AAPM REPORT NO. 42 THE ROLE OF THE CLINICAL MEDICAL PHYSICIST IN DIAGNOSTIC RADIOLOGY Published for the American Association of Physicists in Medicine by the American institute of Physics
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AAPM REPORT NO. 42
THE ROLE OF THECLINICAL MEDICAL PHYSICIST IN
DIAGNOSTIC RADIOLOGY
Published for theAmerican Association of Physicists in Medicine
by the American institute of Physics
AAPM REPORT NO. 42
THE ROLE OF THE CLINICAL MEDICAL PHYSICISTIN DIAGNOSTIC RADIOLOGY
DESCRIPTION OF THE ROLEOF THE CLINICAL MEDICAL PHYSICIST
IN DIAGNOSTIC IMAGING
REPORT OF TASK GROUP 2PROFESSIONAL INFORMATION AND CLINICAL RELATIONS COMMITTEE
Task Group Members
Joel E. Gray, Ph.D. (Chairman)Gary T. Barnes, Ph.D.
Michael J. Bronskill, Ph.D.Mary F. Fox, MS.
G. Donald Frey, Ph.D.Arthur G. Haus
Mark T. Madsen, Ph.D.William Pavlicek, Ph.D.Stanley A. Reed, M.S.
Robert S. Wenstrup, Jr., Ph.D.
Consultants
Richard A. Geise, M.S.Pei-jan Paul Lin, Ph.D.
Donald D. Tolbert, Ph.D.
This statement follows that entitled “The Role, Responsibilities, and Status of the Clinical MedicalPhysicist,” issued by the AAPM in 1986 [1], and concentrates on the role and relationships of theclinical medical physicist practicing in diagnostic imaging.
January 1994
Published for theAmerican Association of Physicists in Medicine
by the American Institute of Physics
DISCLAIMER: This publication is based on sources and informationbelieved to be reliable, but the AAPM and the editors disclaim any warrantyor liability based on or relating to the contents of this publication.
The AAPM does not endorse any products, manufacturers, or suppliers.Nothing in this publication should be interpreted as implying suchendorsement.
Further copies of this report may be obtained from:American Association of Physicists in Medicine
One Physics EllipseCollege Park, MD 20740-3846
International Standard Book Number: 1-56396-311-6International Standard Serial Number: 0271-7344
©1994 by the American Associationof Physicists in Medicine
All rights reserved. No part of this publication may be reproduced, storedin a retrieval system, or transmitted in any form or by any means(electronic, mechanical, photocopying, recording, or otherwise) withoutthe prior written permission of the publisher.
Published by the American Institute of Physics500 Sunnyside Blvd., Woodbury, NY 11797
Printed in the United States of America
Table of Contents
IntroductionResponsibilities of the Clinical Medical Physicist
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2.
3.4.5.6.
7.
Delineation of the Physical Aspects of DiagnosticImaging SystemsEstablishing and Maintaining a Radiation SafetyProgramOptimization of Clinical Imaging ProceduresParticipation in Planning and Resource AllocationParticipation in Educational ProgramsInvolvement in the Community in PublicEducation ActivitiesInvolvement with the Medical Imaging Communityand Other Related Organizations
Medical Physics StaffingQualifications of a Clinical Medical PhysicistRelationship Between Medical Physicists and Others
in Medical Imaging Programs1. Relationship with the Imaging Physician2. Relationship with Technologists
Employment Arrangements1. The Medical Physicist in a Physicians’ Corporation2. The Medical Physicist in the University Setting3. The Medical Physicist as an Employee of the Hospital4. The Medical Physicist as a Contractor to Provide
Services Through a Medical Physics Corporation
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Preface
This document concerns the role of the clinical medicalphysicist in diagnostic imaging, including descriptions of the medicalphysicist’s responsibilities, relationships with other professionals, andpractice conditions. This document is an official statement of theAmerican Association of Physicists in Medicine (AAPM) fordistribution to other professional societies, regulatory bodies, and anyother interested parties. (The role of the medical physicist in radiationtherapy is discussed in the publication entitled “The Role of aPhysicist in Radiation Oncology”[1].)
