Nuclear Medicine Technologist Training Looking Down the Road

Nuclear Medicine Technologist Training Looking Down the Road Kent Hutchings, MS, CNMT VA Palo Alto Health Care System June, 2008; VAPAHCS PET/CT Symposium 2016 2013 2010

History Programs Problems Bachelors NMAP Technological Advancements Clinical introduction of SPECT in the 1980 s PET scan volume more than doubled from 2004 to 2007 and is forecast to triple by 2010 PET/CT Hybrids and the increasing importance of fusion imaging technologies

History Programs Problems Bachelors NMAP Evolution of Nuclear Medicine Major Revisions Outgoing Radioimmunoassay (RIA) Digital Imaging/Processing Heathcare Informatics Shift toward specialists care Dedicated PET/CT and SPECT/CT Molecular Imaging/Therapy PEM & PET/MRI (anticipated) Incoming

History Programs Problems Bachelors NMAP Concerns • “When asked [about] issues facing NMT education programs in the near future, program directors overwhelmingly cited fitting new content into an already crowded curriculum as their main concern. ” SNM 2005 Program Director Survey http: //tech. snmjournals. org/cgi/content/full/36/1/55

History Programs Problems Bachelors NMAP NMT Program Demographics ~30% Universities – 35% of these award a bachelor’s degree (usually 4 years in length) ~30% Community / Junior colleges – 53% of these award an associates degree (Most are 2 year programs) ~40% Hospital-based – One-year certificate program. Intended for health care professionals who wish to specialize in another allied health field SNM Program Director’s Survey – http: //tech. snmjournals. org/cgi/content/full/36/1/55

History Programs Problems Bachelors NMAP JRCNMT Joint Review Committee on Educational Programs in Nuclear Medicine Technology – Nationally recognized accrediting agency for NMT educational programs – The Essentials – Accredited Programs in the US – Regional Accreditation www. jrcnmt. org

History Programs Problems Bachelors NMAP Problem #1: Variable Education NM Technologist Training Programs Ø Clinical • • 59% require more than 1, 200 hours of clinical practicum 10% of NMT programs required fewer than 1, 000 hours – 22% of these were community college programs Ø Didactic (Overall average = 44. 7 credit hours) • • • Programs in academic medical centers (60 hours) Universities or four-year colleges (46. 6 hours) Hospitals with university affiliation (45. 2 hours) Community/junior colleges (39. 7 hours) "Other" settings (44. 7 hours) SNM Program Director’s Survey -- tech. snmjournals. org/cgi/content/full/36/1/55

History Programs Problems Bachelors NMAP NMT Program Award Level Variable NMT Education 2000 2005 http: //interactive. snm. org/docs/Nuclear_Medicine_Technologist_Report_2005. pdf http: //tech. snmjournals. org/cgi/content/full/28/4/280/F 2

History Programs Problems Bachelors NMAP Variable Education (continued) Ø Many NMT possess a degree upon entry – 2005 NM Technologist (Overall Education) Findings from a 2005 SNM Survey of Nuclear Medicine Technologists

History Programs Problems Bachelors NMAP Problem #2: Staffing • Aging Workforce 2000: Mean = 48 years 2005: Mean = 43. 5 years http: //interactive. snm. org/docs/Nuclear_Medicine_Technologist_Report_2005. pdf http: //tech. snmjournals. org/cgi/content/full/28/4/280/F 2

History Programs Problems Bachelors NMAP Problem #2: Staffing • Technologist Shortage – Faster-than-average job growth is anticipated through 2016 • Technological innovations will increase the diagnostic uses of nuclear medicine • The development of new nuclear medicine treatments • An increase in the number of middle-aged and older persons, who are the primary users of diagnostic procedures. http: //science. education. nih. gov

History Programs Problems Bachelors NMAP Problem #3: New Technologies Outpaced Curriculum Revisions Updating today’s NM Technologist Training Programs – – Most NMT programs (~93%) now offer clinical and didactic PET instruction. Almost half provide some clinical and didactic instruction in CT. 50% offer didactic instruction in cross sectional anatomy (but very few offer clinical correlation). Only one-sixth offered clinical instruction in MRI Findings from a 2006 SNM Survey of NMT Education Program Directors

