El especialista en Radiofísica Hospitalaria en el Servicio de Medicina Nuclear / Specialists in Hospital Radiophysics in the Department of Nuclear Medicine

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The ROSS: A Radiological/Nuclear Subject Matter Expert Filling a Critical National Need.

This paper was created from a presentation the author made at the 2017 National Council on Radiation Protection and Measurements (NCRP) Annual Meeting on 6 March 2017. The Fifty-Third Annual Meeting of the NCRP was titled Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? Like the presentation, this paper describes one effort to fill what has been identified as one of the more critical gaps in our U.S. nuclear and radiological emergency preparedness. The Radiological Operations Support Specialist (ROSS) may help address the national need for subject matter experts that can help the nation, states, and municipalities respond to and recover from radiological and nuclear emergencies. The author is one of the four members of the ROSS Steering Committee and was the first state health physicist to serve as a ROSS at a national-level improvised nuclear device exercise. From his experiences, the ROSS is described from its genesis 3 y ago to its status today, along with some thoughts about where the ROSS will be in the future.

Thirteenth Annual Warren K. Sinclair Keynote Address: Where Are the Radiation Professionals (WARP)?

In July 2013, the National Council on Radiation Protection and Measurements convened a workshop for representatives from government, professional organizations, academia, and the private sector to discuss a potential shortage of radiation protection professionals in the not-too-distant future. This shortage manifests itself in declining membership of professional societies, decreasing enrollment in university programs in the radiological sciences, and perhaps most importantly, the imminent retirement of the largest birth cohort in American history, the so-called "baby boomer" generation. Consensus emerged that shortages already are, or soon will be, felt in government agencies (including state radiation control programs); membership in professional societies is declining precipitously; and student enrollments and university support for radiological disciplines are decreasing with no reversals expected. The supply of medical physicists appears to be adequate at least in the near term, although a shortage of available slots in accredited clinical training programs looms large. In general, the private sector appears stable, due in part to retirees joining the consultant ranks. However, it is clear that a severe problem exists with the lack of an adequate surge capacity to respond to a large-scale reactor accident or radiological terrorism attack in the United States. The workshop produced a number of recommendations, including increased funding of both fellowships and research in the radiological sciences, as well as creation of internships, practicums, and post-doctoral positions. A federal joint program support office that would more efficiently manage the careers of radiological professionals in the civil service would enhance recruiting and development, and increase the flexibility of the various agencies to manage their staffing needs.

Radiation Brain Drain? The Impact of Demographic Change on U.S. Radiation Protection.

The use of radiation has a substantial beneficial impact, particularly in the areas of medicine, energy production, basic science research, and industrial applications. Radiation protection knowledge and experience are required for acquiring and implementing scientific knowledge to protect workers, members of the public, and the environment from potential harmful effects of ionizing radiation while facilitating the beneficial use and development of radiation-based technologies. However, demographic changes are negatively impacting U.S. radiation protection and response capabilities. The number of radiation professionals continues to decrease even as the demand for such professionals is growing. These concerns are most pronounced in the medical, energy, research, and security arenas. Though the United States has been the world leader in radiation protection and radiation sciences for many years, the country has no strategic plan to ensure the maintenance of expertise in radiobiology, radiation physics, and radiation protection. Solving this problem will require a significant increase in federal and state funding as well as formal partnerships and initiatives among academia, professional societies, government, and the private sector.

Membership Trends in the Health Physics Society: How Did We Get Here and Where Are We Going?