It is important to stress that this document is not meant to be apresentation of the state of the practice but rather a proposal for thestate of the art. In other words, this document sets goals for theprofessional and ethical practice of clinical medical physics as itrelates to diagnostic imaging, goals we hope to achieve before the year2000. While differences in the practice between major medicalcenters, community hospitals, and small clinical facilities presentlyexist, and will probably exist in the future, this does not imply that thequality of the services provided should be compromised. We alsobelieve that there are some staffing problems due to the shortages ofqualified clinical medical physicists. These and other questions mustbe dealt with and resolved in the decade of the 90’s if the medicalphysics profession is to continue to grow and to provide the neededsupport to our clinical imaging colleagues.
Description of the Role of the Clinical Medical Physicistin Diagnostic Imaging
Introduction
The first responsibility of the medical physicist is to thepatient-to ensure that the programs are in place to facilitate theproduction of quality diagnostic images consistent with the availabletechnology and which optimize safety (including radiation,mechanical, and electrical) for the patient. The responsibility ofproviding a clinically diagnostic image is shared between the clinicalmedical physicist, the imaging physician, and the technologistassisting with the procedure. A clinical medical physicist qualified indiagnostic imaging brings a unique perspective to the clinical team ina diagnostic imaging department: a scientist trained in physics,including imaging and radiological physics, and also in basic medical,clinical, and radiobiological sciences. This document provides adefinition of the specific roles of the medical physicist in realizingthat objective.
It is important that the clinical medical physicist in a diagnosticimaging department be qualified. At the present time, state licensureis rare. In lieu of licensure, the AAPM has developed a definition of aqualified medical physicist (see page 10).
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Responsibilities of the Clinical Medical Physicists
In diagnostic imaging, it is appropriate that the medical physicistsparticipate in the planning for resource allocation for both diagnosticimaging and medical physics. Important contributions should beexpected for:
1. Delineation of the Physical Aspects of Diagnostic ImagingSystems
l Specification of new equipment performance;l Supervision of acceptance testing and performance
verification;l Supervision of calibration, preventive maintenance, repair
of equipment and documentation of all relevantinformation;
l Development and maintenance of a quality managementprogram for all imaging equipment to facilitate theproduction of images of optimum quality whileminimizing radiation doses to patients;
l Responsibility for all instrumentation required for qualitycontrol, image quality, and patient exposuremeasurements;
l Determination of doses from radiological procedures;l Assurance of the use of good radiological technique by
the technologists, e.g., collimation, radiationprotection, etc.
2. Establishing and Maintaining a Radiation Safety Programl Development and administration of the radiation safety
program;
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3.
l Administration of personnel radiation monitoring and aslow as reasonably achievable (ALARA) programs;
l Supervision of the preparation, handling, and disposal ofradionuclides;
l Participation in the institutional radiation safety committeeand other committees as appropriate (e.g.,environmental safety committee);
l Participation in the development of criteria for approval ofnew users of radiation;
l Determination of shielding required for new or renovatedequipment rooms for ionizing radiation and forradiofrequency and magnetic fields;
l Design of special shielding devices;l Facilitation of compliance with all regulating and
certifying agencies (e.g., Nuclear RegulatoryCommission, Joint Commission on the Accreditationof Healthcare Organizations, Occupational Safety andHealth Administration, and appropriate state and localagencies);
l Response to emergency situations s u c h a smisadministrations and spills of radioactive materials;
l Review of policies and procedures related to radiationsafety, action levels, and functions of the radiationsafety officer.