History Programs Problems Bachelors NMAP SNM Revised Scope of Practice SNMTS Presidential Task Force Practice Standards: 1. Diagnostic CT when performed on SPECT/CT or PET/CT camera* 2. Administration of oral and IV contrast (requires education in CT)* 3. Operation of scanners with x-ray tubes for bone density studies* 4. Administer therapeutic radionuclides, radiopharmaceuticals, and pharmaceutical agents by oral and/or intravenous routes* 5. Assist in NM cardiac stress testing procedures* 6. Insertion of peripheral intravenous catheters 7. Administer non-radiopharmaceutical agents* * Under the direction of a physician http: //tech. snmjournals. org/cgi/content/full/35/3/15 A

History Programs Problems Bachelors NMAP Incorporating CT into the Curriculum • To stay current with the market, many programs are incorporating sectional anatomy and CT into their programs. 2004 the ASRT/SNMTS PET/CT Curriculum http: //interactive. snm. org/index. cfm? Page. ID=2760

History Programs Problems Bachelors NMAP Additional Curriculum Requirements • Multi-modality curriculum should include MRI • Health care management: Reimbursement, billing, coding, etc • Research: Evidence-based patient outcomes • Advanced nuclear cardiology including ACLS certification • Molecular and biochemical medicine & radiotherapeutics • Digital Imaging: PACS, software, hardware, troubleshooting October 2004, the PET-CT Task Force of the SNMTS

History Programs Problems Bachelors NMAP Problem #4: Credentialing Which Board Exam Should I Take? Ø 88. 2% are CNMT certified Ø 50. 1% are RT(N) certification 39% have both 37. 7% are licensed in another allied health field: Findings from a 2005 SNM Survey of Nuclear Medicine Technologists

The Future of Nuclear Medicine Ø Baccalaureate degree for entry level NMT by 2015 Ø Education and credentialing standards via state licensure Ø The Nuclear Medicine Advanced Practitioner

History Programs Problems Bachelors NMAP Baccalaureate Degree Standard by 2015 • By 2015, all graduates from nuclear medicine programs should have a baccalaureate degree. • Hospital-Based Programs have 2 options: 1) Recruit from a population of applicants who already possess a baccalaureate degree 2) Affiliate with a university to secure the necessary college credit Society of Nuclear Medicine Technologist Section (SNMTS)

History Programs Problems Bachelors NMAP Baccalaureate Degree Criticisms • A university education is expensive. • Certificate program closures will create workforce shortages. • Many universities are not interested in such affiliations. • Didactic education is prioritized over practical experience. • Nursing and radiation therapy continue to recognize nonbaccalaureate entry level professionals. • Obsolescence of current certificate & A. S. degrees holders Society of Nuclear Medicine Technologist Section (SNMTS)

History Programs Problems Bachelors NMAP C. A. R. E. Act • The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE) Legislation – The act sets education and credentialing standards by requiring state licensure for all technologists who administer radiation. – How do we ensure that states will adopt good standards? https: //www. asrt. org/content/Government. Relations/CAREBill/faq_legislative. aspx

History Programs Problems Bachelors NMAP Advanced Practitioner • A Master’s Candidate who demonstrates a high level of autonomy, technical sophistication, advanced clinical knowledge and strong critical thinking – – – Could assume certain physician tasks under the discretion of the attending physician Credentialed by the NMTCB and/or ARRT. The six graduate-level competency domains are Patient Care, Clinical Nuclear Medicine, Interpersonal and Communication Skills, Evidence-based Decision Making, Professionalism, and Systems-Based Practice. SNMTS Advanced Practice Task Force, 2007

History Programs Problems Bachelors NMAP Advanced Practitioner The six graduate-level competency domains: 1) 2) 3) 4) 5) 6) Patient Care Clinical Nuclear Medicine Interpersonal/Communication Evidence-based Decision Making Professionalism Systems-Based Practice SNMTS Advanced Practice Task Force, 2007

History Programs Problems Bachelors NMAP Advanced Practitioner Questions • Will administration support an FTE for an NMAP? • What criteria should be used to select candidates? • Many states don’t recognize radiologist extenders. • Will Medicare or private payors reimburse? Society of Nuclear Medicine Technologist Section (SNMTS)

Thank You Slides available at: www. nucmedschool. com/education. ppt