The Health Physics Society (HPS), formed in 1956, is a scientific organization of professionals who specialize in radiation safety. Its mission is to support its members in the practice of their profession and to promote excellence in the science and practice of radiation safety. HPS has been a diverse body since its beginnings, encompassing professionals from different disciplines with an interest in radiation safety issues. At that time, health physics was just beginning to emerge as a distinct discipline, initially spurred by the development of the atomic bomb and amplified by the commercial use of nuclear power, and there was a need for a professional group to discuss issues and share ideas and experiences in the field. Over the following years, both the field of health physics and the ranks of the HPS membership experienced a steady increase in numbers and interest. HPS continued to grow in numbers and thrive through the mid-1990s but then began to retract. Concern regarding the "graying" of HPS was being discussed as far back as the late 1990s, yet despite efforts to broaden the base of membership through additional membership criteria, the numbers of Plenary (now referred to as Full) members have continued to shrink. The "graying" of HPS is real-although age demographic data are only available for about the past 15 y (and are provided voluntarily), the shift in age distribution over this timeframe is clear. A recent survey indicated that over 50% of HPS members are over 50 y of age, and over half of the respondents plan to retire within 10 y. As members age, they convert to Emeritus membership or drop their membership altogether, with some members unable to continue for financial or health-related reasons. There is now an age gap-members in their 30s and early 40s are missing from the mix. Potential causes for declining membership may include smaller enrollments in academic programs, reduced employment opportunities, and societal factors. There appears to be reduced employer support for participation in professional activities and travel to conferences. Societal factors include easy access to professional information through the internet, balancing of family commitments, other volunteer opportunities, and a general decline in joining professional groups. So, what is the fate of HPS? We are not alone-other professional groups are experiencing the same overall trends in membership to differing degrees. A number of initiatives have been launched or are being considered by HPS in an effort to offset this trend.

The Medical Physics Workforce.

The medical physics workforce comprises approximately 24,000 workers worldwide and approximately 8,200 in the United States. The occupation is a recognized, established, and mature profession that is undergoing considerable growth and change, with many of these changes being driven by scientific, technical, and medical advances. Presently, the medical physics workforce is adequate to meet societal needs. However, data are emerging that suggest potential risks of shortages and other problems that could develop within a few years. Some of the governing factors are well established, such as the increasing number of incident cancers thereby increasing workload, while others, such as the future use of radiation treatments and changes in healthcare economic policies, are uncertain and make the future status of the workforce difficult to forecast beyond the next several years. This review examines some of the major factors that govern supply and demand for medical physicists, discusses published projections and their uncertainties, and presents other information that may help to inform short- and long-term planning of various aspects of the future workforce. It includes a description of the general characteristics of the workforce, including information on its size, educational attainment, certification, age distribution, etc. Because the supply of new workers is governed by educational and training pathways, graduate education, post-doctoral training, and residency training are reviewed, along with trends in state and federal support for research and education. Selected professional aspects of the field also are considered, including professional certification and compensation. We speculate on the future outlook of the workforce and provide recommendations regarding future actions pertaining to the future medical physics workforce.

Changing Roles of State Health Physicists.

State radiation control programs are responsible for many aspects of radiation protection under their purview. These may include all aspects of radiation protection for sources of radiation not exclusively under federal control under an agreement with the U.S. Nuclear Regulatory Commission and the use of some sources of radiation not regulated by the federal government, such as radiation machines and naturally occurring radioactive material. The roles of state health physicists are ever-evolving, and the scope of their work is constantly expanding. This has come about most recently due to several factors, including additional federal requirements involving source security, emerging radiation machine technologies, expansion of emergency planning to include terrorist incidents, and more states with issues involving technologically enhanced naturally occurring radioactive material. These changes in the role of state health physicists and the new challenges are adding to the need for health physics resources and knowledge base. Several approaches are being used to address the training needs and technological and regulatory challenges, but these will continue to be needed to meet future workforce needs.

Commercial Nuclear Power Industry: Assessing and Meeting the Radiation Protection Workforce Needs.

This paper will provide an overview of the process used by the commercial nuclear power industry in assessing the status of existing industry staffing and projecting future supply demand needs. The most recent Nuclear Energy Institute-developed "Pipeline Survey Results" will be reviewed with specific emphasis on the radiation protection specialty. Both radiation protection technician and health physicist specialties will be discussed. The industry-initiated Nuclear Uniform Curriculum Program will be reviewed as an example of how the industry has addressed the need for developing additional resources. Furthermore, the reality of challenges encountered in maintaining the needed number of health physicists will also be discussed.

Education vs. Training: Does it Matter?

