1. Provide patient and modality specific evaluation of imaging risk assessment.
Examples include assessment of patients with conditional pacemakers in MRI, and assistance with reducing controllable patient skin exposures and facility staff safety for radiology, cardiology, pain clinic, GI with fluoroscopy.
2. Commission new systems and application: Newly purchased devices have new features for which a facility may have specifically requested with a patient population in mind.
Become the technical subject matter expert on a new feature. Determine its best use and assist with integrating into clinical care.
Examples are: Cone beam CT, automated kVp for CT, quality of fat saturation, manufacturer enhancements to SUV, etc.
3. Quantify and optimize image post processing in digital imaging. Patient image data are sent to users in surgery, radiation oncology and medical specialties.
Understand these downstream user’s needs - an optimized image post processing in digital imaging for direct patient care is often not the same optimal processing for primary interpretation.
Advise the radiology service on the creation and export of these image data as it directly affects patient interventions.
Examples include patient specific orthopedic implant manufacture, rigid templates for neurosurgery RF and laser ablations, fiducial marker visualization with key MRI sequences, etc.
4. Identify a process by which the broad range of imaging exams (patients) and device protocols can be systematically examined. Optimize quality and safety of out-patient care.
Be a champion and emphasize data driven metrics for quality and safety. What tool can be used to capture imaging exams, which are sub-optimal?
Examples include identifying the number of routine CT abdomen pelvis with contrast exams that are outside of the AAPM Guidelines for reference dose level (50 mGy), or consistency of imaging in lung cancer screening with CT.
5. Standardize the imaging acquisition protocols on imaging examinations with respect to machine settings. As the physicist performs annual device review, an opportunity exists to review device specific acquisition parameters.
Devise or acquire tools for validating that all devices of a given modality have appropriately identical settings.
Take on the clinical need to achieve highly reproducible exams or procedures as well as an optimized individual device acquisition.
Develop or identify and purchase tools to quantitate quality in the 'systems context'. As imaging devices become a ‘node on the network’, the opportunity exists to gain efficiencies and establish standards more easily than in the past.
6. Collaborate with your administrative partner to fully understand the established Joint Commission guidelines for safety and education with CT, MR and Nuclear Medicine.
Educational needs comprise a large part of these guidelines. The physicist can develop, evaluate and communicate content that meets these needs and strengthen the working relationships with imaging technologists.
Examples include being designated or recognized as the MR Expert, review of Age Appropriate CT acquisition settings, etc.
7. Offer patient exam consultation – establish a mechanism for direct referral to the physicist of patient image data for which radiology interpretation may have been compromised.
An episodic communication should be in documented form and easily communicated by the radiologist (or tech). In the manner of an ordered exam for radiology, the physics consult (physicist findings) must be of high quality and promptly followed up.
Opportunities in Therapy Practice Examples
1. Direct patient care: create a direct interface with the patient from their entry into a radiation therapy department through the course of their treatment.
The physicist who emphasizes the quality review and science of the treatment directly communicates an aspect of quality oversight.
Physicists can grow their knowledge of risk analysis methods (TG100).
Clinical prescription, contours, knowledge base validations are critical components of quality.
Industrial engineering tools are used to (re)design better quality assurance programs, and to use this expertise not only in physics but as a resource for the entire department when other groups are implementing a new process or technique.
2. Be the local expert on post-processing tools and educate physicians and staff.
Is the software state of the art and robust?
Are multiple similar software products or software versions in use at the facility? Can they be standardized?
3. Identify imaging processes that have relevance to Radiation Oncology and work with Diagnostic Radiology to bring them into clinical practice.
Imaging used to identify targets (e.g. advanced forms of PET or MR)
Imaging used to identify avoidance areas (e.g. perfusion/ventilation lung scans to show what areas of the lungs to avoid)
Imaging used to assess tumor response
4. Set up data recording systems to allow large-scale studies correlating treatment procedures/parameters with outcomes.
Be the leader who coordinates medical staff, IT staff, and physics/dosimetry staff so that the systems work in practice.
Do the data extraction and modeling, including radiobiological modeling.
5. Become educated about payment reform and participate in discussions with physicians and administrators on how address economical challenges in terms of cost, quality, and efficiency.
Develop and implement incident learning/practice improvement systems.