Optimization of the Clinical Imaging Proceduresl Consultation with imaging physicians and others using
medical imaging equipment regarding the radiologicaland radiobiological aspects of patient examinations;
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l
l
l
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Monitoring of patient radiation exposures, comparison ofthese exposures to published surveys for similarexaminations, and calculation of specific organ dosesfor diagnostic examinations;
Optimization of imaging procedures, e.g., MRI protocols,radiographic techniques, technologist activities,efficient utilization of imaging equipment;
l Determination of specific patient and organ doses, e.g.,fetal dose for a specific patient;
l Assistance to physicians in the evaluation of quantitativestudies, such as the measurement of cardiac ejectionfraction;
Development of special software for the analysis ofspecific data or for the evaluation of quantitativefunctional studies;
Design and fabrication of examination aids;Assistance to the imaging physician and other physicians
using imaging equipment in the evaluation ofexamination efficacy and participation in imagequality and perception studies;
l Initial education of the diagnostic imaging staff to ensurethe efficient implementation of new technology;
l Consultation with patients regarding concerns aboutradiation exposure.
4. Participation in Planning for Resource Allocationl Participation in the development and implementation of a
cost containment program for medical physicsactivities and imaging equipment;
l Equipment usage and replacement;l New facility design and development;
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l Staff requirements, assignments, and recruitment ofmedical physics staff;
l Budget preparation;l Program and department operations;l Continuing review of the imaging department and medical
physics program’s policies and procedures.
5. Participation in Educational Programsl Didactic and laboratory teaching for radiology and
nuclear medicine residents. This includes beingresponsible for physics training and preparingresidents for the physics portion of the ABR or ABNMexaminations;
l Preparing questions for the ABR or ABNM examinations(on request);
l Didactic and laboratory teaching for medical physicsstudents;
l Didactic and laboratory teaching for radiography studentsand other students in diagnostic imaging programs;
l Continuing education for imaging physicians, nurses,technologists, and other medical physicists;
l Continuing safety education for all employees in theinstitution who are exposed to ionizing radiation orworking in the vicinity of magnetic resonance imagingsystems;
l Continuing education for institutional employeesregarding other safety-related issues such asradioactive waste, etc.
6. Involvement in the Community in Public Education Activitiesl Lectures or demonstrations at local schools and colleges;
l Participation in science fairs, and physics and scienceclubs;
l Involvement with scouting and similar youthorganizations.
7. Involvement with the Medical Imaging Community and OtherRelated Organizations
l Participation at diagnostic imaging and medical physicsmeetings, and other scientific meetings andconferences, to learn and disseminate state-of-the-artinformation;
l Participation in peer review including reviews of paperssubmitted for publication, grant applications, etc.;
l Serving in an advisory capacity and working with federaland state regulatory agencies, and certificationorganizations such as the Joint Commission on theAccreditation of Healthcare Organizations (JCAHO),the American College of Radiology MammographyAccreditation Program (ACR-MAP), and AmericanBoard of Radiology (ABR);
l Participation in local, regional, and national governmentalbodies addressing health and radiation safety issues.
A primary responsibility of the medical physicist in animaging program is development and supervision of a quantitativequality control program. All of the elements of a good qualitycontrol program are contained in the above. It remains only toorganize these parts into an effective program that functions withinthe institution’s quality management program.
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Because of the training in analytical processes and scientificprinciples, the medical physicist plays a principal role in the review ofimage quality and radiation exposure levels, the development ofsystems and policies, the review of consistency between plans and theirexecution, and problem solving. After the development of a testing orquality control procedure or the development of a new imagingprocedure, the medical physicist may delegate to other appropriatelytrained personnel the routine performance of the procedure, whilemaintaining responsibility and supervision as required. Technologistsmaking quality control measurements are a logical and cost effectiveexample of such delegation. An exception is the determination ofradiation doses which is complex and requires the expertise of aqualified medical physicist.
