1. 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 2008

2. Technological Advancements PET scan volume more than doubled from 2004 to 2007 and is forecast to triple by 2010 Clinical introduction of SPECT in the 1980s PET/CT Hybrids and the increasing importance of fusion imaging technologies History Programs Problems Bachelors NMAP

3. Evolution of Nuclear Medicine Major Revisions Incoming Outgoing Radioimmunoassay (RIA) Digital Imaging/Processing Heathcare Informatics Shift toward specialists care Dedicated PET PET/CT and SPECT/CT Molecular Imaging/Therapy PEM & PET/MRI (anticipated) History Programs Problems Bachelors NMAP

4. 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

5. NMT Program Demographics ~30% Universities ~30% Universities –35% of these award a bachelor’s degree (usually 4 years in length) ~30% Community / Junior colleges ~30% Community / Junior colleges –53% of these award an associates degree (Most are 2 year programs) ~40% Hospital-based ~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

6. JRCNMT –Nationally recognized accrediting agency for NMT educational programs –The Essentials –Accredited Programs in the US –Regional Accreditation Joint Review Committee on Educational Programs in Nuclear Medicine Technology www.jrcnmt.org History Programs Problems Bachelors NMAP

7. Problem #1: Variable Education NM Technologist Training Programs  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  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

8. NMT Program Award Level http://interactive.snm.org/docs/Nuclear_Medicine_Technologist_Report_2005.pdf http://tech.snmjournals.org/cgi/content/full/28/4/280/F2 Variable NMT Education 2005 2000 History Programs Problems Bachelors NMAP

9. Variable Education (continued)  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

10. Problem #2: Staffing Aging WorkforceAging Workforce http://interactive.snm.org/docs/Nuclear_Medicine_Technologist_Report_2005.pdf http://tech.snmjournals.org/cgi/content/full/28/4/280/F2 2000: Mean = 48 years2005: Mean = 43.5 years History Programs Problems Bachelors NMAP

11. Problem #2: Staffing Technologist ShortageTechnologist Shortage –Faster-than-average job growth is anticipated through 2016 Technological innovations will increase the diagnostic uses of nuclear medicineTechnological innovations will increase the diagnostic uses of nuclear medicine The development of new nuclear medicine treatmentsThe 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.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

12. 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

13. 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/35/3/15A History Programs Problems Bachelors NMAP

14. Incorporating CT into the Curriculum To stay current with the market, many programs are incorporating sectional anatomy and CT into their programs. http://interactive.snm.org/index.cfm?PageID=2760 2004 the ASRT/SNMTS PET/CT Curriculum History Programs Problems Bachelors NMAP

15. 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

16. Problem #4: Credentialing Which Board Exam Should I Take?  88.2% are CNMT certified  50.1% are RT(N) certification 37.7% are licensed in another allied in another allied health field: health field: Findings from a 2005 SNM Survey of Nuclear Medicine Technologists 39% have both History Programs Problems Bachelors NMAP

17. The Future of Nuclear Medicine Baccalaureate degree for entry level NMT by 2015 Education and credentialing standards via state licensure The Nuclear Medicine Advanced Practitioner      

18. 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

19. Baccalaureate Degree Criticisms A university education is expensive.A university education is expensive. Certificate program closures will create workforce shortages.Certificate program closures will create workforce shortages. Many universities are not interested in such affiliations.Many universities are not interested in such affiliations. Didactic education is prioritized over practical experience.Didactic education is prioritized over practical experience. Nursing and radiation therapy continue to recognize non- baccalaureate entry level professionals.Nursing and radiation therapy continue to recognize non- baccalaureate entry level professionals. Obsolescence of current certificate & A.S. degrees holdersObsolescence of current certificate & A.S. degrees holders Society of Nuclear Medicine Technologist Section (SNMTS) History Programs Problems Bachelors NMAP

20. 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/GovernmentRelations/CAREBill/faq_legislative.aspx History Programs Problems Bachelors NMAP

21. 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

22. Advanced Practitioner The six graduate-level competency domains: 1)Patient Care 2)Clinical Nuclear Medicine 3)Interpersonal/Communication 4)Evidence-based Decision Making 5)Professionalism 6)Systems-Based Practice SNMTS Advanced Practice Task Force, 2007 History Programs Problems Bachelors NMAP

23. 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) History Programs Problems Bachelors NMAP

24. Slides available at: www.nucmedschool.com/education.ppt Thank You Slides available at: www.nucmedschool.com/education.ppt