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Nuclear Medicine Technologist Training Looking Down the Road Kent Hutchings, MS, CNMT VA Palo 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 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) 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 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 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 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 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 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 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 = 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 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 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 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 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 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? 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 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 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. 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, 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 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) 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 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 Thank You Slides available at: www. nucmedschool. com/education. ppt