Medical Physics Staffing
Although the list in the previous section presents most of themajor, identifiable activities usually performed by a clinical medicalphysicist in diagnostic imaging, the list is by no means exhaustive.The nature and relative importance of the different activities dependon the relationships between the medical physicists and imagingphysicians in a given program. However, the list does present atypical set of responsibilities. Some of the activities, such as ensuringthat test equipment and radiation measurement equipment areproperly calibrated, provide basic support of a program regardless ofthe number of examinations or the amount of imaging equipmentutilized. Activities such as routine quality control depend on theamount and complexity of imaging equipment at the facility, whereasothers, such as determination of specific patient organ doses, dependon the number and type of examinations performed. The trilateral
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report published by the AAPM, the American College of RadiologyCommission on Physics and Radiation Protection, and the AmericanCollege of Medical Physics entitled “Recommendations on PhysicsStaffing for Diagnostic Radiology” provides information regardingclinical medical physics staffing levels in diagnostic imaging[2].Additional details are provided in AAPM Report No. 33 entitled“Staffing Levels and Responsibilities of Physicists in DiagnosticRadiology”[3]. These levels should be considered as minimal levelsfor clinical activities, which may vary considerably depending on thetype of diagnostic imaging practice. Research and teaching activitiesrequire additional time commitments. Medical centers generallyconsidered to be “centers of excellence” all have in-house medicalphysics programs. However, staffing varies and many institutions donot derive lull benefits from diagnostic physics staff because ofinadequate staffing levels.
To ensure optimal diagnostic image quality and appropriateradiation exposures, all diagnostic facilities are encouraged to have atleast one experienced and “qualified” (see page 10 and the AAPMReport entitled “The Roles, Responsibilities, and Status of the ClinicalMedical Physicist” [4]) medical physicist responsible for the medicalphysics program. The medical physicist requires sufficient timecommitment to allow familiarity with the daily operations of thedepartment and authority to make changes in procedures andequipment as necessary. A certified medical physicist shouldsupervise, delegate, and coordinate the activities of any medicalphysics staff.
The medical physics section in diagnostic imaging facilitiesmay include radiological engineers or quality control technologists, orboth:
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Radiological Engineers-These individuals repair and performpreventive maintenance on diagnostic imaging equipment.Adequate staffing of in-house service personnel reducesdowntime and equipment maintenance costs, whilemaintaining equipment quality and safety. This may providean economic alternative to outside service contracts.
Quality Control Technologists-These technologists work with bothclinical and medical physics staffs to realize the objectives ofthe quantitative quality control program. These tasks include:l Imaging equipment quality control measurements,
including processor quality control and nuclearmedicine equipment uniformity and resolution;
l Periodic surveys of the condition of radiation-protectiongarments;
l Radiation safety surveys and wipe tests in nuclearmedicine.
In addition to these specialized support personnel, the clinicalmedical physicist needs to have access to the services of an electronicsshop and repair facility, machine shop, and adequate computerresources or an adequate budget for outside services, for theconstruction or modification of equipment and development ormodification of software not available commercially.
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Qualifications of a Clinical Medical Physicist
Evaluating the competency of a clinical medical physicist fora position in a diagnostic imaging program can prove difficult. Thefollowing statement by the AAPM can serve as a guide [5]:
Qualifications for Independently Performing the Dutiesof a Clinical Medical Physicist
The AAPM recognizes the need of both regulating bodies andthose who obtain services of medical physicists to be able todetermine who is qualified to perform certain activities. Thetraining and experience of the membership of the AAPM varywidely. Therefore, membership in the AAPM should not beconsidered to qualify anyone to perform a particular service.There are, however, several organizations which certifypersons to be qualified in certain areas in which expertise istypically sought among medical physicists.
Although individuals may exist who, by virtue of their trainingand experience, may also be qualified, certification in anappropriate area by one of the organizations listed below isthe only way to easily determine adequacy of preparation tofunction independently as a clinical medical physicist. TheAAPM encourages its members to obtain certification in thefields of desired specialization and recommends that expertisebe sought among properly certified individuals. It is ofcritical importance that the agency or employer seekingexpertise ensure that the type or subspecialty, or both, ofcertification match the expertise being sought.
