simple dose calculations for b) in vitro examinationslabcd21. Make simple dose calonlations for c) tracer examinations s a b c d22. Accumulate and process data for MD's interpretation oabcd23. Examine scan test results for general credibility oabcd24. Perform preliminary interpretations of observations for MDAabcd

18192021222324

Equipment/5. Operate a rectilinear scanner for conventional scanning I a b c d 2526. Operate an autofluoroscope for static studies labcd 2627. Operate a scintillation camera for static studies 1 b c d 2728. Operate an autofluoroscope for fast dynamic studies

(under one minute scan) 'abed 2829. Operate a scintillation camera for fast dynamic studies oabcd 2930. Operate a scanner for slow dynamic studies

(over one minute scan) labcd 30.

31. Operate an autofluoroscope for slow dynamic: studies I a b c d 3132. Operate a scintillation camera for slow dynamic studies labcd 3233. Caltbrate nuclear medical instruments oabcd 3334. Check performance of existing and new nuclear medical

instruments against manufacturer's specifications o a b c d 3435. Determine if a nuclear medical instrument is in need of

major repair a b c d 3536. Perform minor maintenance on nuclear medical instrument Oabcd 36

37. Evaluate nuclear medical instruments from manufacturer'sliterature and specify and rank those instruments thatsatisfy the doctors' requirements 0 a b c d 37

38. Advise doctors on the technicalities and procedures in-volved in operating a nuclear medical instrument Oabcd 38

§ateAY.I9---Check monitoring instruments . Oabcd 3940. Monitor personnel in compliance. with hospital regulations Oabcd 40

41. Monitor space in compliance with hospital regulations babcd 4142. Handle and store radioisotopes safely babcd 4243. Assay wet chemical solutions for activity and contaminantspabcd 4344. Safely dispose of radioactive wastes Oabcd 44

Clerical713-77Wiridle secretarial work: appointments, type reports Jabcd 4546. Routinely check incoming equipment Oabcd 4647. Inventory and order radiopharmaceuticals and materials Pabod 4748. Keep accounts of hospital licensing and isotope procurement0 a b c d 48

Others Oabcd 49

50. Oabcd 50

51. Oabcd 51

52. -59- 0 abcd 52

POOR ORIGINAL COPY BESTNMT INTERVIEW AVAILABLE AT TIME HMO- C(111/ 0.7 CCM' I

1.3 Please indicate, using the code given below, why the five or sixadditional tasks you would like to see your technicians perform,which you circled in the task list 1.2, are not now being done by them.

Number' from Reason why taskCode: Task List 1.2 performed now (Code)

1 Technician not trained for.task2 Technician not well trained enough3 Shortage of staff4 Facilities not yet available5 Legal requirement or prohibition6 Other (please specify)

e;

-----74-----71

1.4 Please indicate below which of the tasks you checked off in question1.1 as how being performed by your technician, you think may becomeobsolete by 1972, because of: (give task number from 1.1)

(a) technological innovations 23 - 2t

2,-24(b) change in your department's areas of interest and work

27-

(c) hospital organizational changes (e.g., combining old orcreati?g new departments)

3/-

1. Please indicate what new tasks you think may be performed by yourtechnicians in 1972, ETCause of: (give task number from 1.1,

or a phrase)

() technological innovation

(b) change in department's areas of interest

......0111. 39- 42

(c) hospital organizational changes (e.g., combining old orcreating new departments)

4;

1.6 What tasks, presently being carried out by you, would you turnover to your technicians, if they were better trained? (tasknumber from 1.1, or a phrase)

60

NMT INTERVIEW

1.7 Pleass indicate, in the Table opposite, in the column marked 1.7,the number of major items of nuclear medical equipment which yourDepartment now possesses (or has on order). Please place number ofitems on order in parentheses following number now possessed.Example: 2 (1)

1.8 If there are any other items of nuclear medical equipment locatedelsewhere in the hospital, which do not belong or are not controlledby your Department, please indicate` T-IFI the Table opposite, in thecolumn marked 1.8, the number and types of the equipment.

1.9 For each kind of equipment which you have checked off which you nowp',ssens please indicate, in the table opposite, in the column marled1.9, the average number of man-hours per week your technicians workwith those pieces. Example: 3 Single Probe Scanners used by 4technicians 1/2 time - 3 x 4 x 20 hrs/week - 240 man-hours.

1.10 If there are any items of equipment not operated by your nuclearmedical technicians, please indicate, in column 1.10, below, usingthe following code, the reason for this:

Code: 1. Technicians not sufficiently well-trained to useor work with the equipment.

'2. Too responsible an operation/test to be performedby a technician.

3. Could be done by a technician but you have aspecialist to do it.

4. Other.

1.10 1.71

....

..e

Item of equipment (Number from Table) CodeWill be operatedby technician by

1972

---

-------1,11 Please check in column 1.11, above, if any of the items of nuclear

medical equipment which you indicated in 1.10 as not now beingoperatee by technicians, will be operated-IV-your technicians by1972.

-61-

-5-C2'dJ 02

. =77 1.8 1.9

Equip.in your

Equip.else-wherein

Hosp.

Tech.man-hr.per/wk

onEquip.

.7 Equipment have nowt no parentheses(equipment on order: number in

parentheses) Example: 2 (1) Dept.

MAJOR ITEMS OF NUCLEAR MEDICAL EQUIPMENT

1. Single Probe Scanner -- 3", 5", or 8"

2. Dual ProbeScanner

3. Autofluoroscope.

.

4. Scintillation Camera

5. Whole Body Scanner (radiation distribution)

6. Whole Body Counter (tote.' radiation level)pp.dc

7. Manual Well System

8. Automatic Well System

9. Dose Assay Ionization Chamber

10. Monitoring Ionization Chamber

11. Single Probe Renal System

12. Dual Probe Renal System

13. Computer Applications of Scintillation Camera

14. Liquid Scintillation System

15. Orthodensitometer

16. Multichannel Gamma Ray Spectrometer

17. T-3 Type or T-4 Type Measurement System .

18. Automatic or Semi-automatic Blood VolumeMeasurement Systems

19. Automatic Film Developing Facilities

20. Other*

21. Other:--

-62-

.

444

if if.

Bsti 70

7/ 74

- Vs'

-

-7-

Nt4T INTERVIEW

Cods. -

Section 2 The following questions concern the working conditions whichare characteristic of those experienced by your nuclearmedical technicians.

2.1 Please circle the annual salary range which you now pay yourtechnician.

. (circle one letter in each row)Certification 4,000-6 years of 4,999

5,000-5,999

6,00u-6,999

7,000-7,999

8,0007.8,999

9,000-9,999

10,000- Over11,999 12,000

experience(A)

b

1)

b

b

(3)

c

c

c

(4)

d

d

d

d

(s)e

e

e

e

(6)

f

f

f

f

(7)g

g

g

g

(tf)h

h

h

h

h

h

4

741

//.

'7X

lY

(1)

1. non-certifiedand first year

2.mm-certifiedand second year

:4.non-certifiedand fifth year

4.certified andfirst year

5.certified andsecond year

6.certifie4 and afifth year

2.2 Do you prefer males or females in the role of a nuclear medical (r,tStechnician?

fi'

(0 males (A) females 0) no preference

2.3 Does your NMT technician work

6r, _primarily alone

ell primarily with one other' technician

tb with two other technicians

(4) with more than two other technicians

-64-

-6-

NMT INTERVIEW

Equipment Repair and Maintenance:

1.12 How many service calls were made on all your nuclearmedical equipment in the past year?

1.13 Approximately what percent of these repairs were doneby personnel not from your hospital?

1.14 Approximately what percent of repairs were done by yourhospital's equipment serviceman or maintenance people?

1.15 Approximately what percent of repairs were done by anNMT?

1.16 Now many of the following are performed per month inyour department?

1. Image or lycalization studies

2. Flow studies (e.g., brain blood flow)

3. Dilation studies (e.g., blood volume)

4. Absorpron, Excretion tests (e.g.,Schilling tests)

5. Rapid uptakes (e.g., renograms)

6. Slow uptakes (e.g., thyroid uptakes)

7. In vitro tests (e.g., T-3 tests)

.......11.411

Tota1100%

..

1.17 Is radiotherapy performed in your nuclear medical unit?Yeas Radioparmaceutics1 therapy

Brachytherapy-.

TeletherapyNo:

1.18 Now many technicians in your nuclear medical unit are principallydoing radiopharmaceutical therapy?

(None 0) 0 1 2 3 4 5 6 7 8draw..

-63-

-8- Om/ 41.5-

'NUT INTERVIEW

'2.4 In the process of performing his tasks, the technician interactswith numerous people, in and out of the hospital. For each of thefollowing categories, please indicate the frequency of the inter-action by writing the appropriate letter from this scale:

tic A = frequentlyB t seldom, but the interaction is very important

(11) C ut seldom, and the interaction is relatively unimportant.Ao D = never or hardly ever

Blank ut don't know

.

function ofinteraction to-from-

mWo4-)

8R:11

V)

N1-:

o0d m04gm m

o 0iiI-I 0N.

8

o>

.ri

0I-1

4-1RJ r-I In.1) RI rlri 14 4404 W 'd (4-1

2 ript 41'61tr. Ili la

gRI 00 PV n4-3 oc ti)

k9

E t.44

m...m0

In.

rl

gh 0CA

iiCI il0.1 W.

o>.ri

d -.0

o

.4 44.d 44

ci) a VRI V)

flommsw 1 ilot

*Afam.. " Lt.. MI

, Nat44> 1

th 4-41.4 rl 'CI ufJ ..0 la

Polltsosis

cArchoot

ibiorau

1,414,4tdTWOola,COMM'41104.WM000

1. read resorts from1111111

11111z, A:

2. write re orts to P

3. fill out forms for

4. receive writteninstructions and/or information from IIII1 A'

S. give writteninstructions and/or information to

lir,

Al

Fill

.,

. receive verbalinstructions and/or information from

7. give verbalinstructions and/or information to

-_

IIIL

Z.S. Can you give us soMe samples of the forms (administrative andspecialized) the NNT has to work with'?

2.6 The NMT technicians in your department rep..rt directly to:(a) M.D.la(b) a Head-Nuclear Medical Technician try

(c) a Head Technician Please speETU type. (d) other ..;,Please specify

-65-

;7

07;

if

-9-

Section 3

The following questions concern the hiring of Nuclear Medical Tech-nicians and your projected manpower needs for these technicians.

If some, or all of your technicians work only part-time, pleaseestimate the fraction of their working week devoted to nuclear medicinetests /operations and give the total in terms of numbers of full-timetechnicians. For example, if you have two part time technicians, eachworking half time, and a third technician working three-quarter time,then you would answer question 3.1 as one and three-quarters technicians.)

- 43.1 How many nuclear medical technicians did your Department have at the

7e

beginning of 1969? How many persons did this represent?

3.2 If you have several technidians working ;fart time, and their totaltime is equivalent to one person's normal working tine, is it validfor us to assume that your needs could be satisfied by one nuclear 8cmedical technician?

6,0 yes (1) no

If no, please explain.

3.3 Is this number sufficient for your Department's current needs?

(/1 yes (.1) no

3.4 If your answer to 3.2 was no, please circle the importance of eachof the following constraints which prevent your department from

ear',/e6

17,

hiring more NMT technicians.

Possible constraints-Degree of importance

great some slight none

1. lack of funds for salaries 1 2 3 *. 4 /4'

2. lack of trained technicians 1 2 3 4/9

3. lack of manpower to.traintechnician candidates 1 3 4 2o

4. lack of supervisors fortechniciens 1 2 3 4 2/

5. lack of nuclear medicalequipment 1 2 3 4 .22

6. other (please specify below) 1 2 3 4

-66-

-10-COrd,

N!4T INTERVIEW

3.5 Looking back over the past three years and also looking to thefuture, please answer, for each year, the following questions:

How many persons did you (ordo you expect to): 1966 1967 1968

.

119691970 1971 1972

(a) hire with some NUTtraining: It///A/ / /

(b) hire with no NMI' train-ing, to be trained inyour department.

//I

///

(c) How many techniciansleft your department'semploy?

/((4.0

0-1'a ,

/

.

:'

..,,,../WV;/,' /,

.

/..%.

(d) Of the technicians wholet your department,how many left the fieldof nuclear medicine?

. ,

/.

,;,,,;..

3;

",,/,/;

/.''.';"', ,..

/''..

.p.-.

Yr 7S,

C e.rd C)7

/.2 3a

33- IP

*For each box, answer as follows: number of people

number of equivalent full -tine technician

Example: 5 people, all 1/2 time -

3.6 Please indicate below the most important reason(s) which you believeled to thetr leaving.

1. just want a change - or work, city, experiences

2. lack of opportunity to advance in position

3. inadequate salary schedule

4. lack of interest in the type of work

5. lack of competence to perform the tasks

6. interpersonal conflict

7. other (please specify)

-67-

0+1

POOR OR/GRUI COPYAYAHAlitE

AT TIME FIMEO

49

Car/ 07

NMT INTERVIEW

3.7 Assume that to fill c position as Nuclear Medical Technician, youmust choose among several candidates, all graduates of a high schoolwho appear equal in basic intelligence. Please

(a) establish a base salary for this position

(b) rank the following factors as you would value them incomparing the candidates (1 .2 most important)RAO% Oti1.4 'TOP FOUR0)

(c) indicate the differential (amount in dollars plus or minus)from the base salary produced by each factor

Base salary for the position

Comparison factors candidate has completedRankvalue

SalaryJiff.+

(a) no post-secondary training or experience

(b) two years of on-the-job training inhospital medical laboratories other thanin radiation

51.

(c) two years of on-the-job training in anuclear medical department

A't tY

(d) a two-year X-Ray technician programinvolving hospital experience overseveral semesters

v?------(e) same as (d) plus six-month hospital

internship program---

(f) a two-year nuclear medical technicianprogram involving hospital er,eienceover several semesters / .

(g) same program as (f) plus six-month hospitalinternship program

JR..i

111Wn.roo...................................

(h) a registerei nurse tr.thlinq programis I.

........-----.....

(i) a four-year college degrt:. 1)4.-1,,.am in

biology/chemistry/physics 0(j) four-year Medical Technologist Program

including hospital experience overseveral semesters 17 t,

-68-

-12-Ca 07

iT INTERVIEW

.0 Do you see any parallels in rate of growth of the use and practiceof nuclear medicine and some other, now more developed, specialty 7/of medicine? 0 -/es 40 no

if yes, what field of medicine

.9 What do you see as the major factors which could slot.: or limitthe growth of the use of nuclear medicine?

,10 What do you see as the major fantors which could speed the growthof the practice of nuclear medicine?

.11 Please estimate how many nuclear medical technicians your Department 7! -7will need in (a) 1975

(b) 1980

.12 Suppose that your reputation depended on your success in predictingthe percentage of hospitals in the United States that will havenu lear medical operations (a) by 1975, (b) by 1980. whtit percen-tages would you predict for each? (Presently about )t allhospites listed in the ANA guide have a radioisotope facility).Please circle the appropriate figure for each year.

Ar-kY

% by 1975 20 25 10 35 40 45 50 55 60 65 70 75 80 85 )0 95 100

% by 1980 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

-69-

.11.

-13-Cale/ Ari

NMT INTERVIEW 1 '

Section 5

These questions pertain to the development and growth of yourDepartment.

5.1 In which department did nuclear medical operations begin?

1. Department of Radiology.

2. Department of Pathology

3. Nuclear Medicine was established as a separate department/unit with its own rights.

4. Other (please specify)

5.2 How long is it since nuclear medical tests/operations first startedin your hospital? years

5.3 How many technicians did you have working in nuclear medicine at theend of the first year? (Count tvo half-time technicians as one tech-nician, etc.)

5.4 Are there any other nuclear medical tests/operations carried outelsewhere in the hospital, which are not under your Department'scontrol? w yes /) no

If so, please name Departments

5.6 Please fill in the following organizational chart for your hospital. Ae

1. Please locate and give the actual name of your Nuclear MedicalDepartment in Block(a).

2. Please locate the Department/Unit/Division above the NuclearMedical Department in block (b).

3. If the Pathology or Radiology Departments are not mentioned above,how are they located in the organizational hierarchy in relstionto the Nuclear Medical Department?

POOR OMGINAL COPY BEST

MAILABLEAT TIME FitmED

Ma .. .0. AM

ra-70-1

c-4,./ OAP-14-

NMI' INTERVIEW

Section 4

These questions concern your present training program, and/or the eaAjejkind of training programs, that you would like to see developed to trainnuclear medical technicians.Part h4.1 Please check below, how your technicians are now trained. /7

(a) informal hospital training program

formal hospital training program (ARRT Curriculum _____yesau no

formal training program in collaboration with other hospitals

0)(0 formal training program in collaboration with communitycollege /technical institute

to)(o) formal training program in collaboration with a university

--Medical school0/

(f) only hire trained or experienced technicians

If you checked (f), please skip to question 4.20, Part C

4.2 What is the length of your program? (weeks) (months)

4.3 Who teaches it?40 M.D. s ev Specialists '' Others .

4.4 How many students/trainees were in this program last year?

4.5 How many students/trainses graduated from this program during last j;.j;year?

4.6 How many students/trainees do you expect will graduate from theprogram during this year?

4.7 What degree or certificate, if any, results from this program?17/ none, title of degree/certificate ot,e

4.8 Are the trainees who complete this program eligible to take:

(a) American Registry of Radiologic Technologists Certification Jrexamination, yes al no

(b) Registry of Medical Technologists? rfP yes hi no 29

4.9 Does the length of the program depend on the previous background of 30the trainee? .!,P yes m no

If yea, please explain briefly:

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-15-

NMT INTERVIEW

4.10 Does the content or clinical training of the program depend on theprevious background of the trainee? yes no

If yei, please explain briefly:.

4.11 Please indicate the present number of trainees, and recent graduatesfrom the program, having the following backgrounds.

Recent Graduates

,

Trainees

1967/

1968 1969

1. ,X-Ray technician

2. Medical Technologist

3. Laboratory Assistant

4. High School graduate

5. Nurse

6. College graduate in Science.

7. Other

8. Don't know

tart I)

Please answer the following questions of the program you are nowinvolved in, or that is now being developed, is a collabora0.ve trainingprogram with other hospitals and/or educational institutions. ip IT ISNOT, PROCEED TO.PART C, PAGE 17.

4.12 What kind of education program is involved:

full-time educational program (regular intervals of in-hospitalclinical work alternating with regular interval3 of classroominstruction at the educational institution) without internshipas part of total program; 1.

Pull -time cooperative educational program with foil/winginternship as part of total program; i

Full-time non-cooperative educational program, with post-graduate internship; 3.

Part-tine school' -based courses for full-time hospital employ-ees now in a different medical field; 4.

Part-time school-based courses designed for upgrading full-'time hospital employees already in the field; 5.Other. -72- 6.

-16-

OMT INTERVIEW

Girdi

4.13 How many months of the total program is spent in clinical or classwork at a hospital?

(a) before graduation' class work (weeks)(months)

75-- 76

ks)clinical work (wee7,-78---7-/--(months)

(b) in a post-graduate internship program with a systematic educationaldesign:

(weeks)class work (Months)

(weeks)(months)

_clinical work

eoSeselq

/7. ae

4.14 How many other hospitals and/or schools are collaborating in thisprogram:

hospitals

schools ,

tp

20

4.15 Please give in the Table below, the name(s) of the institution(s)/hospital.(s) involved in the program, and the distatices and time totravel between your hospital and these other institution(s)/hospital(s).

Name of Institution Location

Distance fromyour hospital

in miles

Time to travelby 'public

transportation

1.

2.

3.

.

4.16 How many M.D.'s ox specialists from your hospital are involved in thiscollaborative program?

(a) in teaching?

(b) in advising on deVelopment?

(c) in design and initiation?

;//-22.

25--X

(d) in evaluation?27-. 28

4,17 Do you support the living costs of your staff while they receive 29training outside of your hospital? e?) yes; ."..2) no.

-17-

fl4T INTERVIEW

44.18 Do you pay any of the tuition costs? total (not per person)tuition costs /year..

k_percentage paid by you

4.19 In the discussions both before and after you reached agreement to setup a collaboratiye progrm, which of the following factors apply and

'how important is each to you? 'Please circle the appropriate number:in, each case...

Importancegreat some little7,

(a) That yoti have control oyez: the specializedcontent of the curriculum

(b) That the program include on-the-jobexperience over several semesters

(c) Same as (b) followed by an internshipprogram in a,nuclear medical department

(d)That specialized courses be, taught by MD's

(e) That your Department be represented on anactive advisory board to the educational,program

(f) That the AMA or another professional associati on approve the curriculum. Please specifythe professional association

1

1

1

1

2

2

2

.2

2

3

3

3

3

3

(g) Other

(h) Other

PLEASE PROCEED TO PART D, PAGE 18:1

Part CPLEASE ANSWER THE FOLLOWING QUESTIONS IF YOU DID NOT ANSWER PART B.

. IP YOU ANSWERED PART B, PLEASE SKIP TO PART D, PAE-18.

4.20 Would youconsider establishing a collaborative nuclear medicaltraining program with other Institutions? yes ho

If no, please very briefly give the reasons and then skip to PartD,question 4.30.

a

-74- POOR ORIGINALC

BCOPY.

ESTAVAILABLEAT TIME

FILMED

-18-

KIT INTERVIEW

Can / 0

.4421 If your Department were conside'ring establishing a collaborativeeducgtional program, please rank your preference for working withtivvZollowing:

(a) Other hospitals only;44.3

40(b) Other hospitals and a Univ.ersity Medical School;

(c) University Medical School; 44"

(d) Other hospitals and a Community College or Technical,Institute; -;6

(e) Community College or two-year Technical Institute; 47

(f) Other:

4122 What kind of education program would you like to see?

1. full-time educational program (regular intervals of in-hospitalclinical work alternating with regular intervals of classroominstruction at the educational institution) without internshipas part of total program.

2. full-time program with following internship as part of totalprogram.

3. full-time non-cooperative educational program, with post - graduateinternship.

4. part-time school-based courses for full-time hospital employeesnow in a different medical field.

5. part-time school -based courses designed for upgrading ful'-timehospital employees already in the field.

6. other:

4.23 Assuming that the students entering the collaborative program aremainly high school graduates,, what is the length of the formal train-ing program that you would design, so that the graduate could assumeresponsibility for carrying out nuclear medical tests and operationsin your Department?

Formal training program length years.

'4.24 How many months of the total program would be spent in clinical orclass work at your hospital?

(a) before graduation: class work

clinical work

(weeks)(months)

(weeks)(months)

(b) in a post-graduate internship program with a systematic educationaldesign:

(weeks) SC-;tclass work(months)-75-(weeks)clinical work . immnfhal

-19-erird 09

NMT INTERVIEW

4.25 Please give the names of the institutions /hospitals that you wouldprefer to collaborate with, the distances and time to travel betweenyour hospital and the other institutions/hospitals, in the tablebelow.

. Distance from Time to travelyour hospital by Public

Name of Institution Location in miles Transportation

1. ..

2.

3. .

4.26 Would you be willing to support the living costs of your staff whilethey received training outside of your hospital?e.9 yes (...1) no

4.27 Would you be willing to, pay any of the tuition costs?total tuition ee..,;

costs/year

%paid by you 6-6-

4.28 Which of the following factors would be important to you in settingup a collaborative program with your preferred choice. Please circlethe appropriate number in each case.

Importancegreat some little

(a) That you have control over the specializedcontent of the curriculum. 1

(b) That the program include on-the-job experiencover several semesters.. 1 2

(c) Same as (b) but followed by an internship-program in a nuclear medical department. 1 2 3

(d) That specialized courses be taught by MD's. 1 2 3

(e) That your Department be represented on an ac-tive advisory board to the educational progra . 1 2 3

(f) That the AMA or.another professional associat onapprove the curriculum. Please spoeif/ theprofessional association 1 2 3

(g) Other: 1

(f) Other: 1 2 3

3

-76-

4.6

6'i

-20-

NA' INTERVIEWvt

. SKIP TO PART D, PAGE p, IF YOUR ANSWER TO ,4.21 WAS d) OR c). .

\41.29 If your local community college or technical institute were to seekyour help in setting up a two-year nuclear medical training program,world you:

(a) be willing to collaborate with them? _yes no

(b) if no, would you employ their graduates? yes no

(c) if you are willing to collaborate with them, which of the follow-ing factors would apply and how import4nt is each to you? Pleasecircle the appropriate number in each case.

greatImportanOe

some little

(a) That you have control over thespecialized content of the curriculum

(b) That the program include on-the-jobexperience over several semesters

(c) Same as ('b) but forowed by aninternship program Ln a nuclearmedical depttment

(d) That specialized courses be taughtby M.D!s

(e) That your Department be representedon an active advisory board to theeducational program

(f) That the AMA or another professionalassociation approve the curriculum.

i

1

1

1

1

2

2

2

2

2

3

3

3

3

Please specify the professionalassociation 1 2 3

(g) Other: 1 2 3

(h) Other: 1 2 3

-77-

It

-21-

NMT INTERVIEW

Part D

These questions concern instructional materials, instructional aidsand lab kits which are used, or could be used, in nuclear medical tech-nician training programs. Here is a list of some of the media employed.

MediaCode No. Media

1 Teacher's manuals and/or source books2 Commercially published textbooks3 Manufacturers' manuals4 Progrdlamed instruction booklets3 Your own booklets6 Overhead projector transparencies7 Film8 Film loops9 eilm strips

10 Student lab kits11 Simulation laboratories12 Other

4.30 Please name the instructional materials, etc. which you use or believethat could be used for training nuclear medical technicians. Perhapsyou have a syllabus or reading kit which you could give us.

Instructional Materials (Title and Author) Media Code

4.31 How long ago were these materials updated? _yearsHow often would you like to see them updated? years

4.32 Please name by topics, the new instructional materials, aids, etc.that you feel are most urgently needed for use in programs for trainingnuclear medical technicians. (Example: "Rapid uptake studies" 8)

Topics Media Code

-78-

-22-

NMT INTERVIEW

$ection 6

Is there any other information which you think could be iaportant anduseful to our study which we have not obtained through this questionnaire?If so; please comment below:

Remember!

Question 2.5: Can you give us samples of the forms (administration andspecialized that NMT has to work with?

Section 4: Course syllabus and/or lists of materials.

-79-

Statistical Summary of Findin sestion 1.1

Mean S.D.

(66dingiiplanation: 0=0; a=1; b=2; c=3; d=4)

Preparation1. Chemically prepare short-life isotopes:

a) eluting the column2. b) chemical preparation3. c) sterilize

2.721.020.63

1.801.531.29

4. Calibrate isotopes against a standard 3.11 1.475. Prepare oral dose: measure. from manufacturer's bottle 2.65 1.706. Prepare oral dose: Mix, dilute to measure 2.12 1.777. Prepare injections: measure dose 3.70 0.978. Prepare injections: sterilize dose 0.68 1.369. Set up instruments for operation: a) in vivo studies 3.65 1.01

10. Set up instruments for operation: b) in vitro studies 2.95 1.60

Tests & Patients3.60 0.95ii. Admin ster isotopes to patients: a) orally

12. Administer isotopes to patients: b) by injection 2.46 1.6013. Receive patients, explain tests to them and allay

their fears 3.88 0.5614. Position patient with respect to nuclear medical

equipment 3.92 0.5215. Superficial and specialized examination of patients OLO .11116. Attend to patient's comfort before and during scan 3.88 0.6317. Understand operating room procedures NIB. ORD MN =, 1 MI NIB.

Data Handling18. Abstract simple data from patient's chart 3.03 1.36'19. Make simple dose calculations for a) in vivo examinations 3.65 1.0220. Make simple dose calculations for b) in vitro examinations 2.85 1.65'21. Make simple dose calculations for c) tracer examinations 3.50 1.1222. Accumulate and process data for MD's interpretation 3.60 1.0323. Examine scan test results for general credibility 3.69 0.9424. Perform preliminary interpretations of observations for MD 1.89 1.58

EquipLent25. Operate a rectilinear scanner for conventional scanning 3.74 0.9426. Operate an autofluoroscope for static studies 0.09 0.4327. Operate a scintillation camera for static studies 1.67 1.93.28. Operate an autofluoroscope for fast dynamic studies

(under one minute scan) 0.13 0.58.29. Operate a scintillation camera for fast dynamic studies 1.32 1.7130. Operate a scanner for slow dynamic studies

(over one minute scan) 1.90 1.8031. Operate an autofluoroscope for slow dynamic studies 0.13 0.5832. Operate a scintillation camera for slow dynamic studies 1.46 1.7633. Calibrate nuclear medical instruments 3.04 1.37'34. Check performance of existing and new nuclear medical

instruments against manufacturer's specifications 1.91 1.3435. Determine if a nuclear medical instrument is in need of

major repair 2.61 1.2736. Perform minor maintenance on nuclear medical instrument 1.86 1.23'37. Evaluate nuclear medical instruments from manufacturer's

literature and specify and rank those instruments thatsatisfy the doctors' requirements 1.20 0.90

38. Advise doctors on the technicalities and procedures in-volved in operating a nuclear medical instrument 2.17 1.31

-80-

,

t

Question 1.1 (cont.)

11121X Mean S.D.39. Check monitoring instruments 2.46 172E40. Monitor personnel in compliance with hospital regulations 2.24 1.3741. Monitor space in compliance with hospital regulations 2.46 1.1642. Handle and store radioisotopes safely 3.80 0.680. Assay wet chemical solutions for activity and contaminants 2.26 1.7044. Safely dispose of radioactive wastes 3.39 0.94

Clerical45. Handle secretarial work: appointments, type reports 2.83 1.4546. Routinely check incoming equipment 2.23 1.2747. Inventory and order radiopharmaceuticals and materials 3.34 1.0348. Keep accounts of hospital licensing and isotope procurement 2.56 1.47

Q aestion 1.7

1. Single Probe Scanner -- 3", 5", or 8"

Eqpt. in Tech man-hrs/your dept wk on eqptMean S.D. Mean S.D.1776 1373T

2, Dual Probe Scanner 0.30 0.58

3. Auto fluoroscope 0.04 0.22

. Scintillation Camera

. Whole Body Scanner (radiation distribution)

6. Whole Body Counter (total radiation level)

0.53 0.59

0.07 0.25

0.07 0.26

7. Manual Well System 1.43 1.56

8. Automatic Well System 0.61 0.99

9. Dose Assay Ionization Chamber 0.63 0.82

10. Monitoring Ionization Chamber 1.57 2.13

11. Single Probe Renal System 0.25 0.59

12. Dual Probe Renal System 0.62 0.67

13. Computer Applications of Scintillation Camera 0.13 0.36

14. Liquid Scintillation System 0.54 1.3.1

15. 0.thodensitometer

16. Multichannel Gamma Ray Spectrometer

0.05 0.21

0.39 0.95

17. T-3 Type or T-4 Type MeasureMent System 0.39 0.60

18. Automatic or Semi-automatic Blood Vo3timeMeasurement Systems 0.51 0.58

19. Automatic Film Developing Facilities

TOTAL

1.44 1.07

4.10 3.07 114.47 131.86

-81-

Question 1.16Mean S.D.

How many of the following are performed per month inyour department:

1. Image or localization studies

2. Flow studies (e.g., brain blod flow)

3. Dilution studies (e.g., blood volume)

4. Absorption, Excretion tests (e.g., Schilling tests)

5. Rapid uptakes (e.g., renograms)

6. Slow uptakes (e.g., thyroid uptakes)

7. In vitro tests (e.g., T-3 tests)

TOTAL 494.67 262.03

Proportionof Total

Static studies (scans) - fl ,27

Dynamic function studies - #2, 5, 6 .29

In vitro tests, etc. - #3, 4, 7 .44

1.00

Question 2.1

(coding explanation: mid pt of 4000-4999 = 1;mid pt of 5000-5999 = 2; etc.)

Please circle the annual salary range which you now pay your technician.

Certification & Years Dollar Valueof Experience Mean S.D. Mean S.D.

Certified or non-certified& first year. 2.79 1.17 $6290 $1170

Certified or non-certified& second year 3.52 1.33 $7020 $1330

Certified or non-certified& fifth year 4.60 1.25 $8100 $1250

-82-

Question 2.2

Do you prefer males or females in the role of a nuclear medical technician?

Proportion

Males .25Females .19No preference .56

1.00

Q estion 3.1

H w many nuclear medical technicians did your Departmenth ve at the beginning of 1969?

How many persons did this represent?

Question 3.3

Is this number sufficient for your Department's current needs?

Proportion

Yes .69No .31

1.00

Mean S.D.

2.48

2.54 1.86

Question 3.4

If your answer to 3.3 was no, please circle the importance of each ofthe following constraints which prevent your department from hiringmore NMT technicians.

(I

Proportion each answerDegree of importance

P ssible constraints great some slight none Mean

1

1: lack of funds for salaries .67 .10 .02 .21 1.77

2.!

lack of trained technicians .67 .10 .02 .21 1.79

3. lack of manpower to traintechnician candidates .20 .11 .09 .57 3.11

4. lack of supervisors fortechnicians .00 .12 .15 .74 3.62

5. lack of nuclear medicalequipment .03 .19 .11 .67 3.42

-83-

Question 3.5 and 3.1 combined

How many persons did (you) (or do you expect to):

a) appoint with or with-out NMT training in

b) leave your dept'semploy in

c) leave your dept's em-ploy and the field ofnuclear medicine in

d) employ in

1966 1967 1968 1969 1970 1971 1972 1973

mean

SD

ean

SD

ean

SD

ean

SD

ean

SD

ean

SD

ean

SD

ean

SD

/1At

0.76

0.85

1.11

.44

1.3

.46

0.8

1.1.

.09

1,6

1.0 1'4

:

0,3 0.47 0.6 0.49 Pr

A 4 411

r

A0.16 0.25 0.31

Adg1.22

2.4C

1.64

2.02

1.91

1.9'4

448 2,.87 4.01 Al...9J 5.98

A01111

Question 3.6

Please indicate below the most important reason(s) which you believeled to their leaving.

inadequate salary schedule

other

-84-

Proportion

. 17

. 83

1.00

Question 3.7Salar

PreferredRank

ProportionRanked In

Top 4

MedianRange

$

Mean$

S.D.

No post-secondary training orexperience 10 10

47505250

5140 700

Two years of on-the-job trainingin hospital medical laboratoriesother than in radiation 9 9

5250-5750 5610 1020

Two years of on-the-job trainingin a nuclear medical department 3 3

5750-6250

6270 1400

A two-year X-Ray technician pro-gram involving hospital experi-once over several semesters 6 6

5750 -6250 6040 1460

Same as above plus six-monthhospital internship program 7 7

5750 -6250

6200 1490

A two-year nuclear medical tech-nician program involving hospitalexperience over several semesters 2 1

6250 -6750

6560 1300

Same program as above plus six-month hospital internship program 1 2

6750 -7250

6680 1580

A registered nurse trainingprogram 8 8

6250 -6750 6250 1410

A four-year college degree pro-gram in biology/chemistry/physics 5 5

6750-7250 6820 1740

Four-year Medical TechnologistProgram including hospital exper-ience over several semesters 4 4

6750-7250 6990 1840

Question 3.11

Please estimate how many nuclear medical technicians your Departmen% willneed in Mean SD Median

(a) 1975 ra 3771 5.00(h) 1980 7.95 5.08 6.50

Question 3.12

Suppose that your ::eputation depended on your success in predicting thepercentage of hospitals in the United States that will have nuclear medicaloperations (a) by 1975, (b) by 1980. What percentages would you predict foreach? (Prennntly about 301 of all hospitals listed in the AGA guide have aradioisotope facility.) Please circle the appropriate figure for eacy year.

-85-

Proportion1975 .621980 .79

Question 4.1

Please check below, how your technicians are now trained.

(a) informal hospital training program

(b) formal hospital training program (ARRT Curriculum)yesno

(c) formal training program in collaboration withother hospitals

(d) formal training program in collaboration withcommunity college/technical institqte

(e) formal training program in collaboration witha university medical school

(f) only hire trained or experienced technicians

Question 4.2

What is the length of your program?

0 - 2 weeks

2 - 6 wleks

6 weeks - 3 Ahs

3 - ( onths

6 - 12 months

> 12 months

continuous

Question 4.3

Who teaches it?

