Curriculum for education and training of Medical Physicists in Nuclear Medicine

Abstract

Purpose

To provide a guideline curriculum covering theoretical and practical aspects of education and training for Medical Physicists in Nuclear Medicine within Europe.

Material and methods

National training programmes of Medical Physics, Radiation Physics and Nuclear Medicine physics from a range of European countries and from North America were reviewed and elements of best practice identified. An independent panel of experts was used to achieve consensus regarding the content of the curriculum.

Results

Guidelines have been developed for the specialist theoretical knowledge and practical experience required to practice as a Medical Physicist in Nuclear Medicine in Europe. It is assumed that the precondition for the beginning of the training is a good initial degree in Medical Physics at master level (or equivalent). The Learning Outcomes are categorised using the Knowledge, Skill and Competence approach along the lines recommended by the European Qualifications Framework. The minimum level expected in each topic in the theoretical knowledge and practical experience sections is intended to bring trainees up to the requirements expected of a Medical Physicist entering the field of Nuclear Medicine.

Conclusions

This new joint EANM/EFOMP European guideline curriculum is a further step to harmonise specialist training of Medical Physicists in Nuclear Medicine within Europe. It provides a common framework for national Medical Physics societies to develop or benchmark their own curricula. The responsibility for the implementation and accreditation of these standards and guidelines resides within national training and regulatory bodies.

Introduction

To assist clarity, in this document we will often refer to Medical Physicists working (or training for a career) in Nuclear Medicine as Nuclear Medicine physicists.

Nuclear Medicine is a branch or specialty of medicine and medical imaging that uses radionuclides (unsealed sources of ionising radiation) and relies both on the emission of different kinds of ionising radiation and on the process of radioactive decay for the diagnosis and treatment of disease. Nuclear Medicine physicists are members of the multi-disciplinary clinical team responsible for diagnosis and therapy of disease. The role of Nuclear Medicine physicists is to provide critical scientific input on the physical processes and technology that underpin the whole Nuclear Medicine pathway. In Nuclear Medicine procedures, radionuclides are combined with other chemical compounds or pharmaceuticals, to form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs or cellular receptors. The external detection of radiation emitted by the radionuclide – often called a radiotracer – allows the behaviour of the compound within the body to be followed, thus providing relevant information on the metabolism of the vector, usually but not exclusively, through information obtained by imaging. This property of radiopharmaceuticals allows Nuclear Medicine the ability to determine the extent of physiological processes in the body, based on cellular function and physiology. Additionally, specific vectors combined with short-range particle emitters can by used to selectively irradiate targets (molecular radiotherapy). In this respect, Nuclear Medicine qualifies as an independent medical discipline providing “functional imaging” modalities and radiation oncology options in a clinical setting.

Generally, Nuclear Medicine physicists design and develop the framework of radionuclide handling and delivery, radiopharmaceutical dosimetry, optimisation, quality assurance of individual patient's treatments and of the medical imaging equipment, including radiation safety of the patient and staff. Specifically, the Nuclear Medicine physicist provides expert advice on the development, implementation and improvement of medical imaging with radionuclides and the treatment of benign or malignant diseases with radiopharmaceuticals. The Nuclear Medicine physicist's role is key to the enabling of the practice of safe, state-of-the-art Nuclear Medicine diagnosis and treatment.

In order to acquire and maintain sufficient knowledge and an appropriate level of competence, both initial and continuing education and training are necessary. European legislation has challenged many professional organisations to propose harmonised professional standards of high quality. The European Union's Directives concerning basic safety standards [1] and medical exposures [2] have made it a statutory requirement to involve physicists in the medical uses of ionising radiation and have given impetus to the discussions of education and training requirements in Medical Physics. The European Federation of Organisations for Medical Physics (EFOMP) and the European Association of Nuclear Medicine (EANM) have recently started collaborating on scientific, education and training issues of common interest in the field of Nuclear Medicine. The two organisations have a long-standing commitment to improve clinical practice, science, development, education and training. These guidelines represent the first common attempt by the two organisations to accommodate the contemporary requirements for the knowledge/skills/competences needs in this rapidly evolving field.