The National Council on Radiation Protection and Measurements' (NCRP) "Where are the Radiation Professionals?" initiative brought renewed attention to the declining numbers of individuals in radiation protection fields. This paper is an expanded version of the oral presentation by the author at the 2016 NCRP Annual Meeting. Health physics (HP) as a discipline and vocation is at a critical juncture. Perhaps less well recognized is the extreme peril facing academic HP programs. Higher education today is vastly different from what it was even 20 y ago. Every academic program must now make a budget case to justify its existence. Consequently, HP programs, which are by anyone's measure minuscule, are in very real danger of closing. Given that the country will continue to need radiation protection expertise, we must take immediate steps to reinvigorate the profession and preserve academic programs. We simply cannot train or short-course our way out of this problem. Under routine conditions, individuals trained in basic HP can be expected to safely manage daily operations. But life is full of the unexpected. When the unexpected event involves radiation, we need someone well-versed in radiological fundamentals to understand, assess and safely deal with the problem. A three-pronged approach to bolster academic programs was offered: (1) increase academic cooperation and provide an infusion of cash, (2) more formally recognize the discipline of HP and increase respect for its role in safety, and (3) regulate who can be designated as a health physicist while increasing retention of individuals within the discipline.

Fortieth Lauriston S. Taylor Lecture: Radiation Protection and Regulatory Science.

It took about 30 y after Wilhelm Konrad Roentgen's discovery of x rays and Henri Becquerel's discovery of natural radioactivity for scientists in the civilized world to formulate recommendations on exposure to ionizing radiation. We know of these efforts today because the organizations that resulted from the concerns raised in 1928 at the Second International Congress of Radiology still play a role in radiation protection. The organizations are known today as the International Commission on Radiological Protection and, in the United States, the National Council on Radiation Protection and Measurements (NCRP). Today, as we have many times in the past, we honor Dr. Lauriston Sale Taylor, the U.S. representative to the 1928 Congress, for his dedication and leadership in the early growth of NCRP. NCRP's mission is "to support radiation protection by providing independent scientific analysis, information, and recommendations that represent the consensus of leading scientists." The developments in science and technology, including radiation protection, are occurring so rapidly that NCRP is challenged to provide its advice and guidance at a faster pace than ever before. NCRP's role has also expanded as the Council considers newer uses and applications of ionizing radiation in research and medicine as well as the response to nuclear or radiological terrorism. In such a technical world, new areas have been established to deal with the nexus of science and regulation, especially in the United States. Lord Ernest Rutherford supposedly said, "That which is not measurable is not science. That which is not physics is stamp collecting." I wonder what he would say if he were alive today as now many embrace a new field called "regulatory science." This term was suggested by Professor Mitsuru Uchiyama in Japan in 1987 and was reviewed in literature published in English in 1996. Some have attributed a similar idea to Dr. Alvin Weinberg, for many years Director of the Oak Ridge National Laboratory. He actually introduced the term "trans-science," which he defined as the policy-relevant fields for which scientists have no answers for many of the questions being asked. He was influenced by the heavy involvement of the Laboratory in developing methods to assess environmental impacts as mandated by the 1969 National Environmental Policy Act. Professor Uchiyama defined regulatory science as "the science of optimizing scientific and technological developments according to objectives geared toward human health." In essence, regulatory science is that science generated to answer political questions. This paper will introduce regulatory science and discuss the differences between what some call "academic science" and "regulatory science." In addition, a short discussion is included of how regulatory science has and will impact the practice of radiation protection and all areas involving the use of radiation and radioactivity.

Meeting the Needs for Radiation Protection: Diagnostic Imaging.