MD's

Technologists

Other

Combination -86-

Number Pro .

103 .53

26 .13

.03

.05

9 .05

36 .19

193 1.00

Number Proportion

2 .01

11 .08

19 .14

16 .12

45 .33

13 .09

31 .22

137 .99

Number Proportion

22 .10

26 .21

7 .06

70 .56

125 1.01

Questions 4.1 x 4.2

0-2wks.

informal hosp.training prog. 1

formal hosp.training prog.,ARRT curriculum

Typeformal hosp.

of training prog.,not ARRT curr.

Programcollab. withotil4r hoop.

1

collab. withcommunity coll.or tech. inst.

collab. withuniversitymedical school

2

Length of Program

2-6wks.

6 wks.3 mos.

3-6MOS.

6-12MOS.

over12mos.

cont-inuous

84

27

4

6

8

8

9 14 11 18 31

16

1

2 IND

1

2

11 19 16 45 13 31 137

-97-

Question 4.4

were in this program last year?

No. of Hospitals Proportion No. of stud/trnees

How many students/trainees

0 32 .28

1 33 .29 33

2 16 .14 32

3 14 .12 42

4 6 .05 24

5 4 .04 20

6 1 .01 6

7 0 .00 0

8 2 .02 16

9 0 .00 0

10 1 .01 10

11 1 .01 11

14 1 .01

20 3 .03 60

114 1.01 268

Question 4.5

How many students/trainees graduated from this program during last year?

No. of Hospitals Proportion No. of stud/trnees

.39 00 41

1 34

2 14

3 7

4 2

5 2

6 1

7 0

8 1

9 0

10 0

11 1

15 1

16 1

105

.32 34

.13 28

.07 21

. .02 8

.02 10

.vi 6

.00 0.

.01 8

.00 0

.00 0

.01 11

.01 15

.01 16

-88-

1.00 157

Question 4.7

What degree or certificate, if any, results from this program?

No. of Hosps. Proportion

none 77 .69

certificate received 34 .30

111 .99

Question 4.8

Are the trainees who complete this program eligible to take:

(a) American Registry of Radiologic Technologists Certificationexamination?

Yes 66 .59

No 46 .41

112 1.00

(b) Registry of Medical Technologists?

Yes 17 .17

No 83 .83

100 1.00

Question 4.9

.Does the length ofthe trainee?

the program depend on the previous background of

Yes 75 .64

No 42 .36

111 1.00

Question 4.10

Does the content or clinical training or the program depend on theprevious background of the trainee?

Yes 68 .59

No 48 .41

116 1.00

-89-

Question 4.11

1967 1968 1969

rkM0

o

Iligst

04a0

ill(1)g14

04a

U)

Wg

4 .1-1 4 4J 2o44 44o 44 44 44 44

i 2 Z ig'k' 2

0

Z

0

(a 1 2

0

8

o

8

X-Raytechnician 1.19 1.92 57 68 1.34 1.82 70 94 1.65 2.20 72 119

MedicalTechnologist 0.24 0.73 42 10 0.48 1.62 54 26 0.44 1.56 59 .2.

LaboratoryAssistant 0.05 0.22 40 2 0.08 0.34 51 4 0.07 I 56

High Schoolgraduate 0.70 3.38 40 28 0.59 2.34 53 21 0.85 2.70

Nurse 0.13 0.52 40 5 0.12 0.39 50 6 0.00 0.00 53 III

College gradu-ate in Science 0.15 0.49 39 4 0.12 0.48 49 6 0.17 0.53 59 1'

Don't know 0.00 0.00 37 0 ;0.02 0.15 47 1 0.04 52

Question 4.12

Number ProportionWhat kind of education program is involved?

a) Full-time educational program (regular intervals ofin-hospital clinical work alternating with regularintervals of classroom instruction at the educationalinstitution) without internship as part of total

15

3

1

2

2

, .65

.13

.04

.09

.09

program;b) Full-time cooperative educational program with

following internship as part of total programsc) Full-time non-cooperative educational program,

with post-graduate internship;d) Part-time school-based courses for full-time hospital

employees now in a different medical fieldse) Part-time school-based courses designed for up-

grading full-time hospital employees already in thefield;

23 1.00

-90-

Question 4.13

How many weeks of the total program are spent in clinical or classwork?

class work

clinical work

Question 4.17

Do you support the living costs of your staff while they receivetraining outside of your hospital?

Mean SD

18.58 15.37

35.57 23.05

Number Proportion

yes 14 .70

no 6 .30

20 1.00

pnestion 4.19

(coding explanation: 1 12 greats2 in some; 3 is little)

(a) That you have control over the spe-Mean SD

cialized content of the curriculum(b) That the program include on-the-job

experience over several semesters(c) Same as (b) followed by an intern-

ship program in a nuclear medicaldepartment

(d) That specialized courses be taughtby MD's

(e) That your Department be representedon an active advisory board to theeducational program

(f) That the AMA or another professionalassociation approve the curriculum.

2.00

1.25

2.21

1.75

1.65

0.92

0.64

0.92

0.64

0.81

Please specify the professionalassociation. 1.42 0.69

Question 4.20

Would you consider establishing a collaborative nuclear medicaltraining program with other institutions?

Number Proportion

yes 135 .86

no 22. .14

-91-157 1.00

Question 4.21

If your Department were considering establishing a collaborativeeducational program, please rank your preference for working withthe following:

No. ranked#1

(a) Other hospitals only; 2

(b) Other hospitals and a University Medical School; 48

(c) University Medical School;

(d) Other hospitals and a Community College or Technical

35

Institute 31

(e) Community College or two-year Technical Institute 16

(f) Other 6

138

Question 4.22

What kind of education program would you like to see?

Number Proportion

(a) Full-time educational program (regularintervals of in-hospital clinical workalternating with regular intervals of class-room instruction at the educational insti-tution) without internship as part of totalprogram 56 .44

(b) Full-time program with following internshipas part of total program 56 .44

(c) Full-time non-cooperative educationalprogram, with post-graduate internship 2 .02

(d) Part-time school-based courses for full-time hospital employees now in a differentmedical field 5 .04

(e) Part-time school-based courses designedfor upgrading full-time hospital employeesalready in the field 4 .03

(f) Other 3 .02

126 .99

-92-

Question 4.23

(coding explanation: if on a border, choose the lower code)

Assuming that the students entering the collaborative program aremainly high school graduates, what is the length of the formal train-ing program that you would design, so that the graduate could assumeresponsibility for carrying out nuclear medical tests and operationsin your Department?

Number Proportion

0-6 months 1 <.01

6-12 months 18 .14

12-18 months 2 .02

18-24 months 68 .52

24-30 months 6 .05

30-36 months 22 .17

36-42 months 13 .10

42-48 months 0 .00

>48 months 1 (.01

131 1.00

Question 4.6

Would you be willing to support the living coststhey received training outside of your hospital?

of your

Number

staff while

Proportion

Yes 51 .49

No 54 .51

105 1.00

Would you be willing to pay any of the tuition costs?

Yes 44 .42

No 40 .38

Maybe 15 .14

Dcn't know or no authority 7 .07

106 1.01

-93-

Question 4.28

(coding explanation: 1 = greats 2 = some 3 = little)

(a) That you have control over the specialized contentof the curriculum.

(b) That the program include on-the-job experienceover several semesters.

(c) Same as (b) but followed by an internship programin a nuclear medical department.

Mean SD

1.72

1.33

2.11

0.74

0.62

0.85

(d) That specialized courses. be taught by MD's

(e) That your Department be represented on an activeadvisory board to the educational program

(f) That the AMA or another professional associationapprove the curriculum. Please specify theprofessional association.

2.00

1.39

1.43

0.75

0.61

0.73

Question 4.29

If your local commw ,% college or technical institute were to seekyour help in setting up a two-year nuclear medical training program,would you:

(a) be willing to collaboate with them?Number Proportion

Yes 72 .95

No 4 .05

76 1.00

Question 4.29 cMean SD

(a) That you have control over the specializedcontent of the curriculum

(b) That the program include on-the-jobexperience over several semesters

(c) Same as (b) but. followed by an internship

1.68

1.32

'0.87

0.70

0.62

program in a nuclear medical department 2.08

(d) That specialized courses be taught by MDs

(e) That your Department be represented on an activeadvisory board to the educational program

(f) That the AMA or another professional associa-tion approve the curriculum. Please specifythe professional association

1.95

1.33

1.48

0.77

0.54

0.76

-94-

Question 5.1

In which department did nuclear medical operations begin?

Number Proportion

1) Department of Radiology 122 .62

2) Department of Pathology 22 .11

3) Nuclear Medicine was established as aseparate department unit with its ownrights. 25 .13

4) Department of Internal Medicine 13 .07

5) Other or >1 department 14 .07

196 1.00

puestion 5.2

How long is it since nuclear medicalin your hospital?

0-5 years

tests/operations

Number

first started

Proportion

45

6-10 years 58 .30

11-15 years 48 .25

16-20 years 29 .15

21-25 years 11 .06

26+ years 1 .01

192 1.00

Question 5.4

Are there any other nuclear medical tests/operations carried out else-'where in the hospital, which are not under your Department's control?

Number Proportion

Yes 105 .54

No 91 .46

196 1.00

-95-

Question 5.5

What is the current status of your department?

Nuclear Medicine is:

equal to Radiology, Pathology

a subunit of Radiology

a subunit of Pathology

other

Respondents to Survey Interviews

MD

Physicist

Chief Technician

Other Technician

Combination

Other

Number Proportion

42 .22

120 .62

12 .06

20 .10

194 1.00

Number Proportion

96 .48

17 .08

56 .28

13 .06

19 .09

1 .00

202 .99

I.

Introduction

Appendix B: Manpower Needs

Pale

103

104Manpower - Interview Data

A. General Assumptions 104

B. Raw Data 104

1. The Number and Proportion of Hospitalsin the U.S. with a Nuclear MedicineFacility 104

2. The Average Number of Nuclear MedicineTechnicians in a Hospital with NuclearMedicine Operations 106

C. Manpower Needs for Specified Years 108

1. 1969 108

2. 1966-68 109

3. 1970-73 111

4. 19;5, 1980 113

5. A Different Method 116

D. Summary of Manpower Needs 116

E. Number of Graduates of Preparatory ProgramsPrograms Needed 117

II. Manpower - Mailed Sample Data 118

A. Manpower Needs for Specified Years 118

1. 1969 118

2. 1975, 1980 119

-97-

Introduction

In the appendix which follows, we have attemptedto determine the number of Nuclear Medicine Techniciansneeded (and needed to be prepared) for future years. Datafor these projections were gathered in an interviewsample of 202 hospitals and a mailed questionnaire sampleof 104 hospitals, although only the former providedenough reliable data to serve this purpose (see page 53for further explanation).

Since respondents were not in total agreement as tothe extent of future growth in nuclear medicine, nosingle set of assumptions proved sufficient for theprediction of Nuclear Medicine Technician needs. Theassumptions were related to the year(s) for which theestimates were made; thus, results were obtained withinthe following categories: 1966-68, 1969, 1970-73 and1975 and '80. For the first three time spans, the numberof Nuclear Medicine Technicians in each year (Ni) wasa function of the number of hospitals with nuclear medicineoperations in that year (hi) and the average size of theseoperations (mi). Thus:

N.1

= h.1 m.1 .

For 1975 an additional factor was added to account forthe assumption that hospitals just beginning nuclearmedicine operations would have fewer NMT's than hospitalswith established departments.

Partl ofthisappendix describes in detail thetechniques used. Section A lists the assumptions whichwere relevant to all the calculations. Section Bexplains the techniques and presents the differentassumptions used to produce values for the average numberof hospitals with nuclear medicine and the average numberof Nuclear Medicine Technicians in these hospitals foreach year. In section C , these values are combinedin different ways to provide estimates of the totalnumber of NMT's needed in those years. Section D summarizesthese findings, while section E takes these conclusionsone step farther by suggesting a relationship betweenthe number of technicians needed in any year and the numberneeded to be prepared.

Part II is based on the data collected from themailed sample. Sections A and B above are assumed toapply and values for manpower needs for certain years weredetermined. It proved impossible to summarize theseresults, since significant information was lacking.

-98-

Part I: Manpower - Interview Data

A. General Assumptions

1. The data we have collected via interview and question-naires are essentially accurate reflections of the situationin these hospitals.

2. The interview sample is representative of all hospitalswith nuclear medicine operations (see comment pages 53-54).

3. There are no significant differences between hospitalsthat agreed and did not agree to be included in the samples.

B. Raw Data

1. The Number and Proportion of Hospitals in the U.S. witha Nuclear Medicine Facility.

a. The mailed sample was sent to hospitals listed in theJournal of the American Hospital Association's 1966 Guideas having either a radioisotope facility or a radiotherapyfacility or both. Of 117 responses from hospitals listed ashaving a radioisotope facility, 102 ,87%) indicated that theyreally had such a tacility while the remaining 15 (13%)reported having no nuclear medicine operations. For purposesof determining the number, of hospitals in the U.S. withnuclear medicine operations, it is therefore assumed thatthe proportion of hospitals listed in the guide as havinga radioisotope facility should be reduced by 13% (the"correction factor").

b. The total number of hospitals reported by the AHA guidehas recently been extremely stable (an average increase of.15% per year from 1964-67). It is assumed that the numberof hospitals through 1975 will not significantly changeand will remain at about 7,150.

c. i)* The proportion of hospitals with radioisotopefacilities listed in the AHA guides in 1964-66 (1965-67guides) has changed as follows:

c i) and c ii)represent mutually exclusive setsof assumptions.

-99-

4

1964 - 24.9%

1965 - 26.5%

1966 - 25.8%

Since more recent comparable data are not available,and since the above represents no clear trend, it is assumedthat the average of these figures (25.7%) is a reasonableestimate of the proportion of hospitals which woundcontinue to be listed in the guide as having a radio-isotope facility. Incorporating the correction factor,the number of hospitals in the U.S. with a radioisotopefacility (1967-1980) is

hi = (7,150)(.257)(1.00 - 0.13)

= 1,592 (i = 1967-80)

ii) Of 203 hospitals surveyed, the number beginningnuclear medicine operations each year from 1950-65 wasextremely stable,(10 hospitals, or about 5% of thosesurveyed, per yeca..) If we accept the 1966 data (fromthe 1967 AHA guide) as a base, incorporate the correctionfactor, and add 5% of this figure each year, the numberof hospitals in the U.S. with a nuclear medicine facility(1966-80) is:

1.5

h. = h66

(1.00 - 0.13) + (.05) (h66) (1.00 - 0.13) Eii=1

The resulting number of hospitals (arid the proportion (i=1-15=of all hospitals) for each year through 1980 is the 1966-1980following:

Year Number Proportion

1966 1,603 .22

1967 1,684 .24

1968 1,764 .25

1969 1,844 .26

1970 1,925 .27

1971 2,005 .28

1972 2,085 .29

-100-

Year Number Proportion

1973 2,165 .30

1974 2,245 .31

1975 2,326 .32

1976 2,406 .34

1977 2,486 .35

1978 ;1567 .36

1979 2,646 .37

1980 2,727 .38

2. The Average Number of Nuclear Medicine Techniciansin a Hospital with Nuclear Medicine Operations

a. Respondents were asked the number of people theyhave hired or expect to hire in 1966-72, as well as thenumber who left their employ and the field of nuclearmedicine from 1966-69 (Question 3.5). Respondents werealso asked the number of Nuclear Medicine Technicians intheir department as of the beginning of 1969 (Question3.1).

1)* The average number of technicians employed in adepartment with nuclear medicine operations was obtainedby the following methods:

for 1969: m of Question 3.1

Priort.01969:m.=1 mi+1 - ma+b-c**

after 1969: . m1 1 - a+b**.

By this method the average number of Nuclear MedicineTechnicians (1966-73) is:

a 1) and a 2) represent mutually exclusive sets ofassumptions.

** Por interpretation of letters, see Question 3.5.

-101-

k"UM-

1966: m66

= 1.22

1967: m67 = 1.64

1968: m68 = 1.97

1969: m69 = 2.48

1970: m70 = 2.87

1971: m71

= 4.01

1972: m72 = 4.93

1973: m73

= 5.98.

2) Unfortunately, it was uncertain whether respondents'replies concerning the number of people they expected tohire did or did not incorporate turnover. Since abouthalf of those hired from 1966-69 repreF'Inted replacementsfor those who had left, it can be assn that thisproportion will be continued. The previous sectionassumed that those appointed (a+b)* included thisturnover rate. Without making this assumption thenumber of new employees should be reduced by half; thusthe average number of Nuclear Medicine Technicians (1970-73)is:

m. =1 mi-1

ma+b*

2

1970: m70 = 2.92

1971: m71

= 3.47

1972: m72 = 3.98

1973: m73

= 4.49

Expressed algebraically, the above sets of conclusions,a 1) and a 2), can be understood more clearly:

For both, Ni =Ni_i + - fi-1' where

* For interpretation of letters, see Question 3.5.

-102-

Ni = number of NMT's in year i

hi

= number of NMT's hired in year i

fi = number of NMT't leaving in year i.

For the first, f. = 0 because it is assumed to be includedin hi. For the second,

b. Respondents were asked to estimate the number ofNMT's they would need in 1975 and 1980 (Question 3.11).Averages of these figures are:

m75

= 5.66

m80

= 7.95.

It should be noted that the form of Question 3.11 differedsomewhat from Question 3.5. The former asked for thenumber "needed," while the latter requested the numberthey "expect to hire."

C. Manpower Needs for Specified Years

1. 1969

a. Direct Expansion of Number of Nuclear Medicine Techniciansin Sample to Entire Population (1969)

Explanation

This method consists of a simple multiplication ofaverage number of Nuclear Medicine Technicians in ahospital by number of hospitals with nuclear medicineoperations.

Technique

m69

= average number of NMT's in a department

h69

= number of hospitals w4th nuclear medicine operations

N69 = number of NMT's in 1969

N69

= m69

h69

-103-

Calculations

i)* hospitals with nuclear medicine constant

m69 = 2.48

h69 = 1,592

N69

= (2.48)(1,592)

= 3,948

ii)** hospitals with nuclear medicine increasing

(from pages 106-107)

(from pages 104-105)

m69 = 2.48 (from pages 106+107)

h69 = 1,844 (from pages 105-106)

N69

= (2.48) (1,844)

= 4573

2. 1966-1968

a. Number of Nuclear Medicine Technicians Based onRespon ents Reports of Hiring Hfitory (1966-1968)

Explanation

Beginning with the present number of Nuclear MedicineTechnicians, the number hired each year was successivelydeducted to determine the number extant for each targetyear.

Technique

m. ,---- average number of NMT's in year i

* Under each technique in this section, morethan one set of calculations is presented, each basedon different assumptions. The page(s) on which thoseassumptions are stated are provided for reference; inaddition, each set of calculations is preceded by abrief description of the assumption(s) which distinguish(es)it from its neighbors.

** "Best estimate" (see graph2 page32) is basedon this value.

-104-

1

hi= number of hospitals with nuclear medicine operations

in year i

Ni= number of Nuclear Medicine Technicians in year i

Ni = m hi i

hi

Calculations

i) hospitals with nuclear Medicine constant

m66

= 1.22

m67

= 1.64

m68

= 1.97

h66

= h67

= h68

= 1,592

(from pages 106-107)

II

II

(from pages 104-105)

N66

= (1.22)(1,592) = 1,942

N67

= (1.64)(1,592) = 2,611

N68

= (1.97)(1,592) = 3,136

ii)* hospitals with nuclear medicine increasing

m66

= 1.22

m67

= 1.64

m68

= 1.97

h66

= 1,603

n67

= 1'684

h68

= 1,764

N66

= (1.22)(1,603) = 1,956

N67

= (1.64)(1,684) = 2,762

N68

= (1.97) (1,764) = 3,475

(from pages 106-107)

II

Ii

(from pages 105-106)Ii

II

*"Best estimates" (see graph 2, page 32) are basedon these values.

-105-

3. 1970-1973

a. Needs Based on Respondents' Estimates of Hiring Patternsof New Nuclear Medicine Technicians

Explanation

This method is similar to the above, except that the dataare respondents' estimates of expected hiring patternsrather than their reports of past hiring patterns.Although we expect that the average number of Nuclear Medi-cine Technicians in departments created within the nextfew years will be less than the average number of NuclearMedical Technicians in long-established departments, weare assuming that the difference is not significant.

Technique

m. = average number of NMT's in a hospital with nuclearmedicine operations in year i

h. = number of hospitals with nuclear medicine operationsin year i

Ni = number of Nuclear Medicine Technicians in year i

N.=u1 . h1 ..

Calculations

i) hospitals with nuclear medicine constant; average num-ber of Nuclear Medicine Technicians includes turnover rate

m70

= 2.87

m71

= 4.01

m72

= 4.93

m73

= 5.98

(from pages 106-107)

fl

h70 = h71 = h72 = h73 = 1,592 (from pages 104-105)

N70

= (2.87)(1,592) = 4,569

N71

= (4.01)(1,592) = 6,384

N72 = (4.93) (1,592) = 7,849

-106-

N73

= (5.98)(1,592) =

ii) hospitals with nuclearnumber or Nuclear Medicine

m70 2.87

m =71 4.01

m72 = 4.93

5.98m73 =

h70

= 1,925

h71 = 2,005

h72 = 2,085

h73

= 2,165

N70

= (2.87) (1,925) =

N71

= (4.01) (2,005) =

N72

= (4.93) (2,085) =

N73

= (5.98)(2,165) =

9,520

increasing; averageincludes turnover rate

(from pages 106-107)

11

11

11

(from pages 105-106)

tl

medicineTechnicians

5,525

8,040

10,279

12,947

iii) hospitals with nuclear medicine constant; averagenumber of. Nuclear Medicine Technicians reduced by turnover

m70 = 2.92 (from page 107)

m71

= 3.47

m72

= 3.98

m73 = 4.49

h70 = h71 = h72 = h73

N70

= (2.92) (1,592) =

N71 = (3.47)(1,592) =

N72

= (3.98) (1,592) =

= 1,592

4,649

(from pages 104-105)

5,524

6,336

-107-

N73 = (4.49)(1,592) = 7,148

iv)* hospitals with nuclear medicine increasing/ average

number of Nuclear Medicine Technicians reduced by turnover

m70

= 2.92 (from page 107)

m71

= 3.47

m72 = 3.98

m73

= 4.49

h70

= 1,925 (from pages 105-106)

h71

= 2,005

h72

= 2,085

h73

= 2'

165

N70

= (2.92) (1,925) = 5,621

N71

= (3.47) (2,005) = 6,957

N72

= (3.98) (2,085) = 8,298

N73 = (4.49)(2,165) = 9,721

4. 1975, 1980

a. Needs Based on Respondents' Estimates of Departmental

Needs for Nuclear Medicine Technicians

Explanation

This method uses as data the respondents' estimates ofthe number of Nuclear Medicine Technicians theirdepartment will need in 1975 and 1980 and the proportionof hospitals expected to have nuclear medicine operations

in those years. The latter is introduced because

respondents have indicated that they expect a significantincrease in hospitals conducting nuclear medicine operations.

*"Best estimates" (see graph 2, page 32) are based

on these values.

-108-

Technique

m = average number of NMT's in those hospitals whichpresently have nuclear medicine Operations in year

a. = average number of NMT's in those hospitals whichdo not have nuclear medicine operations but whichwill have nuclear medicine operations in year i

Hi = the total number of hospitals in year I

po = proportion of all hospitals which presentlyhave nuclear medicine operations

pi = proportion of all hospitals which will have nuclearmedicine operations in year i

NA= number of NMT's in year i

(i = 1975, 1980)

Ni = mip69

H69

+ ai(p

iHip69

H69

)

Calculations

i)* proportion of hospitals with nuclear medicinebased on past data

m75

= 5.66

m80

= 7.95

a75

= 2.52

a80

= 2.57

H69 H75 H807,150

po 0 .26

p75 = .32

p80 = . 38

(from page 108)

It

(from Questions 3.1and 5.2: average numberof NMT's in hospitalsreporting that NM oper-ations began. 0-5, 0-10years ago)

(from page 104)

(from pages 105-106)

*"Best estimates" (see graph 2, page 32) are basedon these values.

-109-

N75

= (5.66) (.26) (7,150) + (2.52) (.32 - .26) (7,150)

= 11,592

N80 (7.95) (.26) (7,150) + (2.57) (.38 - .26) (7,150)

= 16,984

ii) proportion of hospitals with nuclear medicine basedon respondents' estimates

m75

= 5.66

m80

= 7.95

a75

= 2.52

a802.57

H69 H75 H807,150

p69 = .26

p75 = .62

P80 .79

(from page 108)

(From Questions 3.1and 5.2; average numberof NMT's in hospitalsreporting that NM operation)began 0-5, 0-10 years ago.)

(from page 104)

(from pages 104-105)

(from Question 3.12)

N75 12 (5.66)(.26)(7,150) + (2.52)(.62 - .26)(7,150)

=2 16,996

N80 (7.95)(.26)(7,150) + (2.57)(.79 - .26)(7,150)

= 24,519----Notes In answering Question 3.12, respondents wereincorrectly informed that the present proportion ofhospitals with nuclear medicine operations was 30%. Thisundoubtably stimulated an upward bias in their responses.

iii) proportion of hospitals with nuclear medicine constant

m75

= 5.66

m80

= 7.95

-110-

(from page 108)

a75

= 2.52

a802.57

(from Question 3.1 and5.2: average number ofNMT's in hospitals report-ing that NM operationsbegan 0-5, 0-10 years ago.)

If

H69 = H75

= H80

= 7,150 (from page 104)

P69 P75 ' p80 = .26 (from pages 104-105)

N75

= (5.66)(.26)(7,150) + (2.52)(.26 - .26) (7,150)

= 10,511

N80

= (7.95) (.26) (7,150) + (2.57) (.26 - .26) (7,150)

= 14,779

(iv) can also be calculated for values of m obtained byextrapolating from both sets of values listed on page 107;combined with three different "p" values above, sixother results can be obtained.)

5. A Different Method

An attempt was made to determine future manpower needsusing only present and recent data. It was hypothesizedthat certain hospitals could be indentified as being furtheradvanced than others with respect to the quantity of theiruse of nuclear medicine operations and that the rate atwhich their use of nuclear medicine was growing woulddiffer from the rate at which less advanced hospitalswere increasing their nuclear medicine operations. Ifhospitals could be so ranked, it would be reasonable toassume that the less advanced hospitals would, over time,approach the occupational distribution ( defined as thenumber of Nuclear Medicine Technicians per hospital orhospital size) of the more advanced hospitals. Givensuch a categorization of hospitals, the need for NuclearMedicine Technicians could be derived without using databased on future estimates. The data. however, proved Intract-able on this point. None of the expected trends materializedand this method had to be abandoned.

D. Summary of Manpower Needs

Hy the techniques described above, numerous valueswere derived for manpower needs for certain years. These

results can be combined in many ways; through linearand curvilinear regression analysis, almost an infinitenumber of lines can be made to fit these data points. Wefeel that such an exercise is not very valuable, and thatk,ur findings can be portrayed more clearly simply byplotting the data points and allowing them to definea range. Thus, the need for Nuclear Medicine Techniciansfor any given year is most likely within the shaded. areain graph 2, page 32.

To narrow this range to a more specific figure itis necessary to make certain judgments concerning theassumptions listed in sections 1-3 above. The datapoints circled on the graph represent our "best estimate"of future Nuclear Medicine Technician needs. The assump-tions on which they are based are that:

a. hospitals with nuclear medicine facilities willincrease at a rate of about 80/year; and

b. the average number of Nuclear Medicine Technicians/department will increase at a rate determined by therespondents' estimates of their hiring patterns,combined with their reports of past turnover rate.

E. Number of Graduates of Preparatory Programs Needed

Were every existing Nuclear Medicine Technician toremain indefinitely in the field, there would be aneed each year to prepare the difference between thepresent number and the number needed for the followingyear. Since NMT's have a tendency to become pregnant, orto leave for other reasons, it is necessary to prepare asomewhat larger number than this yearly increase.

The data we have obtained indicated that roughlya third of those who leave a position as a Nuclear Med-icine Technician completely foresake the field of nuclearmedicine. Since the number of new Nuclear Medicine Tech-nicians in any given year has tended to be about twicethe number of employees leaving, the following relation-ship obtains:

Gi = number of graduates of a Nuclear Medicinetraining program in year i

Ni= number of Nuclear Medieine Technicians in

year i

-112-

G.1-1

= Ni1

- N.-1

(1/3)(1/2)(N. Ni -1)

= 7/6 (Ni -Ni -1)

Thus, for preparatory programs to produce enough newNuclear Medicine Tecnnicians to till both the expectedincrease and the replacement need in any year, the numberof graduates should be approximately one-sixth greaterthan the expected increase.

For the data points circled ( graph 2, page 32) thismeans that there will be a need to graduate about 1,, 300

new Nuclear Medicine Technicians per year through 1975.

Part II: Manpower - Mailed Survey Data

A. Manpower Needs for Specified Years

1 ).969

a. Direct Expansion of Number of Nuclear MedicineTechnicians in Sample to Entire Population (1969)

Explanation

This method consists of a simple multiplication of averagenumber of Nuclear Medicine Technicians in a hospital bynumber of hospitals with nuclear medicine operations.

Technique

m69

= average number of NMT's In department

h69

= number of hospitals with nuclear medicine operations

N69

= number of NMT's in 1969

N69

= m69

h69

Calculations

i) hospitals with nuclear medicine constant

m69

= 1.97

h69

= 1,592

-113-

(from Question 3.1)

(from pages 104-105)

N69

= (1.97)(1,592)

= 3,136

ii) hospitals with nuclear medicine increasing

m69

= 1.97

h69

= 1,844

(from Question 3.1)

(from pages 105-106)

N69

= (1.97)(1,844)

= 3,633

2. 1975, 1980

a. Needs eased on Respondents' Estimates of DepartmentalNeeds for Nuclear Medicine Technicians

Explanation

This method uses as data the respondents' estimates ofthe number of Nuclear Medicine Technicians their departmentwill need in 1975 and 1980 and the proportion of hospitalsexpected to have nuclear medicine operations in thoseyears. The latter is introduced because respondents haveindicated that they expect a significant increase inhospitals conducting nuclear medicine operations.

Technique

mi

= average number of NMT's in those hospitals whichpresently have nuclear medicine operations in year i

ai

= average number of NMT's in those hospitals which donot have nuclear medicine operations but which willhave nuclear medicine operations in year i

Hi

= number of hospitalii in year i

po = proportion of all hospitals which presently havenuclear medicine operations

pi = proportion of all hospitals which will havenuclear medicine operations in year i

Ni

= numLea of NMT's in year i

(i = 1975, 1980)

-114

Ni = mip69H69 ai(piHi - p69H69)

Calculations

i)

m75

= 3.73

m80

= 5.51

a75

= 2.52

a80

= 2.57

H69 H75 H807,150

p69 = .26

p75 0 .32

P80 '38

(from Question 3.11)

(from Questions 3.1 and5.2: average number ofNMT's in hospitalsreporting that NMoperations began 0-5.0-10 years ago.)

(from pages 104-105)

(from pages 105-106)

N75

= (3.73) (.26) (7,150) = (2.52) (.32 -.26) (7,150)

= 8,009

N80

= (5.51) (.26) (7,150) + (2.57) (.38 - .26) (7,150)

= 12,441

(ii) .can also be calculated for other values of "p")

-115-

Appendix C: Certification Requirements

Page

Requirements of the American Registryof Radtologic Technologists 122

Requirements of the Registry of MedicalTechnologists 123

-116-

Registration InNuclear Medicine Technology

(Reprinted by Permission ofThe American Registry of Radiologic Technologists

2600 Wayzata BoulevardMinneapolis, Minnesota 55405)

General Qualifications of Trainees

Applicants for training leading to registration innuclear medicine technology must be citizens of theUnited States or shall have filed a Declaration ofIntention or a Petition for Naturalization for UnitedStates citizenship; may be male or female, must have hada high school education, or the equivalent thereof, aswitnessed by such documentary evidence as the Board ofTrustees shall deem acceptable, and must be of goodmoral character. Applicants who have been convicted ofa crime must have served their entire sentence, includingparole, and have had their civil rights restored.

Basic Eligibility Requirements (for NMT examination) .

Candidates shall have at least one year of fulltime experience in clinical radioisotope work, includingdidactic experience e-uivalent to the radioisotoe cur-riculum recommen e. . the American Society o Ra.

giCTschnoio fats ointl with the Commission on Techno-logist st f airs o t e er can o ege o *a io ogy orproposed byTRitillstry of Medical. Technologists (ASCP).In addition, applicants must meet at least one of thefollowing sets of conditions:

o-

1. Graduation from an A.M.A. approved program inx-ray technology.

2. Certification as an x-ray technologist by theAmerican Registry of Radiologic Technologists(ARRT).

3. Certification as a medical technologist by theRegistry of Medical Technologists (ASCP).

4. Registration as a professional nurse.S. A baccalaureate degree from an accredited

institution.

Alternate Qualifications

As an alternative to the basic eligibility require-ments, candidates may meet one of the following:

-117-

1. The successful completion of a course of atleast two years in radioisotope technologyaccepted by The American Registry of RadiologicTechnologists.

2. Graduation from a four year hirjh school courseplus at least five (5) years of full time (40hours per week) experience in a clinicalradioisotope laboratory or department acceptedby The American Registry of Radiologic Technol-ogists.

3. Certification as an x-ray technologist byThe American Registry of Radiologic Technologistsplus at least two (2) years of full time (40hours per week) experience in a radioisotopelaboratory or department accepted by The AmericanRegistry of Radiologic Technologists.

The Alternate Qualifications may be altered ordiscontinued at the discretion of the Registry Board.

Certification inNuclear Medical Technology*

(Reprinted by Permission ofThe Registry of Medical Technologists

ofThe American Society of Clinical Pathologists

P. 0. Box 2544Muncie, Indiana 47302)

The examination in this field is being sponsored bythe ASCP Council on Radioisotopes and the American Societyof Medical Technologists Special Committee on NuclearMedical Technologists. Applicants must meet at leastone of the following requirements:

a. Certification in Medical Technology by the Boardof Registry of Medical Technologists of theAmerican Society of Clinical Pathologists, plusone year of satisfactory experience in anacceptable clinical radioisotope laboratory.

*The qualifications for certification by the Registry ofMedical Technologists are under review at the present time.There is a possibility that these requirements may be altered.

-118-

b. Baccalaureate degree in biologic sciences orchemistry from a college or university accreditedby a recognized accrediting agency, plus 2 yearsof satisfactory experience in an acceptableclinical radioisotope laboratory.

c. Two years (60 semester hours or 90 quarter hours)in a college or university accredited by arecognized accrediting agency. During thetwo years, at least 12 semester hours or 18quarter hours of biology and one full year ofchemistry (including lectures and laboratoryacceptable toward a major in the field), and aminimum of 3 semester or 4 quarter hours ofqualitative analysis, organic chemistry orbiochemistry, plus 4 years experience in anacceptable clinical radioisotope laboratory.

d. Baccalaureate degree in the physical sciences(including the courses listed in "c") from acollege or university accredited by a recognizedaccrediting agency, plus 2 years of experiencein an acceptable clinical radioisotope laboratory.

e. High School diploma plus 6 years experience inan acceptable clinical radioisotope laboratory.

-119-

Appendix D: Preparation forNuclear Medicine Technicians

Page

Programs Reported by Hospitals Interviewed 126

Programs Reported in Correspondence 133

American Society of Radiologic Technologists:Minimum Radioisotope Curriculum 135

Radiologic Technology School of IndianaUniversity Medical Center: RadioisotopeTechnology Curriculum 140

Community College of Denver: NuclearMedicine Technology Training Program .. 146

Miami Dade Junior College: NuclearMedical Technology Program 153

University of Cincinnati: A Program ofStudy and Training Leading to theBachelor of Science Degree in MedicalTechnology with a Nuclear Medicine Option 160

-120-

Programs Reported by Hospitals Interviewed

The preparatory programs which are listed below arelimited to the hospitals which were interviewed and in-dicated having a formal program graduating a minimumof three students per year. This rather arbitrary break-off point is intended to imply that there is a differencein the methodology of teaching small and large numbersof students. This does not necessarily imply that there isa qualitative difference in the products of the9e programs;given the right combination of individuals, it is entirelyreasonable to believe that some of the students preparedinformally are better Nuclear Medicine Technicians thanothers who underwent a formal preparatory program. How-ever, given the need to prepare increased numbers ofNuclear Medicine Techniciane efficiently, we feel thatformal programs, with at least a minimum number of students,are essential.