The European Association of Nuclear Medicine was founded in 1985 as the umbrella organisation of Nuclear Medicine in Europe and represents the sector towards the European Institutions. Within this role, the EANM aims at advancing science and education in Nuclear Medicine for the benefit of public health. Moreover, the EANM aims at promoting and coordinating, throughout Europe and beyond, discussion and exchange of ideas and results relating to the diagnosis, treatment, research and prevention of diseases through the use of unsealed radioactive substances. The goal of the EANM is thus to provide a suitable medium for the dissemination and discussion of the latest results in the field of Nuclear Medicine and related subjects.

The Physics Committee together with the Dosimetry Committee of EANM have the task to lead the formal input of Medical Physics advice to the EANM Executive Committee, and to coordinate the activities related to Medical Physics and Dosimetry within the EANM. The committees identify areas of Nuclear Medicine practice in Europe that would benefit from formal input from Medical Physicists, by way of guidelines, standards, education and training or evaluation. The Physics Committee in particular has established formal links with EFOMP in order to coordinate work on Physics and Instrumentation topics. The Dosimetry Committee collaborates with international organisations or committees, such as the MIRD committee of the American Society of Nuclear Medicine (SNM) and the IAEA (International Atomic Energy Agency). Both committees issue guidelines, published in the European Journal of Nuclear Medicine and Molecular Imaging (EJNMMI) and other European Journals in this field, on various topics related to Medical Physics in Nuclear Medicine. In addition, they participate in the elaboration of clinical guidelines by reviewing their Medical Physics content (image acquisition and processing, instrumentation QA, radiation safety and dosimetry).

EFOMP is an umbrella organisation for national Medical Physics organisations, with one of its main objectives the harmonisation and promotion of the best practice of Medical Physics within Europe. To accomplish its goals, EFOMP has presented various recommendations and guidelines in a number of Policy Statements, which have been unanimously adopted by EFOMP Member Organisations. Policy Statement No. 9, “Radiation Protection of the Patient in Europe: The Training of the Medical Physics Expert in Radiation Physics or Radiation Technology” [3], is the EFOMP response to the Medical Exposure Directive, 97/43/Euratom [2]. Here EFOMP presents its recommendations on the role and the competence requirements of the Medical Physics Expert (MPE), as defined in this Directive [2], together with recommendations on education, training and Continuing Professional Development (CPD). General criteria for structured CPD have been laid down by EFOMP in Policy Statement No. 8, “Continuing Professional Development for the Medical Physicist” [4]. CPD is the planned acquisition of knowledge, experience and skills, both technical and personal, required for professional practice throughout one's working life. EFOMP recommends that all Medical Physicists who have completed their basic education and training should be actively involved in CPD to maintain and increase competence and expertise after qualification. The EFOMP approach to achieve harmonisation is to encourage the establishment of national education and training schemes at all levels in line with EFOMP recommendations. Guidelines for formal EFOMP recognition of National Registration Schemes for Medical Physicists were established in 1995 [5]. EFOMP approval requires inter alia clear statements of theoretical and practical competences, as well as training programmes consistent with the EFOMP policy on training, and a regular renewal mechanism. CPD is now being recommended as the best way to meet the requirement for a renewal mechanism, and Policy Statement No. 10 “Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists” [6], and Policy Statement No. 12 “The present status of Medical Physics Education and Training in Europe. New perspectives and EFOMP recommendations” [7], recommend National Member Organisations to set up their own detailed CPD Scheme. In Policy Statement No. 12 additional recommendations on education and training of Medical Physicists within the context of the current developments in the European Higher Education Area arising from “The Bologna Declaration”, and with a view to facilitate the free movement of professionals within Europe, are given. Other initiatives in educational issues have been developed by EFOMP in cooperation with ESTRO [8] (“Guidelines for education and training of Medical Physicists in radiotherapy. Recommendations from an ESTRO/EFOMP working group.”). EFOMP is a partner in the EC project to develop a guidance document on Medical Physics Expert (MPE) that includes the required Education and Training of the MPE. A more recent EC project is the updating of the “Guidelines on education and training in radiation protection for medical exposures” [9]. EFOMP is also a partner in this project.

This curriculum for Medical Physicists in Nuclear Medicine arises from the necessity to update the education and training requirements to accommodate today's competence needs in modern Nuclear Medicine.

This document includes also other competence areas as organizational competence, professionalism, communication, collaboration, social actions, in addition to Nuclear Medicine physics skills and knowledge.