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Certifying Organizations
The American Board of Radiology (ABR) certifies medicalphysicists in the specialties of Therapeutic RadiologicalPhysics, Diagnostic Radiologic Physics, or Medical NuclearPhysics. ABR certification is also given in all of the aboveareas under the headings of Radiological Physics or RoentgenRay Physics. Certification by the ABR includes examinationin clinical aspects of medical physics, medical radiologicalequipment and instrumentation, and radiation safety. Use ofnonionizing radiations are covered in the diagnostic andgeneral examinations.
The American Board of Medical Physics (ABMP) certifiesmedical physicists in Radiation Oncology Physics, DiagnosticRadiological Physics, Nuclear Medicine Physics, HyperthermiaPhysics, and Medical Radiation Protection, Certification bythe ABMP includes examination in clinical aspects of medicalphysics, appropriate equipment and instrumentation, andsafety.
The American Board of Science in Nuclear Medicine(ABSNM) certifies individuals in the separate areas ofNuclear Medicine Physics and Instrumentation, NuclearMedicine Computer Science, Radiopharmaceutical andRadiochemistry Science, Radiation Protection, and NuclearMagnetic Resonance.
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The Canadian College of Physicists in Medicine (CCPM)certifies physicists in radiological physics. Fellowship ormembership implies equivalent testing to ABR certification inRadiological Physics (all subspecialties).
The American Board of Health Physics (ABHP) certifiesphysicists in Comprehensive Health Physics (for radiationsafety).
Following the policy outlined in the AAPM statement, only thosepersons certified by the ABR in Radiological Physics, DiagnosticRadiological Physics, or Medical Nuclear Physics; by the ABMP inDiagnostic Radiological Physics or Nuclear Medicine Physics; by theABSNM in Nuclear Medicine Physics and Instrumentation; or by theCCPM in Radiological Physics can be assumed to have attained thebasic competency in their profession defined by their peers.(Certification by ABHP in Comprehensive Health Physics indicatesbasic competency only in areas related to radiation safety.)Participation in a postgraduate training program and practicalexperience alone do not imply competency. Furthermore, it must bestressed that Board certification in areas other than diagnosticimaging does not imply knowledge in diagnostic medical physics.Technical measurements are only part of the medical physicist’s job.Equally demanding parts of the diagnostic medical physicist’sresponsibilities are in the interpretation of the radiation exposurelevels and the transfer of technical information to imaging physiciansand support staff. Management of these complex assignmentsrequires experience and the buildup of trust developed over time byconstant interaction.
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Relationship Between Medical Physicists and Others in MedicalImaging Programs
1. Relationship with the Imaging PhysicianA collegial relationship should prevail between medical
physicists and physicians involved in medical imaging. Both themedical physicist and the imaging physicians must feel free to expresstheir opinions in a professional manner and should always considercarefully the opinion of the other.
The nature of the personal relationship between the physicianand the clinical medical physicist shapes the exact form ofconsultations between the two and the product of the effort. Thephysician is responsible for the diagnosis and is entitled to expect themedical physicist to ensure responsibility for the quality of the image.The medical physicist, however, should be aware of the clinicallimitations of examinations, the doses optimal for image formation,the limitations of the imaging equipment, and other technical factorsthat may affect the quality of the examination or dose to the patient.Documented systematic problems should be corrected and thecorrective action documentation brought to the attention of theinstitution’s quality management committee.