City

Name of sponsoring institution;address; collaborating hospitalsor institutions; other remarks

Atlanta

Grady Memorial Hospital; 80 ButlerStreet SE, Atlanta, Georgia 30303;program for students who have had2-year X-ray training course; maybe shortened to 6 months for stu-dents who have had several collegescience courses.

ty,

oW

4-1 tA0

4-,004-+ 0010v0P rl

$.,

ww

10CD

o >1%"..

21 0E xT1 r0Pi00 -0/-1 tn

040414-14 O

$.,

0 ni0*0

0 W0 tni

4-111).H W4-/ /-114 tn07;Q nj

M*Es.

0WO

00

r0-1 .81A 144ri Atn 4-1

.ri f-IF-1 CD

ill 0

6

or12

3 -- Yes

* C stands for certificate of completion only, not forrecognition by a society.

** There are two titles designated RT. (RegisteredTechnologist). Ono is for Radiologic TeWnologists (X-Ray Tech-nologists) and the other for Nuclear Medicine Technologists.One need not complete the x-ray examination before taking thenuclear medicine examination. The examination indicatedabove is the Nuclear Medicine Technologist examination..

-121-

Baltimore

Johns Hopkins Hospital; 601 NorthBroadway, Baltimore, Maryland 21205;program for graduates of AMA-approvedSchools of radiologic Technology.

University of Maryland Hospital;Redwood and Greene Streets, Baltimore,Maryland 21201

Boston

Children's Hospital Medical Center;300 Longwood Avenue, Boston, Massa-chusetts 02115

Chicago

Cook County Hospital; 1825 WestHarrison Street, Chicago, Ill. 60612

Cleveland

Nuclear Medicine Institute; Box 4562Cleveland, Ohio 44106; programcombines class and clinical work;students do clinical work at HillcrestHospital, Cleveland Heights, Ohio,at St. Vincent Charity Hospital,Cleveland, Ohio, and others. (Seealso under Wasnington, D.C.)

-122-

1 iig

w 130 04i

.5 2

Elc4

Ell g

$4 0)1i;44 10

44 c0 1 r1 RI /4 0O 4

)4

. rU4 131

t

4!14) 2

0 VJ V4 "r1ty, a $4 Cri 4-) /4 t:IN 4J0 04 )4 tri .el q.$ .1 g"`F04 ept il

12 3 C Yes

3 5-6 -- No

36 3 C Yes

12 C Yes

12 20 C Yes

Dallas

Methodist

Hospital

of

Dallas;

301

West

Colorado,

Box

5999,

Dallas,

Texas

75208;

program

lasts

6 months

for

Radiologic

Technologists,

30

months

for

others.

Denver

Colorado

General

Hospital

(part

of

University

of

Colorado

Medical

Center);4200

E.

9th

Avenue,

Denver,

Colorado

80220;

program

in

collaboration

with

Denver

Community

College

and

9 other

hospitals

(see

entries

which

follow)under

the

sponsorship

of

Colorado-

Wyoming

Regional.

Nuclear

Medical

Training

Program;

program

lasts

12

months

for

students

who

have

alreadycompleted

a diagnostic

x-ray

program,24 m

onths

for

others;

Denver

collab-orating

hospitals

include:

Denver

General

HospitalFitzsimons

General

HospitalGeneral

Rose

Memorial

Hospital

Lutheran

Hospital

and

Medical

Center.

Mercy

Hospital

Porter

Memorial

HospitalVeterans

Administration

Vospital

Presbyterian

Medical

Center;

East

19th

Avenue

and

Gilpin

St.,

Denver,

Colo.

-123-

ti O00

a

Hg PI

as

in

14 `00 41)

4)

HG

4H gX°

00 'd

43 43 43 ra 44 4.$

44 II)

g R1

1-4

fil0 A CU

R0 171

41)

C./4-1

r0 ri r-4

,r4A 0 X 0 44 CU

A 44

4-i

0 0 -1-1

*ri

0.)

r4 ri

CT

%

H $4 IA 4-I

$4 CT

%

4-Ig 04 $4 CT

%

*ri

/-10 g 04 CI)

r-I

Cl.)4 ri 4 O 0 r0 41 C

.)

6or

- --

30

12

or

20 N.A.

Yes

24

12

4

--

Yes

Detroit

Henry

Ford

Hospital;

2799

We3t

Grand

Blvd.,

Detroit,

Michigan

48202;

program

lasts

12

months

for

students

with

Radiologic

Technologist

certi-

fication,

24

months

for

others.

Kansas

City,

Kansas

University

of

Kansas

Medical

Center;

39th

and

Rainbow

Blvd.,

Kansas

City,

Kansas

66103

Los

Angeles

(and

vicinity)

Loma

Linda

University

Hospital;

1105

Anderson

Street,

Loma

Linda,

Calif.

92354;

program

lasts

12

months

for

students

with

Radiologic

Technologist

certification,

24

months

for

others.

Los

Angeles

County

General

Hospital

and

University

of

Southern

California

Medical

Center;

1200

North

State

Street,

Loa

Angeles,

California

90033

Miami

Miami

Dade

Junior

College;

11380

NW

27th

Ave.,

Miami,

Fla.;

program

ex-

pected

to

start

with

15

students

in

August

1969

and

to

expand

to

30

students

in

its

seccnd

year;

1year

-124-

g1v 6%

o$.4

I$.10 >

I

14,4:100

4.1

Elc4 J. g

K$w

o14

O

44y)

q o its

9 ni

4.,

ri ra '14

r-ir4.P,

80 44 (1)1

:9 t44

0 ON

14

tn r-I

140 0 0444

0 0 4-4

4114 r4 4 0 (..)

r4:3

W U

12

4 C Yes

or24

12

4 C Yes

12 3 A.A.

Yes

or24

12

s C Yes

12

15 A.A.

Yes

or24

__...,

program

for

Registered

X-Ray

Technolo-

gists

who

have

graduated

from

a 2-year

program,

for

ASCP

Medical

Technologists

with

a B.A.

or

B.S.,

and

registered

nurses

with

a B.A.

or

B.S.;

2year

program

for

high

school

graduates

with

a C+ a

verage

and

courses

in

chemistry,physics

and

math.

Collaboratinghospitals

include:

Dade

Brower

Hospital

Hollywood

Hospital

Jackson

Memorial

Hospital

Mercy

Hospital

Mt.

Sinai

Hospital

St.

Francis

Hospital

Minneapolis

Veterans

Administration

Hospital;

48th

Ave.

and

54th

Street

S.,

Minneapolis,

Minnesota

55417;

program

in

collabor-

ation

with

the

University

of

Minne-

sota;

first

two

years

of p

rogram

make

students

eligible

for

Radiologic

Technologist

certification;

after

third

year

they

become

eligible

for

the

Nuclear

Medicine

Technologist

certification

examination.

Philadelphia

American

Oncologic

Hospital

(Cancer

and

Allied

Diseases);

3234

Powelton

Avenue,

Philadelphia,

Pennsylvania

-125-

tr0P

W

rdP0 a)0 >I

14 nC10 (1)

ElW N

Z iC

R W0

04 W W d0 0

4) 4) 4) ril

q4 4)

44 ts)

q a rts

i-i

rd

0.0

W Ut7)

WO41 4 rd 4 I-4

ii.0 0 )4 0 44 W XI

44

41 0 0 4-1

./-1

W ,4 /-1

CT

0 14 isi

4-1

14 tn 4)0 04 14 r.T)

-1 14

W 0 0444

W W r-I

W

0 el

4 0 Li'C

I

41 t.)

36

3 C Yes

12

6 C Yes

19104; program also qualifies studentsto take Registry of Medical Technolo-gists examination, if they are notMedical Technologists (ASCP) already.

Jeanes Hospital; Hasbrook Avenue andHartel Street, Philadelphia, Pennsyl-vania 19111; students receive a cer-tificate from the Philadelphia CountyMedical Society.

Misericordia Hospital; 54th and CedarAvenue, Philadelphia, Pennsylvania19143

St. Louis

Mallinckrodt Institute of Radiology,Barnes Hospital, 510 South KingsHighway, St. Louis, Missouri 63130.

St. Louis University Hospital; 1325South Grand Blvd., St., Louis, Mis-souri 63104; program for studentswho are L'lready Radiclogic Technolo-gists.

Washington, D. C. (and vicinity)

Georgetown University Hospital; 3800Reservoir Road, N.W., Washington, D.C.20007; collaborative program withGeorge Washington University, HowardUniversity, and the Nuclear Medicine

-126-

514,

°)

Cil w u

Hge -4

11)o 0 >4 0 41) 004 CD VI

4-) 4-)11) 04-) d

0 0-144 4-)

4-I VI II 0 RI 1.4 dCI 'Ili .2 t 1' r' I . 2

cril0IZ 0

0 491.4 Cfl

1./ ii.i4-1 14

:2t 4-)

0 Pi $.1 tit 'OA t-I0 0 al 4-4 CD 41,1 4-1 CDi--1 "1 rzt 0 (! nzi W t.)

18 8 C Yes

10 5 C Yes

12 4 C Yes

9

or3 -- Yes

12

12 8-10 Yes

Institute in Cleveland; student spend3 months in Cleveland and 9 months inWashington hospitals (to begin in Sep-tember, 1969).

U. S. Naval Hospital, National NavalMedical Center; Rockville Pike,Bethesda, Maryland 20014; moststudents are naval medical corpsmen;students mu3t have 6 months additionalhospital work to be eligible for ARRTexamination.

-127-

s-i

moPa1+4 0O.0

4J4 g4) 0eZCI g$-4 -t

PW

Pas

1 0g >1

.......

ci, 044 4)id g

cli1'i rCIX 00 4)P u)0(a414 0

0P aid

W4J

a) g1 rd

;dU to

. -44-1 0ri W4-$ PP tnCJ 1:1)

C..) r0

E4C4

1 eH MN xIx a)4

gI40o ..-1

4-4 4-,(ZS0 U

H ' riXI 4-1,- ,-tp 4-,r1 PH0W 0

6 20 C No

Programs Reported in Correa ondence

The following formal training programs are in insti-tutions which were not interviewed. They have come to ourattention in correspondence and the background studypreceding the survey. We are sure that many othersexist throughout the country which have not been calledto our attention.

Duke University Medical Center; Division ofNuclear Medicine, Department of Radiology, Durham,North Carolina 27706; 1 year program; 4-10 studentsper year; ARRT curriculum (graduates eligible forboth ARRT and RMT certification).

Harrisburg Hospital, Section of Nuclear Medicine,South Front Street, Harrisburg, Pennsylvania 17101;collaborative program with Harrisburg Area CommunityCollege and Pennsylvania Jr. College of MedicalArts; 12 month program for high school graduates.

The Harrisburg Polyclinic Hospital; Harrisburg,Pennsylvania; students must be registered RadiologicTechnologist) before entering the program; 12months; graduates eligible for ARRT certification.

Indiana University Medical Center; 1100 WestMichigan Street, Indianapolis, Indiana 462071program in collaboration with School of RadiologicTechnology; grants AA degree.

Oak Ridge Associated Universities, Special TrainingDivision; P.O. Box 117, Oak Ridge, Tennessee 37030;holds periodic 4-week courses for experiencednuclear medicine technologists.

The Penrose Cancer Hospital; 2215 North CascadeAvenue, Colorado Springs, Colorado 80907.

St. Mary's Hospital, School of Nuclear Medicine;720 South Brooks Street, Madison, Wisconsin 53715

Tampa General Hospital, School of Nuclear Medicine;Tampa, Florida; 1-year program for students whohave at least 1 year of full-time experience inclinical radioisotope work, and who have had abackground as X-Ray Technologists, or RegisteredNurses, or who have a B.S. degree; 3 studentsper year; graduates eligible for ARRT certification.

University of Cincinnati College of Medicine,

-128-

Radiology Department; sponsored by the U.S. PublicHealth Service; two and four year programs leadingto A.A. and B,S. degrees respectively; graduateseligible for ARRT certification; catalog may beobtained from Registrar, McMicken College of Artsand Sciences, University of Cincinnati, Cincinnati,Ohio 45221.

University of Mississippi Medical Center; 2500North State Street, Jackson, Mississippi 39216;all students are either Registered Radiologic Tech-micians cr are eligible for Re,istry Examination;one-year program; 3 students per year.

University of Tennessee, College of Medicine,School of Nuclear Medical Technology; Walter F.Chandler Building, 865 Jefferson Avenue, Memphis,Tennessee 38103; one-year program for graduates ofschools of Radiologic Technology of B.S. holders(around whom program is being revised); program iscurrently in process of reorganization, will be partof a new School of Health Related Sciences.

University of Virginia Hospital, School of NuclearMedicine Technology, Department of Radiology; Char-lottesville, Virginia; program for ARRT certifiedtechnologists, ASCP Registered Medical Technologists,nurses with two years of college or baccalaureateand holders of the B.S. degree,

Vanderbilt University, Division of Nuclear Medicineand Biophysics; Nashville, Tennessee 37203; programfor students with either 1 or 2 years of x-raytraining or with backgrounds as Medical Technologistsor nurses; program is part of the Regional MedicalProgram of the Southeastern Chapter of the Societyof Nuclear Medicine.

-129-

American Societ of RadiologAu TechnolulstsMin mum Ra o sotope Curriculum

Prepared and Presented by:The American Society of Radiolncrio Technologists

Length of Course: 12 Months

Eligibility of Applicants:

1. Must be a graduate of A.M.A. approved schoolof X-ray Technology or

2. Registered Technician (A.R.R.T.) or

3. Medical Technologist, (A.S,C.P. certified,(see note), or

4. Registered Nurse with two years of collegecredits, or with a baccalaureate degree or

5. Bachelor of Science degree with a major inBiology, Chemistry or Physics, (see note).

Note: In addition, applicants under section 3:Ind 5 must have completed a basic course inhuman anatomy and physiology of at least 60clock hours.

Curriculum

A.B.C.D.E.

Introduction to CourseRadiological bo.thematicsBasic Radiation PhysicsInteraction of Radiation with MatterInteraction of Radiation with Physiological

Systems

2

30201010

hourshourshourshourshours

F. Radiation Units 5 hoursG. Protection and Shielding 10 hoursH. Introduction to Radioisotopes 20 hoursI. :Instrumentation (including Laboratory) 40 hoursJ. Clinical Laboratory Equipment and Procedures 10 hoursK. Specific Procedures 130 hoursL. Records and Administrative Procedures 5 hoursM. Records, Coding and Filing 3 hoursN. Clinical Application

(All remaining hours should be devotedto experience in performing clinicalradioisotope procedures.)

Total: 79-51FOIIrs

-130-

I. Introduction to the CourseA. Description of text materialB. Professional relationships

1. Physician-Technologist-Patient-Family

2. Medico-legal aspects3. Ethics

II. Radiological MathematicsA. General

1. Review of fractions, decimals2. Review of algebra3. Exponents and powers

B. LogarithmsC. GraphsD. Slide Rule (demonstration and practice)E. Calculators (demonstration and practice)

III. Basic Radiation PhysicsA. Review of atomic structure and particlesB. Ioniztng radf' ions

1. Electrom tica. Production of X-radiation

(1) Continuous and character-, istic(2) Secondary

b. Gamma radiation(1) Natural occurring sources(2) Artificially produced

sources2. Corpuscular

a. Alphab. Beta

IV. Interaction of Radiation with MatterA. Photo-ElectricB. CamptonC. Pair productionD. Coherent and incoherent scatteringE. PhotodisintegrationF. Total and component absorption coeffi-

cientsV. Interaction of Radiation with Physiological

SystemsA, Systems sensitive to radiationB, Biological effects of radiation

1. Acute effectsa. Localb. Systemic

2. Delayed effectsa. Genetic

-131-

2 hours

30 hours

20 hours

10 hours

10 hours

b. Increased tumor incidencec. Life-span shorteningd. Growth and developmental

defectsVI. Radiation Units

A. RoentgenB. Absorbed dose--RadC. Relative- biological - effectD. Roentgen-equivalent-manE. Curie

VII. Protection and ShieldingA. Protective regulations

1. Permissible exposure limits2. Monitoring and surveying3. State and local regulations and

registration requirements4. A.E.C. regulations

B. Techniques for reducing hazards tooperator1. Shielding2. Distance

a. Review of Inverse Square Lawb. In re: source and scattering

mediac. Remote handling equipment

IX. Introduction to Radioisotop'sA. Nature and characteristics

1. Sources2. Methods of production3. Decay4. Half-life5. Specific activity

B. Useful radioactive isotopes1. Diagnostic

a. Internal dose calculationsb. External dose calculations

2. Therapeutica. Internal dose calculationsb. External dose calculations

X. Instrumentation(Including laboratory instruction)A. Statistics of countingB. Counting equipment and detectors

1. Geiger-Mueller tubes2. Scintillation detectors3. Scalers4. Count rate meters

C. Survey Instruments1. C4iger-Mueller survey meter2. ionization chamber survey meter

D. Personnel monitoring equipment

-132-

5 hours

10 hours

20 hours

40 hours

1. Dosimeter or pocket chamber2. Film badge

E. Standardization and calibration(general)

XI. Clinical Laboratory Equipment andProcedures

XII. Specific ProceduresA. Radioactive iodine

1. Standardization2. Diagnostic applications3. Therapeutic applications4. Equipment and administration5. Measurements6. Calculations and interpretations

B. Radioactive gild1. Standardization2. Diagnostic applications3. Therapeutic applications4. Equipment and administration5. Measurements6. Calculations and interpretations

C. Radioactive phosphorus1. Standardization2. Diagnostic applications3. Therapeutic applications4. Equipment and administration5. Measurements6. Calculations and interpretations

D. Radioactive chromium1. Standardization2. Diagnostic applications3. Therapeutic applications4. Equipment and administration5. Measurements6. Calculations and interpretations

E. Radioactive cobaltI. Standardization2. Diagnostic applications3. Therapeutic applications4. Equipment and administrationS. Measurements6. Calculations and interpretations

F. Radioactive strontium1. Standardization2. Diattlostic applications3. Therapeutic applications4. Equipment and administration5. Measurements6. Calculations and interpretations

G. As additional radioactive isotopesbecome available for clinical use, hours

-133-

10 hours

130 hours

should be added to correspond tobreakdowns noted in all sectionsunder "XII."

XIII. Records and Administrative ProceduresA. A.E.C. rules and regulationsB. Application formsC. Sources of supply

XIV. Records, Coding and FilingA. Inventory - receipt and disposalB. Personnel monitoringC. Surveys

XV. Clinical ApplicationAll remaining hours should be devoted toexperience in performing clinicalradioisotopic procedures.

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5 hours

3 hours

Radiologic Technology School of Indiana UniversityAiedical CenteLiciAotimellachnolosyENIrriculum

I. IntroductionA. Description of courseB. History of nuclear medicineC. Professional and patient

relationships1. Ethics: Physician-technologist-

patient2. Medical-legal aspects

II. Mathematics and Statistics in NuclearMedicineA. General mathematics

1. Review of fractions, decimals2. Review of algebra3. Exponents and powers

B. LogarithmsC. Means of notation

1. Digital2. Analog

a. Graphs-arithmetic, log andsemilog

b. TablesD. Mathemtie instrumentation

1. Slide rule2. Calculators3. Computers

E. Statistics1. Definition2. Rates, ratios and percentages3. Frequency distribution

a. Mean, median, modeF. Reliability of data

1. Standard deviation, coefficientof variation

2. Standard error3. Range

G. Counting statisticsIII. Basic Nuclear Radiation Aysics

A. Review of atomic and nuclear structure1. Periodic system2. Elements of quantum theory3. Valence theory4. Atomic structure and particles

a. Atomic numberb. Atomic weightc. Atomic paaicles

(1) Alpha particles(2) Deutrons(3) Protons(4) Electrons

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2 hours

22 hours

8 hours

(5) Positrons(6) Neutrons

B. Ion!zing radiation1. Corpuscular and wave theories

a. Electromagneticb. Particles

(1) Uncharged(2) Charged

2. Production of x-irradiationa. Continuous and characteristicb. Secondary

3. Photonsa. Gamma radiation

(1) Natural sources(2) Artificially produced

sourcesIV. Interaction of Radiation and Matter,

Energy TransferA. Introduction-linear energy transfer

from corpuscular and photon sources1. Photoelectric effect2. Compton effect3. Pair production4. Scatter radiation5. Internal conversion6. Relationship of half value layer

to density, atomic number andtype and energy of radiation

V. Interaction of Radiation with BiologicSystems.A. Radiochemical and photochemical

reactionsB. Radiobiologic reaction

1. Reaction with water2. interaction with biomolecules3. Radiation effects upon cells

a. Latencyb. Recoveryc. Mitosisd. Viability

4. Radiation effects upon organs andorgan systems, blood formingorgans, 0.1. tract, etc.

5. Radiation effects upon organismsa. Effects of dosage and type of

radiationb. Acute radiation syndrome

Chronic effects(1) Malignancy(2) Genetic(3) Effect on life span

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10 hours

10 hours

6. Modification of radiobiologiceffecta. Water, temperature, oxygen,

chemicalsVI. Radiation Units

A. RoentgenB. RadC. Relative biological effectD. Roentgen-equivalent-manE. Curie

VII. Safe Handling of RadioisotopesA. General principles

1. Shielding, distance,exposure time

B. Consequences of poor techniqueC. Permissible exposure-internal,

environmentalD. Procedures

1. Monitoring and surveying2. Laboratory usage3. Hospital usage4. Contamination5. Radioactive waste disposal

E. Protective regulation1. AEC, state, local, hospital

Viii. IsotopesA. StableB. Radioactive

1. Sources2. Production methods

a. Reactors, accelerators,n, gamma; gamma, n; byother particles

3. Propertiesa. Emission-alpha, beta, gamma;

positron, neutron, deutron,k-capture, x-ray

b. Decay(1) Half life: effective life

c. Units of activity; specificactivity

C. Useful radioactive isotopes1. Diagnostic?. Therapeutic

/X. Measure of RadiationA. Counting equipment and detectors

1. ionization chamber2, Proportional counters3. Geiger-Mueller counter4. Scintillation counters5. Liquid phosphors6. Semiconductor detectors

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5 hours

10 hours

20 hours

40 hours

7, Photographic emulsion8. Biologic detectors

B. Auxiliary instruments1. Scalers, amplifiers, discriminators2. Count rate meters3. Pulse height analyzers, single

end multiple channel4. Read out devices

C. Geometry1. Collimation and shielding2. Distance and Inverse Square Law

D. Measurement application1. Counting2. Scanning3. Autoradiography4. Surveying5. Monitoring of personnel and work

areasE. Fundamentals of instrument measurements

1. Characteristics of instrumentationand calibrationa. Voltageb. Energy level measurements-

resolutionc. Sensitivityd. Efficiencye. Pre-set time and countf. Resolving timeg. Read out methodsh. Background

2. Principles of in %itro countinga. Standardization

(1) Absolute standards(2) Relatile stan3ards, dry,

solutions, etc.(3) Geometric considerations

(a) Isodose, isosensitivity,attenuation, 4 pi and2 pi geometry

(b) Particulate emitters(c) Detector type

b. Characteristics and preparationof samples(1) Physical state(2) Type of emission(3) Type of detector

3. Principles of in vivo counting,a. Quantitative

(1) Whole body(2) Regional or compartmental

b. Distributive(1) Automatic and manual scanning

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c. Time clearance andaccumulation studies(1) Compartmental, regional

X. Specific ProceduresA. Radioactive iodine-including colloidal

albumin forms1. Standardization2. Diagnostic applications3. Therapeutic applications4. Equipment and administration5. Measurements6. Calculations and interpretations

B. Radioactive gold1. Standardization2. Diagnostic and therapeutic

applications3. Equipment and administration4. Measurements5. Calculations and interpretations

C. Radioactive phosphorous1. Standardization2. Diagnostic and therapeutic

applications3. Equipment and administration4. Measurements5. Calculations and interpretations

D. Radioactive chromium1. Standardization2. Diagnostic and therapeutic

applications3. Equipment and administration4. Measurements5. Calculations and interpretations

E. Metastable technetium1. Standardization2. Diagnostic applications3. Equipment and administration4. Measurements5. Calculations and interpretations

F. Radioactive metastable indium1. Standardization2. Diagnostic applications3. Equipment and administration4. Measurements5. Calculations and interpretations

0. Radioactive cobalt1. Standardization2. Diagnostic and therapeutic

applications3. Equipment and administration4. MeasurementsS. Calculations and interpretations

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lit) hours

H. Radioactive strontium1. Standardization2. Diagnostic and therapeutic

applications3. Equipment and administration4. Measurements5. Calculations and interpretations

I. New radiopharmaceuticalsX/. Records and Administrative Procedures

A. A.E.C. rules and regulationsS. Application formsC. Sources of supply

XI/. Records, Coding and PilingA. Inventory-receipt disposalS. Personnel monitoringC. Surveys

XIII. Clinical ApplicationAll remaining hours will be devoted toexperience in performing clinicalradioisotopic procedures.

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5 hours

3 hours

Community College of DenverNuclear Medicine TEy"rargsechnolo'CWIProram

(The following is quoted from a paper entitled "RadiationTherapy-Nuclear Medicine Technology Training Programs,"by William R. Hendee, Ph.D., Colorado-Wyoming RegionalMedical Program]

Although many health professions are experiencing amanpower shortage, a critical shortage of trained person-nel exists in the fields of radiation therapy and nuclearmedicine technology. The Rocky Mountain region has anunusual scarcity of well-trained technical personnel inthese fields, primarily because few training programs innuclear medicine and radiation therapy technology areavailable within this geographical area. To help alle-viate this shortage of trained technologists, the Colora-do-Wyoming Regional Medical Program has provided a grantto establish two-year training programs in Denver.William R. Hendee, Ph.D., is project director for thegrant.

Under the direction of a Polity Committee composedof radiologists, technologists and other persons, repre-sentatives from Denver Community College and a number ofDenver hospitals have developed training programs inradiation therapy and nuclear medicine technology. The7eprograms are scheduled to begin in September, 1969. Stu-dents enrolled in the programs attend classes and lecturesat Denver Community College and receive on-the-job trainingin hospitals participating in the programs. Entrance re-quirements, curriculum and clinical training are estab-lished by the Policy Committee.

Who Is Eligible?

To be eligible for admission, a student must (1) bea high school graduate, (2) fulfill college entrance re-quirements and (3) receive recommendation by the PolicyCommittee.

Students who earn an Associates Degree after com-pleting either of the two-year training programs are eli-gible for examination and certification in radiation thera-py or nuclear medicine technology by the American Registryof Radiologic Technologists.

During the second year of study, a stipend is flu.-nished to students who have demonstrated academic aoility.

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No stipend will be 'urnished during the first year.Persons already certified in diagnostic radiologic

technology are admitted, as space permits, into the secondyear of the training programs. These persons must satisfyentrance requirements identical to those established fortwo-year students and, additionally, may be raquirecl totake first-year courses which were not included in theirprevious training. An Associates Degree is awarded ifthese students satisfy the degree requirements establishedby Denver Community College. The Policy Committee attemptsto find part-time employment for diagnostic technologistsenrolled in the second year of the programs.

Registered diagnostic radiologic technologists whocomplete the second year of one of the training programsare eligible for examination and certification by theAmerican Registry of Radiologic Technologists in eithernuclear medicine or radiation theripv technology.

Advantages of the Program

1. Unlike existing programs requiring three yearnof training beyond high school, these training programsrequire only two years. Also, specialized training innuclear medicine or radiation therapy is provided duringboth years of the programs, whereas specialized trainingis offerad only during one year in most other programs.

2. College credits received for participating inmost of the courses in either program may be creditedtoward a Bachelor of Science or Bachelor of Arta degreeat most four-year colleges and universities. Efforts areunderway to develop a second two-year program leading toa bachelor's degree.

3. The Denver training programs offer many coursesnot included in the curricula of most other programs.Some of these courses, such as "(Aemistry of nuclear med-icine,* "electronics," "introductidn to data processing,""radiation biology and pathology," "nuclear medicinemethodology" and "radiation therapy methodology," improvethe students' technical competence. Other courses, suchas composition, publi: speaking and psychology, increasethe students' capabilities to communicate and relateeffectively with other persons.

4. Since there are full-time coordinators for bothprograms, it is possible to assist graduates in findinginteresting, professionally rewarding positions.

5. Personnel and facilities of several institutions

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are used to increase the effectiveness of the trainingprogram.

6. Students are exchanged among participatinghospitals to increase the exposure of the students todifferent instrumentation and techniques.

7. Nationwide recruiting, plus a stipend during thesecond year of the programs,draw good students into theprograms.

8. Technologists certified in diagnostic radiologictechnology can become eligible for examination and certi-fication in nuclear medicine or radiation therapy tech-nology by completing only the second year of one of theprograms.

Course Outline

Core Curriculum (First Year) for All Specialties

R.T. = radiation therapy students onlyD.T. = diagnostic students onlyN.M. = nuclear medicine students only

Fallniirish Composition 3 hoursMedical Terminology 2 hoursBasic Health Science 4 hoursSurvey of Radiologic Technology 3 hoursFundamentals of Mathematics 3 hours

WinternIgh Composition 3 hoursAnatomy/Physiology 4 hoursFundamentals of Chemistry 4 hoursPsychology 3 hoursCollege Algebra 3 hours

prangEnglish Composition 3 hoursAnatomy/Physiology 4 hoursNursing Procedures and Ethics 3 hoursRadiation Physics 3 hoursCollege Trigonometry 5 hours

SummerRadiation Physics 3 hoursIntroduction to Data Processing -R.T. 3 hoursorElectrical Instruments and Measurements--N.M. 3 hours

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orDiagnostic Methodology--D.T.Clinical Technology

Nuclear Medicine (Second Year)

FallGeneral ChemistryNuclear Medicine MethodologyClinical Technology

WinternrieFil ChemistryNuclear Medicine MethodologyClinical Technology

SpringChemistry of Nuclear MedicineNuc)v,ar Medicine MethodologyClinical Technology

Summer=Cal Tecnnology

4 hours4 or 6hours

5 hours3 hours6 hours

5 hours3 hours6 hours

3 hours6 hours6 hours

10 hours

Description of Courses

DCC = Denver Community Collegeother courrea are given in hospitals

Composition T (English 121) (3) DCC: English 121 and 122constitute a two-quarter sequence designed forstudents intending to transfer to a four-year degreegranting institution. The student will preparethemes frequently to develop skill in expositorywriting.

Composition II (English 122) (3) DCC: Continuation ofEnglish 121 with further study and practice in writtencomposition emphasizing logical c-ganization andclarity of expression.

Basic Health Science (Biology 130) (4) DCC: A core bio-logical science course for health science students.Subject matter from anatomy, physiology, bacteriology,microbiology, and pathology are studied with refer-ence to the appropriate health science program. Onelaboratory session per week.

Nursing Procedures and Professional Ethics (3) DCC: The

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nursing procedures relative to patient and servicesto be offered. The organization of hospitals andpublic health nursing services. Practical demonstra-tions in nursing and professional obligations to thepatient.

Fundamentals of Mathematics (Mathematics 100) (3) DCC: Areview of mathematics involving wl,ole numbers, frac-tions, decimals and percentages. This course is inten-ded to develop background for students who have hadlittle or no previous training in mathematics.

Algebra I (Mathematics 105) (3) DCC: Intended for thestudent who has not had high school algebra or whoneeds review. An introduction to the basic conceptsof algebra sets, properties of the real number sys-tem, operations on algebraic expressions, linearequations and systems of quadratic equations. Prere-quisite: Developmental Mathematics or equivalentmathematics background.

Algebra II (Mathematics 111) (3) DCC: Fundamentals ofalgebra, linear functions, exponents and radicals,quadratic equations, ratio and proportion, probabil-ity, theory of equations and determinants. Prere-quisite: Introductory Algebra or High School Algebra.

Anatomy/Physiology I (Biology 123) (4) DCC: Detailedstudy of gross and microscopic anatomical structureof the human body and the function to structure rela-tionships.

Anatomy/Physiology II (Biology 124) (4) DCC: A continuationof Anatomy and Physiology. Prerequisite: Biology123.

Medical Terminology (Health Se/vice Terminology) (3) DCC:A study designed to acquaint the student with theorigin and structure of medical terms. The intentof this course is to help the student interpret andunderstand medical terms, medical reports and medicalrequests applicable to his field.

Public Speaking (Speech 102) (3) DCC: Instruction andintensive practice in essential speech processes andskills. Organization and effective oral presentationof reports and speeches related to the student'scareer interests.

Radiation Physics I (3) DCC: Structure of matter, pro-duction and nature of radiation, interactions ofradiation with matter, radiation detection and

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measurement, nuclear instrumentation, radiation ex-posure and dose, introduction to therapy treatmentplanning, radiation protection and safety.

Radiation Physics II (3) DCC: Continuation of RadiationPhysics I.

Psychology 111 (3) DCC: Introduction to basic principlesand methods in the scientific study of human behavior,including perception, motivation, learning, emotions,maturation and psychological development. Intendedto meet occupational studies and college transferrequirements.

Electronic Devices (4) DCC: A study of electronic devices;how they work, nomenclature, materials, apparatus,and characteristics. Both tube characteristics andsolid state device characteristics are covered. Thiscourse utilizes the mathematical tools as they becomeavailable. Laboratory techniques and skills aretaught by extensive use of a variety of devices andequipment.

Principle of X-Ray Technique (3) DCC: Radiographic andfluoroscopic instrumentation and procedures, darkroomtechnique, evaluating image quality and specialtechniques of diagnostic radiology.

Introduction to Data Processing (3) DCC: An introductionto basic methods, techniques, and systems of manual,mechanical, and electronic data processing. Coversmanual and machine accounting equipment and systems,punched tape or integrated data processing, and elec-tronic or automatic data processing.

Nuclear Medicine Methodology I (3) CGH: Radiation units,properties of nuclides, detectors and instrumenta-tion, counting procedures, identifying nuclides,absolute counting, calibrating nuclides, scintillationspectrometry, diagnostic and therapeutic isotope pro-cedures, scanners and cameras, patient dose, radia-tion shielding and safety, administration and recordkeeping, slide rule, mechanical and electronic cal-culators, digital computers, etc. Most of this courseis devoted to laboratory work.

Nuclear Medicine Methodology II (3) CGH:Nuclear Medicine Methodology I.

Nuclear Medicine Methodology III (6) CGH:of Nuclear Medicine Methodology II.

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Continuation of

Continuation

Inorganic Chemistry I (Chemistry 111) (3) DCC: Intro-ductory study of principles of inorganic and organicchemistry; properties of matter, nature and chemicalchanges. This course may be taken by the studentwishing to improve his background before takingGeneral Chemistry but is required for chemistry majors.

Inorganic Chemistry II (Chemistry 112) (3) DCC: A be-ginning general college chemistry course which in-cludes the laws of chemical combination, states ofmatter, atomic and molecular structure, bonding andother basic principles. Prerequisite: Chemistry 111.

Chemistry of Nuclear Medicine (3) CGH: Hematology,radionuclide generators, dilution analysis, sterilityand pyrogenicity tests, chemical, radiovhemical andradioisotopic purity, labeling procedures, calibra-tion of nuclides, literature of nuclear medicine,regulations, equipment and nuclide suppliers.

Clinical Technology (PH): Credit hours granted for super-vised participation in radiation therapy or nuclearmedicine programs at participating hospitals.

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Miami Dade Junior CollegeNuclear Medical Technology 'Program

First Semester

NMT 201 Nuclear MedicalTechnology

NMT 202 Physics for NuclearMedical Technologists

NMT 203 Procedures in NuclearMedical Technology I

NMT 210 Radiochemistry and Radio-pharmaceuticals

Ele "tive (Recommend Math110, 112)

NMT 212 Seminar

Second Semester

NMT 220 Instrumentation andLaboratory Equipment

NMT 221 RadiobiologyNMT 206 Procedures in Nuclear

Medical Technology IIExternshipElective

NMT 221 Seminar

Spring and Summer

Externship

Cr. lirtywh, Hrs/sem.