Radiation and potential risk during medical imaging is one of the foremost issues for the imaging community. Because of this, there are growing demands for accountability, including appropriate use of ionizing radiation in diagnostic and image-guided procedures. Factors contributing to this include increasing use of medical imaging; increased scrutiny (from awareness to alarm) by patients/caregivers and the public over radiation risk; and mounting calls for accountability from regulatory, accrediting, healthcare coverage (e.g., Centers for Medicare and Medicaid Services), and advisory agencies and organizations as well as industry (e.g., NEMA XR-29, Standard Attributes on CT Equipment Related to Dose Optimization and Management). Current challenges include debates over uncertainty with risks with low-level radiation; lack of fully developed and targeted products for diagnostic imaging and radiation dose monitoring; lack of resources for and clarity surrounding dose monitoring programs; inconsistencies across and between practices for design, implementation and audit of dose monitoring programs; lack of interdisciplinary programs for radiation protection of patients; potential shortages in personnel for these and other consensus efforts; and training concerns as well as inconsistencies for competencies throughout medical providers' careers for radiation protection of patients. Medical care providers are currently in a purgatory between quality- and value-based imaging paradigms, a state that has yet to mature to reward this move to quality-based performance. There are also deficits in radiation expertise personnel in medicine. For example, health physics academic programs and graduates have recently declined, and medical physics residency openings are currently at a third of the number of graduates. However, leveraging solutions to the medical needs will require money and resources, beyond personnel alone. Energy and capital will need to be directed to:• innovative and cooperative cross-disciplinary institutional/practice oversight of and guidance for the use of diagnostic imaging (e.g., radiology, surgical specialties, cardiologists, and intensivists);• initiatives providing practical benchmarks (e.g., dose index registries);• comprehensive (consisting of access, integrity, metrology, analytics, informatics) and effective and efficient dose monitoring programs;• collaboration with industry;• improved use of imaging, such as through decision support combined with evidence-based appropriateness for imaging use;• integration with e-health such as medical records;• education, including information extending beyond the medical imaging community that is relevant to patients, public, and providers and administration;• identification of opportunities for alignment with salient media and advocacy organizations to deliver balanced information regarding medical radiation and risk;• open lines of communication between medical radiation experts and appropriate bodies such as the U.S. Environmental Protection Agency, the U.S. Food and Drug Administration, and the Joint Commission to assure appropriate guidance on documents and actions originating from these organizations; and• increased grant funding to foster translational work that advances understanding of low-level radiation and biological effects.

Meeting the Needs of the Nation for Radiation Protection: Summary of the 52nd Annual Meeting of the National Council on Radiation Protection and Measurements.

The 52nd Annual Meeting of the National Council on Radiation Protection and Measurements (NCRP) was held in Bethesda, MD, 11-12 April 2016, on the topic of "Meeting National Needs for Radiation Protection." This meeting was an outgrowth of the NCRP initiative "Where are the Radiation Professionals?" (WARP), which addresses looming shortages in professional personnel trained in the radiological disciplines, including but not limited to health physics, radiological engineering, radiobiology, radiochemistry, radioecology, radiation emergency response; and the medical disciplines of diagnostic and interventional radiology, radiation oncology, nuclear medicine, and medical physics. A shortage of radiation professionals has been predicted for at least 20 y but now seems to be imminent. Obviously radiation professionals are needed for regulatory responsibilities at both state and federal levels, national defense, energy production, waste management, industrial applications, education, and medicine. Although the supply of radiation professionals in medicine appears to be adequate for the next decade or so, the use of radiation in medical diagnosis and therapy will continue to increase with the aging of the general population.

Surveying trends in radiation oncology medical physics in the Asia Pacific Region.

OBJECTIVE: Our study aims to assess and track work load, working conditions and professional recognition of radiation oncology medical physicists (ROMPs) in the Asia Pacific Region over time. METHODS: A structured questionnaire was mailed in 2008, 2011 and 2014 to senior medical physicists representing 23 countries. The questionnaire covers 7 themes: education and training including certification; staffing; typical tasks; professional organisations; resources; research and teaching; job satisfaction. RESULTS: Across all surveys the response rate was >85% with the replies representing practice affecting more than half of the world's population. The expectation of ROMP qualifications (MSc and between 1 and 3years of clinical experience) has not changed much over the years. However, compared to 2008, the number of medical physicists in many countries has doubled. Formal professional certification is only available in a small number of countries. The number of experienced ROMPs is small in particular in low and middle income countries. The increase in staff numbers from 2008 to 2014 is matched by a similar increase in the number of treatment units which is accompanied by an increase in treatment complexity. Many ROMPs are required to work overtime and not many find time for research. Resource availability has only improved marginally and ROMPs still feel generally overworked, but professional recognition, while varying widely, appears to be improving slowly. CONCLUSION: While number of physicists and complexity of treatment techniques and technologies have increased significantly, ROMP practice remains essentially unchanged over the last 6years in the Asia Pacific Region.