The medical physicist should be cognizant of any federal orstate government guidelines or regulations that have an effect ondiagnostic imaging and the requirements of organizations responsiblefor certification of imaging, hospital, or clinical practices. Themedical physicist is responsible for keeping the physician informed ofpatient doses and how they compare to doses used nationally,advances in the field of medical imaging, limitations of the imagingprocess, and the technical characteristics of specific imaging
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equipment. The medical physicist must be aware of advances inrelevant safety technologies, e.g., in MR safety and electrical safety,technologic limitations in imaging equipment, national standards ofimage quality, comparative aspects of different imaging modalities,relevant requirements of private certifying groups, relevant safetyrequirements for chemical safety, and relevant medical advances thatwill affect equipment purchase.
The clinical medical physicist should be aware of newtechnologies, in the field of medicine and from other fields that mayimpact on medicine or provide improvements in medical imaging.The physicist should be familiar with medical uses of newtechnologies in their areas of expertise and how these impact on thequality of patient care. This means that medical physics todayincorporates all aspects of medicine, including cardiology, laserimaging, laser therapy, and other new technologies that are beingdeveloped. This expands the concept of the medical physicist farbeyond its conventional (traditional) meaning. As the world changes,medical physicists must also change and use their expertise with thetechnologies to which they are capable of contributing.
While the imaging physician is responsible for theexamination and final diagnosis, the medical physicist is responsiblefor the quality of the diagnostic images, the safety (radiation,mechanical, and electrical) of equipment, and the supervision of thetechniques used by the technologist. If there is a problem that mayaffect the quality of the diagnostic images or the safety of the patientor personnel involved in the procedure, the medical physicist shouldadvise the physician immediately. The medical physicist shouldconsult with the imaging physician on technical factors which affectimaging or assist in interpretation of the images in light of unusual or
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difficult imaging parameters. If there is a potential radiation,mechanical, or electrical safety hazard for the patient or staff, themedical physicist should not allow the examination to be performeduntil satisfied that proper actions have been taken to eliminate thehazard. The medical physicist should be available to advise imagingstaff on how to respond to questions from the patient regardingradiation exposures. If the patient is unduly anxious about thepotential for risk from radiation exposure, the medical physicistshould assist the physician in counseling the patient. The medicalphysicist’s first responsibility is to the patient and, consequently, thereis an ethical obligation to seek outside reconciliation of seriousdifferences of opinion with regard to image quality and patient safety.
2. Relationship with TechnologistsA collegial relationship should also exist between medical
physicists and the medical imaging technologist. Each mustrecognize the expertise and experience of the other, feel free toexpress opinions in a professional manner, and seriously considerideas suggested by the other. The medical physicist should be able toadvise the technologist on the roles of individual parameters definingthe techniques in producing an optimal image. This combinedexpertise can facilitate the production of the highest quality imagespossible for diagnostic purposes.
Employment Arrangements
Some of the more common relationships describing theemployment of a medical physicist in clinical medical imaginginclude:
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1. The Medical Physicist in a Physicians’ CorporationGenerally, physicians staffing a diagnostic imagingdepartment in a hospital work as part of a physicians’corporation which contracts with the hospital to provideservices. Employees of a physicians’ corporation mayreceive benefits not available through employment by ahospital. Physicians and medical physicists in such acorporation may be employees or partners. Becoming apartner sometimes involves substantial financial investmentin the corporation; however, partnership allows moreinvolvement in making decisions and added financialbenefits. At the present time, there are no mechanisms fordirect reimbursement for medical physicists’ services inimaging. The precedent has been set, however, for physicsservices being considered “technical”. Should imagingphysics services be accepted by Congress at some laterdate as reimbursable as a technical charge, the physicians’group including a medical physicist should be aware ofthe need to negotiate the reimbursement of medicalphysics services with the hospital.
2. The Medical Physicist in the University SettingEmployment relationships for the medical physicistpracticing in a university setting may be similar to thosedescribed in items 1 and 3 entitled “The Medical Physicistin a Physicians’ Corporation” and “The MedicalPhysicist as an Employee of the Hospital”, respectively.In addition, academic rank systems may prevail or amultiplicity of optional arrangements may exist. Forexample, the medical physicist may be a university
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employee with supplemental salary and benefits beingpaid from a physicians’ corporation.