1 1 16

4 5 80

4 5 80

2 2 32

3 3 481 2 32

4 5 801 1 16

4 5 80? 20 3203 3 481 2 32

? 40 480

Desoription of Courses

Nuclear Medical Technology (NMT 201), 1 cr., 16 hrs/sem.:Intended to provide the student with an introductionto the basic concept of the Nuclear Medical Techno-logy Laboratory. Ethics, terminology, personnel pro-tection and administrative records and coding areamong the material covered. Proposed course outlinefollows:

I. Ethics 1

II. Terminology 3

III. Laboratory Rules 1

IV. Personnel Protection 2

V. Examination 1

VI. Records 3

VII. Administration 2

VIII. Coding 2

IX. Filing 1

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Physics for Nuclear Medical Technologists (NMT 202),4 cr., 80 hrs/sem.: Intended to provide the studentwith a thorough understanding of the nuclear physicsapplicable to Nuclear Medical Technology. Atomicand nuclear structure, radioactivity, interactionsof radiation with matter and shielding methodologyare among the subjects covered. The laboratoryperiments are structured as to provide maximumlation with the lecturer. Proposed coursefollows:

I. Atomic structureA. Nuclear structure

1. Nuclear constituent2. Nuclear models3. Nuclear energy levels

II. Radioactivity

ex-corre-

outline

Hrs. Hrs.Lect. Lab.3

18

2

12

A. Natural radioactivityB. Induced radioactivityC. Modes of decayD. Properties of nuclear

radiationsE. Mathematics of radioactive

decayIII. Interaction of radiation with

matter 21 14

A. Charged particle interactionsB. Uncharged particles and quantaC. Interaction cvefficients

IV. Radiation protection and shielding 6 4

Laboratory

I. Statistics of counting 2

II. Counting of background radiation 2

III. Propagation of error 2

IV. Scintillation counting - effect of H.V. 2

V. Linear amplifier and PHA 2

VI. Differential gamma ray spectra 2

VII. Intagral counting and optimum counting 2

VIII. Resolving time studies - sample volumeand count rate 2

IX. Quantitative gamma determination 2

X. Backscatter and sidescatter - halfvalue layer 2

XI. Evaluation of collimators 2

XII. Radioactive decay and half-life 2

XIII. Effect of crystal size on gammaenergy and pulse height resolution 2

XIV. Shielding requirements 2

2 lab exams 4

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Procedures in Nuclear Medical Technology I (NMT 203),----Icr., 80 hrs/sem.: Intended to provide the student

with the basic and procedural information on eachexamination routinely performed in the nuclearmedicine laboratory. The several types of proceduresare presented along with rationale which promotestheir usage. Laboratory experiences are providedto reinforce procedural methodology. Proposedcourse outline follows:

Hrs. Hrs.Lect. Lab.

I. General laboratory procedures ry 10A. Lab rulesB. Basic laboratory math

1. Units of radioactivity2. Decay3. Specific activity4. Dilutions5. Percentages6. Sources of error

C. Modes of tracer administration1. Oral2. Intravenous3. Inhalation4. Other

D. Sample preparationE. PHA calibrationsF. Window settings

II. Therapevtic procedures 6 4

A. 11311. Functional2. Neoplastic

B. Au- colloidC. P32 colloidD. P32 phosphateE. InterstitialF. Applicators

III. Diagnostic procedures 9 6

A. Thyroid anatomy and physiologyB. Thyroid pathologies

1. T-3 studies2. T-4 studies3. Thyroid uptake and variations4. Others

C. Dilution studies 9 6

1. Dilution theorya. Anatomy and pathophy-

siology of the vascularcompartment(1) RIHSA plasma volume(2) Tagged red cell

volume

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Hrs. Hrs.Lect. Lab.

(3) Sources of errorb. Anatomy and pathophy-

siology of other bodycompartments(1) HIO, others(2) Ptitassium(3) Sodium

D. Hematologic studies 6 4

1. Anatomy and pathophysiologyor erythrokineticsa. Ferrokineticsb. Fecal blood lossc. RBC survival

2. Anatomy and pathophysiology ofVitamin B

12metabolism

E. Miscellaneous studies 3 2

1. Anatomy and pathophysiologyof fat metabolisma. Trioleic acidb. Oleic acid

2. Protein losing enteropath-ologies

Radio harmacolo and Radiochemistry (NMT 210), 2 cr.,32 rs sem.: Intended to provide the student withan overview of the basic problems and concepts ofthe radiochemical and radiopharmaecutical laboratory.A review of basic principles is provided followedby an overview of the various methodologies andcommon practices of the radiopharmacy. Proposedcourse outline follows:

I. Review of chemical principles and 3

proceduresII. The principles of radiopharmaceuti-

cals 2

III. Pharmacology 1

IV. Toxicology 1V. Bacteriology and pyrogenicity 1

VI. Chemistry and stability 1

VII. Sterilization and asepsis 1

VIII. Characteristics of radiopharma-ceuticals 2

IX. Methods in quality control 3

X. Personnel protection in theradiopharmacy 1

XI. Generator systems 2

XII. Preparation and control ofcolloids 2

XIII. Red cell labeling 1

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Hrs. Hrs.Lect. Lab.

XIV. Protein labeling 1XV. Radioactive, gases 1

XVI. Methods of preparing anddispensing radiopharmaceuticals 6

XVII. Record keeping in the radiopharmacy 1

2 exams 2

Instrumentation and Laboratory Equipment (NMT 220), 4 cr.,80 hrs /sem.: Intended to proviae the studentwith a thorough grounding in the operation and limi-tations of all equipment in common use in thenuclear medical laboratory. The simplest throughthe most sophisticated systems are studied andevaluated. A careful correlation of lectures andlaboratories provides the student with practicalapplication of each system studied. Proposedcourse outline follows:

I. Gas ionization detection systems 6 4A. Principles of ionizationB. Ionization chambersC. Proportional countersD. Geiger-Mueller countersE. Laboratory instruments

1. Survey meters2. Radiopharmaceutical survey

instrumentsF. Sources of error with gas

detectorsII. Counting statistics 6 4

III. Scintillation detectors 9 6

A. Principles of scintillationdetection1. NAI (TL)2. Plastic scintillators3. Liquid scintillators

B. Scintillation detectionelectronics

C. Instrument using scintillationdetection

D. Sources of error with scintillationdetection

IV. Other radiation detectorsV. Organ visualization instruments 21 14

A. Principles of organ visuali-zation

B. Principles of collimationC. Probe systemsD. Rectilinear scanning systemsE. Camera systems

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Hrs. Hrs.Lect. Lab.

F. Other systemsVI. Data display systems 3 2

Radiobiology (NMT 221), 1 cr., 16 hrs/sem.: Intended toprovide the student with a compacted view of thepresent state of knowledge in radiobiology. A briefreview of pertinent biological syt.M.ems is given fol-lowed by selected topics in the effects of radiationon biological systems. Proposed course outlinefollows:

I. Review of pertinent radiation physics 1II. The cell 1

A. The nucleusB. The cytoplasmC. The extranuclear organelles

III. Mitosis and meiosis 1VI. Genetic materialV. The target theory 1

VI. The aqueous system 1

VII. Relative sensitivity of the nucleusand cytoplasm 1

Exam 1VIII. Organs and organ systems 1

IX. Effects in the total organismA. Immediately lethal effects 1

B. Bone marrow syndrome 1

C. Gastro-intestinal syndrome 1

D. Central nervous system syndrome 1

E. The late effects 1X. Factors influencing the effects

of radiation 1

XI. Low level radiation effects 1

Procedures in Nuclear Medical Technology II (NMT 206),4 cr., 80 hrs/sem.: A continuation of the materialand philosophy of NMT 203. The dynamic studiesand gamma imaging systems are given maximum stress.Proposed course outline follows:

I. Gamma imaging (rectilinear)A. Rectilinear scanning

1. Theory of rectilinearscanning

2. Production of the photoscan3. Scan configurations

B. Thyroid scanning1. Anatomy and pathophysiology2. Radionuclides

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9 6

Hrs. Hrs.Lect. Lab.

3. Chemical form4. Tracer amount5. Positioning and scan

productionC. Brain scanning

1,2,3,4, and 5 as aboveII. Dynamic studies 12 8

A. Renogram1,2,3,4 and 5 as above

B. Cardiac output1,2,3,4 and 5 as above

C. Cerebral blood flow1,2,3,4, and 5 as above

D. Lung perfusion and ventilation1,2,3,4 and 5 as above

III. Gamma imaging (camera and rectilinear) 24 16A. Hepatic scanning

1,2,3,4 and 5 as aboveB. Splenic scanning

1,2,3,4 and 5 as aboveC. Pancreatic scanning

1,2,3,4 and 5 as aboveD. Renal scanning

1,2,3,4 and 5 as aboveE. Brain scanning

1,2,3,4 and 5 as aboveF. Lung scanning

1,2,3,4 and 5 as aboveG. Bone scanning

1,2,3,4 and 5 as aboveH. Other organs and systems

IV. Data handling and computerapplications 3 2

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Universiti+ of - A Pro ram of Study andng to the BtmE:osciwweleg_re7-3Tn

Medical Technologx wit a Nuc ear Me c ne Option .

1st QuarterEng. Ibi-Tomp.)-T-chem 101 3

Chem 111 (Lab.) 2

Math. elective 3

Foreign lang. 5Phys. Ed. 1

let Quarter Cr.)ng. (Lit.

elective) 3

Chem. 204 Org.) 4Biology 101 5

Soc Study (soc.,econ., hist.,po]i. sci.) 3

Phys. Ed. 1

1AtALIAt191_ Cr,FHTI1WViych. TAnal. Chem 341 3

Anal. Chem 351 2

Lit., Psych orsocial study

Biol. 201 (Anat.ant. Physiol.) 3

Physics 101 5

Freshman Year

2nd Quarter Cr.Si. 102 (Comp.)YChem 102 3

Chem 112 2

Math. elective 3Foreign lang. 5

Phys. Ed, 1

Sophomore Year

and_Quarter(Lit.

elective)Chem 205 (Org.)Biology 102Soc. StudyPhys. Ed.

Junior Year

Cr.

3

4

5

3

1

2nd Quarter Cr.Phil. or Psych. `T`Anal. Chem. 342 3

Anal. Chem. 3r,2 2Lit., Psych or

social study 3

Biol. 202 (Anat.and Physiol.) 3

Physics 102 5

Senior Year

3rd Quarter 'Cr.Eng. 101 -rChem 103 3

Chem 113 2

Math. elective 3Foreign lang. 5

Phys. Ed. 1

3rd Quarter Cr.Eng. (Lit.

elective) 3

Biochem 206 orelective 4

Biology 103 5

Soc. Study 3

Phys. Ed. 1

3rd Quarter Cr.nil. or

Psych. 3

Lit., Psych.or socialstudy 3

Biol. 203(Anat. andPhysiol.) 3

Physics 103 5

Bacteriol. 271 4Elective 4

The senior year is a 12 month hospital internship programduring which the student receives both formal trainingand practical experience in the Radioisotope Laboratoryof the Cincinnati General Hospital.

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Nuclear Physics andInstrumentation 6

Radioisotope MeasurementsRadiation ProtectionTracer Methodology and

RadiopharmaceuticalsHematology and LaboratoryChemistry Lectures

Clinical Application. ofRadioisotopes

Technical Evaluation ofNuclear Medicine Procedures

Clinical Nuclear Medicineand Hematology Practicum

. Credits. Per. QuarterSummer Fall Winter Spring

63

3

1 1

1 1 1

2 2 2 2

6 6 6 6

14 16 13 12

111111 ..1 \Om..

Since the above are newly developed specialized courses,they are outlined in some detail.

Nuclear Physics and Instrumentation: This course isdesigned to provide the student with the fundamentalsin:physics, mathematics, and principles of nuclearinstrumentation necessary for him to understand thephysical aspects of the use of radioisotopes inmedicine. Course content is as follows:

I. Atomic structureA. Electron configurationB. Nucleus

3.. Nuclear particles and their properties2. Nuclear binding energy

II. Radioactive decayA. Modes of decayB. Unite of activityC. Mathematical decay law

I/I. Interaction of radiation with matterA. CorpuscularB. Electromagnetic

IV. Principles of radiation detection instrumentsA. Gas ionization instruments

1. /on chambers2. Proportional' counters3. G-M counters

B. Photographic emulsionsC. Scintillation detectorsD. Semiconductor detectorsR. Thermoluminescent media

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Radioisotope Measurements: This course is a continuationof the instrumentation part of the "Basic NuclearPhysics and Instrumentation" course which is pre-requisite. The "principles of radiation detectioninstruments"section is used as a stepping stone todiscuss various nuclear counting systems withemphasis on operating characteristics. Coursecontent is as follows:

I. Operating characteristics and associated elec-tronics of each of the following instrumentsystemsA. G-M countersB. Ion chambersC. Proportional countersD. Scintillation detectors

1. Integral counters2. Spectrometers (includes scanners)

I/. Principles of in vitro countingA. AbsoluteB. Relative

III. Principles of in vivo countingA. Whole bodyB. Distributive

1. Scanning2. Quantitative measurements

C. Kinetic studiesIV. Statistics of nuclear radiation countingV. Quality control of counting systems

Laboratory sessions for these courses include:

1. Determination of operating voltage for anintegral laboratory counter.

2. Determination of counting efficiency.3. Determination of the half-life of a

radionuclide.4. Calibration of a single channel pulse height

analyzer.S. Calibration of a multichannel pulse height

analyzer.6. Interpretation of a gamma spectrum.7. Five two hour sessions on organ scanning using

phantoms.

Radiation Protection: In this course safe handling ofradioactive materials is stressed. Emphasis is placedon maximizing the diagnostic information obtained froma procedure while minimizing the radiation exposure toboth the technician and patient. The course contentis as follows:

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T. Units of radiation exposure and doseA. RoentgenB. RadC. RemD. RBEE. Quality factorF. Dose equivalent

II. Biological effects of radiationA. Cellular effectsB. Macroscopic effects

III. Radiation protection guidesIV. Radiation protection instrumentation

A. Survey instruments1. Beta - Gamma2. Alpha

B. Personnel instruments1. Film badges2. Pocket chambers3. Thermoluminescent dosimeters

V. Basic principles of radiation protectionA. External

1. Time2. Distance3. Shielding

B. Internal1. Good housekeeping practices2. Protective clothing3. Proper pipetting techniques

VI. Emergency procedures

T4'rAcca.p114542yed2111221Arisetaullr The chemicalan o og ca basis or us ng the ra ioisotope asa tracer are discussed in this course. Propertiesand methods of production of radioactive tracersare also covered. Course content is as follows:

I. Tracer MethodologyProperties of radioactive tracersA. Physical properties

1. Half-life2. Type and energy of emissions

B. Chemical propertiesC. Biological localization

/II. Methods of production of radioactive tracersA. Nuclear reactors

1. Fission products2. Neutron activation

B. CyclotronC. Generators

Clinical Applications of Radioisotcoes: This courseconsists of a series of lectures on varied topics

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of interest. Each one is presented by a specialistin his subject. Lecture titles include:

1. Diagnostic Use of 111I (2 lectures)2. Therapeutic Use of13II3. Radioisotopes in Ophthalmology4. Regulations for Radioisotope Use5. Technical Aspects of Scanning6. Liquid Scintillation counting7. Hematologic Studies with Radioisotopes8. Metabolic Studies with Radioisotopes9. Dynamic Function Studies

10. Lung and Cardiovascular Blood Pool Scans11. Brain Scanning12. Bone Scanning13. 0.8. and Gyn Radioisotope Studies14. Liver Scanning15. Spleen and Pancreatj,c Scanp/016. Therapeutic Use of "P and 1"Au17. Whole Body Counter Applications18. Cyclotron Production of Radionuclides19. New Developments in Radiopharmaceuticals and

Short Lived Isotopes20. Principles of Radiopharmaceutical Preparation

Technical Evaluation of Nuclear Medicine Procedures:This portion of the training consists of sessionsheld at the end of each day in which a staffphysician, along with other staff members, reviewsand interprets the studies performed on that day.These sessions (approximately one hour each day)provide a much needed correlation between the workthe technologist performs and its significance inthe practice of medicine. Tne student is able tosee directly how the work he has done each dayfits into the overall diagnosis of each patient.Also the importance of the technical factors andhow they affect the final interpretation of astudy is stressed in these sessions.

Clinical Nuclear Medicine and Hematology Practicumt

This portion of the curriculum will provide thestudent with practical experience in diagnosticand therapeutic procedures performed with radio-isotopes. Approximately 30 hours per week will bespent in this activity. The students work under theclose supervision of staff physicians and experiencednuclear medical technologists and learn, IA doing,all of the procedures performed in the RadioisotopeLaboratory. These ihclude metabolic studies, thyroidtests, diagnosis of gastrointestinal, cardiovascular,

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ii

and urogenital diseases, localization of tumors,hematologic studies, etc.

The student also spends time in the clinical hema-tology laboratory where he performs differentialblood counts and other hematologic procedures.

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Appendix Et Essentials of an Accredited EducationProgram in Nuclear Medicine Technology (AMA)

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111111,111111ft.a....... ,..",-.-+,

Essentials of an Accredited Educational Program inNuclear Medicine Technology

Approved by the AMA House of Delegateson 15 July, 1969

PREAMBLE

The organization primarily concerned with themaintenance of acceptable standards for educationalprograms for nuclear medicine technologists and techniciansis the Council on Medical Education of the American MedicalAssociation. The American College of Radiology, theSociety of Nuclear Medicine, the American Societyof Clinical Pathologists, the American Society of MedicalTechnologists, the American Society of Radiologic Techno-logists, and the Society of Nuclear Medical Technologistshave obvious interest and concern in such training.To organize their concerns and provide an orderlymechanism for preparation of recommendations to theCouncil on Medical Education, a single Board of Schoolsof Nuclear Medicine Technology shall be concernedwith the evaluation and survey of educational programs forNuclear Medicine Technologists and Technicians, themaintenance of high standards of education, and thedevelopment of new teaching programs.

The Board of Schools of Nuclear Medicine Technology shallconsist of two representatives each from the American Collegeof Radiology, the American Society of Clinical Pathologists,and the Society of Nuclear Medicine; and two representativeseach, registered in nuclear medicine technology, from theAmerican Society of Radiologic Technologists, the AmericanSociety of Medical Technologists, and the Society Of NuclearMedical Technologists.

The Board of Schools shall serve as the reviewing bodyfor all educational programs for Nuclear Medicine Technologyand make recommendations to the Council on Medical Educationof the American Medical Association concerning approvalstatus.

Nuclear Medicine Technologists and Technicians aretrained in these programs to work under the direction ofphysicians qualified in the clinical use of radionuclides,and not to work as independent practitioners.

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I. ORGANIZATION

A. Acceptable schools for training in nuclear medicinetechnology may be conducted in approved medical schools,accredited colleges or universities, accreditedgeneral hospitals or other acceptable laboratoriessuitably organized in accordance with present educa-tional standards. Facilities providing clinicalservices in nuclear medicine must be maintained,and must provide an adequate volume and variety ofprocedures in relation to student enrollment.Under special circumstances, programs may be developedin specialty hospitals, laboratories, or in generalhospitals where experience may not be possible inthe full range of radionuclides. In such cases, theinstitution may arrange for affiliation with someother facility to provide training and experiencein desired procedures with the approval of theBoard of Schools of Nuclear Medicine Technology.

B. Affiliation with an accredited college, communitycollege, university, or medical school is desirable butnot essential. When such an affiliation exists, anadvisory committee should be established includingrepresentatives from the sponsoring institution andfrom the department of the college, university, ormedical school which participates in the trainingprogram.

C. All training of technologists and technicians shall beunder competent medical supervision.

D. Resources for continued operation of the school shouldbe assured through regular budget, gifts, or endowments.A monthly stipend to the student may be permitted.

II. ADMINISTRATION

A. The nuclear medicine faculty shall comply with federal,state, and hospital regulations for safety procedures.Adequate space, light, and modern equipment should beprovided in the training area.

B. A library containing up-to-date references, texts, andscientific periodicals pertaining to nuclear medicinetechnology should be readily accessible to students.

C. Satisfactory records must be kept for all workaccomplished in the department.

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D. Transcripts of college credits and other credentialsmust be available. Records must be kept of each student'sattendance and grades, as well as the number and types oftechnological procedures performed.

E. A current outline of the curriculum and the rotation ofassignments must be available in the office of theprogram director.

F. Approval of a program may be withdrawn if no studentsare enrolled for a period of two consecutive years.

G. Institutions sponsoring programs for nuclear medicinetechnology should submit an annual report to the Coun-cil on Medical Education and to-the Board of Schoolsof Nuclear Medicine Technology.

H. Periodic resurvey will be conducted by the Board ofSchools of Nuclear Medicine Technology in collaborationwith the Council on Medical Education. If thephysician director in charge of the training programor the curriculum is changed, the Council shall benotified, and reevaluation may be required.

III. FACULTY

A. The program must have a competent and adequate teachingstaff. The director must be a physician qualified inthe clinical use of radionuclides. He must be eligiblefor certification by a medical specialty examiningboard recognized by the American Medical Association,or have qualifications acceptable to the Council onMedical Education. He shall take part in and be respon-sible for the actual conduct of the training programand shall be in daily attendance for sufficient timeto supervise properly the work and teaching in thedepartment.

B. The teaching staff should include qualified instructorsin radiation physics and radiation biology adequatefor both group and individual instruction. It shouldalso include at least one instructor who is a registerednuclear medicine technologist and who is activelyengaged in nuclear medicine technology.

IV. ADMISSION REQUIREMENTS

Applicants must be at least eighteen years of age at

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the time they reach the training period when they will beworking with radionuclides. Candidates for admission mustsatisfy one of the following minimal requirements:

A. For a Baccalaureate Degree Program; Technologists:Registered as a Medical Technologist, M.T. (ASCP); Rad-iologic Technologist, R.T. (ARRT); or RegisteredNurse, R.N.; and have earned at least three years(90 semester hours) of college creditfrom an accreditedcollege, university, or medical school, includingcredit acceptable toward a major in the biologicalor physical sciences.

B. For Associate Degree Programs; Technicians: Applicantsmust have successfully completed four years of highschool or have passed a standard equivalency testfor admission to a college. Successful completion oftwo years study, including the twelve month trainingprogram, may qualify the individual for an associatedegree. For those who have successfully completedone year of college, including at least three credithours in chemistry and mathematics, the twelve monthtraining program may qualify the individual for anassociate degree.

C. Those registered as M.T. (ASCP); R.T. (ARRT); or R.N.may, by completing the twelve month training programsqualify for registration in Nuclear Medicine Technology.

V. CURRICULUM

A. The following suggested basic minimum curriculum ispresented as a guide for an educational program innuclear medicine technology. The designation oftechnologist applies to those holding a bachelor orhigher degree in .science. Only the minimum essentialsor requirements for a program of nuclear medicinetechnology education are suggested, so a curriculumbeyond that necessary for an associate degree (technician)is not suggested in these essentials. The final dibtinc-tion between technologist and technician lies in thepurview of the certifying registry.

B. The training program must be at least twelve monthsin duration, should be uninterrupted, and shouldinclude approximately 300 didactic hours, or morewhere the clinical training is part of a totalintegrated educational program lealing to an associate

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degree or baccalaureate.

C. Adequate clinical experience should be provided. Theinstruction.should follow a planned outline and includetext assignments,. lectures, discussions, demonstrations,supervised practice, practical examinations, and quizzes.

Curriculum:

1. 'Orientation and Introduction (4 hours)2'. Basic Anatomy, Physiology, and Pathology (40-

100 hours.)3. Mathematics (20 hours)4. Radiation Physics (10-20 hours)5. Nuclear Physics and Instrumentation (60.100 hours)6. Radiation Biology (20-30 hours)7. Radiation Protection (15 hours or minimum for .

Federal or State laws)`8: Basic Laboratory Procedures and Techniques (10-50 hours)9.' Clinical Application of Radionuclides (100-150 hours)

10.- Records and Administrative Procedures (5 houks)'Presentation of regulatory requirements relatingto licensing and inspection.

11. Therapeutic Radionuclides (10 hours)12. Radiochemistry and Radiopharmaceuticals (25 hours)

The hours indicated are only suggestions and notessential provided an adequate total educational prograMis offered.

VI. ETHICS

Excessive student fees and commercial advertisingare considered unethical. Educational programs must notsubstitute students for paid technologists and technicians.

VII. HEALTH

Applicants for admission to an acceptable educationalprograM shall be required to submit evidence of good healthand successful vaccinations, and a report of a medicalexamination should be a part of student records. Thisexamination shall include an x-ray of the chest. Healthcare and hospitalization shall be available to the student,

VIII. ADMISSION TO THE APPROVED LIST

Application for approval of an educational program in

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nuclear medicine technology should be submitted to the Depart-ment of Allied Medical Professions and Services, Divisionof Medical Education, American Medical Association,535 North Dearborn Street, Chicago, Illinois 60610, Formswill be supplied for this purpose on request and should becompleted by the director of the institution requestingapproval.

Approval may be withdrawn whenever, in the opinionof the Council on Medical Education, a school does notmaintain an educational program in accordance with theminimum standards stated above.

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ApRendix F: Existing Films, Books andMaterials on Nuclear Medicine

[Prepared by A. Bertrand Brill, M.D., for theCommittee on Education, Southeastern ChapterSociety of Nuclear Medicine, April, 1969]

Page

Introductory Statement 175

Films

I. Radiation Fundamentals

A. Radiation Fundamentals, Popular 176

B. Radiation Fundamentals, Technical 177

C. 1. Atomic and Nuclear Physics 177

2. Reactors 180

3. Accelerators 181

4. Detection and Measurement ofIonizing Radiation 182

5. Radiochemistry 185

II. Radiation Hazards

A. General Principles 186

B. Monitoring 191

C. Protection 192

III. Applications

A. Biological 193

B. Medical Research 195

C. Clinical

1. General 196

2. Particular 199

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Page

IV. Industrial Applications 201

V. Sources of films 203

Books and Other Materials 208

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I

Introductory Statement

This appendix contains a summary of materials,emphasizing films and books, which may provide useful re-sources for training in nuclear medicine. The majoreffort in preparing the annotated bibliography and filmlist was made by Dr. A. Bertrand Brill of the Divisionof Nuclear Medicine and Biophysics at Vanderbilt: Universityin Nashville. This bibliography was prepared in April, 1969by Dr. Brill for the Committee on Education of theSoutheastern Chapter of the Society of Nuclear Medicine. Afew additions have been made to the basic list, but for themost part thanks must be given to Dr. Brill for this con-tribution.

Several points should be made about this appendix. First,these resource materials are concerned almost exclusivelywith nuclear medicine. A training program for NuclearMedicine Technicians would undoubtedly include other coursessuch as mathematics, chemistry, anatomy, or English.Material for other courses is not of primary concern, althoughsome references are given. A second point is that manyresources included here, notably some books, may have.particular relevance to the specialized interests of phy-sicians. Titles and notes give some indications of thecontent and intended audience. Certainly many entries,including some of the more specialized subjects, wouldbe appropriate and useful for the NMT.

This appendix is intended to be neither completenor comprehensive. It should be looked upon as a startin an effort to consolidate a catalog of resources fortraining programs in nuclear medicine. This list hasmost certainly missed many materials being used locallyin training programs. The existence of additional trainingresources should be made known in order that trainingefforts can be as effective and efficient as possible.Technical Education Research Center would appreciatereceiving additions to or comments . Lhis appendix.The basic bibliography and resource list will be updated,and additional information furnished to all those concernedwith the training of Nuclear Medicine Technicians.

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lA - RADIATION FUNDAMENTALS, POPULAR

"A" Is For Atom - 15 minutes; 16 mm; color.

An amusing character called Dr. Atom takes the audiencethrough "Element Town" to explain the atomic structure ofthe 92 naturally occurring elements. An understandableexplanation of the principles of nuclear fission is givenin an intersting and entertaining manner. In cartoonanimation, the film goes on to explain principles of atomicenergy, and how this energy can be applied to peacet4meuses in industry, medicine, agriculture, and science. AEC.

Taking the X out ofX:EsK - 10 minutes; 16 mm; black and white.

With narration by Coolidge, this film describes thenature and development of x-rays from their discovery byRoentgen to the present day. Included is a descriptionof the mechanisms by which x-rays are produced from bothhot and cold cathode tubes. The theory of fluoroscopy andthe production of radiographs is covered. AEC

Of Man and Matter (1963) - 29 minutes; 16 mAl; sound, color.

This film describes the design, development and operationof the alternating gradient synchrotron (AGS) at BrookhavenNational Laboratory. Shows the various major componentsof this 33 billion-electron-volt particle accelerator,and explains how the high energy protons produced in themachine are used in physical research. An actual experimentis seen, in which the particle beam is guided into a bubblechamber and the resultant interactions with the targetnuclei are photographed. The methods adopted in scanningand analyzing the photographs are also shown. By means of abrief lecture, a Brookhaven physicist explains that suchgigantic and complex machines as the AGS are necessary inorder to study the fundamental particles and the forceswithin the atomic nucleus that are the basic components ofall existing metter. AEC 1/4

The High Energy People (1963) - 5 1/4 minutes; 16 mm; soundcolor.

This film offers a brief description of the problems andtools of high energy physics, illustrated by some of thework being done with Zero Gradient Sychrotron. Scientists

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and technicians 1.e lo work with this giant atom smasherdescribe various phases of their work. Aside fromthe Synchrotron itself, the Spark Chamber is shown andexplained, as are the automatic cameras which photographthe tracks of sub-atomic particles. Examination and analysisof the photographs are also described. AEC

1B - RADIATION FUNDAMENTALS, TECHNICAL

ATOMIC AND NUCLEAR PHYSICS

Nuclear Structure, Part III, Atomic Physics Series - 19minutes; 16 mm; black and white, sound.

This film begins with the discovery of naturalradioactivity by Henri Becquerel in 1896, showing theeffect of radiation on a photographic plate. This isfollowed by a review of the work of the Curies in isolatingradium, the various types of radiation and their behavior ina magnetic field, and Rutherford's experiments showingthat alpha particles are helium nuclei and how the patternof their scatter by a gold foil served as a basis for theclassical concept of the atom. The structure of selectedsimple atoms is then shown and the importance of the atomicnumber of elements, rather than the atomic weight isdeveloped through a review of the results of Moseley'sexperiments with characteristic x-rays. The film concludesby showing the realization of the dream of the alchemistto change one element to another, when Rutherford bombardedatoms of nitrogen with alpha particles, forming oxygenand hydrogen. AEC

Atomic Physics (1948) - 90 minutes; 16 mm; black and white,sound.

This film discusses the history and development ofatomic energy, stressing nuclear physics. Dalton's basicatomic theory, Faraday's early experiments in electrolysis,Mendeleev's periodic table, and early concepts and size ofatoms and molecules are discussed also. The film demonstrateshow cathode rays were investigated and how the electron wasdiscovered; how the nature of positive rays were found andput to use. The film also presents research tools of nuclearphysics, explains work of Joliot Curie and Chadwick indiscovery of neutron, and splitting of lithium atom byCockcroft and Walton. Einstein tells how their workillustrates his theory of equivalence of mass and energy.Uranium fission is explained, as well as why it is possible

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to make an atomic bomb. AEC

Atomic Theory, Part I, Atomic Physics Series - 10 minutes; 16mm; black and white, sound.

This film developes the rebirth of the atomic theory ofmatter beginning with the discovery of the law of definiteproportions and Dalton's basic atomic theory. Mendeleeff'speriodic table, Brownian movement, and the early experimentsof Michael Faraday, showing that electric current must becomposed of unit particles of electricity, are reviewed.The film concludes with a summary by Lord Rutherford. AEC

Rays from Atoms, Part II, Atomic Physics Series - 10 minutes16 mm; black and white, sound.

This film reviews the early investigations of cathoderays showing that they are small particles which possessmass and charge and which travel in straight lines.Included are the basic principles of the experiments byJ. J. Thompson. The film concludes with a review of thenature of positive rays and the discovery of x-rays byRoentgen. AEC

Fundamentals of Radioactivity (The Radioisotope - Film IPart 1) - T5 minutes; 16 mm; black and white.

This film opens with a sequence tracing uranium, theraw material of atomic energy, from the prospector to theAtomic Energy Commission.. The film shows how uraniumchanges into other elements through the natural processesof radioactive decay and nuclear fission. Einstein'sequation E=mc2 is cited. Mention is made of the atomicbomb and the use of nuclear power for industry. Stable andradioactive isotopes are also discussed. AEC

Fundamentals of Radioactivitx ( The Radioisotope - Film IPart 2) 35 minutes; 16 mm; black and white.

Charts and energy-level diagrams are employed toillustrate the decay of radionuclides. The various rad-iations resulting from nuclear changes are described indetail. The nuclear reactor is described in terms offission and moderation. Several scenes show targetmaterials introduced into a typical nuclear reactor andwithdrawn as radionuclides. The processing of fissionproducts is also shown. AEC

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Understanding the Atom: Alpha, Beta, and Gamma (1962) -44 minutes.

This film gives some insight into the origin and natureof alpha, beta, and gamma radiation. After a shortdiscussion of the methods of describing atoms and theintroduction of the energy-level concept, the lecturerintroduces the potential energy well model of the nucleus.This, together with the barrier model, is used as theframe of reference for a variety of other nuclear concepts.The energetics in alpha emission and the Gamow tunnelingeffect are used to describe alpha-ray emission and theenergy levels in the nucleus. The lecturer discussesneutron absorption leading to the formation of nucleihaving neutron-proton ratios differing from stable ornaturally occurring nuclei. The transformation of excessneutrons into negative beta radiation and the return tostability are considered in some detail. Similarly, gammaradiation arising from a nuclear cooling process is described.The nuclear well model is then used to introduce decayschemes. AEC

Understanding the Atom: Nuclear Reactions (1963) -29 1/2 minutes.

This segment of tho series continues the discussion ofFilm No. 1 ("Understanding the Atom: Alpha, Beta and Gamma")and involves some of the basic concepts of nuclearreactions. Use is made of the nuclear well model whichwas introduced in Film No. 1 as a useful teaching diagram.Neutron capture processes are described with the gammaemission and particle ejection reactions being studied.Nuclear fission is also discussed. As an example of thecalculations involved in nuclear reactions, the filmdescribes the activation of a gold sample in a nuclearreactor. Emphasis is placed Oh the minute quantitieswhich can be detected with the subsequent applications to thetechnique of activation analysis. It is shown thathundredths of a part per billion of certain materialscan be detected by nuclear techniques. AEC

Understanding the Atom: Properties of Radiation (1962) -30 minutes

This film includes a discussion of general problemsof radiation decay, such as the laws of radioactive decay,including the concept of half life, Statistical considera-tions are introduced and the basic notion of the standarddeviation in counts expected in various experiments is

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4

described. The energy spectrum from alpha and betaemitters is considered, and the use of absorption curves tostudy the energy distribution of beta radiation is introduced.The density thickness expressed in milligrams per squarecentimeter is introduced as a useful term. ThAl filmalso considers problems of self-absorption, special activity,and backscattering of radiation. AEC

Understanding the Atom: Radiation and Matter (1962) -44 minutes

This film, which considers the interaction of radiationwith matter, develops the various processes by which alpha,beta, and gamma radiation give up energy to their surroundings.The similarities and differences of alpha and betaparticles are considered, with emphasis on the methods bywhich ionization occurs. It is pointed out that sincethe interaction of radiations in the absorption processtakes place essentially only with orbital electrons on theatoms, the density of electrons in matter is the determiningfactor. The relation between energy of a particle and thenumber of ion pairs formed is also explained. The lecturerfollows with a discussion of gamma, or electromagneticradiation, which is described as a non-ionizing event interms of the initial interaction between photons and atoms.Four possibilities of gamma-ray absorption (Excitation,photo-electric effect, Compton effect, and pair production)are discussed. The viewer, however, is alerted to thefact that there is only a certain probability that oneparticular process may take place rather than another,depending upon the energy of the gamma ray. This probability,expressed as absorption coefficient, is then related to eachof the four absorption processes. AEC

REACTORS

Atomic Furnaces (Challenge Film No. 4)

The operation, principl3s, and scientific applicationsof nuclear reactors, used as research tools in various projectsare briefly described. Types of research that reactorsand associated equipment make possible are shown at length.The Gamma Ray Spectrometer, the Neutron Chopper, and anew reactor designed specifically for high-and low-radiationexperiments in biology are also described.

