Medical Physics Cross-Specialization in the Era of Radiotheranostics
Presentations
MO-J-202-0 (Monday, 7/11/2022) 4:30 PM - 6:00 PM [Eastern Time (GMT-4)]
Room 202
Radiotheranostics is a medical procedure, also known as targeted radionuclide or radiopharmaceutical therapy, that uses the same or very similar radionuclides conjugated or unconjugated to biomolecules for both diagnosis and treatment of a disease. Radiotheranostic pairs in clinical use or under trial will be presented, and the role and challenges of medical physicists in imaging, pharmacokinetics modelling and internal dosimetry, explored. Arguments will be provided for patient-individualized radiation dose assessment to become a routine practice, as it is in other uses of radiation in therapy. Individual objections to patient-specific dosimetry will be raised and addressed. Examples from the literature demonstrating improved outcomes when dosimetry is performed will be presented. Such approaches are superior to the current practice of using a fixed activity (or activity per unit body weight) in nuclear medicine therapy. It will be demonstrated that standardized and automated methods, with adjustment for patient-specific physical and biokinetic data, are of similar cost and difficulty to those used in other therapeutic modalities. Most importantly, the data show that patient-individualized radiation dose estimates correlate well with observed effects and result in better patient outcomes, improving the quality of patient medical care and reducing costs for the institutions involved.
The U.S. Nuclear Regulatory Commission (NRC) and its Agreement States license and regulate the possession and use of radioactive materials for nuclear medicine. As stated by the US NRC regulations, an “authorized medical physicist “ is an individual who is certified by a specialty board whose certification process has been recognized by the Commission or by an Agreement State, and who meets certain training requirements. These may be satisfied by completing either a training program provided by the vendor or by supervised training by an authorized medical physicist for the type(s) of use for which the individual is seeking authorization. (Ref: https://www.nrc.gov/reading-rm/doc-collections/cfr/index.html 10CFRPart20). Becoming a Qualified Medical Physicist (QMP) with specialization in nuclear medicine includes: graduate education, training (residency), board certification, and in some states, licensure. Graduate education requires the completion of a CAMPEP accredited masters or doctoral degree in medical physics; or a CAMPEP accredited certificate program designed to supplement the academic background of PhD applicants in science, technology, engineering, or mathematics, rather than in medical physics. The American Board of Radiology (ABR) requires the completion of a CAMPEP accredited residency; the American Board of Science in Nuclear Medicine (ABSNM) requires practical training under the supervision of a QMP for a specified duration. To maintain board certification, both ABR and ABSNM require participation in a maintenance of certification program.
Since most of the objections for individualized patient dosimetry are economic, cost reimbursement pathways will be explored. Recent experience in obtaining the first diagnostic medical physics CPT code 76145 (assessing peak skin dose during prolonged interventional fluoroscopy procedures) may be used as a model in applying for a CPT code that provides reimbursement for the medical physics services rendered for radionuclide therapy. The nuances of obtaining CPT codes and how a similar approach can be applied for radiotheranostics medical physics services will be discussed.
Learning objectives:
1. Learn the fundamentals of radiotheranostics and the advantages of individualized patient dosimetry
2. Become familiar with NRC and Agreement States regulations to be an “Authorized Medical Physicist” and with the pathways for medical physics certification to become a “Qualified Medical Physicist”
3. Examine the possibility to obtain reimbursement for medical physics services in radiotheranostics
Handouts
- 175-63595-16291659-186999-70933634.pdf (Caridad Borras)
- 175-63596-16291659-187000-102266580.pdf (Michael Stabin)
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