WHERE IN THE WORLD JILL LIPOTI?

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2 WHERE IN THE WORLD IS JILL LIPOTI?

3 HELLO FROM NEW JERSEY

4 CRCPD - National Symposium on Fusion Imaging and Multimodalities February 18-20, 2004 Kansas City, Missouri New Jersey s Requirements As They Pertain To CT/PET Imaging Al Orlandi, Supervising Radiation Physicist NJDEP - Bureau of Radiological Health

5 Who s Regulating What in NJ? New Jersey Department of Environmental Protection's Radiation Protection Programs The Bureau of Radiological Health (BRH) Register and Inspect Ionizing Radiation Producing Equipment License Radiologic and Nuclear Medicine Technologists and Approve Schools Certify Medical Physicists The Bureau of Environmental Radiation (BER) License and Register Radioactive Materials

6 NEWJERSEY S CT/PET EQUIPMENT REQUIREMENTS

7 BRH s Computed Tomography Requirements 306 CT scanners registered in New Jersey Subject to New Jersey s QA Regulations (NJ.A.C. 7:28-22) Three QA requirements: QA Manual Facility QC Tests to be completed at the required frequencies Initial and Annual QC Survey to be completed by a certified medical physicist

8 QA Manual Heart of the QA Program Facility s Quality Assurance SOP QA Coordinator QC tests to be performed Procedures for performing QC tests Staff who are responsible for QC tests Plan for Corrective Action Policies and Procedures

9 Facility Daily QC Tests CT Warm Up (Safety Checks) CT Number in Water Field Uniformity Facility Weekly QC Test Laser Printer QC

10 Facility Monthly QC Tests Low Contrast Resolution High Contrast Spatial Resolution Noise Table Position Indicator Accuracy Scan Increment Accuracy Scan Localization Light Accuracy

11 Medical Physicist s CT QC Survey Scan Increment Accuracy Scan Localization Light Accuracy Patient Dose (MSAD or CTDI) Pre-Patient Collimation Accuracy Contrast Scale Field Uniformity CT Number in Water Slice Thickness Low and High Contrast Resolution Noise Scan Protocol Review (Adult vs Pediatric) Review of Facility QC Records

12 Facility Annual QC Tests Medical Physicist s CT Survey Must be performed by a NJDEP Certified Medical Physicist QA Program Review with the medical physicist

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15 BER s Radioactive Materials Requirements NJ is not an Agreement State License NARM (460) 276 Medical Use 110 for F-18 3 are Radiopharmacies Conduct Pre-Licensing Inspections Approval of Authorized Users for NARM Register NRC Licensed Materials (520) Revising regulations to be more consistent with NRC regulations. Coordination of emergency response activities involving radioactive materials

16 NARM Requirements Security and Storage Assaying of Doses Disposal of Radioactive Waste Record-Keeping and Reporting QC testing as contained in the license application NJDEP has a recommended QC document Compliance with conditions of the license Verify the credentials of technologists and medical users

17 New Jersey s CT/PET Status 11 CT/PET Units Registered 5 Hospitals, 5 Medical Offices and 1 Mobile First CT/PET unit installed in February 2002 All are GE Units 3 Radiopharmacies manufacture F-18 in NJ Prior to these pharmacies opening in 2003, all F- 18 was ordered from out-of-state pharmacies. A one - way trip to one facility was 120 minutes. This led to transportation accident concerns

18 HEY AL, WHY DON T YOU DISCUSS NEW JERSEY S CT/PET OPERATOR REQUIREMENTS

19 Current NJ Licensure Program Diagnostic Radiologic Technology (CT) Nuclear Medicine Technology (PET) Radiation Therapy Limited Chest Radiography Limited Dental Radiography Limited Orthopedic Radiography Limited Podiatric Radiography Limited Urologic Radiography A total of 20,300 technologists are licensed and 63 schools of radiologic technology are approved.

20 NJ Licensure of Operators New Jersey is 1 of 21 states that license individuals involved in both radiographic and nuclear medicine procedures. New Jersey has 8,100 licensed diagnostic radiologic technologists and 1,100 licensed nuclear medicine technologists. 79 are licensed in both licensure categories

21 NEW JERSEY S LICENSURE PROBLEMS

22 The Radiologic Technologist Act does not permit a nuclear medicine technologist to operate x-ray equipment. The Act lacks much needed flexibility in order to establish additional licensure categories. The shortage of radiologic technologists

23 Results of NJDEP s Survey Conducted in May 2003 Modality Diagnostic X-ray Nuclear Medicine CT/PET* Shortage 15.3% 17.5% 12.5% * 6 out of 7 CT/PET facilities responded. The total FTE was 3.5 1,500 questionnaires were mailed to all hospitals and medical offices. The overall response rate was 46%.

24 NJ s Temporary Solution Have an operator who is licensed in both categories. Use physicians and authorized users to fill any gaps in coverage. Cooperative scheduling between CT and Nuclear Medicine departments Review the steps involved in an CT/PET procedure and the licensure scopes of practice to identify where non-licensed personnel can be used.

25 Who is Allowed to Do What In NJ (GE CT/PET Scanners only) TASK F-18 Preparation and Administration Monitoring Patient During Relaxation Period (45 mins) CT Scout and Setting Tech. PERSONNEL Nuc Med Tech or Authorized User Any person with adequate training Diag Rad Tech or MD CT Scanning (Start to Finish) Place Table in PET Mode and Start PET Imaging Monitoring Patient During PET Imaging (40 mins) Diag Rad Tech or MD Nuc Med Tech or Authorized User Any person with adequate training

26 NJ s Future Solution To amend the Radiation Protection Act to allow for additional licensure categories to be established by regulation. This would allow for greater flexibility to establish new licensure categories in order to either provide greater protection from unnecessary radiation or allow for greater availability of competent technologists. This amendment may be introduced by Spring 2004.

27 Additional Licensure Categories Under Consideration (In Priority Order) Advanced Licensure in CT Fusion Imaging Limited Licensure in X-ray Bone Densitometry Medical Dosimetry Radiologist Assistant MRI Medical Sonography

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