Criticality - 22 minutes; 16 mm; color.

This film discusses the theory of criticality,

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and describes the conditions which will produce it, emphas-izing the importance of mass, shape and moderation.Included are many examples of precautions which must be takenin industry to assure that fissionable material will not becomecritical. AEC

Medical Research Reactor (1958) - 22 minutes; 16 mm; color andsound

This film, prepared primarily for those concerned withthe design and utilization of reactors for medical researchdemonstrates the need for such a reactor and defines thedesign criteria. The reactor and its components are shownduring construction and assembly. Operation of the reactorand shutters controlling its neutron beam are shown by anima--tion. There is also a neutron-capture therapy experimentsequence at the Brookhaven graphite reactor which canbe compared with the patient treatment facility at thenew medical reactor. AEC

ACCELERATORS

High Energy Particle Accelerators (1958) - 30 minutes;16 mm; color and sound.

This technical film surveys the work of particleaccelerators in high-energy physics, shows the majoraccelerator installations in the U. S., major acceleratorsunder construction, and a series of typical experiments withhigh-energy particles. It explains, with both live actionand animation, the components and operations of varioustypes of accelerators and gives a description of bubblechambers. The film features information on the followingoperating accelerators: the Brookhaven National LaboratoryCosmotron (proton-synchrotron), the University of CaliforniaRadiation Laboratory's Bevatron (largest proton-synchrotronoperating in the U.S., as of the fall of 1958), the CaliforniaInstitute of Technology electron-synchrotron, the CornellUniversity electron-synchrotron, and Stanford University'slinear accelerator; also, construction work and principlesof the Princeton University - University of Pennsylvaniasynchrotron (Cosmotron type), Argonne National Laboratory'sproton-synchrotron (up to 12 Bev), Brookhaven's alternatingGradient Synchrotron (25-30 Bev), and the Harvard-MITAlternating Gradient Electron Synchrotron (6 Bev). Alsoincluded are brief data on studies at Stanford, Oak Ridge,and Midwestern Universities Research Association on the

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linear, spiral magnet, and fixed-field alternatinggradients types, respectively. AEC

High Energy Radiations for Mankind (1958) - 16 minutesit mm; sound, color.

This semi-technical film, for high school and college-level audiences, describes the principles, assembly anduses of the Van de Graaff particle accelerator toproduce intense stable controlled beams of all basicradiation for basic and applied research, industrial process-ing, chemistry, metallurgy, and biology and medicine.It shows stages of assembly, testing and use of verticaland horizontal machines ranging from 1 to 6 million electronvolts; the Microwave Linear Accelerator; and the 10-Mev Tandem Van de Graaff for exploring the binding energyof heavier elements. Examples include use for basic research,nuclear engineering, petrochemistry, drug sterilization,food preservation, radiography, and cancer treatment. AEC

Atom Smashers (1954)

Explains purposes, principles and methods of particleaccelerators. Shows how swift atomic projectiles "smash"atomic nuclei apart for scientific examination of subatomicparticles. Views of various particle accelerators, includingthe first 4-inch Cyclotron, the giant Bevatron, the Cosmotron,and of photographic trails left by smashed atoms. AEC

Searching for the Ultimate (Challenge Film No. 3)

Atomic structure, one of the most basic forms ofnuclear research, permits the scientist to discover thenature of the universe through the use of atom smashersor particle accelerators. The machines produce intensebeams of radiation which enable study of the structure ofthe atom, the nucleus, and the basic components of thenucleus. This film explains how accelerators operate andshows one of the world's largest particle acceleratorsbeing constructed. Sub-nuclear particles and the conceptof matter and anti-matter are also explained. AEC

DETECTION AND MEASURMENT OF IONIZING RADIATION

Properties of Radiation (PMF-5145-B) - 68 minutes.

This film shows a Geiger counter used to compare

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penetrations of alpha, beta, and gamma radiation and toderive their characteristic absorption curves. Thebeta-radiation section of the film presents the cloud -c )iamber electrostatic generator ana beta-ray spectrometeras well as the concepts of ionization, electron volt, beta-rayspectrum, neutrino, scattering, nonlinear absorption,and density thickness (mg/cm4). The gamma-radiation sectionexplains bremsstrahlung, photoelectric effect, Compton Scatter-ing, pair production, exponential absorption, absorptioncoefficient, and half thickness. The final section concernsthe interpretation of composite absorption curves. ARMY

Understanding the Atom: Radiation Detected by Ionization (1962)-30 minutes

The basic principles of ionization detectors aredescribed, particularly in relation to the pulse heightas a function of voltage curves. Brief descriptions ofionization chambers, proportional counters, and Geigercounters are included, and examples of instruments operatingin these regions are shown. Special consideration isgiven to Geiger counters, including the mechanism of gasquenching and the determination of a counting-rate plateau.The resolving time of a counter is discussed, as well asvarious components of a practical instrument, includingamplifiers and scalers. AEC

Understanding the Atom: Radiation Detection by Scintillation(1962) - 30 minutes

A short review of gamma interactions with matter isshown, with particular reference to useful scintillationcrystals. The scintillation process is described, andthe efficAency of the conversion of gamma radiation tovisible light in the scintillator is discussed. Solidand liquid scintillators are shown along with specialdetection devices using this principle. A descriptionof the operation of a photomultiplier tube is given, and theconcept of pulse height is developed. The principle ofoperation of a pulse-height analyzer is shown, and thespectrum obtained with such an instrument is shown anddiscussed. Brief mention is made of solid state radiationdetectors. AEC

The Roentgen - 15 minutes; 16 mm; black and white, sound.

This film develops the concept, definition, and measure-ment of the Roentgen unit. By way of introduction, the

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relative penetrating and ionizing abilities of the varioustypes of ionizing radiation are compared. This is followedby illustrations of the production of ion pairs by x- andgamma radiation and a pictorial demonstration of the conceptsof secondary electron equilibrium and air equivalent walls. AEC

Introduction to Radiation Detection Instruments - 19 minutes;---16 mm; black and white.

This film presents the fundamentals necessary to anunderstanding of the theory of operation of radiationdetection instruments. Emphasis is on the need for instrumentsfor detection as our senses are unable to detect ionizingradiation. It includes a brief description of a dosimeter,pocket chamber, ion chamber survey meter, alpha portablesurvey meter, Geiger-Mueller tube and a Geiger-Muelle-type survey meter. A discussion is included of the penetrat-ing ability of alpha, beta, and gamma rays, calibration ofinstruments, and their use in the event of disaster.Laboratory instruments are shown as used in more detailedanalysis. A brief description of film-badge monitoring isalso included. A radiological monitoring group is shown inaction as they evaluate various radiological hazards. AEC

Practical Procedures of Measurement(The Radioisotope - Film III)48 minutes; 16 mm; black and white.

The user of radionuclides must be concerned withradiation measuramente for safety and experimental purposes.Several sequences cover the principles and use of varioustypes of instrumuntation, with emphasis on the Geiger counter,and illustrate background, threshold value, plateau, andcounting statistics. The remaining part of the filmis devoted to absolute measurchAnt, wherein the trueactivity of a iiifoliTs determined by using a calibratedstandard, and comparative measurement, wherein the activityof a sample is sE5mTiiirgith that of a control sample inorder to determine the quantitative change it ,Activitywhich resulted from decay or dilution. ABC

Beta Ray_ Spectrometer (1963) - 7 minutes; 16 mm color and sound.

By animation and live action, this film explains theprinciples and working of the Coincidence Beta Ray Spectrometer,a device which is used to measure to intensity and directionof electron emissions known as beta particles. Components

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of the device are shown and assembled. A source is introduced.Mashing for beam direction and size is demonstrated. Detectorsare shown and explained. AEC

RADIOCHEMISTRY

The Atomic Pharmacy (1954)

Describes the storage and handling of radioisotopes,and illustrates remote-control devices for safe manipulationof radioactive liquids. Explains use of radioisotopesin hospitals, research laboratories, and industrial facilities.AEC

Tagging the Atom (1954)

Describes the use of radioisotope "tracers" as scientificresearch tools. Shows details of radioisotope production,methods of handling, purification, and packaging. AEC

The Art of Separation- (Challenge Film No. 12)

This film deals with the separation of chemicalcompounds into basic substances in the purest form possibleby the process known as chromatography and with the import-ance of that process in chemistry work. Using radiation, thechemist is able to work with much greater speed and ease inthe field of chromatography. The basic principles and Variousmethods of modern chromatography are explained and demonstrated.Actual separation of a chemical compound is shown. AEC

Isotopes. (1959) - 20 minutes I 16 mmt color and sound

TAie film describes the production of stable isotopesand radioisotopes and the separation of fission products.The first part of the film explains, in layman's language,radioactivity, half life, and the three methods of producingradioisotopes. Live photography and animation tell thestory of radioisotopes production at the Oak Ridge NationalLaroratory (ORNL) , The remainder of the film explains,in semitechnical language, the large-scale separation oflong-life fission products at ORNL's pilot plant. Animationillustrates in detail the separation of fission productsfrom wastes derived during the processing of spent reactorfuels. AEC

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2 - RADIATION HAZARDS

GENERAL PRINCIPLES

Radiation Protection in Nuclear Medicine (1962)- 45 minutes1-6 mm; color and sound.

This semitechnical film demonstrates the proceduresdevised for naval hospitals to protect against the gammaradiation emitted from materials used in radiation therapy.However, its principles are applicable in all hospitals.The practices demonstrated are based on three principlesestablished at the outset. The film explains the nature ofgamma radiation relative to how time, distance, and shieldingare used to provide protection from its harmful effects.Time is considered in two ways: (1) the half life of theradioactive materials used and (2) the speed in handlingthem. The film shows the continuous application of theseprinciples from the moment radioactive materials arereceived at a hospital, through their storage,their preparation for use, their therapeutic administration,the nursing care of radioactive patients, and the disposalof radioactive human waste. The film details the specialtechniques and equipment used in the handling of radiumand radioactive gold, iodine, and iridium as representingthe variety of such materials that hospital personnelencounter and the consequent variations in time, distanceand shielding employed as protection against them. The useof monitoring devices and the maintenance of records oftheir readings form a recurrent theme throughout the film.It makes the dual point that radiological-safety recordsaro used (1) to provide immediate protection for hospice'personnel and (2) as a basis on which the stff canreevaluate and improve techniques, always with the purposeof keeping the exposure of each person below the establishedmaximum permissible levels. AEC

Radiation in Perspective (1963) - 43 minutes; 16 mm; sound, color.

The film, in the form of a lecture by CommissionSafety Engineer Francis L. Brannigan, presents the salientpoints of an approach to the understanding of the radiationproblem which has been found useful for persons requiringa layman's understanding of the nature of radiation -- suchas teachers groups, public safety officials, transportationexecutives, insurance executives, service clubs, collegesand universities, etc. The film will also be useful to those

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technically qualified, since it demonstrates proven techniquesfor explaining the radiation hazard to the layman. Sinceis it basic to the acceptance of any hazard that we expect toget some benefit from it, the lecture-film briefly summarizessome of the beneficial uses of radioactive materials -- inmedicine, agriculture, industry, systems for nuclear auxiliarypower, food sterilization -- that justify acceptance ofthe hazard. The lecturer then explains briefly theinternal radiation problem, and in detail the externalradiation problem. Information is given on ionization,background levels of radiation, the roentgen, the radiationlevels required to produce immediate injury and low-levelradiation exposures over long periods of time. The lecturerdiscusses the somatic effects (on the individual) andgenetic effects (on future generations), and makes acomparison of the acceptable-versus-dangerous levels forradiation with that of the levels for carbon monoxide, toshow the conservative nature of radiation regulations.An explanation is given of time, distance and shieldingand how they are used to control external radiation exposure.The lecturer points out that the question is not radiationversus no radiation, but rather how much more radiationpeople can accept consistent with the other hazards of ourenvironment -- all balanced against the tremendous indust-rial, medical and research benefits of the nuclear age.He summarizes and concludes: "Radiation is another of thehazards with which we must deal as we make progress in ourindustrial age. Radiation energy in quantity can damageliving tissue. However, within limits we can live withthis problem so that we can obtain the benefits of theatomic age. This parallels our acceptance of other hazards.There is a tremendous spread between the routinely acceptableoperating radiation levels and the dangerous levels -- manythousands of times greater than the corresponding spreadfor other hazards. All radiation contributes to but isnot the sole cause of mankind's genetic problems.The proportion due to atomic energy is very small. Theconclusion is clear: we can enjoy the benefits of thenuclear age with safety to employees and the public." AEC

Understanding the Atom: Radiological Safe_ _y - 30Minutes; 16 mml black and white, sound.

Part seven of this series examines the field of radio-logical safety or health physics, and tries to give a basisfor a perspective on potential biological radiation damage.It first considers background radiation and the natureof the difference in this radiation. Larger doses of radiation

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can be a potential cause of both somatic (direct bodily).damage and genetic (hereditary) damaye, and considerationis given to the maximum permissible limits or radiationguide levels which have been established by various radiolo-gical protection committees and the Federal Radiation Council.Various units are described, with these including theroentgen, the rad, and the rem. The latter unit is ameasure of the biological dose equivalent and considers therelative biological effectiveness (RBE) of the radiation.Consideration is also given to the maximum permissibleconcentration of radioisotopesin air or water, and theproblems involved in the localization of radioactive materialsin the body. Various factors that mutt be controlled inreducing the radiation hazard include the quantity ofradioactive material, the distance, the time of exposureand shielding. Internal exposure must be minimized bythe use of special laboratory facilities and techniqueswhich are required to minimize the admission of radio-active isotopes into the body. The importance of havingcalibrated instruments available is stressed in any programinvolving the use of radiation sources. AEC

Practice of Radiological Safety (PMF-5145-F) - 33 minutes.

This film depicts a visit through a radioisotopelaboratory and discusses handling of radioisotope shipments;preparation of therapeutic doses; need for, and functionof a local radioisotope committee; laboratory design;decontamination; use of shielding; measurement of personnelexposure, an other topics pertinent to health safety. ARMY

Atomic Biology for Medicine (1956)

Explains experiments to discover effects of radiationon mammals, including effects on lungs, eyes, bones andother tissues, cell division, and tumors. AEC

Living with the Atom (1960) - 18 minutes; 16 mm sound, color.

This nontechnical film for intermediate throughcollege-level audiences, explains the radiation safety devicesand procedures used to protect workers in the atomicindustry, which is among the efest of U. S. heavy Industries.Through the viewpoint of a community representative talkingwith the health physicist of a nearby atomic installation,the film also details the precaution taken for thefrotection of the communities. AEC

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Living with Radiation (1958) - 28 minutes; 16 mm; sound, color.

This semitechnical film, for intermediate throughcollege-level audiences, documents in detail the radiationsafety program of the U. S. atomic energy program, usingprocedures at the National Reactor Testing Station inIdaho as typical, illustrative examples. It explains:separation-distance factor; storage and/or disposal ofradioactive waste; protection of populations, water,crops and livestock by monitoring of air and environment;remote-control devices, radiation counters, decontaminationprocedures, and bio-medical studieb. AEC

A matter of Contamination Sense - 10 minutes; 16 mm;Black and white.

This is a short relatively humorous film showing a case ofcontamination in a nuclear installation. It stresses commonsense and points out several possible ways a person mightbecome unknowingly contaminated. AEC

Principles of Radiological Safety (PMF-5145-E) - 51 minutes.

This film introduces concepts of internal and externaland acute and chronic radiation exposure by means of ahistorical sequence on hazards Associated with X-ray andradium therapy and radium-dial painting. A discussion ofionization from external and internal sources of alpha,beta and gamma radiation, with detailed explanations ofroentgen and "equivalent" or "energy" roentgen, is presented.Maximum permissible exposure and the theory of radiation-measuring instruments are also discussed. Formulas aredeveloped for computing dosage rates from internal sources.Concepts of single and continued uptake, physical decayand biological elimination of activity, biological halflife and effective half life are considered. The responsibi-lity of the radioisotope user to other members of the labora-tory and to the public is emphasized. ARMY

Bikini Radiolo ;cal (1949) - 22 minutes;mm; sound, color.

This nontechnical film, for intermediate through college-level audiences, explains studies of effects of radioactivityfrom the 1496 atomic tests at Bikini Atoll, on plants andmarine life in the area threl years latter. AEC

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Building Blocks of Life (Challenge Film No. 8)

Unique fragments of molecules caused by radiationin living systems, which are known as free radicals,either kill or seriously damage living cells. The howand why of both the particles and the damage they causeis the topic of this film. AEC

Radiation and the Population (Challenge Film No. 5)

Because genetic damage is one of the most seriouseffects of radiation, the U. S. Atomic Energy Commissiongenetics program is desi211ed to learn how radiationdamages cells and what the long term effects of suchdamage might be. This film explains how radiationcauses mutations and how these mutations are passedon to succeeding generations. Mutation research isillustrated with results of experimentation on generationsof mice and includes discussion of work with fruit fliesand induced mutations. Fallout and its implicationsare also discussed. AEC

Radiation as a Cause of Cancer - 20 minutes; 16 mm .

co or.

This film presents an explanation of the histologicalstep-by-step formation of cancer in various experimentalanimals and man after exposure to ionizing radiations.A brief review is made of basic atomic structure, radio-activity, and interaction of radiation with tissue;free radical formation is discussed in some detail.Also shown is an interesting experiment in which rats,re fitted with jackets lined with strontium-90 beads.After a suitable exposure and ensuing latent period,skin cancer appears in the test animals. The carcino-genic hazards of external skin exposure are comparedwith internal exposures resulting from the uptakeof radioactive materials by the gastrointestinal tractand the respiratory system. AEC

Tale of Two Cities (1947) - 20 minutes= 16 mm: sound,lack and w tee.

This nontechnical film, for intermediate throughcollege-level audiences, shows the destructive resultsof atomic bombings of Hiroshima and Nagasaki, withclose-ups of effects on buildings and materials. AEC

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MONITORING

Primer on Monitoring (1953) - 30 minutes; 16 mm; sound, color.

This semitechnical film, for high school and college-level audiences, describes the different types of radiation,various devices for monitoring each type, andthe basic principles of health monitoring procedures. AEC

Offdite Monitoring of Fallout During Nuclear Tests - 29 min-utes; 16 mm; color.

This film describes the radiological safety activitiesof the Public Health Service in the offsite area of theU. S. Atomic Energy Commission's Nevada Test Site - a300-mile radius, including portions of Nevada, California,Utah, and Arizona. Included is a description of thetraining provided PHS Commissioned Reservists from statehealth departments, universities, and industry; monitoringand public information activities of representativePHS Sone Commanders; methods of collection, and laboratoryanalysis of environmental samples. AEC

Protecting the Atomic Worker (1954)

Explains safeguards used to rrotect men and womenworking closely with radiations film badges, ionizationpencils, shielding, decontamination, laundry, healthmonitors, blood counts, breath testing, and health records.AEC

K:BELLiamakza - 21 minutes; 16 mm; black and white.

The theory of x-ray production and the applicationof the principle of differential absorption of x-raysin a medium to radiographic inspection of metallicartifacts are briefly discussed. The procedures ofsimple radiographic inspection of a cast gear blankare shown in detail, from the technician's viewpoint.Some x-ray protection principles are mentioned. Releasedby United World Films, Inc. AEC

Radiation and Public Health (1965)-25 minutes; 16 mm;iotriarct=-114711)Describes th!! current activities of the Diviaion of

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Radiological Health, U. S. Public Health Service, directedtoward the development of a nation-wide Federal-StateHealth Agency program capable of insuring that thebenefits of radiation are accrued with a minumum ofhealth risks to the public. It depicts the measurementand surwdillance of environmental radiation to determinethe extent of human radiation exposure; the developmentof methodology for exposure reduction control; researchin radiology; epidemiology and environmental sciencestraining of scientific manpower; assistance to Stateand local Health Departments. Scientific projects featuredin the film include: institutional diet sampling,radiochemical analyses of environmental samples, X-rayexposura assessment, thyotoxicosis followup, training,and assistance to State radioactive materials controlprograms. U. S. PUBLIC HEALTH SERVICE

PROTECTION

Modification of Radiation Injury in Mice (1958) - 10minutes; 16 mm; color and sound.

This film shows the effects on mice of chemicalprotection by mercaptoethylguanidine (MEG) L2foreirradiation and bone-marrow transplant after exposureto lethal doses of 900 r, as well as possible implicationsregarding treatment of some human diseases. The irradi-ation that kills 50 per cent of mice in 30 days canbe doubled with MEG protection and nearly doubled withbone-marrow treatment. With chemical protection followedby bone-marrow treatment, the dose of irradiation thatit takes to kill 50 percent of mice it 30 days cannearly be tripled. MEG reduced the effect of a lethaldose of 900-r X irradiation on the bone marrow, spleen,thymus, and body weight by about a factor of 2. MEGis not effective when given after irradiation. Bone-marrow injection was primarily responsible for replacingthe destroyed bone marrow. It is not effective whengiven before irradiation. In combined treatment, theanimal received the advantages of both types of therapy andsurvived much greater exposure. AEC

You Can Be Safe112ELLEAtt - 10 minutes; 16 mm; blackand white.

This film is intended for those whose occupationsnecessitate frequent exposure to x-radiations. Emphasisedare the facts that penetrating radiation cannot be detected

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by one's five senses and radiation damage is cumulativeand may not be noticed until permanent harm has beendone. With illustrations in animation, the film isprimarily designed for photofluorographic operatorsmaking mass chest x-ray surveys. It has many well-illustrated public health principles equally of interestto anyone engaged in x-ray work. AEC

Radioactive Waste Disposal (1961) M-443 - 24 minutes;16 mm; sound, color

Shows extreme precautions used at the NationalInstitutes of Health in handling radioactive wasteand the care used in its ultimate disposal in the ocean.U. S. PUBLIC HEALTH SERVICE

Radiation M-461 (1962)24 minutes; mm; sour color.

Depicts the activities of the Division of RadiologicalHealth of the Public Health Service, showing publichealth programs designed for protection against radiation.U. S. PUBLIC HEALTH SERVICE & AEC

3A - BIOLOGICAL APPLICATIONS

The Atom and Biological Science (1953) - 12 minutes;mm; sound, black and white.

This is a technical film for intermediate throughcollege-level audiences. It identifies and illustratesuses of radioactivity in several areas of biology:effects of radiation on growth and heredity of plantsand animals; tracer studies: photosynthesis studies;and measures to protect the investigating scientists. AEC

Chromosome Labelin B Tritium (1950) - 15 minutes; 16 mm;(3Ior an sound.

This film discussed the advantages of tritum overother radioisotopes as labeling material in autoradiography.AEC

The immtine Resenss (Challenge Film No 7)

This film is concerned with the mechanism by which

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the body builds antibodies against disease and otherforeign substances. The effects of irradiation ofrabbits with X-rays are shown and conclusions are discussed. AEC

The Living Solid (Challenge Film No. 9)

This film shows that bone is not a faikly stablesubstance but is active, living matter, constantlyremodeling and reforming itself. The importance ofbone to the entire body as a supplier of calcium isemphasized, and the systems by which this calcium getsfrom bone to blood and vice versa are illustrated.Effects of radiation are illustrated in photographs ofbone cross-section. AEC

Liquid Scintillation Counting (1958) - 14 minutes; 16 mm=sound and color.

This film describes the use of a liquid scintillatorfor counting low-energy beta emitters commonly used inbiological and medical tracer experiments. It alsoexplains the advantages of the single- and double-photomultiplier tube liquid scintillation countersover the solid-phase and gas-phase counters, e. g.the ease of sample preparation, high efficiency, andexcellent sensitivity. The filn describes countingtechniques, how the counters work, and how a sampleis prepared. Liquid scintillation counting is anextremely useful technique, particularly for weak betaemitters, such as C and tritium, where the number ofsamples to be counted places a premium on the ease ofsample preparation. AEC

The Radioisotope: Methodology (PMF-5145-D) - 40 minutes.

This film contains a historical sequence showing theearly work of Hevesy in studying plant metabolism withnaturally occurring radiolead, after which it explainsseven criteria for setting up a tracer experiment: (1)

radiochemical purity, (2) single chemical state, (3)e-limination of exchange error, (4) knowledge of the degree.to which the labeled molecules remain intact, (5) avoid-ance of isotope effect, (6) avoidance of chemical effectsand (7) avoidance of radiation effects. The film alsoillustrates the relative importance of economy of timeand materials and accuracy by depicting a typicalbiological tracer experiment from the formation of anidea to the final results. ARMY

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Time -- The Surest Poison (Challenge Film No. 6)

This film explores the natural process of aging andthe methods used in its study. Aging might be consideredone of the deleterious side effects of radiation sinceradiation injury resembles natural aging in so many ways.Results of study of the aging process involving the useof radiation are presented. The conduct of researchon animals using low-level gamma irradiation is illustrated.AEC

Micro uncture of Cells b U. V. Microbeam (624) - 20m nu es; b acx and w te, soun .

Marcel Bessis, M.D. - A pictorial record showing inmotion picture form the results obtained from irradiatingvarious cells, either wholly or in part. SQUIBB

Death of a Cell (571) - 15 minutes; black and whitel.sound.

Marcel Bessis, M. D. - Uses phase contrast microscopyand time lapse photography to show the complex anatomicalchanges that occur in cells during death produced byvarious mechanisms. SQUIBB

Anatomy of the Cell (612) - 20 minutes; black and white,sound.

Marcel Bessis, M. D. - Uses phase contrast microscopyand time lapse photography to show now cells function,multiply, suffer and having served their purpose, die.SQUIBB

3B - MEDICAL APPLICATIONS

MEDICAL RESEARCH APPLICATION OP RAD/OISOTOPEE

Tracing Living Cells, (Challenge Film No. 11)

Radioactivity is often mankind's servant. In recentyears, the use of radioactive isotopes in the study ofcell divirion and in medical therapy has helped man overcomedisease. This film demonstrates some of the manyhelpful and healthful uses of atomic energy, includinguae of radioactive tracers in blood and cancer research.AEC

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Ionizing Radiation in Humans (1958) - 15 minutes; 16 mm;color an sound.

This film shows the design and operation of ArgonneNational Laboratory's whole body counter for determiningidentification, quantity, and location of internallydeposited radioelements. Various techniques in accumulationof data, the tilting chair, one meter arc, and collimatingthe crystal are also shown. AEC

Human Radioactivity Measurements (1958) - 9 minutes;16 mm; color and sound.

This film shows a method developed at Los AlamosScientific Laboratory to monitor personnel exposed to thepossible intake of gamma-emitting materials and tostudy the retention and excretion of radioactive isotopesby the body. The liquid scintillation counter is largeenough to contain a man and sensitive enough to detecteven the minute amounts of his natural gamma radioactivity.AEC

The Atomic Apothecar (1954) - 38 minutes; 16 mm; blackand white, sounn .

This film discusses radioisotope research in biologyand medicine, including research in radioactive dust,calcium absorption in animals and effects of radioiodinein their diet; use of astatine, effect on blood flow,oxygen tension studies, radioactive iron in bone marrow,arteriosclerosis, and the use of cyteine. AEC

CLINICAL APPLICATIONS OF RADIOISOTOPES

GENERAL APPLICATIONS

Too Hot To Handle -- The Two Faces of Radiation - 1 hour,lack an w ite.

Excellent survey of diagnostic and therapeuticmedical uses of radioisotopes. Also covers radiationbiology in a very effective set of presentations by someof the major researchers in this field. ROBECK

The Atom in the Hospital (1961)

At the City of Hope Medical Center, the followingfacilities are shown: (1) the stationary cobalt source

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that uses radioactivn cobalt to treat various forms ofmalignancies; (2) a rotational therapy unit called the"cesium ring," which revolves around the patient andfocuses its beam on the diseased area; and (3) the total-body irradiation chamber for studying the effects ofradiation on living things. Studies can be carried outto determine the effects of massive doses of radiation.Data from these studies will be used for civil defensepurposes, for investigating skin grafts and organ trans-plants, etc. At the UCLA Medical Center the total-bodycounter facility, which measures the slight radioactivitynormally present in the animal or human body, is shown.The counting facility makes it possible to employ newdiagnostic procedures requiring much smaller amounts ofradioactive materials by eliminating practically allbackground radiation. AEC

The Atom and the Doctor (1954)

Shows three applications of radioisotopes inmedicine; testing for leukemia and other blood disorderswith radioiron; diagnosis of thyroid conditions withradioiodine "cocktailS," and cancer research withradiogallium. AEC

Medicine (1957) - 20 minutes; 16 mm; sound, color.

This nontechnical film gives four illustrations ofthe use of radioactive materials in diagnosis and therapy;exact pre-operative location of brain tumor; scanning andcharting of thyroids; cancer therapy research and thestudy of blood diseases and hardening of the arteries. AEC

Radioisotopes: Their Application to Huhs (1954)

32 minutes; 16 mm; color and sound.

This film is a comprehensive review of the uses ofradioisotopes in hilman applications as tracer studies andfor therapeutic use. Uses of radioactive iodine, sodium,iron, calcium, lanthanum, strontium, cobalt, phosphorus,gold, and the neutron-capture therapy involving boron fortreatment of brain tumors are also discussed. AEC

Radiation: Ph sician and Patient - 45 minutes; 16 mm; color.

This film is essentially an informal talk by Dr. Richard

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H. Chamberlain (of the University of Pennsylvania Schoolof Medicine and member of the National Committee onRadiation Protection and Measurements) about medicalradiology -- the problem it raises; its biologicaleffects; its physical behaviour; and its proper use inclinical examination. Many eminent authorities in theradio-biological field, who are interviewed in theirown laboratories, discuss such matters as radiationeffects on chromosomes, somatic effeots of radiation, anddosage problems in radiation and clinical application. AEC

The Atom Comes to Town - 27 minutes; color 21st CenturyTelevision Series, "CBS Presents", Walter Cronkite.

Popular level film which surveys the followingtopics in language which is easily understood by non-technical as well as technical workers: Whole bodycounting, reactors used for isotope production, differenttypes of labelled compounds and their use in scanningprocedures, Ca:bon-14 breath studies, and radioactiveisntol?o pom Supplies. Different forms of radiotherapyincluding "LI, extracorporeal irradiation, pituitaryirradiation with radioactive seeds, cobalt therapy, andthe uses of computers in '.treatment planning are presentedin a well done non-technical film.

Radiation: Silent Servant of Mankind.(1956)

Depicts four uses of controlled radiation to benefitmankind: bombardment of plants from a radioactivecobalt source, to induce genetic changes for study andcrop improvement; irradiation of deep-seated tumors witha beam from a particle accelerator; therapy of thyroidcancer with radioactive iodine; and possibilities fortreating brain tumors.. AEC

R24123t2T1209LVILEESZIEt22AlyhYsician (1958)m ; mm; color and sour .

This film illustrates the purification and processingof radioisotopes to render them suitable for use by thephysician. Emphasis is placed upon the production ofvarious radiopharmaceuticals in encapsulated form,together with methods used for their assay and standardiz-ation. A clinical section deals with the newestmethods of thyroid uptakes, new iodine therapy, and theuse of Racobalamin (R) (radiocyanocobalamin) and Raolein(radioiodinated triolein) for the diagnosis of pernicious

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anemia and faulty fat absorption, respectively. AEC

From Head to Toe

Documentary type film. ABBOTT

PARTICULAR APPLICATIONS

Iodine - 131 (1958) - 15 minutes; 16 ;um; color and sound.

This film shows the diagnostic and therapeutic usesof the radioisotope 1131 for hyperthyroidism, thyroid cancer,and heart disease. The characteristics, techniques, andresults are discussed, as well as the problems of standard-,ization and calibration of scanning devices for 1131, whichis probably the most used isotope in the field of medicine.AEC

Clinical Organ Photoscanning - 3 reels; 25 minutes each; 16 mm;

Dr. Henry Wagner, (The Johns Hopkins Hospital),presents examples and discusses the role of radionuclideorgan scanning in different clinical situations. Thyroid,lung, blood flow, liver, spleen scans and bolus studiesare presented and discussed. This film is an excellentpresentation for residents and practitioners as anintroduction to the role of scanning studies in medicine.NAVY

The Radioisoto ic Reno ram in Renovascular H extension20 minutes; 16 ;um; color, sound. James L. Quinn III,M.D. and Joseph E. Whitley, M.D.

The authors indicate that the radioisotope renogramcan contribute significantly to the diagnosis of renovasc-ular hypertension. The acceleration of the vascularphase of the renogram to monitor the inflow pattern ofradioactivity into the renal bed, has increased thediagnostic accuracy of the renogram in their hands,especially in bilateral renal artery disease. Themethod of performing and interpreting the "modifiedrenogram" or renovasculogram is described. The attendantartifacts and pitfalls of interpretation are discussed.The coordinated role of the contrast urogram, radioisotoperenogram and renal arteriouram in the diagnosis of reno-vascular hypertension is stressed. The more common

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abnormalities of each of these examinations are illustrated.SQUIBB

RISA Cxsternography and Ventriculography (1968) - 20 minutes16 MM.

An excellent film by Dr. DiChiro describing thedynamics of cerebrospinal fluid production and distribu-tion in normal and abnormal situations. Illustratesthe way in which this technique can be used clinically.(Author, NIH)

P-32 Thera y and Joint Scanning-3 reels; 25 minutes each1 mm.

Dr. Bill Maxfield discusses the biological turnoverof P-32 and the different ways in which it is used in thetherapy of polycethemia vera. The relationship betweenP-32 therapy and the subsequent appearance of leukemiais discussed in the light of the most recent knowledgederived from the studies of large numbers of patientsso treated. The use of P-32 plus testosterone for thetreatment of patients with breast cancer metastases tobone is presented. Therapeutic regiment and expectedoutcome are presented. The 3rd reel describes the useof scanning techniques for the study of joints in patientswith arthritis. NAVY

Detection of Occult Bone Metastases - 3 reels; 25 minuteseach; 16 mm.

Dr. David Charkes (Albert Einstein Medical Center)describes the clinical use of bone scanning with radioiso-topes. Normal and abnormal bone metabolism are discussedalong with the way in which isotopes have contributedto knowledge in this area. Emphasis is placed on evaluatingpatients with neoplasms for metastases to bone. NAVY

TeJetherapy and Brachytherapy (1958) - 18 minutes; 16 mm;color and sound.

This film shows the diagnostic and therapeutic usesof such radioisotopes as c0601 cs137, Eu152-41 11311 andY90 in ftletherapy and brachytherapy by using machinesthat aim a high-energy beam at a tumor or by using implantsof radioactive materials in the form of needles, beads,sterile tubinglseeds, etc. AEC

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Iridium -192 Implant for Cancer of the Floor of the Mouth(631) - 1., minutes 16 mm; color, sound.

This film, from the Tumor Institute of the SwedishHospital, Seattle, Washington, demonstrates an iridium-192implant for cancer of the floor of the mouth. A 62 yearold male with large submandibular metastases bilaterallyfrom a squamous cell carcinoma under the tongue isimplanted with iridium-192 seeds in nylon tubing as apart of the radiation therapy for his disease. SQUIBB

4 - INDUSTRIAL APPLICATIONS

The Atom Comes to Town - 29 minutes; 16 mm; color and sound.A survey 151thepeacetime uses of atomic energy.

Included: How heat from nuclear fission in a reactor canbe used to make electricity, and what nuclear power willmean to the man on the street and to all of America: Scenesof various experimental and prototype power plants, withdiscussion of types, kilowatt capacity, principles andfuture developments: Explanation of radioisotopes -how they awe made and how they are used to alleviatesuffering and raise the standard of living; Uses ofradioactive materials in diagnosis and treatment ofdisease: Use of radionuclides in agriculture forproduction of better crops: Atomic energy as a means ofquality control in manufacturing and industrial operations(studies on washing machines, engine wear, tires, tooth-paste, plastics): Food preservation by radiologicaltechniques. AEC

The Atom and You (1953) - 16 minutes; 16 mm; sound,7-7---S1aek and white.