The medical physicist must be a member of theprofessional staff and preferably a member of the medicalstaff if employed by a university hospital. Often he or sheacts as a technical administrator for the department andreports to the department chair as do the imagingphysicians. The medical physicists’ function in thedepartment requires that he or she be intimately involvedin all decisions affecting image quality, radiationprotection, etc., as described under “Responsibilities ofClinical Medical Physicists”.
3. The Medical Physicist as an Employee of the HospitalThe hospital may contract with a single medical physicistfor services either as an outside contractor or anemployee. It is important for the hospital to establish anadministrative entity for the hospital-wide medical physicseffort. The chair of that effort, who must be a medicalphysicist, should be administratively responsible for bothfinancial and personnel management to the imagingdepartment chair. The chair of the medical physics effortshould be a member of the medical staff.
An important issue involves the opportunity to consult.The time and considerations under which consulting isallowed should be negotiated. The hospital should befully informed if the medical physicist will use hospitalequipment for consulting purposes because of theincreased exposure to liability by the hospital.
The medical physicist must be a member of theprofessional staff and a member of the medical staff ifemployed by a hospital. Often he or she acts as atechnical administrator for the department and reports tothe department chair as do the imaging physicians. Themedical physicist’s function in the department requiresthat he or she be intimately involved in all decisionsaffecting image quality, radiation protection, etc., asdescribed under “Responsibilities of Clinical MedicalPhysicists.”
If the hospital is not affiliated with a university, theteaching responsibilities of the medical physicist areusually limited to radiographic technology students, alimited number of residents, or staff in-service training.
4. The Medical Physicist as a Contractor to Provide ServicesThrough a Medical Physics Corporation
Some medical physicists provide services to hospitalsthrough corporations similar to those of physicians. Sucha situation provides more financial independence for amedical physicist at the price of increased risk. When alarge corporation provides services to several smallerhospitals, such medical physics consultation services canprovide access to expensive, limited-use equipment. Alarge medical physics consultation service can ensurecoverage of a client hospital without disruptions forvacations, meetings, or illness. Such a large medicalphysics consultation service provides the opportunity tothe individual medical physicists to consult with and learn
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from their colleagues on a day-to-day basis, therebyenhancing the services provided by the group. Hospitalssometimes find it administratively easier to contract formedical physics services than to maintain personnel ontheir budgets. As with physicians’ corporations, medicalphysicists can work in a medical physicists’ corporation asa partner or as an employee.
Each practice arrangement has advantages and disadvantageswhich a medical physicist entering into a given arrangement shouldconsider. These issues include, but are not limited to, salary, benefits,retirement contributions, vesting period, ability to consult, malpracticeinsurance coverage, and administrative (reporting) structure.
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References
1. AAPM Professional Information and Clinical RelationsCommittee, Task Group 1. The Role of a Physicist inRadiation Oncology. AAPM Report No. 38, Published bythe American Institute of Physics for the AAPM, 1993,New York.
2. ACR, AAPM, and ACMP Tri-Lateral Task Force on PhysicsStaffing for Diagnostic Radiology, Recommendations onPhysics Staffing for Diagnostic Radiology, AAPMNewsletter, Vol. 15, No. 4, pages 15-17 and AdministrativeRadiology, pages 23-30, September 1990.
3. AAPM Diagnostic X-ray Imaging Committee, Task Group 5.Staffing Levels and Responsibilities of Physicists in DiagnosticRadiology. AAPM Report No. 33, Published by the AmericanInstitute of Physics for the AAPM, 1991, New York.
4. The Roles, Responsibilities, and Status of the Clinical MedicalPhysicist, AAPM Policy Statement, 1986, AmericanInstitute of Physics, New York.
5. . Qualifications for Independently Performingthe Duties of a Clinical Medical Physicist. AAPMNewsletter, 17:6, Sep-Oct 1991.
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