This nontechnical film, for all audience levels,consolidates three newsreels covering the use ofradioisotopes in biology, medicine, agriculture andindustry, and also the development of atomic power. AEC

Foundations for the Future (Challenge Film No. 13)

Problems that are still to be solved by nuclear scien-tists are discussed in this film. Akeas of particularinterest to the scientist in his work now and in thefuture are identified as being the effects of radiation,the peaceful uses of radiation, and the dangers ofradiation. AEC

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Gauging Thickness with Radioisotopes - 4 1/2 minutes;mm; black and white, sound.

This brief film explains how beta gauges are usedfor precise measurement and control of feedback apparatusin steel, plastics, rubber, and paper manufacturing.AEC

Industrial Applications of Radioisotopes - 57 minutes;16 mm; color.

This semi-technical film surveys the current wide-spread uses of radionuclides throughout American industry.Three major areas of use are described: nuclear gaging(thickness, density and level), radiography and tracing.Luminescence, static elimination, isotopic power and usesof high intensity radiation are covered briefly. Basicprinciples are explained by animation, followed byexamples of in-plant uses. The film is designed toacquaint industrial management with the versatility,economy and ease with which radioisotope techniquescan be adapted to plant requirements. AEC

The Mighty Atom - 27 minutes, color. 21st Century TVSeries, CBS Presents" - Walter Cronkite.

Popular level film which surveys the followingtopics in language which is easily understood.by non-technical as well as technical workers: OperationPlowshare, reactors used as a source of electricalpower and for propulsion of vehicles, food sterilization,whole body irradiation in the treatment of leukemia,the basic concepts involved in controlled fission reactions,isotope production and breeder reactors.

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AVAILABLE SOURCES:

A1012JEDIsm2iElimiari

Area:

Washington (state) Director, Information DivisionOregon U. S. Atomic Energy CommissionAlaska Hanford Operations Office

P. 0. Box 550Richland, Washington

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North Dakota U. E. Atomic Energy CommissionSouth Dakota Chicago Operations OfficeMissouri 9800 South Cass AvenueIowa Argonne, Ill.uhioIndianaMichiganMinnesotaWisconsinIllinois

Colorado Director, Information DivisionWyoming U. S. Atomic Energy CommissionKansas Grand Junction Operations OfficeNebraska Grand Junction, Colorado

California Assistant to the ManagerHawaii U. S. Atomic Energy Commission

San Francisco Operations Office518 17th StreetOakland 12, California

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Idaho Operations OfficeP. O. Box 1221Idaho Falls, Idaho

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Atomic Energy Commission Area:

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Assistant to the Manager forPublic Education

U. S. Atomic Energy CommissionSavannah River Operations OfficeP. 0. Box AAiken, S. C.

Public Information Service(Pictorial)

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Reference List of Books in Nuclear Medicine

The following list of books is divided under four main head-ings although many of the books deal with a wide varietyof topics and cannot really he categorized.

I. General

Princi les of Nuclear Medicine, Wagner. W. B. Saundersompany, i 6 .

Latest, most comprehensive book published in nuclearmedicine.

Atomic Medicine, Behrens. Williams & Wilkins, 4thEdition, 1964.

Comprehensive textbook including both radiationbiology and nuclear medicine.

Radioisotope Techniques in Clinical Research and Diagnosis,yeah and Vetter. ButtervIdor1,958.

Good introductory text. Reads easily and is clinicallyoriented.

Radioaktive Isotope in Klinik and Forschung.Papers presented at biennial International

Symposium, 1964. Urban and Schwarzenberg,Munich and Berlin.

Many excellent fundamental and some clinical papers,most of which are in English.

Nuclear Medicine, William H. Bland. Blackstone Div.of McGraw-Hill Book Co., 1965.

Comprehensive text with excellent section on renaldisease, among others.

Manual of Inotopes in Radiology and Nuclear Medicine,Bogardus. warren H. Green, 1968.

Announced. Not yet reviewed locally.

Progress in Atomic Medicine - Volume II, Lawrence.Gruen and Stratton, 1967.

Recent Advances in Nuclear Medicine, Croll and BradyAppleton Press, 1966.

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Yearbook of Nuclear Medicine, Quinn (Ed.). YearbookPublishing Co.

Annual synopsis of important new clinical and technicaladvances in the field.

Z. Imaging

Clinical Radioisotope Scanning, Wang. Charles C. Thomas1967.

Covers all the major organ scanning topics in a simplelucid, somewhat superficial aspect.

Progress in Medical Radioisotope Scanning.

(Proceedings of Symposium at the Medical Divisionof Oak Ridge Institute of Nuclear. Studies -October 22-26, 1962.)

Description of collimator properties, data acquisitionand display systems for use in isotope scanning.Good discussions of thyroid, brain, liver, kidneyand spleen scanning. Still worthwhile in 1968 atboth technical and clinical levels.

Medical Radioisoto e Scannin - Vol. I. InternatirmalAtomic Energy gency, 1 .

This volume deals with the technical aspects of instru-mentation in nuclear medicine and fundamental analysesof systems performance.

Medical Radioisoto e Scanning - Vol. II. InternationalAtom c Energy Agency, 1964.

Deals with the choice of radioisotopes and labelledcompounds, clinical applications, and interpretationof results. Includes discussions by the leadingauthorities in the field.

Scannini------er--g11--r-r-a-v---"linical"edicirie, Quinn.naries . Thomas Co., 1964.

Report of papers presented at a meeting in 1964. Timelyin 1964. Still of interest in several areas wheregood illustrations and back-up material are shown--forexample, McAfee's section on Brain Scanning.

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Fundamental Problems in Scanning, Gottschalk and Beck (Eds.)aiTIFETZTThomas Co., 1968.

An excellent technical presentation of the basicproblems in rIdionuclide imaging.

III.Biological Aspects

Dynamic Clinical Studies with Radioisotopes. (Pro-ceedings or at the Medical Division ofOak Ridge Institute of Nuclear Studies, October21-25, 1963. Available from Office of TechnicalServices, U. S. Department of Commerce, WashingtonD. C.)

Mathematica: techniques for the analysis of tracerkinetic data are described and results of researchinvestigations utilizing these formulisms presented.Excellent compendium but difficult for the novice tofollow in detail.

Compartments, Pools, and Spaces in Medical Physiology.(Proceeding3 of a Symposium held at the Oak RidgeInstitute of Nuclear Studies, October 24-27,1966. Available as Conf-661010 from Clearing Housefor Federal Scientific and Technical Information,National Bureau of Standards, U. S. Departmentof Commerce, Sprirlfield, Va. 22151)

Presentations of methods of compartmental analysisand results of applications to body space, and poolturnover studies are given. Excellent, up to datereview for the sophisticated reader and fellow researchers.

Clinical Aspects of Iodine Metabolism, Wayne, Koutras,and AFexander. Blackwell EraniTafic Publications1964.

Excellent, succinct, typically British textbook with astrong physiologic approach. Easy reading.

The Thyroid and its Diseases. Means, DeGroot, and Stembury.McGraw-Hill Book 6777963.

A second edition of a classic in the field which haslost little of its original flavor.

Report of the United Nations Scientific Committee onthe Effects of Atogriladia ion.(Supplement )16 -A/5210 - Available from the UnitedNations, New York City)

An excellent review of current knowledge of the effects

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of irradiation on man and his environment. An excellentsummary review of necessary background information inphysics, biology and radiobiology.

The Use of Isotopes in Hematology.. Lajtha. Charles-----77Thomas co. 1961.

Very short book, well written, which includes informationon red cell volume, red cell life span, Vitamin B-12metabolism, iron metabolism, and autoradiography.

Radioactive Nuclides in Medicine and Biology - Vol. II.SarriF71,eaaraPebiger Co. 1968.

Comprehensive textbook on nuclear medicine with heavyemphasis on thyroid physiology, the author's specificfield of interest.

Radioactive Pharmaceuticals. (Proceedings of Symposiumat Oak Ridge Institute of Nuclear Studies, Nov.1-4, 1965. Available as Conf-651111 - See #5for address.)

Only book of any comprehensive magnitude dealing withthis subject.

Radioisotopes in Medicine: In Vitro Studies.United States Atomic Energy Commission - Divisionof Technical Information - June 1968. Availableas Conf-671111 from Clearing House for FederalScientific and Technical Information - See #5 forAddress.

Annual Oak Ridge Symposium - Presents up to date infor-mation on radioimmunoassay method and applications,activation analysis, and findings derived from cytologicand chromosome labelling studies.

Report of the United Nations Scientific Committee onThe Effects of Atomic Radiation. (g-upplement#14 -A/5814 - Available from United Nations,New York City (1964).

Excellent two-page summary on radiation carcinogenesisin man. More detailed explanation of summary in annex.

The Thyroid, Sidney Werner. Hoeber Medical Book, 1962.

This book is the most comprehensive text on the thyroidavailable. Encyclopedic.

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Radioisotopes' in Medicine.The United States Army - United States Atomic EnergyCommission. Available from the Superintendentof Documents, U. S. Government Printing Office,Washington 25, D.C., 1953.

IV. Physical Aspects and Instrumentation.

Radio-tracer Methodology in Biological Science. Wangand Willis. Hall, inc., 065.

Good, lucid presentation of basics of radiation measure-ments.

Organic Scintillation Detectors, Schram. Elsevierpublishing Co., 1963.

This deals primarily with liquid scintillation countingof low energy beta emitters by means of organic fluor-escent substances. Excellent description of fundamentalaspects of radiation counting systems, per ee.

Safe Handlin, of Radioactive T oto es in Medi alPractice.Qu y. ' an o., u.

Excellent treatise on the health physics of clinicalnuclear medicine.

The Measurement of Clinical Radio-Actiltitt. D.A. Rossnd C. C. criIi7761E=1I11- Avail-Mile fromClearing House for Federal Scientific and TechnicalInformation - See #5 for address)

Excellent discussion of clinical gamma-ray spectrometryaddressed to physicians, x-ray technicians, and para-medical personnel.

Nuclear Radiation Physics. Lapp and Andrews. Hall, inc,'1954.

An old book which has excellent thought-provoking diagrams.

Instrumentation in Nuclear Medicine. Hine. AcademicPress, 7.

A detniled book on instrumentation used in nuclearmedicine.

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The Basic Physics of Radiation Therapy. Selman.Charles C. Thomas Co., 1960.

Chapter 15, "Medical Use of Radioactive Isotopes," iseasily read and is the one of particular interestfor nuclear medicine.

Radioactive Nuclides in Radiation and Biology - Vol.----77171TagT77FEETWO: Feidelburg. Lea an Febiger,

1963.

Good basic introduction to radiation physics and instru-mentation.

Nuclear Instruments and their Uses. Volume I. ArthurH. Snell. Wiley, 1962.

Excellent.

Source Book on Atomic Energy. Samuel Glasstone. D. VanNostrand Co., Inc., 1950.

Excellent glossary of terms used in nuclear medicine.

Radiological Health Handbook. Edited by Division ofRa o og ca- Heal n, ..S. Department of Commerce,Office of Technical Services, Washington, D.C. (25)

Contents: Glossary of Terms - Physical, chemical andmathematical data - Radioisotope, decay and radioassaydata - Radiation protection data - Table of Isotopes'(Deacy Schemes).

MIRD - Supplement 11 .7 Journal of Nuclear Medicine,February 1968.

A schema for absorbed-dose calculation for biologicallydistributed radionuclides. Absorbed fractions forphoton dosimetry.

MIRD - Sup lament #2 - Journal of Nuclear Medicinearc .

Radioactive Decay Schemes.

Nuclear Radiation Detection - Second Edition. William. Pr ce. cGraw T 1 BOOX CO., NeW 'ork.

In depth presentation on the principles of operation

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of radiation detectors including some electronics. Agood chapter on statistics of radiat.i.41 counting.

Scintillation Spectrometry. Second Edition. R. L. Heath.Clearing House for Federal Scientific and TechnicalInformation. U. S. Department of Commerce, Washing-ton, D. C. (25)

(AEC Report IDO-16880-2)Volume I - Scintillation SpectrometryVolume II - Gamma-Ray Spectrum Catalogue

Radioisotopes in the Human Body- Physical and BiologicalAspects. P. W. Spfers.

Authoritative work directed particnlarly to the internaldosimetry of alpha and beta emitters in bone.

V. The Following Four Textbooks are Used in NMT Trainingat the Nuclear Medicine Institute, Cleveland Ohio.

Algebras First Course. Mayor and Wilcox. PrenticeHall

Illustrated Physiology. McNaught and Callander.The and Wilkins Co.

IntrodnAory Chemistry - Third Edition. Lillian HoaglandAeyer. MacMillan.

Structure and Function in Man. Jacob and Francone.Saunders.

VI. Materials Published by Commercial Firms

Abbott Radio-Pharmoeuticals. Abbott Laboratories, Inc.14th and Sheridan RCM. Chicago, Iii. 60064.

Fundamentals of Nuclear Medicine. Frank Low. Picker--111711EW12731Ernoranecirie. White Plains, N.Y.

10605

Medotopes. E. R. Squibb & Sons, New Brunswick, N.J.

Nuclear Medicine Handbook, The Nucleus. Nuclear ChicagoCorp, 333 Howard St. Des Plaines, Ill. 60018.

-209-

Vignettes in Nuclear Medicine. Marshall Brucer. Mallinc-krodt, St. Louis, Mo.

VII. Additional Materials Recommended by Survey Respondents

Basic Cunce is of Nuclear Chemistry. R. T. Overman.e n o . Corp., 1 3.

Basic Principles of Scintillation Countin for MedicalInvestigators. C. C. Harris, D. D. H len andJ. E. Franca'. Office of Technical Services,Dept. of Commerce, Washington, D.C.

Clinical Nuclear Medicine. C. Douglas Maynard. Leaand Febiger, 1969.

Clinical Use of Radioisotopes. T. Fields and L. Seed.

Laboratory Guide to Nuclear Medicine. Revised Edition.Naval Medical School. National Naval Medical

Center. Bethesda, Md. 1969.

A Manual for Nuclear Medicine. King and Mitchell.Charles C. Thomas Co. 1961.

Nuclear Chemistr and its A lication. M. Haissinsky.A son- es ey, 19 .

Nuclear Chemistry, Technique of Inorganic Chemistry,Volume It. R. R. Johnson, E. and G. D.O'Kelley. Intersoience Publishers, 1963.

Nuclear and Radiochemistry. G. Friedlander, J. W.kenneAy and M. Miller. John Wiley and Sons, 1964.

Princi les of Radioisoto e Methodolcly - Third Edition.Grafton D. hase an Joseph L. Rabinowitz.Burgess, 1967.

ATrainint.nialforNtflaziedicalTechnologists .Guy . Simmons and orge A exander. S.

Dept of Health, Education and Welfare. PHSBureau of Radiological Health Training and Man-Power Development Program, Rockville, Md.

This manual (247 pages) was prepared for use in thedidactic portion of a training program in Nuclear

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Medicine Technology taught at the university of Cin-cinnati. The program was developed under a traininggrant from the Public Health Service, Bureau of Radio-logical Health. The purposes of the grant project areto investigate, through pilot programs, various approach-es to training NMM's and to develop training materialswhich can be used by others. The program in whichthis manual is used leads to the B.S. degree in MedicalTechnology with a Nuclear Medicine option.

C. Douglas Maynard, M.D.Director, Nuclear Medicine LaboratoryBowman Gray School of MedicineWake Forest UniversityWinston-Salem, North Carolina 27103

The Nuclear Medicine Laboratory at Bowman Grayhas developed a self-instructional unit in nuclearmedicine designed primarily to teach medical students,technicians and residents on an individual basil'.It bonsists of a front viewing carousel-type projection8mm Fairchild loop projector, and closed-circuittelevision. All the soft-ware presently being used wasmade for the laboratory's own use and is not commerciallyavailable at this time.

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Appendix G: "Radiopharmaceuticals and Instrumentation"

Chapter 1 from Clinical Nuclear Medicineby C. Douglas Maynard, M.D.

[Reprinted by permission of Lea and FebigerPublishers, Philadelphia)

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ClinicalNuclear Medicine

C. DOUGLAS MAYNARD, M.D.

Assistant Professor of Radiology, Associate in

Neurology, The Bowman Gray School of Medi-

cine, Wake Forest University; Director of Nuclear

Medicine, North Carolina Baptist Hospital,

WinstonSalem, North Carolina

353 illustrations on 194 figures

LEA & FEBIGER PHILADELPHIA 1969

213

radiopharmaceuticalsand instrumentation

Introduction

During the past 5 to 10 years, nuclear medicine has progressed from aminor subspecialty under the jurisdiction of several fields, primarily radiology,pathology, and internal medicine, to a position in which full recognition as aseparate specialty is under consideration. This rapid growth has been due tomany factors: the simplicity and low morbidity associated with the procedures;the valuable information not attainable by any other means; the awareness ofthe clinician as to the worth of the tests; and the increased accessibility due tothe introduction of nuclear medicine into hospitals of all sizes, Without question,however, the two major causes for this surge have been the introduction andavailability of many new and better radiopharmaceuticals and the developmentof improved radioisotopic imaging devices.

All persons interested in the application of nuclear medicine in clinicalpractice should have at least a limited acquaintance with radiopharmaceuticalsand instrumentation. With a basic understanding of these subjects, the physiciancan more logically select the appropriate tests, more skillfully supervise theprocedure, and more wisely interpret the results he obtains.

2

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CLINICAL NUCLEAR MEDICINE

RADIOPHARMACEUTICALS

To understand the principles involved in all radioisotopic procedures, one

must have a working knowledge of the composition of the radiopharmaceuticalsemployed, how they are obtained, their desirnble and undesirable characteristics,

and how they are utilized to obtain the information sought. Radiopharmaceuticals

differ from other medically employed drugs In two ways: (1) they are not generally

used to produce a pharmacological effect, and (2) they all contain a radionuclide

(radioisotope) which is used for localization and/or measurement in diagnosticprocedures and for radiation effects in therapy. No pharmacological responseis elicited with the majority of drugs used In nuclear medicine because only very

minute quantities are necessary. Radiation effects are apparent only with thera.peutic doses.

RADIONUCLIDES

A radionuclide (radioisotope), which is essential to all radiopharmaceuticals, behaves chemically in a manner similar to its nonradioactive counter.part. The difference lies in the fact that the binding energy of the nucleus ofthe radioactive atom is not sufficient to hold it together, and it disintegrates.In so doing, it emits energy of two types: either particulate, such as alpha andbeta particles, or electromagnetic, such as gamma or X rays. The electromagneticradiations are employed In most diagnostic tests, particularly with externaldetection systems (liver scanning, thyroid uptake determination), while the par.ticulate radiations are utilized for internal therapy (treatment of hyperthyroidism)although they can also be satisfactorily employed for sample counting (urine,plasma, etc.) with specialized equipment.

Radionuclides disintegrate at a constant rate, with the time required toreach 50% of the original number of atoms referred to as the physical halflife.Every radionuclide has a fixed halflife ranging from seconds to years. Most ofthose used in clinical nuclear medicine have halflives in the range of minutes todays. Radionuclides generally are measured in terms of the amount of radioactivesubstance that disintegrates In 1 second. The specific units employed are referred to as curies, named after Marie Curie, and a single curie equals 3.7 x 101°disintegrations per second. The most commonly employed units in nuclearmedicine are the millicurie (mCi), which is 3.7 x 10' disintegrations/second, andthe microcurie (sCi), which is 3.7 x 104 disintegrations/second.

There are a limited number of naturally occurring radioactive elements,mainly among the heavier elements, and these are of little importance In nuclear

RADIOPHARMACEUTICALS AND INSTRUMENTATION

medicine today. The majority of the radionuclides utilized clinically are obtainedby converting stable elements into radioactive forms by means of nuclear re-actois or cyclotrons. These unstable forms are "created" by bombarding stableelements with other particles, mainly neutrons. Since most hospital laboratoriesemploying radionuclides in daily practice are not near such installations, theradionuclides available to them are "half-life" limited; that is, their half-life mustbe tong enough to allow for transportation from the maker to the user sinceradioactive decay naturally occurs during this transit period. Radionuclides withshort half-lives, such as fluorine18 with a half-life of 1.8 hours, are therefore

available only to institutions located near these devices.

NUCLIDE GENERATORS

Because of the desirability of short-lived nuctIoes to reduce patient ex-posure and to allow the administration of larger amounts to achieve bettercounting statistics, the nuclide generator (Figure 1.1), commonly referred to asa "cow", has been introduced to help solve this problem. These generatorsconsist of a longerlived parent nuclide that produces a short-lived daughter inits decay scheme (Figure 1.2). The daughter can be separated as needed fromthe parent and utilized in diagnostic procedures. The Necessity for replacement

of the generator depends upon the half -life of the parent.

apace

Moss

Some

Collect Elueta

Insert Reorient

Rubber stopper

"Frilted"Olose

Molybdenum 99

Oloto

Rubber Stopper

teed

A

FIO. 1-1. A. Replaceable "cow" obtained commercially. B. Schematic drawing of the maincomponents of the generator system.

216

CLINICAL NUCLEAR MEDICINE

DECAY SCHEME Sells108m-- Sn813 (1 tad)

C.ntt (1.73h)

390 kev 11 t

In"' (stable)

Flo. 1-2. Decay scheme of tin.J13in.chum 113m. Tin113(theparent)changesby electron capture to indium113m(the daughter) which decays by emissionof a monoenergetic gamma photon of390 Key to stable indium.11 3.

A generator is comprised of a small container of powdered aluminum onwhich the parent is firmly attached. As the daughter is "produced", it may beseparated from the parent ("milked") by passing the proper reagent through thealumina column and collecting the eluate. The "cow" may be "milked" morethan once a day with improved total yields. Most systems come equipped withlead shielding to avoid excessive exposure during the "milking" process (Figure1.3).

The eluate is then checked for "breakthrough" of the parent (undesirablebecause of the longer halife and different energy of the parent) and radio.assayed. If obtained from a "closed", sterile generator, it is ready for immediateuse or for the preparation of tagged compounds. Presently a number of "open"generators (nonsterile) are available, and the material obtained is neither sterilenor pyrogenfree. In these cases sterilization must be accomplished prior to use,

but pyrogen testing, due to the short physical halflife of the r uclide, can be doneonly after the fact. The systems most commonly employed clinically today aremolybdenum99technetium99m, tin 113indium113m, yttrium87strontium87m, tellerium132iodine.132, and germanium-68gallium-68.

Although some radionuclides are employed in the ionic form (tl% 85Sr),in the majority of cases the radionuclide is only a part of the radiopharma-ceutical, serving as the "tag" to make measurement or detection possible. Inthese instances, the chemical and biological behavior of the material labeleddetermines its use in the procedure. In 99mTc sulfur colloid employed for liverscanning, the "rnIc plays no role in its localization in the liver. The colloidalmaterial is phagocytized by the reticuloendothelial system in the liver, and thisis responsible for its deposition in the organ; the presence of 98mTc permits itsdemonstration in the organ by external scintillation detectors. Other rad:o-nuclides, such as ininIn and 191Au, can also be prepared in colloidal form andcan therefore be satisfactorily employed for liver scanning.

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RADI(PHARMACEUTICALS AND INSTRUMENTATION 7

A B

Fia. 1.3. A. One of several commercially available generators and milking systems. Thelead is provided to reduce personnel exposure. The inside system is replaced weekly. B. Across sectional view of the system. L Connector from "cow" to outside system. 2. Leadstand. 3. Replaceable "cow". 4. Lead shielding. 5. Connector to milking reservoir.6. Reservoir of eluent 7. Multidose vial to collect the cluate. 8. Milking tube (replaced ateach milking). 9. Double needle to milk two "cows" in tandem. (Courtesy E. R. Squibb and

Sons.)

The mechanisms of localization are numerous, and the most commonlyemployed have been outlined by Wagner' (Table 1.1). In some instances thereare several tagged compounds with different biological behavior which will givesimilar scans of a specific organ. In these situations, it is extremely importantto know the clinical problem involved. An example of this is liver scanning withboth radioactive colloid, which gives a picture related to the reticuloendothelialsystem, and radioiodinated rose bengal, which provides information concerning

polygonal cell function and biliary patency. A tagged colloid would be preferred

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CLINICAL NUCLEAR MEDICINE

Table 1.1. Methods of Localization

1. Active transport

2. Phagocytosis

3. Cell sequestration

4. Capillary blockage

5. Simple or exchanged diffusion

6. Compartmental localization

(example, thyroid scanning with radioiodide)

(example, liver scanning with tagged colloidalparticles)

(example, spleen scanning with heat damagedtagged red blood cells)

(example, lung scanning with labeled macroaggregated albumin)

(example, bore scanning with strontium85)

(example, cardiac scanning with tagged humanserum albumin)

to determine the presence of a spaceoccupying lesion, whereas 1311 rose bengal

would be the agent of choice to evaluate the presence of a patent biliary tract.In cases such as these, multiple tests employing different mechanisms of localization may be used to obtain complementary information.

In organ system visualization, two general types cf "pictures" are obtained.The first is that in which the administered tagged compound localizes in theabnormal area and thus appears as a region of increased uptake or a "hot" area,

as in brain and bone scanning. The second is that in which the scanning agentlocalizes in the normal tissue of an organ or organ system, with the abnormalareas presenting as areas of decreased to absent activity or "cold" areas, asin liver and thyroid scanning. In general, the scans are more satisfactory if theabnormal area concentrates the tagged material.

SELECTION OF A RADIOPHARMACEUTICAL

No single group of characteristics can be utilized in the selection of aradiocompound for all uses in clinical nuclear medicine since a desirable char-acteristic in one instancy may be undesirable in another. For example, the betaradiation from 1111 is useless in thyroid scanning, but essential in 1311 therapyfor hyperthyroidism. Certain factors, however, should be considered in choosinga radiopharmaceutical for use in a given laboratory: the type of radioactive decayand physical half-life of the radionuclide; the biological behavior of the taggedmaterial; the specific activity of the radiopharmaclutical; the type of instrumentation available for use; the radiation exposure to the patient; and certainly thecost to the patient.

The type of radioactive decay is of considerable importance since only

219

RADIOPHARMACEUTICALS ANO INSTRUMENTATION

gamma rays, X rays, and annihilation radiation are suitable for external detection. Practically speaking, gamma rays under 500 Key are preferable sincehigher energy radiations may penetrate the shielding of the crystal and the septa

of the collimators, causing a decrease in spatial resolution (maximum ability of

a detection system to separate small changes in the distribution of radioactivity).

A radionuclide with extremely low energy (less than 20 Key is unsatisfactory)may also present problems since many photons may be absorbed by the tissueprior to reaching the detector, and some instruments are not constructed tohandle them with any efficiency. Radionuclides with multiple gamma ray energies

are also less desirable since generally only one "peak" is utilized and the others

add radiation exposure to the patient and may distort the count rate or imagedue to scattered radiation. In diagnostic procedures associated emissions ofbeta particles, conversion electrons, and low energy photons, which have alimited range in tissue, are likewise undesirable since they add to the patients'exposure without contributing useful Information. Consequently, in most diagnostic procedures, a radionuclide with a pure gamma or X ray emission with-out particulate radiation is desirable. In therapy the particulate radiation, usually

beta, contributes a major portion of the absorbed dose and is therefore essential.

The physical half-life (previously discussed) Is of obvious importance, but

of equal importance is the biological half-life (time required for 50% of theoriginal substance to be removed from an organ or the body by means of excre-

tion, exhalation, etc.), since the combination of these two results in the effectivehalf-life (time for 50% of the administered radionuclide to be removed from anorgan or the body) and determines radiation exposure. An effective half-life of1 to 1% times the time required to perform the test is generally accepted to beideal for diagnostic procedures.

The biological behavior is important in determining the radiation exposureto each individual organ system as well as in interpreting the results. Where theradiopharmaceutical accumulates, what its turnover rate is in these areas, andwhen and how it is eliminated from the body all play a part in establishing theexposure rate to indKidual organ systems. The "critical" organ is that one which

rev:Ives the highest absorbed dose from a given radiopharmaceutical. Information concerning biological behavior is also necessary to interpret many testsadequately. For example, the excretion of $5Sr by the bowel is important indetermining when a bone scan of the pelvis should be performed since shortlyafter administration the normal presence of the radionuclide in the colon maycause some difficulty in interpretation. By waiting several days, excretion of thismaterial makes Interpretation easier.

220

CLINICAL NUCLEAR MEDICINE

Specific activity refers to the number of radioactive atoms in relation tothe number of nonradioactive atoms of the same material. This is usuallyexpressed in millicuries per gram. Specific activity is of particular importance inInstances when it is desirable to administer only that amount of a substancethat is essential since untagged material does not contribute photons for detection. An example of this is in the study of the cerebrospinal fluid flow with tagged

(IN or "n'Tc) human serum albumin. Large amounts of albumin administeredintrathecally may cause aseptic meningitis;3 therefore, a high specific activitymaterial is mandatory. "Carrier.free" material refers to those cases in which all

of the material is tagged, and the specific activity is the highest possible.The type of instrumentation available must definitely play a role in the

selection of the radiopharmaceutical for a specific laboratory, since certaininstruments are designed to be more effective with radionuclides within a specific

energy range. Most camera systems, for example, are not satisfactory with low

energy radionuclides such as In,. Also, the effective half-life of the radiopharma-

ceutical must be considered in relationship to the equipment available since acompound with a 1-minute half-life cannot be satisfactorily utilized with a devicethat takes hours to perform the procedure.

Another factor to be considered is the cost of the procedure. At times thisis difficult because of the many factors involved in selecting a radiopharmaceutical. Generally in practice, an attempt must be made to achieve the mostinformation at the least possible cost to the patient, in expense as well as inradiation exposure.

INSTRUMENTATION

Just as it is necessary to have some understanding of radiopharma-ceuticals to select, supervise and interpret radioisotopic procedures, it is equallyimportant to have some basic knowledge concerning the instrumentation in-volved. After the administration of the appropriate radiopharmaceutical, radiationdetection devices are necessary to perform five broad categories of tests: (1)dilution, absorption, and excretion studies, where a known amount of radio-pharmaceutical is administered to a patient and the dilution which occurs or thepercentage that is absorbed or excreted in a specific time period is determinedby collecting a sample of blood constituents, urine, stool, or other body fluid andcomparing it to a known amount of the original substance administered (Schillingtest, blood volume, Triolein absorption); (2) concentration studies, where a radio-pharmaceutical is given to the patient and the percentage localization in an

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RADIOPHARMACEUTICALS AND INSTRUMENTATION

organ or region is measured by comparing it to a known sample of the material(thyroid uptake); (3) dynamic function studies, where the administered radio-pharmaceutical Is observed as it arrives and/or leaves a particular organ orregion (cerebral blood flow, renogram); (4) organ system or "pool" visualization,

where following administration, the distribution of the radiocompound is dis-played in pictorial fashion (brain and cardiac blood pool scanning); and (5) "invitro" tests, where the radiopharmaceutical is added not to the patient but toa sample of the patient's blood constituents to indirectly determine the amountof a specific substance present (T3, T4 tests). Often two or more of these testsare thed jointly to obtain complementary information, as with the thyroid uptake(.1 concentration study) and the thyroid scan (an organ system visualization).

It is obvious that, with the diversity of performance necessary to achievesatisfactory results with all these different tests, no one Instrument is availab:swhich can do them all. Although there are a large number of radiation detectiondevices which operate on several different basic principles (gas Ionization cham-

ber, cloud chamber, etc.), the scintillation counter Is by far the most widelyemployed in everyday clinical nuclear medicine.

SCINTILLATION COUNTERS

The scintillation counter basically consists of a detector system and aprocessing and display unit (Figure 1-4). The detector system is generally madeup of a sodium iodide crystal (thallium activated), optically coupled to a photo.multiplier tube (Figure 1.5). When photons strike this crystal, flashes of blue.violet light or scintillations occur. The crystal is shielded and collimated, usually

with lead, so that only Incoming photons from the source can strike it. Thecrystal itself is transparent to light and is enclosed in a lighttight container.Between it and the surrounding container is a powder to reflect light out onlythrough the area of the crystal adjacent to the photomultiplier tube. When theseflashes of light reach the sensitive surface of the photomultiplier tube (usuallymade of substances such as cesium and antimony whose electrons are easilydislodged by light), a pulse of electrons is released. These are amplified in the

photomultiplier tube and are transmitted through a preamplifier to the main unitto be further amplified. From here the pulses are ready for processing anddisplay. The output signal from the detector System is directly related to the total

light emitted, and this is proportional to the energy released in the crystal bythe gamma photon.

An integral part of most detector systems is a collimator. it is designedto allow the detector to "see" only those photons coming from a specific area

-222-

1Scoler 1

Intensity I

IPosition"' I

Preamplifier

PhotornulliplierTube

Crystol

Col limotor

f-re- Source -4-i ii\XDetection System

Visuol 1Disploy

Spectrometer

Processing

Roteeier

I

and Display Unit

Fro 14. Block diagram of a scintillation counter in simplified form.' Only necessary forcamera systems.

PM tube

Lead shield

Transporentshield

No! (Ti) crystalLight tight eonCollimator

223

Fie. 1.5. Simplified drawing of thebasic components of most scintillation detection units.

RADIOPHARMACEUTCAL3 AND INSTRUMENTATIO0

in the patient while rejecting others. There are several types of collimators, withthe most commonly employed being the wide angle, the parallel multichannel,and the focusing multichannel (Figure 1.6). Each type is designed for a specific

purpose. The wide angle, foi instance, is used when only counts from a largefield of view are desired, such as with the thyroid uptake. Parallel multichannelcollimators are employed mainly with the camera systems, which also view a large

area but are designed to help produce an image of the distribution of the radio.pharmaceutical, as with liver imaging. Focusing collimators are commonly em.ployed with scanning devices and are used to view a small area, usually at adepth?within the patient, as in brain and liver scanning. The focusing collimator

is constructed to increase the number of photons utilized from a given region.Most commercial Imaging devices come equipped with several Interchangeablecollimators with varying numbers of holes and depths of focus. Since the shield.

ing requirements for low energy photons are much less than for high energyones, the septa have to be thicker with the higher energy photons, allowing lessof the crystal to be used. In general terms, the collimator with more holes has

Wide Angle Parallel Multi -channel Focusing

Fro. 1-6. The three types of collimators commonly utilized In nuclear medicine.

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1 4 CUNICAL NUCLEAR MEDICPNE

otiFlo. 1.7. Schematic indicating the manner in which a spectrometer "window"can be adjusted to see either the majorpeak of one isotope or to count twoseparate peaks in the presence of eachother. In the case of the Fe window noCr will be counted; with the Cr windowthere is contribution from the Fe. FromORK-4 I 53.4

increased resolution, but decreased sensitivity (number of counts measured in

relation to the number emitted), and vice versa for a collimator with less holes.From the detector system, the electrical pulses are generally directed to a

processing unit. Usually the gamma spectrometer is a part of this unit. It is aninstrument which can be preset to sort the spectrum of gamma energies and

accept or reject those of a specific pulse height (energy). This allows the "counting" of only those photons desired, thus eliminating those which have been

somewhat attenuated in the patient (scattered radiation) or which may bephoto-is of different energies emitted by the nuclide administered. It also permits

the measurement of one gamma emitting isotope in the presence of a second

if their energies are somewhat apart (Figure 1.7). The "window", as the spectrom

eter setting is commonly called, may be adjusted to reject all pulses both below

and above certain energy levels. it can usually be moved up a.4 down thespectrum and adjusted in width to encompass only one or more "peaks" of thenuclides administered.

From the spectrometer, the selected information is sent forward to bedisplayed in some form, either as counts )n a scaler, a needle deflection on arate meter, a "dot" on special types of paper, a specific color on paper, or aflash of light on a photographic film or an oscilloscope. Often more than onetype of presentation is possible in the same instrument.

The instruments currently available can be divided into four major categorier: stationary probes. well counters, scanners, and cameras. Obviously theyare designed to be employed for somewhat different purposes.

STATIONARY PROBES

Stationary probes are used mainly for tests of concentration in an organor a region and for dynamic function studies,. A large number are availablecommer'ally, common!), equippeo with one or more probes of varying sizes(Figure 1.8) and wide angle collimators. The information is normally presentee

-225-

RADIOPHARMACUITOCALS AND INSTRUMENTATION 1

jam.

1

11C.

na. 14. Commercially available two probe detector designed mainly for renography(Courtesy Nuclearhkigo Corporation.)

as counts per/unit time, time required to obtain a preselected number of counts,

or a tracing on a paper chart recording.

WELL COUNTERS

These operate on the same basic principle but are constructed mainly for

counting samples of urine, blood constituents, feces, etc. They are commonly

-226-

1 6 CONICAL NUCLEAR MEDICINE

Fla. 14. Manual wellcounter designed to countvials or larger containers.Note considerable lead

shielding to decrease back-ground counts. (CourtesyNuclear Division, Picker

XRay Corporation.)

used in dilution, absorption and excretion studies, in in vitro tests, and in counting samples of tissue removed at surgery. Manual single vial units (Figure 1.9)are available as well as automatic scintillation gamma counters in which 50 to100 vials can be loaded and systematically counted (Figure 1.10). They normally

express the results in counts per minutes or record the time required to achievea preselected number of counts.

SCANNERS

Widely employed, these instruments are designed to produce two.dimenSiOnal -pictures" of the distribution of a radiocompound in an organ system.They can also be used to do some tests of concentration, dilution, excretion,and absorption. Organ scanning is accomplished by the systematic movementof a scintillation detection assembly, generally equipped with a focusing colli

tanning back and forth across the area of interest (Figure 1.11). Thedetector "sees" only a small region at a time, and the total "picture" is builtup line by line until the preset pattern is completed. This is displayed on aphotographic film, an oscilloscope, or a special type of paper with the differences

in concentration of the nuclide depicted by changes in density on the film, inbrightness on the oscilloscope, or in different colors or numbers of "dots" onthe paper recordings.

-227-

Flo. 140. Automatic well

counter. (Courtesy Nuclear.Chicago Corpora t ion. )

III. 1.11. Schematic of a mechanical rectilinear &Canner. A. Collimator. O. Scintidationdefecting unit. C. Pholomoltiptier tube. D. Photo recumling aspect. E. Processing und.E. -Dot- recording unit.

-228-

1$ CLINICAL NUCLEAR MEDICINE

,'

: ,

;aids.

Via. 1.12. Commerdany availabl e 5 >e 2 inch rechli near scanner with color atiachinent.(Courtesy Nuclear Picker X-Rey Corporation.)

Scanners are available in many types, with the principal differences beingin the site and number of the sodium iodide crystals they possess. The mostcommonly employed is the single detector system with a crystal 3 inches indiameter by 2 Inches thick; however, 5 x 2 inch (Figure 1.12) and 8 x 2 inch singleand dual detector systems (Figure 1.13) are Increasing In popularity. Also avail.able Is one multiprobe scanner (figure 1.14) with 10 separate sodium iodidecrystati 6 *Ph x 2 inches in size, each coupled to p photornultiplier tube (Figure1.15). As a region Is scanned, ten fines are drawn with each passage insteadof one as with the commonly employed 3 x 2 inch scanner. Complete "pictures"

-229-

e .4* '

;

Fle. Ia. Dual head scanning system with one detection system above the table and thesecond mounted under the table (not visualized). They move as a paired unit and produce

two views at one time. Example: both lateral brain projections. (Courtesy Ohio-Nuclear, Inc.)

.11

.446%

4" 4110 11

CM elAio.1. .

-`s Ce.

41, 4 's

-t-1/4 . '

Tao. 1.I4. A Multiprobe scanner (14napix) with detecting and processing units. (CourtesyPicket X-Ray Corporation.)

311

-230-

CLINICAL kLIClEAR MEOCiNE

Flo. 1.15. Schematic of detector/collirna.for assembly of the unit in Figure 1.14,(Hindel and Gilson, Multicrystal Scanneris Rapid and Versatile. Nu, %-,onics 25:52,

1967.)

may be achieved in 4, 8, or 16 sweeps of the detector unit. In scanning instru

menls, the size and number of crystals is of importance in that they are closelyrelated to the time required to perform the procedure. Generally speaking, with

the larger crystals and/or increased number of detectors, the time required toperform a scan is decreased.

CAHERAs

A radioisotope camera is an imaging device that can produce a "picture"without movement of the detector. it has the ability to "see" some organs intheir entirety and to display visually changes in an organ during a dynamicfunction test. Most are constructed so the detector head can be positioned todo organ imaging either in the recumbent or the sitting position.

Presently there are three cor..-nercially available cameras which utilize thebasic principle of the scintillation counter and come equipped with several typesof collimators for use with different radionuclides or organ systems.1.4 Twoconsist of a large sodium iodide crystal coupled with multiple (19) pholomultipliertubes (Figure 1.16). The photomultiplier tubes view overlapping areas so that thelight created in the crystal by a scintillation is divided among the 19 tubes (Figure1.17). The photo tubes are connected to an analog computer which identifiesthe position and brightness of each scintillation. The scintillations are thenreproduced on an oscilloscope in the same XY coordinates as they occur in thecrystal. They may be stored on an oscilloscope or photographed and reproducedon film (usually Polaroid) for visualization.

The secolid camera system consists of a rectangular matrix of 294 small

-231-

rir 1'4

,C4

1)0. 1.16. One of the commercially available camera systems with detecting unit (left) andprocessing console (right). (Courtesy NucleaChicago Corporation.)

FIG. 1.17. Schematic of the detector /col-limator assembly of the system depictedin figure 1.16. the crystal is 11 inches indiameter and 1, inch thick backed by ahexagonal array of 19 photornuftiplrettubes. (from Instructional Manual.

Nuclear-Chicago Corpora lion.)

-232-

2 2 CLINICAL NUCLEAR MEDICINE

Fit MIL AutoPuoroscope. (Courtesy Baird Atomic Corporation.)

Individual crystals, each linked electronically to its own magnetic core mamory(Figure 1.18). The resulting picture can be reproduced on an oscilloscope bydisplaying the data collected by each crystal individually.

Recently Introduced is another camera which does not en ?ioy the scintilla-tion crystal principle but is an image intensifier similar to those employed indiagnostic radiotogy.s It is at present in limited use and can only be employedwith low energy isotopes (preferably below 150 Kev).

POSII RON Kt EC I MO SYS I t

The use of the positron should be mentioned since considerable investigalion Is now under way in this area. Annihilation of a positron is usually accom-panied by the emission of two 0.51 Mev photons in opc.):,ite directions. The baskconcept is to uA two opposing detector systems, constructed to record data only

when 'hit" simultaneously by the photons derived by annihilation. This allowsfor adequate collimation without the need for lead collimators. Both scanningand camera systems have been constructed on this principle.

233

RADIOPHARMACEUTICALS AND INSTRUMENTATION

Conclusion

There are large numbers of different types of radiopharmaceuticals, each

designed to localize in a specific organ system. Likewise, there are several typesof radiation detection devices available which are constructed to perform specific

functions. An understanding of these two areas is essential to the proper applica

Lion of nuclear medicine to clinical practice. Since there is constant change inthe radiocompounds available due to their development by both commercialrathopharmaceutical houses and research personnel in niedical centers, areassessment should be made periodically to decide if the radiocompound being

employed is the best one to provide the information desired with the feast radialion to the patient. With the design of other radiation detection systems, it isalso apparent that not only will the procedures be improved in the future, but .more information may be derived as well.

text references

1. Wagner, H. N., Jr.: Pharmacological Principles in the Development of Radio.pharmaceuticals for Radioisotope Scanning in Scintillation Scanning in ClinicalMedicine. Ed. by J. L. Quinn, III. Philadelphia, W. B. Saunders Co., 1964. .

2. Nicol, C. F.: A second case of aseptic meningitis following isotope cistemograohYusing "II human serum albumin. Neurology 17:199, 1967.

3. Anger, H. 0.: Scintillation camera with multichannel collimators. J. Nucl. Med.5:515, 1964.

4. Bender, M. A., and Blau, M.: The aJtofluoroscope. Nucleonics 21:52, 1963.S. Terogossian, M., Kastner, J., and Vest, T. B.: Autoflurography of the thyroid

gland by means of image amplification. Radiology 81:984, 1963.6. Ross. D. A., and Harris, C. C.: The measurement of clinical radioactivity.

ORNL-4153, UC-48, Biology and Medicine, Oak Ridge National Laboratory,1968.

general references

1. Bland. W. H., ed.: Nuclear Medicine. New York, McGraw MI Book Co., 1965.2. Pinar elk), D. J., and Witcofski, R, L.: Basic Radiation Biology. Philadelphia, lea

& Febiger, 1961.3. Wagner, H. N., Jr.. ed.: Principles of Nuclear Medicine. Philadelphia, W. 8.

Saunders Co.. 1968.4. Wang. Y.: Clinical Radioisotope Scanning. Springfield, Charles C Thomas, 1967.

5. Harris, C. C.: Certain Fundamental Physical Considerations in Scanning inScintillation Scanning in Clinical Medicine. Ed. by J. L. Quinn, Ill. Philadelphia,W. 8. Saunders Co.. 1964.

-234-

Appendix Hospitals Participatin9 in Survey

-235-

AlabamaHuntsville

Huntsville HospitalMobile

Providence HospitalMontgomery

Jackson Hospital and ClinicArizona

PhoenixVeterans Administration Hospital

TucsonTucson Medical CenterVeterans Administration Hospital

ArkansasLittle Rock

Arkansas Baptist Medical CenterUniversity Hospital, University of Arkansas

Medical CenterCalifornia

La JollaScripps Clinic and Research Foundation Hospital

LancasterAntelope Valley Hospital

Los Angeles Metropolitan Area (Interviews)Holy Cross HospitalHuntington Memorial HospitalLoma Linda University HospitalLong Beach Community HospitalLos Angeles County General Hospital andUniversity of Southern CaliforniaMedical Center

Memorial Hospital of Long BeachSt. John's HospitalSt. Mary's Long Beach HospitalSt. Vincent's HospitalUniversity of California at Los Angeles HospitalWhite Memorial Medical Center

NapaQueen of the Valley Hospital

San Francisco Metropolitan Area (Interviews)Alta Bates Community HospitalFrench HospitalLetterman General HospitalMarin General HospitalMount Zion Hospital and Medical CenterPresbyterian Hospital and Medical Center of

San FranciscoSamuel Merritt HospitalSan Francisco General HospitalU.S. Public Health Service HospitalUniversity of California Hospitals

(University of California Medical Center)

-236-

Veterans Administration HospitalColorado

Denver Metropolitan Area (Interviews)Colorado General Hospital (part of University

of Colorado Medical Center)Denver General HospitalFitzsimons General HospitalGeneral Rose Memorial HospitalLutheran Hospital and Medical CenterMercy HospitalPorter Memorial HospitalPresbyterian Medical CenterSt. Anthony HospitalSt. Luke's HospitalSwedish HospitalVeterans Administration Hospital

ConnecticutBridgeport

Bridgeport HospitalMiddletown

Middlesex Memorial HospitalNorwalk

Norwalk HospitalDelaware

Wilmington (Interview)Wilmington Medical Center, Memorial Hospital

District of ColumbiaMetropolitan Area (Interviews)

District of Columbia General HospitalDoctor's HospitalGeorgetown University HospitalMorris Cafritz Memorial HospitalSt. Elizabeth's HospitalSibley Memorial HospitalVeterans Administration HospitalWalter Reed General HospitalWashington Hospital Center

FloridaMiami Beach

St. Francis HospitalMiami Metropolitan Area (Interviews)

Doctor's HospitalJackson Memorial HospitalMercy HospitalMiami Heart InstituteMount Sinai Hospital of greater MiamiNorth Miami General HospitalNorth Shore HospitalSouth Miami HospitalVeterans Administration HospitalVictoria Hospital

TampaTampa General Hospital

-237-

GeorgiaAtlanta (Interviews)

Crawford W. Long Memorial Hospital of EmoryUniversity

Emory University HospitalGeorgia Baptist HospitalGrady Memorial HospitalSouth Fulton HospitalVeterans Administration Hospital

SavannahWarren A. Candler Hospital

HawaiiHilo

Hilo HospitalHonolulu

St. Francis HospitalU.S. Army Tripler General Hospital

IllinoisAlton

Alton Memorial HospitalChampaign

Burnham City HospitalChicago (Interviews)

American Hospital of ChicagoAugustana HospitalChicago Wesley Memorial HospitalChildren's Memorial HospitalColumbus HospitalCook County HospitalFranklin Boulevard Community HospitalGrant Hospital of ChicagoHoly Cross HospitalIllinois Central HospitalIllinois Masonic Medical CenterJackson Park HospitalLouis A. Weiss Memorial HospitalMercy HospitalMichael Reese Hospital and Medical CenterMount Sinai Hospital Center of ChicagoNorthwest HospitalPresbyterian-St. Luke's HospitalProvident Hospital and Training SchoolRavenswood HospitalSt. Elizabeth's HospitalSt. Joseph HospitalSt. Mary of Nazareth HospitalSwedish Covenant HospitalSouth Chicago Community HospitalUniversity of Chicago Hospitals and ClinicsUniversity of Illinois Research andEducational Hospitals

Veterans Administration Research HospitalVeterans Administration West Side Hospital

-238-

EvanstonSt. Francis Hospital

KankakeeRiverside Hospital

PekinPekin Memorial Hospital

RockfordSwedish-American Hospital

UrbanaCarle Memorial Hospital

IndianaGreenfield

Hancock County Memorial HospitalLafayette

St. Elizabeth HospitalRichmond

Reid Memorial HospitalIowa

Cedar RapidsSt. Luke's Methodist Hospital

KansasDodge City

St. Anthony HospitalKansas City (Interviews)

Providence HospitalUniversity of Kansas Medical Center

KentuckyLouisville

John N. Norton Memorial InfirmarySouth Williamson

Williamson Appalachian Regional Hospital.Louisiana

New Orleans (Interviews)Charity Hospital of Louisiana atNew Orleans

Hotel Dieu Sisters' HospitalMercy HospitalMethodist HospitalOchsner Foundation HospitalSouthern Baptist HospitalTuoro InfirmaryU.S. Public Health Service HospitalVeterans Administration Hospital

MaineAugusta

Augusta General HospitalPortalnd

Maine Medical CenterWaterille

Thayer HospitalMaryland

Baltimore (Interviews)

-239-

Church Home and Hospital of the City ofBaltimore

Johns Hopkins HospitalNorth Charles General HospitalSt. Agnes Hospital of the City of BaltimoreSt. Joseph HospitalSinai Hospital of BaltimoreUniversity of Maryland Hospital

Bethesda (Interviews)Clinical Center, National Institutes

of HealthU.S. Naval Hospital

Camp SpringsU.S. Air Force Hospital

Fort George G. MeadeKimbrough Army Hospital

FrederickFrederick Memorial Hospital

MassachusettsBeverly

Beverly HospitalBoston Metropolitan Area (Interviews)

Beth Israel HospitalCarney Memorial HospitalChildren's Hospital Medical CenterFaulkner HospitalMount Auburn HospitalNew England Deaconess HospitalNorwood HospitalPeter Bent Brigham HospitalSt. Elizabeth's HospitalNew England Medical CenterVeterans Administration Hospital

Fall RiverSt. Anne's Hospital

HolyokeProvidence Hospital

FraminghamFramingham Union Hospital

LowellSt. Joseph's Hospital

Methuen ,

Bon Secours HospitalNorth Adams

North Adams HospitalPittsfield

St. Luke's HospitalSpringfield

Mercy HospitalStoneham

New England Sanitarium and HospitalTaunton

Taunton State Hospital

-240-

WorcesterSt. Vincent Hospital

MichiganDetroit (Interviews)

Grace Hospital Northwest UnitHarper HospitalHenry Ford HospitalMount Carmel Mercy HospitalSinai Hospital of Detroit

FlintHurley Hospital

MidlandMidland Hospital

MinnesotaMinneapolis-St. Paul (Interviews)

Bethesda Lutheran HospitalCharles T. Miller HospitalFairview HospitalLutheran Deaconess Home and HospitalMidway HospitalMount Sinai HospitalNorth Memorial HospitalNorthwestern Hospital of MinneapolisSt. John's HospitalSt. Luke's HospitalSt. Mary's HospitalUniversity of Minnesota HospitalVeterans Administration Hospital

MissouriKansas City (Interviews)

Baptist Memorial HospitalKansas City General and Medical CenterMenorah Medical CenterResearch Hospital and Medical CenterSt. Luke's Hospital of Kansas CitySt. Mary's HospitalVeterans Administration Hospital

St. Louis (Interviews)St. Louis City Hospital - Max C. StarkloffMemorial

Daconess HospitalDePaul HospitalHomer G. Phillips HospitalLutheran HospitalMallinckrodt InstituteMissouri Baptist HospitalSt. John's Mercy HospitalSt. Louis University HospitalSt. Luke's HospitalVeterans Administration Hospital

SpringfieldSt. John's Hospital

-241-

MontanaBillings

Billings Deaconess HospitalButte

St. James Community HospitalGreat Falls

Columbus HospitalMissoula

St. Patrick HospitalNebraska

LincolnSt. Elizabeth Hospital

NevadaLas Vegas

Sunrise HospitalSouthern Nevada Memorial Hospital

New JerseyOrange

Orange Memorial Hospital UnitSomerville

Somerset HospitalNew Mexico

AlbuquerqueBernalillo County-Indian Hospital

HobbsLea General Hospital

New YorkBinghamton

Our Lady of Lourdes Memorial HospitalBuffalo

Veterans Administration HospitalIthaca

Tompkins County HospitalMount Vernon

Mount Vernon HospitalNew York City (Interviews)

Beth Israel HospitalFrench HospitalHospital for Special Surgery (Cornell

School of Medicine)Jewish Memorial HospitalLenox Hill HospitalNew York Medical College - Flower and Fifth

Avenue HospitalsNew York University Medical CenterPresbyterian Hospital in the City of New YorkRoosevelt HospitalSt. Vincent's Hospital and Medical Center

of New YorkNathan B. Van Etten Tuberculosis HospitalVeterans Administration Hospital

New York City (Mailed Sample)Maimonides Hospital of Brooklyn

-242-

Mt. Sinai HospitalU.S. Public Health Service HospitalWillowbrook State School

SchenectadySt. Clare Hospital of Schenectady

YonkersSt. John's Riverside Hospital

North CarolinaCharlotte

Charlotte Memorial HospitalDurham

Duke University Medical SchoolRa3eigh

Rex HospitalNorth Dakota

BismarckSt. Alexius Hospital

MinotSt. Joseph's Hospital

OhioAkron

Akron City HospitalCanton

Mercy Hospital of CantonCleveland Metropolitan Area (Interviews)

Cleveland Clinic HospitalHillcrest HospitalLakewood HospitalMount Sinai Hospital of ClevelandSt. Vincent Charity HospitalSuburban Community HospitalUniversity Hospitals of ClevelandVeterans Administration HospitalWoman's Hospital

ColumbusRiverside Methodist Hospital

KetteringCharles F. Kettering Memorial Hospital

SanduskyGood Samaritan Hospital

TroyDettmer Hospital

OklahomaOklahoma City

Presbyterian HospitalTulsa

St. Francis HospitalOregon

PortlandGood Samaritan Hospital and Medical Center

PennsylvaniaAltoona

Mercy HospitalBradford

Bradford Hospital

-243-

Drexel HillDelaware County Memorial Hospital

HarrisburgHarrisburg Hospital

LancasterLancaster General Hospital

New KensingtonCitizens General Hospital

Oil CityOil City Hospital

Philadelphia (Interviews)Albert Einstein Medical Center (Northern

Division)American Oncologic Hospital (Cancer and

Allied Diseases)Graduate Hospital of the University of

PennsylvaniaHahnemann Medical College and Hospital of

PhiladelphiaJeanes HospitalJefferson Medical College HospitalMethodist Episcopal HospitalMisericordia HospitalNortheastern Hospital of PhiladelphiaPennsylvania HospitalPhiladelphia General Hospital

PittsburghAllegheny General Hospital

SomersetSomerset Community Hospital

Rhode IslandProvidence

Roger Williams General HospitalVeterans Administration Hospital

WoonsocketJohn E. Fogarty Memorial Hospital

South DakotaSioux Falls

Sioux Valley HospitalTennessee

KnoxvilleEast Tennessee Baptist HospitalSt. Mary's Memorial Hospital

MemphisBaptist Memorial HospitalVeterans Administration Hospital

NashvilleVanderbilt University Hospital

TexasDallas Metropolitan Area (Interviews)

Baylor University Medical CenterCollin Memorial Hospital

-244-

Methodist Hospital of DallasParkland Memorial Hospital-Dallas County

Hospital DistrictPresbyterian Hospital of DallasSt. Paul HospitalVeterans Administration Hospital

Fort Worth (Interviews)Fort Worth Radiation Center (The RadiationCenter and Medical Research Foundationof the Southwest)

Harris HospitalSt. Joseph Hospital

HoustonBen Taub General HospitalUniversity of Texas M.D. Anderson Hospital and

Tumor InstituteSan Antonio

Baptist Memorial HospitalWilford Hall U.S. Air Force Base Hospital

UtahSalt Lake City

Holy Cross HospitalVirginia

NorfolkDePaul Hospital

RoanokeRoanoke Memorial Hospitals

WashingtonSeattle (Interviews)

King County HospitalNorthgate General HospitalNorthwest HospitalProvidence HospitalSt. Frances Xavier Cabrini HospitalSwedish Hospital Medical CenterUniversity HospitalVeterans Administration HospitalVirginia Mason Hospital

West VirginiaHuntington

Veterans Administration HospitalWheeling

Wheeling HospitalWisconsin

Eau ClaireSacred Heart Hospital

MadisonSt. Mary's Hospital

ManitowocHoly Family Hospital

MilwaukeeMilwaukee County General Hospital

-245-

SheboyganSheboygan Memorial Hospital

WyomingCasper

Memorial Hospital of Natrona County

-246-

Appendix I: Reviewers' Commentson First Draft Report

-247-

Upon completion of the first draft of this report,Copies were sent to several physicians and NMTs for theircomments and recommendations. We were most gratified bytheir responses, as they proved invaluable in helpingto focus and improve many sections. Their statementsvaried from detailed corrections of termin3logy to generalappraisals of our approach, methodology and conclusions.Most of their remarks have been incorporated into the bodyof the report, although they are by no means responsiblefor any of the report's remaining inadequacies. To thefollowing individuals, we thus acknowledge a major debtof gratitude.

Millard N. Croll, M.D.Hahnemann Medical College and Hospital ofPhiladelphia, Pennsylvania.

Howard J. Dworkin, M.D.U.S. Naval Hospital, National Naval MedicalCenter, Bethesda, Maryland.

C. Craig Harris, M.S.Duke University Medical CenterDurham, North Carolina.

William Hendee, Ph. D.University of Colorado Medical Center,Denver, Colorado.

Merle Loken, M.D.University of Minnesota Hospital, MinneapolisMinnesota.

Will B. Nelp, M.D.University of Washington Hospital, Seattle,Washington.

E. James Potchen, M.D.Washington University, St. Louis, Missouri.

Mrs. Bev Lee, R.T. (ARRT)St. Anthony HospitalDenver, Colorado.

Many of the comments which we received providedinsights on topics which went somewhat beyond the scopeof this report. Others either supported or contradictedour findings. As if to emphasize one of the major themes

-248-

of the report, the fragmented aspect of the field ofnuclear medicine, many of the comments tended to contra-dict each other. We feel that inclusion of some of theseremarks will provide a valuable asset in understandingboth the dilemmas and the dynamism of nuclear medicine andthe preparation of Nuclear Medicine Technicians.

Comments listed below have been sorted by topic toprovide a framewark within which to view them. Theyhave not been otherwise edited except to conformwith page changes from the f5.rst draft.

Several comments were made concerning terminologyused in the report. The distinction between "technician"and "technologist" and the various types of "programs"("education," "training," "preparatory," "instructional")have already been mentioned. The follOwing discussion ofother terms is also of value.

I have penciled in red pencil a number ofcomments within the body of the copy that hasbeen returned to you enclosed. One correctionthat you will see throughout is a correction ofthe word, "medical" in the expression, "nuclearmedical technician," to read "nuclear medicinetechnician." This does not represent a morbidpreoccupation on my part, but rather an appealto you to help us continue to straighten outa very difficult semantic situation. Unfortunate -ly, the Medical Technology Registry has a sortof "Squatter's rights" on the term, "MedicalTechnician or Medical Technologist." When theyadditionally certify a person in nuclear medicinetechnology, they call this person a RegisteredNuclear Medical Technologist. I am not exactlycertain at this point what the American Registryof Radiologic Technologists calls the personthat it certifies in nuclear medicine technology.(medicine, see Appendix C).

It was a rather necessary, inherent part ofthe Essentials to use the term, "nuclear medicinetechnician" and "nuclear medicine technologist,"because it was felt that :.he use of the word" medicine" as distinguisiled from "medical" wouldprovide a properly, generally descriptive term.

My repeated correction of this ynrasein the draft copy does not reflect an obsessionwith this matter, but rather an attempt to

-249-

help you find the places that would have tobe corrected if you were to accept this suggestion.

--Harris.

Page 5: I would suggest that you put theword, "radioisotope" in quotes, because the useof that term is certain to decline in the future...Let me submit to you a polemic on this terminology.I can document my point of view with substantialstatements from many responsible persons in thefield of nuclear medicine, and in the fieldof utilization of radioactive materials ingeneral. A specimen of a nuclear species iscalled a "nuclide;" hence a nuclide is anythingthat occupies a block on a !'chart of the nuclides."Example: iodine-127, copper-65, and hydrogen-3and gold-198 are examples of nuclear species andare therefore called, "nuclides." Example:hydrogen-3 and gold-198 are radioactive;thery are therefore "radionuclides." It isnever proper to speak of an "isotope" unless thecontext is one of referring that particularnuclear species to another of the same chemicalkind. In other words, one may speak of "isotopesof an element" but to say, "we injected theisotope into the patient" is an improper statement.What was injected was either a "radionuclide"(in elemental or inorganic compound form) ora "radiopharmaceutical." (If it is injectedor otherwise administered to man it is a drug.by order of the FDA.)

--Harris

Some of the major criticisms concerned the validityof the statistical conclusions, citing the inadequacy ofour sampling techniques. Some of the points inquestion have been discussed in the report and manpowerappendix in sections which were unavailable for the firstdraft. Others continue to be valid criticisms.

I am curious to know more than is submittedregarding the characteristic of the populationthat you interviewed. I think that it would beessential to correlate the results of the interviewinformation with the source of that information.for instance, of those interviewed how manywere physicibAs and what were their backgrounds

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in speciality and training. (see Appendix A,Statistical Smmary) What fractions were techni-t.cians and at what level in training or experiencewere these individuals. I get the impressionthat the sample was rather heterogeneous andno where in the discussion of the initial resultsand impressions from the questionnaire is itclear which opinions were primarily physiciangenerated and which opinions were primarilytechnician generated.

In addition, it might be useful to morecompletely characterize the hospitals from whichcompleted questionnaires were received. The currentpractice of nuclear medicine appears to be linkedclosely.with hospital size, the type of medicinepracticed within the hospital as to speciality, etc.(see list of hospitals, Appendix H)

--Nelp

I think the most serious question that comesto my mind and, I am sure will come to the mindof readers who are closely familiar with the field,is the fact that there is no explanation of the mannerin which the data were accumulated (with regard toefforts made to examine a truly representativecross-section of Nuclear Medicine departments.)I do not know personally how you selected thehospitals or the respondents and to my mind comesthe question of the statistical significance ofthe results and whether they are skewed because ofthe selection of the respondents. Please under-stand, I am not saying that this is true--onlythat as a reader of the report I would have noway of knowing if the data truly represent theDepartments throughout the United States orwhether inadvertently the examining team hastalked to a biased group and obtained a falseor statistically inaccurate picture. I sincerelythink that the report must contain statementsas to selection of departments, the volume andtype of work the departments are doing, and prefer-ably an actual listing' of the institutions andthe names of the individual respondents givingthe answers to the interviewer.

While on the same topic, I would call yourattention to page 55 under the heading "TheGrowth of Nuclear Medicine". The first paragraph

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is interesting but there is reason to contest itsaccuracy and, this becomes more difficult becausethere is no reference source listed for your inform-ation. As you will realize, physicians are pro-grammed to carefully substantiate any statementsthat they make or conclusions they draw by accuratereferences to source. They are just as programmedto look for documentated substantiation of anystatements that they read and expect to fullybelieve. I think this is a serious deficit inthe report itself. Again, I would emphasize thatthis in no way implies any falsefication of databut only that serious doubt will come intothe mind of the critical reader. On page 4it becomes apparant that those respondents who werenot always capable of giving the variety ofinformation requested but who did complete thequestionnaire were.guessing. This would suggestsome alteration in the st&tistical significance ofthe results.

--Croll

The comment that nuclear medicine might become obsolete(page 30) elicited a strong reaction from nome reviewers.

Wow! This is a curious observation andreflects on your sample population. I have hadconsiderable experience in thermography, ultra-sonics and nuclear medicine and I must say thatyour respondents are not very familiar with thefacts. This should be kept in the report sinceit does point out one important aspect of thesurvey population.

--Potchen

On page 30 statements in the third paragraphsuch as the field would be obsolete, etc. is,of course, highly unlikely but including thistype of information in report is a distraction. I

notice throughout the report many physician state-ments of similar minor importance have been inclu-ded. I think these should be curtailed as much aspossible.

--Nelp

Reaction was mixed concerning the validity of themanpower section. It should be noted that this sectionhas been changed considerably from its first draft form.

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Starting on page 30 and going through 32 youmake manpower projections which are rather criticalfor the nature of this report. Your assumptions(in Appendix B)that the samples you have chosenare representative of all hospitals with nuclearmedical operation has a high risk in beingincorrect. It appears you chose hospitals inmetropolitan centers and probably larger anda good number of teaching hospitals. Of the7,200 [7150] hospitals in the United States manyof them will have characteristics quite dissimilarfrom your interview hospitals. Many will have nonuclear medical facilities and many (smallercommunity hospitals and speciality hospitals) mayhave no need for nuclear medicine facilities inthe immediate future, possibly within the nextten years of your projection. In addition,the third assumption that you made (in AppendixB) that there were no significant differencesbetween hospitals which did and did not returnquestionnaires seems inappropriate. There pro-bably are significant differences between thesehospitals where those with the most interest,neel and insight may have responded.

--Nelp

.As indicated in the introduction, thissurvey had five objectives relating to trainingof techicians in nuclear medicine. The firstobjective related to determination of thenumber of technicians currently employed., thenumber currently needed and the increase innumbers of trained technicians in the future.The data obtained appear valid in estimating anincrease in technician requirements from thepresent number of 3900 (4000 - 4600)approximately 5400 (550( -5700) by 1970 and almosta four fold increase during the next decade.

- -token

Congratulations also for the section onbasic assumptions for manpower projections.Without this qualifying section, the reportwould have been crippled.

--Harris

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Our profile of the "average" NMT elicited contradictorycomments.

Page 18: This is excellent information,well written and most interesting.

--Potchen

As I indicated in my response to the question-naire, it may well be that the concept of the"average" technician was a mistake. Recognizingthat it has already been done, I am still curiousas to why this was done. It has been my experiencethat there are all levels of nuclear medicinetechnicians and technologists. They range fromthe med tech, who does the normal laboratorytests and incidentally does T-3's and the X-raytech, who once in a while does a scan, to thehighly skilled, professional-level, full-timenuclear medicine technologist. Perhaps it ispremature to elicit these various levels at thistime. I should think, however, that subsequentquestionnaires would provide an opportunity toidentify levels of technician accomplishment.

Recognizing that the report must reflectthe information gained from the questionnaireactually used, I would still say that the term"average" can be handled poorly if you try hard.On page 39, I would definitely suggest removingthe statement, "the average Nuclear MedicineTechnician is female." That is about as badas saying that the average social sciencestudent is "hippie", but some are female and someare male and some leave us to wonder.

In contrast, however, on page 13 the lastparagraph is excellent and will go a long way towardcommunicating some knowledge of the actual taskof the technologist to the lay person who wouldread this report.

--Harris

Most of the reviewers' comments on nuclear medicinetests and equipment have already been incorporated intothe body of this report. Several miscellaneous statementsare included here.

Regarding the difficulty of a scanner vs. camera;Dr. Potchen wrote:

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Page 15, fourth paragraph, second sentence:This is erroneous and I'm not sure exactly why,but I think anyone who has had any experience inthe field appreciates the camera operation, ifanything, is considerably easier than learningto run a rectilinear scanner. I don't necessar-ily favor cameras but there is no question thatit is easier for technicians to run and requiresa less knowledgeable technician to performthe camera studies.

On the statement that an NMT "may point out an areaof interest on a scan to a doctor (page 15, third para-graph)'':

The redlined statement in the middle of thepage could stand the hair up on the back ofsomebody's neck. I would suggest that it beremoved.

--Harris

Concerning new tasks for the NMT:

Page 12, paragraph 2, lines 7-10: Chemicalpreparation of radioactive compounds promisesto become in the near future a very significantpart of a r.echnician's responsibility.

--Hendee

In response to our request for a review of the firstdraft of the report, Mrs. Lee developed a model of theneeds of nuclear medicine.

The indeterminate destination of nuclear medicinein status among the other medical professionalfields is due to the different physician supervisionsand to its youthfulness in comparison to radiologyand/or pathology. It must be recognized as beingvery dynamic (as mentioned in the draft) at itsearly age and thus has a great future ahead.

Requisites to progress in nuclear medicine are:1) recognition by the AMA, 2) dedication to nuclearmedicine alone, by the physician in charge, and 3)publicity of the values of nuclear medicine pro-cedures. These requisites would bring abouta) more financial funds for availability ofadvanced, more sophisticated equipment, and b) improvethe educational opportunities which are so desiredand desperately needed. Suggestions for educationalimprovements other than the actual training programcurriculum are outlined below:

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I. METHODS OF GENERAL EDUCATIONAL IMPROVEMENTSIN THE FIELD OF NUCLEAR MEDICINE.

A. Publicity.

1. Hospital staff physicians.

The physician in charge of the nuclearmedicine department should keep thehospital staff physicians aware of nllthe different procedures and theirvalues. This can be done by presentingperiodic conferences and display exhibits.This arouses much interest and lesstraumatic procedures can be performed onthe patient in deriving a diagnosis.

2. The general public.

By educating the general public to theseprocedures and their values, apprehensionis less and more cooperation on theirpart enables the departments to functionbetter, I believe, improving status.

3. Academic students.

a. Through "career days" or counselors,information regarding or pertinent tonuclear medicine would open the fieldto more students and increase interestin this medical profession.

b. College and university programsoffering special courses towarddegrees would improve professionalStatus.

B. Teaching references.

1. Text books.

a. Improvement with more current inform-ation.

b. Teaching manuals of training programsubjects.

2. Films.

a. Many films are now available but

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outdated. These could showcertain areas of the field ordemonstrations where the subjectis unobtainable or not availabledue to the locale.

3. Mock laboratory technique kits.

a. Some kits are beginning to come onthe market at the present. Thesewould increase technical efficiencywith less possibility for errors.

C. Post graduate courses.

1. Subjects could include pharmacology,computers, etc. that apply to thisspecific field.

I realize that some of these educational improvementsuggestions may be available at the present butthe awareness of their availability is lacking.Better communications or publicity could be improvedthrough, a service which might be offered by one ofthe nuclear medicine societies.

--Lee

The problems of certification and standardizationresulted in a variety of comments, some of which derivedfrom the fact that the first draft of this report waswritten prior to the July meeting of the AMA. Mr. Harris'statement proved to be especially enlightening in clarifyingthe various aspects of AMA "recognition" of nuclear medicine.

Page 8, Mid-portion. The recognition of nuc-lear medicine as a tripartite subspecialty ispretty well underway with the American MedicalAssociation. At the July meeting the nuclearmedicine board application was approved in principlebut the exact structure and relative position wasleft for further clarification.

--Potchen

Page 10: Please recognize that the estab-lishment of a "speciality" by the AMA is a slightlycomplicated thing, and has several stages andaspects. First of all, there was some element ofrecognition of nuclear medicine in allowing board

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certified medical specialists to list the initials,S N M as a part of their biographies in theDirectory of Medical Specialists. Here the recog-nition of the Society of Nuclear Medicine constit-uted something of a recognition of the "field ofnuclear medicine." A second level of recognitionis implicit if, and when, the AMA establishesa Section on Nuclear Medicine to present a partof its scientific program. For several years nowthere have been sessions on nuclear medicinepresented under the Section on MiscellaneousTopics or the Section on Special Topics. Intime this activity, together with certain others,will result in the establishmenc of a Sectionon Nuclear Medicine in AMA programs. A thirdlevel of recognition of nuclear medicine as aspeciality will occur when, and if, an AmericanBoard of Nuclear Medicine is given sanction bythe Advisory Board for Medical Specialities andthe Council on Medical Education of the AMA. Stepsare currently being taken in that direction also.The two or three places that "recognition ofnuclear medicine as a speciality by the AMA" asthey tend to affect growth of the field and pro-fession are mentioned, seem to be a little out oftouch with the foregoing facts.

--Harris

Page 39: Certification discussion is verygood and when appended with the recent AmericanMedical Association report makes a real contribu-tion. Perhaps additional emphasis of the needto fix the uniform code could be helpful.

--Potchen

Page 2, paragraph 2: Fragmentation of thefield of nuclear medicine is apparent not onlyamong various hospitals, but also within the AMAand among the various Boards which are attemptingto establish criteria for certification ofspecialists (physicians and technicians) in nuclearmedicine. Because of this fragmentation, essential-ly no standardization of training in nuclearmedicine has been established. This lack ofstandardization, and the confusion it causes,should be emphasized strongly and clearly.

--Hendee

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Reviewers also commented on the role of other organ-izations in reducing or contributing to the fragmentationof nuclear medicine.

On page 40, Table 6, is most revealing. Asyou and I have discussed, this points out thesignificant and important role that the Societyof Nuclear Medicine plays in the training of Nuc-lear Medical Technologists.

--Croll

A problem closely associated with trainingprograms is that of certification. As was pointedout, presently certification is available throughtwo groups with somewhat different requirements.Your findings show that more than 50 per cent ofthose interviewed felt that it would be best tounify certification under one agency, namelythe Society of Nuclear Medicine. I am surprisedthat this percentage is not significantly higher(approximately 90 per cent).

--Loken

Page 12: In a recent statement of theAmerican College of Radiology, the field ofRadiology has been defined by them to includethe field of radiation, including ultrasound,thermography and X-rays. It also addressesattention to nuclear medicine, but the AmericanCollege of Radiology is admittedly putting onlya temporary roof over the field of nuclearmedicine.

--Harris

'.elated to the discussion of organizations is the tieof nuclear medicine to radiology.

In my opinion, trends quoted do not support yourconclusion that nuclear medicine is not related closelyto radiology. The incentive for separation seemsto be the recognition by a growing number ofphysicians that nuclear medicine is a reputablemedical discipline.

--Hendee

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On page 11, there is a very serious breachof accurate data and what we might loosely term .

"medical politics". The relationahip of "rad-iation therapy" to Nuclear Medicine is anextremely sensitive affair in the minds of allphysicians who are practicing full-time NuclearMedicine. Historically, the early development ofthe field of Nuclear Medicine came about, asthe survey reports, as a third area of activityin the field of radiology. Diagnostic radio-logy, of course, was the initial and largestarea, and radiation therapy was the secondaryarea. Nuclear Medicine then became a thirdarea smaller than the other two and in manyinstances because of limitations of space andpersonnel, Nuclear Medicine was physicallylocated in an area adjacent to the RadielonTherapy Department. It even developed thatadministratively Nuclear Medicine was lumped withradiation the:, This concept is now dis-appearing as i 'ightly should. Nuclear Medi-cine has far leas in common with radiationtherapy than it has with diagnostic radiology.

--Croll

On Pages 9 and 10 some valuable pointsare brought out: The fact, that Nuclear Medicineas a speciality will expand as it becomes freedof its subordinate status to other departments,is most astute. Those of us who have bean inthe field long enough and in an academicenvironment are well aware of this, but thegeneral Nuclear Medical population is not. Theconcept that a career in Nuclear Medicine ismost difficult is not true, as the survey pointsout, although it does require some very importantqualifications in the individual. I think thisarea needs further evaluation.

--Croll

Not only is the field of nuclear medicine tied toradiology but--as has been emphasized earlier--most NMP'shave also begun as X-ray technicians. Reviewers' opinionson this situation differed radically.

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Of those trained during the year 1969,approximately 62 per cent were initially trainedas X-ray technicians pointing out the commonfeatures of performance of X -ray techniciansand nuclear medicine technicians.

--Loken

Page 33, paragraph 2: Tle low rating givento technicians trained in diagnostic radiologymay reflect dissatisfaction of physicians withthis type of preparation.

--Hendee

Page 11: The statement about medicaltechnologists picking up in vitro techniquesis certainly a true one. It is lso true thatthe in vitro work does not demand the amount oftraining requisite in a separate technology.However, it has been our experience and thatof many others, that the medical technologistis much more adept at the systematic calculationof results than is the X-ray technologist, who ingeneral is oriented away from numbers.

--Harris

Page 33: X-ray techu have theexcellent attributes, in general, of being verygood with patients, being able to operateequipment on a push-button or routine basisand they have some feeling for scan-recordproduction. They even, on occasionvihave someknowledge of anatomy and physiology. They sufferin general, from lack of motivation in goingdeeper than the "black box" approach toinstrumentation and many of them go into completeshock at being faced with a mathematical calcul-ation. They tend to_routine and rote ratherthan to thinking in many cases. Medical technol-ogists, on the other hand, are generally excellentat thought processes, mathematics, and assumingresponsibility. They ;ave to be taught virtually

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6

from scratch about instrumentation and the actualcare of patients.

- -Harris

The various expectations of the NMT were reflected inreviewers' comments on the section entltlel "Workingconditions" (pages 25-29). Dr. Loken expanded on the need fordifferent levels of NMT's with different levels of training.

The statement on NMT working conditions is good.

- -Harris

Page 28: Second paragraph is outstandingand clearly dispalys an excellent understandingof the situation. It is well written and shouldbe read by anybody interested in trainingnuclear medicine technologists (technicians).

- -Potchen

Your study showed that the majority of thoseinterviewed felt that the training of nuclearmedicine technicians could be carried out intwo years, providing the individual had somebackground in X-ray technology with certificationin that field. It was somewhat surprising thatso few (less than 1 per cent) felt the necessityof obtaining a bachelor of arts degree in orderto function most effectively as a technicianin nuclear medicine. At this point I thinkit deserves mentioning that it may be worthwhileto consider two levels of training for technicalindividuals WITh the first group includingthose covered in this report (training leadingto certification as a nuclear medicine technician)and the second program for training individualswhose training would lead to a bachelors andpossibly masters degree. This latter group iscertainly needed in order to provide competenttechnical leadership in nuclear medicine.

--Loken

To the statement that NMT's need good "bedsidemanner" (page 28) Mr. Harris commented: "Good! especiallyin allaying fear of radioactivity.

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To the idea of an NMT in an associate relationshipwith the M.D. (page 28) Dr. Dworkin's comment was:"ridiculous; perhaps a Ph.D. in nuclear medicine."

Several comments were made on the section concerningsalaries for NMT's.

As expected, there is a wide range in salariesbeing paid to technicians varying all the wayfrom about $4,000 to $12,000 per year. Thisis not surprising because of the tremendousdifferences in the responsibilities and trainingof the individuals involved.

--Loken

Page 31: Discussion on salaries is verywell done and should be very useful to people inthe field of nuclear medicine. Undoubtedly,this leaves one with the impression that increasein salaries will be essential if we are ever toobtain the goals of a reasonable number of peopleentering this field. Perhaps this should beemphasized.

--Potchen

The section on traininc of NMT's was in very rudiment-ary form when sent to reviewers. Thus they were unableto make substantive comments on this most important section.Nevertheless, certain of their statements are usefuladditions to the report.

The final objecti.ve of your survey was toexplore the feasibility of nuclear medicine train-ing programs in cooperation among hospitals andeducational insit,ations. Your survey concludesthat most of the individuals interviewed werein agreement with this concept, which I feel isindeed the proper approach in order to providesufficient numbers of trained nuclear medicinetechnologists to fill the projected needs for thefuture of this rapidly growing field.

- -token

I think your information on the currenttraining of nuclear medicine technologists iswell presented and the routes available for

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certification, the AMA guide linen, etc. areuseful in obtaining a perspective for the overallstudy.

--Nelp

Parenthetical thoht: Now that the Essen-tials have been approved by the House of Delegatesit might be in order to put out a questionnaire oncurriculum content; maybe we can get a handleon reasons for the "poor quality of trainingprograms for technicians" (page 9),

--Harris

The third objective was to determine thenature and extent of existing training programsfor NMT's. Your finding that approximately50 per cent of those employed as technicianstoday were trained on-the-job appears somewhatlow to me because of the dearth of trainingprograms. It was of interest to note thatapproximately 20 per cent of those interviewedstate that they hire only trained technicians. I

wonder where these trained technicians come from.

--Loken

Only one comment concerned the idea of an intern-ship. "The wage fits the service value. These interns maydo more damage than good." --Dworkin.

Finally criticisms of the interview protocol werecommon, with most statements critical of.its bulk. Commentson the report as a thole were generally favorable.

The questionnaire was felt to be a mostdifficult one to comply with, mainly due to themethod of classifying or stating degrees ofevaluations.

--Lee

The questionnaire is comprehensive, some-what cumbersome in design and I would imagine youto have a tremendous amount of data availablefrom its answers.

--Nelp

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I have some criticism of the survey form,but to-dwell on that would serve no usefulpurpose. No instrument is perfect, but thequestionnaire elicited a great deal of informationthat is vitally needed at this point in spiteof its imperfections. Most of the problemsrelate to an outsider's lack of familiaritywith the language of nuclear medicine.

--Harris

The following are some general comments made onthe report.

In general, I believe you have developedan excellent survey of the current and futurerequirements for technologists in nuclearmedicine.

--Hendee

I have read, in detail, the "draft finalreport" project No. 7-0313 entitled "Developmentof Career Opportunity for Technicians in theNuclear Medicine Field -Phase I." I think itcontains much valuable information which washeretofore inaccessible In summary, the reportcontains much valuable information and shouldprove most useful in assessing and establishingnuclear medicine technologists (technicians)training program.

--Potchen

I have read the final draft of "Developmentof Career Opportunities for Technicians in theNuclear Medicine Field" with great interest. TERCis to be commended for this effort since it isthe first I know of. In general I feel the factualdata is quite accurate. The conclusions andprojections are undoubtedly overly optomistic.

--Dworkin

Inasmuch as I am about to be very candidand blunt in my constructive criticism of thisdocument, let me say that is is an excellentreport, lucid and informative. This documentis the first intelligent compendium of informationon this subject that has come out...In summary,

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I feel that the report shows a remarkable under-standing cf the field of nuclear medicine by theTERC group. Certain anomalies of the language,however, tell me that additional familiarizationcan be found profitable. I am extremely pleasedwith the content of this most vital report.None of my "nit-picking objections havealtered the general presentation of your majorfindings, impressions, and conclusions.

--Harri3

In summary, I would again emphasize, asI did at the beginning of this report, that ingeneral the survey appears to be fulfillingits objectives, and I am stare that it willbecome an extremely useful tool in developingthe training program. I have purposefullybeen critical and candid in my remarks about it--bouquets would be of little value at this stage.

--Croll

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Appendix %Ts Duke University Medical Center JobSpecifications for Nuclear MedicalTechnicians and Technologists

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Nuclear Medicine Technician I

Nature of Work

A technician in this classification performs entry-levelwork as a trainee in nuclear medicine procedures. Thesetasks are carried out under the direction and guidance ofhigher level personnel. The individual is responsible forperforming a limited number of procedures accurately, orassisting in setting up procedures, and for recording perti-nent data. Assignments may be in specialized areas, such as:scanning, in vitro studies or other areas as determined bythe patient-care needs of the servi,:e or the aptitude of the;echnician trainee. Duties are performed under direct super-vision of both senior technologists and physicians, althoughsome phases may be performed without repeated instruction.The work is evaluated by observation.

Employment in a position of this classification provides,over an appropriate interval of instruction and experience,training to lead to certification as a Registered NuclearMedicine Technologist.

Illustrative Examples of Work

Performs thyroid uptakes, T-3 serum binding tests ,nd

similar basic nuclear medicine laboratory procedures; cal-culates results under supervision.

Operates rectilinear scanners, including adjustment ofthe instrumentation, positioning of the patient; obtainsdevelopment of film record,and reloads film cassette.

Operates other radiation detection and measurementinstrumentation.

Maintains working area and surfaces in proper stateof cleanliness.

May be assigned to accompany higher level technicianor technologist on night call rotation.

Performs other related work as assigned.

Knowledge, Skills and Abilities

Working knowledge of the principles of instrumentationand radiopharmaceuticals used in nuclear medicine procedures;this may be gained by on-the-job training.

Ability to follow procedures, instructions and regula-tions precisely.

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Ability to communicate instructions and explanationseffectively to patients.

Ability and aptitude to perform routine, repetitiveprocedures.

Ability to maintain effective working relationshipswith other employees and with patients.

Acceptable Training and Experience

1. Graduation from high school and graduation froma school of radiologic technology accredited bythe Council on Medical Education of the AmericanMedical Association with eligibility for certi-fication as a Registered Radiologic Technologistby the American Registry of Radiologic Technologists.

Experience in nuclear medicine techniques duringabove X-Ray technology training is desirable, OR,

2. Graduation from high school and completion of atleast three years of a program in medical tech-nology leading to the degree of Bachelor of Scienceof Medical Technology, OR,

3. Graduation from highschool and ninety or morecollege credit hours, including courses in mathe-matics, chemistry and biology. Some exposure toprinciples of radioactivity detection in thistraining is desirable.

Nuclear Medicine Technician II, Nuclear MedicineTechnologist II

Nature of Work

A technician or technologist in this classificationperforms routine technical work related to nuclear medicineprocedures using radioactive tracers and instrumentation per-taining to the measurement thereof. The level of perform-ance is above that of an entry-level technician, but doesnot call for completely unsupervised performance. The in-dividual is responsible for performing a large number ofprocedures accurately, for setting up procedures and forrecording pertinent data. Assignments may be in any areaof the nuclear medicine laboratory, e.g.. assignment torectilinear scanners, thyroid uptake area, of in vitrostudies. Supervision is of a general nature aria Firarm-ance is evaluated by observation, both by senior technol-ogists and by physicians.

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Illustrative Examples of Work

Performs thyroid uptakes, T-3 serum binding tests,blood volume determinations and similar basic nuclearmedicine laboratory procedures; calculates results subjectto checking by supervisory personnel as the need is indi-cated,

Operates all radiation detection instrumentation usedin the diagnostic clinical laboratory. This includes rectt-linear scanners; with film processing and patient setup.Some of this work may be carried out under supervision.

Performs special studies, with supervision, such asrenograms and operates complex equipment such as the scin-tillation camera and its associated instruments.

On occasion, with supervision, calculates and draws upradiopharmaceutical material for patient injection; withclose supervision, may formulate certain radiopharmaceu-ticals from pre-prepared kits.

Calculates results of patient studies and radio-activedecay using calculations requiring the use of algebra andoccasionally logarithms.

Performs specially designed tracer studies as outlinedin specific protocols.

May be assigned to night call for emergency procedures.

Performs daily instrumentation calibration and entersresults in log.

Makes entries in radiopharmaceutical receiving, dis-pensing and disposal log books.

Performs other related work as assigned.

Knowledge, Skills and Abilities

Considerable knowledge in the principles of operationof certain specific instrumentation used in nuclear medicineprocedures; considerable understanding of radiopharmaceu-ticals used in certain nuclear medicine procedures.

Working knowledge of use of instrumentation usedoccasionally.

Working knowledge of enough chemistry and laboratory .

procedure to prepare, from kit materials, certain radio-pharmaceuticals with little or occasional supervision.

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This requires the ability to maintain aseptic technique inpharmaceutical preparations and the maintenance of cleanradioactive conditions.

Ability to follow procedures, instructions and regu-lations precisely, with the additional ability to partici-pate to a limited extent in formulation of new proceduresand instructions.

to communicate instructions and explanationseffectively to patients.

Ability and aptitude to perform routine, repetitiveprocedures with reliable results under limited supervision.

Ability to maintain effective working relationshipswith other employees and patients.

Nelpfult Knowledge in the use and operation of X-Rayequipment, OR,

Knowledge of equipment and procedures used ingeneral medical clinical laboratories.

Koptable Training and Experience (Order of preference isneither expressed n3iWrrai----

1. Graduation from high school, with completion ofaccredited training with certification as aRegistered Radiologic Technologist by theAmerican Registry of Radiologic Technologistsand certification as a Registered Nuclear MedicineTechnologist, OF,

2. Graduation from high school, completion of accredi-ted training with certification as a RegisteredRadiologic Technologist of the American Registryof Radiologic Technicians and at least two years'experience as a technician in a clinical practiceof nuclear medicine, OR,

3. Completion of accredited training and certificationby the American Society of Clinical Pathologists asa Registered Nuclear Medicine Technologist, OR,

4. Completion of accredited training and certificationby the American Society of Clinical Pathologists asa Registered Medical Technologist with two years'experience as a technician in a clinical practiceof nuclear medicine, OR,

S. A Bachelor of Science degree in one of the lifesciences with some experinece as a technician in

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clinical nuclear medicine. Both the content ofthe academic training and of the technician experi-ence in nuclear medicine are subject to review, OR,

6. Other conbinations of preliminary training andaccredited programs of technologies, formal aca-demic training in the life sciences and in clinicalexperience as a technician in nuclear medicine maybe found acceptable for this classification uponreview of the applicant's credentials.

NOTE: Identification of an individual as a technician or asa technologist will be made upon an eiiiniTURofrciarifiTO7115rmal training credentials. In general,the title technologist requires registry as a tech-nologist in the specified occupation or a baccalaureatedegree in same.

Nuclear Medicine Technician III, Nuclear MedicineTechnologist III

Nature of Work

A technician or technologist in this classification iecapable of performing any of the usual procedures in theclinical nuclear medicine laboratory with only minimal oroccasional supervisory guidance. This classification iden-tifies the technician or technologist as a senior technicianor technologist, and assumes that the individual is of aresponsible nature, having had intensive training and ade-quate experience. The individual is responsible for per-forming a large number and variety of procedures accurately,to develop and evaluate new procedures and should be capableof developing optimal means for recording pertinent data.As a senior technician or technologist, assignments may beto perform or to supervise in any area of the nuclear medi-cine laboratory, including scanning, in vitro studies andradiopharmaceittical preparation. The woOrrii performedunder general supervision and is evaluated by observation.

Illustrative Examples of Work

Supervises, coordinates, and performs such studies asthyroid uptakes, T-3 serum binding tests, blood volumedeterminations; is responsible for the calculated resultby himself or those under his supervision.

Operates, with general supervision only, all radiationdetection instrumentation used in the diagnostic clinicallaboratory including rectilinear scanners, stationary imag-ing devices and apparatus for in vitro counting.

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Assists in the devising of, the supervision of and theperformance of special studies such as renograms and rapid-sequence dynamic function studies with the scintillationcamera.

Supervises and performs the calculation and drawing upof radiopharmaceutical material for patient injection:supervises and performs formulation of certain radiopharma-ceuticals from pre-prepared kits.

Supervises and performs calculations of the results ofpatient studies and radioactivity decay using calculationsrequiring the use of algebra, logarithms and transcendentalfunctions.

Suporvises and teaches students in the program ofnuclear medicine technology training or other specifictrainees, assigned to his area.

Maintains appropriate stock levels of supplies requiredin his assigned work Area.

Performs daily instrumentation calibration, entersresults in log, and is responsible for review of calibrationdata to detect trends indicating malfunction.

Is assigned to night call for emergency procedures.

Performs and assists in the devising of cpeciallydesigned tracer studies to meet the needs of specific pro-tocols. Supervises and participates in the keeping of entriesin radiopharmaceutical receiving, dispensing and disposal logbooks. Maintains record of bacteriologic culture reports.

On assignment by chief technologist or by physician,may consult with physicians and investigators from otherdisciplines on applications to tracer techniques to specificprojects anticipated or existing.

Assumes the responsibility of seeing that appropriatenursing care is provided for the p&z.ients in his care andthat supplies for same are made available.

Performs other related work as assigned.

Knowledge, Skills and Abilities

Considerable knowledge in the principle of operationof all specific instrumentation used in nuclear medicineprocedures; considerable understanding of radiopharmaceu-ticals used in all routine nuclear medicine procedures;working knowledge of radiopharmaceuticals used in specialprocedures.

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Considerable knowledge in chemistry and laboratory pro-cedures, sufficient to supervise the preparation and formu-lation, from pre-prepared kits, of all commonly used radio-pharmaceuticals. This requires the ability to provide meansfor, and maintenance of, aseptic technique in pharmaceuticalpreparation and in the maintenance of clear radio-activeconditions.

Ability to interpret and Follow procedures, instructionsand regulations with the additional responsibility to seethat these are carried out in the clinical operat;ons.

Ability to participate actively in the formulation ofnew procedures, instructions and regulations.

Ability to perform well-defined, technologically orientedresearch projects.

Ability to train and advise subordinates, evaluate theirwork and help resolve technological problems they encounter.

Ability to perform a reasonable number of non-routinenuclear medicine procedures.

Ability to communicate inutructions and explanationseffectively to patients.

Ability to supervise effectively subordinates in theperformance of routine, repetitive procedures, and to main-tain effective co-worker relationships with others.

NOT ABSOLUTELY REQUIRED IN ALL APPLICANTS, BUT EXTREMELYDESIRABLEt

Considerable knowledge in the use and operation ofX-Ray diagnostic equipment, OR,

Considerable knowledge of equipment and proceduresused in general medical clinical laboratories.

Some knowledge of data processing methods or orienta-tion to computer methodology.

Acceptable Training and Experience (Order of preference isnneit Freer ---triareTe) nor implied)

1. Graduation from high school, with completion ofaccredited training with certification as a Regis-tered Radiologic Technologist by the AmericanRegistry of Radiologic Technologists and certifi-cation as a Registered Nuclear Medicine Technolo-gist, plus a broad experience in all aspects ofnuclear medicine technology, OR,

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2. Graduation from high school, and subsequent com-pletion of accredited training and certificationby the American Society of Clinical Pathologistsas a Registered Medical Technologist with sub-sequent certification as a Registered NuclearMedicine Technologist, plus broad experience inall aspects of nuclear medicine technology, OR,

3. A Bachelor of Science degree in Nuclear MedicineTechnology in an accredited program of nuclearmedicine technology training with either sub-sequent certification as a Registered NuclearMedicine Technologist or clinical experience asa nuclear medicine technologist, OR,

4. A Bachelor of Science degree in one of the lifesciences with broad experience as a technician innuclear medicine technology. Both the content ofthe academic training and of the technician experi-ence in nuclear medicine are subject to review, OR,

S. A diploma or baccalaureate degree as a RegisteredNurse with suitable clinical and supervisory ex-perience in nuclear medicine technology. Thetraining and experience in nuclear medicine wouldbe subject to review.

NOTES Identification of an individual as a technician or asa technologist will be oade upon an evaluation ofrePstry or formal traiilIng credentials. In general,the title technologist requires registry as a tech-nologist in the specified occupation or a bacca-laureate degree in same.

Nuclear Medicine Technologist IV

Nature of Work

A technologist in this classification carries out thesupervisory responsibilities of tin overall chief technolo-gist. This position carries the responsibility of organis-ing the technologic staff of the Division of Nuclear Medicineand devising and maintaining an orderly approach to the com-pletion of each day's work load. This work is accomplishedwith the advice and guidance of the Instructor and incoordination with the clinicians and other faculty membersresponsible for the clinical service of nuclear medicine.

Illustrative Examples of Work

Supervises and coordinates studies performed in allareas of the laboratory/ may conduct, or participate in,any phase of the technologic operation.

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Schedules the working hours of the technologic staffto provide optimal service coverage of the laboratory.Assumes personal responsibility to assure technologiccoverage of after-hours emergencies.

Supervises preparation of radiopharmaceuticals forpatient administration.

Maintains a close liaison with Radiation Safety Officein regard to personnel monitoring and laboratory monitoringof radioactive materials.

Consults and advises with the clinical and technicalstaff regarding problems of technique or equipment.

Aasists the Instructor in teaching nuclear medicinetechnology students and, with the guidance of the Instructor,is responsible for the training of persons with the classi-fication of Nucioar Medicine Technician I.

Consult° with physicians and investigators from otherdisciplines regarding technical applications of .racertechniques and nuclear medicine equipment applications tospecific projects anticipated or ongoing.

Assumes the responsibility for seeing that appropriatelaboratory supplies and nursing care needs are available toall areas of the laboratory.

Supervises daily the results of calibrations and mal-function checks in all areas of the nuclear medicine labo-ratory, and is responsible for performance of such additionaltests on the equipment necessary to confirm equipment failure.Takes action to have equipment restored to proper service.

Knowledge, Skills and Abilities

Thorough knowledge in the principle of operation of allinstrumentation used in nuclear medicine procedures; thoroughunderstanding of radiopharmaceuticals used in all routinenuclear medicine procedures; considerable knowledge ofre iopharmaceuticals used in special procedures.

Considerable knowledge in chemistry, radiation physicsand laboratory procedures sufficient to supervise the prep-aration of all commonly used radiopharmaceuticals. Thisrequires the ability to provide means for, and maintenanceof, aseptic technique in pharmaceutical preparations and inthe maintenance of clean radioactive conditions.

Ability to participate in the devising of well-defined,technologically oriented research projects.

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Ability to promulgate new procedures, instructions andregulations.

Ability to train and supervise the technology staff,evaluate their work, and resolve problems that they encounter.

Ability to train staff technologists in communicationof effective instructions and explanations to patients.

NOT ABSOLUTELY REQUIRED IN ALL APPLICANTS, BUT EXTREMELYDESIRABLE:

Considerable knowledge in the use and operation ofX-Ray diagnostic equipment, OR,

Considerable knowledge of equipment and procedures usedin general medical clinical laboratories.

Some knowledge of data processing methods or orientationin computer methodology.

Acceptable Training and Experience (Order of preference isnerEher expressed nor implied]

1. Bachelor of Science degree in Nuclear MedicineTechnology in an accredited program of nuclearmedicine technology training with either sub-sequent certification as a Registered NuclearMedicine Technologist ar considerable clinicalexperience as a Nuclear Medicine Technologist, OR,

2. Completion of an accredited program of trainingwith certification as a Registered RadiologicTechnologist by the American Registry of Radio-logic Technologists and certification as aRegistered Nuclear Medicine Technologist plusconsiderable experience as a supervisor-technicianor tochliologist in the field of clinical nuclearmedicine technology, OR,

3. Completion of accredited training and certificationby the American Society of Clinical Pathologists asa Registered Medical Technologist with subsequentcertification as a Registered Nuclear MedicineTechnologist, as well as broad experience at thesupervisory level in clinical nuclear medicinetechnology, OR,

4. A Bachelor of Science degree in one of the lifesciences with broad supervisory and clinical ex-perience as a technologist in nuclear medicine.Both the content of the academic training and of

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the supervisory technologic experience in nuclearmedicine are subject to review, OR,

5. A diploma or baccalaureate degree as a RegisteredNurse with suitable clinical and supervisoryexperience in nuclear medicine technology. Thetraining and experience in nuclear medicine wouldbe subject to review.

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Appendix Kt Task Frequency Data andStatistical Analysis

-279-

Task Frequency Data and Statistical Analysis*

Legend: n = number of respondents per task item

= mean coded value per task item

0 = task not performed in department (value assigned: 0)

a = task performed in department, but not by an averagetechnician in that department (value assigned: 1)

b = 1-3 times per month

c = 4-10 times per month

d = 11 or more times per month

Preparation1. Chemically prepare short-life isotopes:

a) eluting column2. b) chemical preparation3. c) sterilize4. Calibrate isotopes against a standard5. Prepare oral dose: Measure from manufacturer's

bottle6. Prepare oral dose: mix, dilute to measure7. Prepare injections: measure dose8. Prepare injections: sterilize dose9. Set up instruments for operation: a) in vivo

studies10. Set up instruments for operation: b) in vitro

studies

11. Administer isotopes to patients: a) orally12. Administer isotopes to patients: b) by injection13. Receive patients, explain tests to them and allay

their fears14. Position patient with respect to nuclear medical

equipment15. Superficial and specialized examination of

patients16. Attend to patient's comfort before and during

scan17. Understand operating room procedure

Data Handling18. Abstract simple data from patient's chart

:19. Make simple dose calculations for a) in vivoexaminations

20. Make simple dose calculations for b) in vitroexaminations

21. Make simple dose calculations for c) tracerexaminations

22. Accumulate and process data for MD'sinterpretation

23. Examine scan test results for general credibility24. Perform preliminary interpretations of

observations for MD

(value assigned: 2)

(value assigned: 3)

(value assigned: 4)

n x 0

INT]

a

_197 2.7 27.9 3.

197 1.0 63.4 7.

196 0.6 75.5 8.

198 3.1 14.1 3.1

198 2.6 25.8 2.

198 2.1 35.3 5.

7:00 3.7 4.5 2.

i98 0.7 74.8 8.

197 3.7 5.6 1.

196 2.9 17.3 7.

199 3.6 2.5 4.

200 2.4 10.5 34.

200 3.9 0.5 2.

200 3.9 1.5 O.

Respondents varyin into

200 3.9 2.0Una

0.inluni

Respondents varying

199 3.0 4.0 20

198 3.7 4.0 5

196 2.9 18.9 9

199 3.5 5.5 4

200 3.6 3.0 7

200 3.7 2.5

198 1.9 19.7 391

*In some cases, frequency percentages for a given taskwill total more than 100%, because of rounding off.

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INTERVIEW DATA

a b d n x 0

MAILED BATA

a b

3.6 1.5 . . 7.2 s

7.6 8.1 5.1 1100191=111111111IIIITP191

90.0

ll

88

98

9

111-111

4

2.7

2.9

.04.8 _ALI_

7 I_8.73.5 7.1

I

7.6 23.5

2.0 7.6 11.1 13 4 72 2 11,1111111,15.6 9 0

3213.5

IIIIMIT1112.5

46.: :75 72.1 ---Aiij I 1/111

III7.6

MI

1.5 1.5 4 : . : 1MIN . 111111111111111113.1 6 6 65.3 97 3.3 13.4 3.1 5.2

4.0 5.5 7 0 II 98 3.3 8.2 1 4

4.5 3.0 3.0 11E01011MA

1 11

II

M99

la

1 2

2.0

OFEW11111114111111114111119EMPI

6.1 1 0 _C__2.0 _1.5

in

0.5 1.0

..---------1-

interpretations

2nti.11-114

97.0

led

2 0

to non-

3.8 3.0 9,

Respondents varying interpretations led to

9 3.0 __1.0 8.1ing interpriiiEohs

dataled

8.0

to non-

61.3

.---nstananilscialata_..----Respondents

97 2.9

varying

5.2

interpretations

17.5 10.1_13.1,11A,

_2.0

4.1

led

15.2

12.4

to

76.8

62.9

0

uniform

20.1 6.5

5.0 1.0,

3.6

1.5

4.6

08.4

63.8

99

97

3.6

3.1

_1.0

12.4

5.0

8.29 9.2

5 4.0 5.0 6.0 79.4 97 3.2 6.2 10.3 3.1 17.5 62.9

0 7.0 2.0 3.5_,2.0

84.588.5

9591

3.53._4_,,

1.7

1.03.1

2518

8.4 3.23.-Y_

5.4

13.7 73.75 s7-4' _1.5 10.3

36.6

7.2 76.3

25.87 39.4_ _4.6_. 5.0 31.3 93 6.4

25:7gifite a rectilinear scanner for conventionalscanning

26. Operate a autofluoroscope for static studies27. Operate a scintillation camera for static

studies28. Operate an autofluoroscope for fast dynamic

studies (under one minute scan)29. Operate a scintillation camera for fast dynamic

studies30. Operate a scanner for slow dynamic studies

(over one minute scan)31. Operate an autofluoroscope for slow dynamic

studies32. Operate a scintillation camera for slow

dynamic studies33. Calibrate nuclear medical instruments34. Check performance of existing nd new nuclear

medical instruments against manufacturer'sspecifications

35. Determine if a nuclear medical instrument isin need of major repair

36. Perform minor maintenance on nuclear medical4istrument

37. Evaluate nuclear medical instruments frommanufacutrer's literature and specify andrank those instruments that satisfy doctors'requirements

38. Advise doctors on the technicalities and proce-dures involved in operating a nuclear medicalinstrumeAt

__Safety)9. Check monitoring instruments40. Monitor personnel in compliance with hospital

f regulations41. Monitor space in compliance with hospital

regulations42. Handle and store radioisotopes safely43. Assay wet chemical solutions for activity and

contaminants44. Safely dispose of radioactive wastes

Clerical,ankle secretarial work: appointments, type

reports46. Routinely check incoming equipment47. Inventory and order radiopharmaceuticals and

materials48. Keep accounts of hospital licensing and isotope

procurement

n x 0

IN

200 3.7 0 .

196 0.1 94.1..

195 0.1 93.1

199 1.3 57.3 7.

195 1.9 41.5

195 0.1 92.8 :I

196 1.5 54.6196 3.0 8.7

,196 1.9 12.8

1.5

35

24196 2.6

193 1.9 14.0-..............

16.9

26

. ,.*195 1.2

196 2.2 9.7 26

199 . 2.5 5.5 21

198 2.2 9 6..:.

19198 :1.5 3.52

2, 28 1000 5.5

19: 2.8 3.S 2819. 2.2 4.. 3'

3 0.5 1 .

195 2.6 5.6 37'

,.4.11,11111,

INTERVIEW DATA

d {

MAILED DATA

I 14.. 1.0 1.0 92.0 100 3.7 6.0 1.0 7.Q 86.04,1

4.0

0.5

2 0

0.5

39.2

0.5 94

95

0.2

0.9

92.6

74.7

4.3

2.1

3.2

1.0 22.1

4.1 0.5 0.5 1.5 94 0.2 3 6 2 1 1 1 3 2

-...7.. e : , e

: 36.4 96 1.9 39.6 7.3 9.4 8.3 35.4

11,11111111111.7 10.2

4 1 2.2

60.2 979

2.46.2

18.6' 3 2 7 412.4 16.5

4.3 14.9,15.5 37.1

*5 1.7 28.4 22.1i

22 1 9.5 1 9

26.0 8.7 39.8 97 2.2 10.3 23.7 29.9 9.3 26.8

26,9

'

33.7

20.0

10.4

1.5

15.0

4.6

934 1.6

93 1.0

21.5

40.9

31.2 1 30.1

32.3 18.3

2.2

1.1

15.0

7.5

1 26.2 24.1 17.4 22.6 96 1.5 27.1i

29.2 I 19.8 11.5 12.5

i 21.1 26.1 16.1 31.2 98 2.3 9.2 21.4 ' 27.6 17.4 24.5

26tj 22.7 11.6 28.8 97 2.3 10.3 20.6 24.7 18.6 25.8

19.2 30.3 22.2 24.8 96 2.4 5.2 17.7 32.3 19.8 25.02,0 2.5 5.5 88.5 100 3.6 2.0 8.0 13.0 77.0

'1 10.7 40.3 94 2.2 22.3 18.1 12.8 13.8 33.03.5 65.5 99 3.2 1.0 9.1 16.2 12.1 61.6

i 2 6.6 3.0 58.1 95' 2.5 10.5 : 31.6 4.2 7.4 46.328.6 9.7 26.5 95 1.8 . 17.9 33.7 21.0 7.4 20.0

6 7.0 18.1 63.8 99i 1.0 i 12.1 ; 9.1 18.2, 59.6

32.3 8.7 7.2 46.2 961 2.6 5.2 30.2 10.4 8.3 45.8