AAPM medical physics practice guideline 10.a.: Scope of practice for clinical medical physics

Abstract The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline (MPPG) represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiation requires specific training, skills, and techniques as described in each document. As the review of the previous version of AAPM Professional Policy (PP)‐17 (Scope of Practice) progressed, the writing group focused on one of the main goals: to have this document accepted by regulatory and accrediting bodies. After much discussion, it was decided that this goal would be better served through a MPPG. To further advance this goal, the text was updated to reflect the rationale and processes by which the activities in the scope of practice were identified and categorized. Lastly, the AAPM Professional Council believes that this document has benefitted from public comment which is part of the MPPG process but not the AAPM Professional Policy approval process. The following terms are used in the AAPM's MPPGs: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Generalthe procedure is performed under a Qualified Medical Physicist's overall direction and control. The QMP's presence is not required during the performance of the procedure, but must be available by phone to provide assistance and direction if needed.
Under General Supervision, the training of the personnel who actually perform the procedure and the maintenance of the necessary equipment and supplies are the responsibility of the QMP.
Directa Qualified Medical Physicist must exercise General Supervision and be present in the facility and immediately available to furnish assistance and direction throughout the performance of the procedure. Direct Supervision does not require that the QMP must be present in the room when the procedure is being performed.
Personala Qualified Medical Physicist must exercise General Supervision and be present in the room during the performance of the procedure.
If there is an existing standard or guideline related to the task or activity, it is referenced. The scope of practice described here identifies the activities and responsibilities that a medical physicist can undertake based on the individual's training, qualifications, and demonstration of competence.
In addition to describing what duties must be performed by a QMP, the scope of practice also defines what duties must be overseen by a QMP and those which a QMP could perform to bring additional value. The rationale for these distinctions is grounded in practice standards and guidelines, qualifications and training, and needs for patient, employee, and public safety. Ultimately the scope of practice defined here is the position of the AAPM, not a compilation of regulatory requirements or accreditation guidelines. It is also important to note that some states may have additional restrictions on the qualifications required to perform the tasks listed here.
This document describes the overall responsibilities and qualifications of a clinical medical physicist and includes a specific, but not exhaustive, list of clinical activities that are performed by medical physicists for four areas of practice: radiation oncology, diagnostic, nuclear medicine, and magnetic resonance imaging. As technology and patient care processes change this list must be modified. The descriptions in some cases are deliberately broad in order to anticipate changes in healthcare. While some skills are common to all medical physicists, some activities require the expertise of a medical physicist qualified in one of these specific subspecialties. According to AAPM Professional Policy 1, 1 a QMP is qualified to practice on in the subfield(s) in which they are certified. This distinction is made for the activities listed in the Appendix.

| INTEN DED USERS
The contents of this document can aid a QMP when determining an overall scope of practice for the performance of medical physics activities. It can also be referenced by administrators, regulators, and accreditation bodies to identify what qualifications are necessary for individuals performing medical physics activities. In accordance with the rules of AAPM Medical Physics Practice Guidelines, this document will be revised at intervals not to exceed 5 yr. Any adoption of these recommendations by other organizations must be incorporated by reference, to reflect any updates made to this practice guideline.

| DEFIN ITIONS
Medical Physics is a branch of physics associated with the practice of medicine. The term Medical Physics, as it is used here, includes the subspecialties of diagnostic medical physics, therapeutic medical physics, nuclear medical physics, and magnetic resonance imaging (MRI) physics.
Radiation includes both ionizing and nonionizing radiation such as electromagnetic radiation, particulate radiation, and ultrasound.
These modalities, used for diagnostic or therapeutic purposes as prescribed by a properly qualified practitioner, are herein described as

| RESPONSIBILITIES
The essential role of the QMP is to assure the safe and effective use of radiation in medicine. The QMP performs or oversees the scientific and technical aspects of procedures necessary to achieve this objective. In the clinical setting, this involves the use of ionizing or nonionizing radiation in the delivery of radiation oncology treatments or performance of diagnostic medical imaging, nuclear medicine, or MRI examinations and procedures.
To perform these duties, the medical physicist often collaborates with physicians, other physicists, engineers, dosimetrists, radiation therapists, radiologic technologists, nurses, information technology professionals, and administrative staff. Successful integration as a member of the healthcare team requires that a QMP have comprehensive knowledge of many aspects of patient care, even if the specific task is typically performed by a non-QMP team member.
For example, a QMP working in radiation therapy should have in-depth knowledge of patient setup techniques and treatment planning, even though those activities may be performed by a technologist and dosimetrist, respectively. In addition, the medical physicist must communicate with and provide education for healthcare professionals and patients. A QMP must be an integral part of the team that uses radiation therapy equipment, diagnostic imaging equipment, or radioactive materials in medicine. Typically, a QMP is employed by, or has a professional services contract with, a facility or healthcare provider. The responsibilities of the QMP must be recognized and supported by the administration and medical director of the facility.
The QMP's scope of practice categorizes medical physics activities into the following areas: In order to effectively fulfill these responsibilities, the QMP may delegate certain tasks to other non-QMP individuals. However, the QMP is responsible for ensuring that those individuals are adequately trained for such tasks. Furthermore, the QMP is responsible for overseeing the delegated work performed by those individuals and maintains ultimate responsibility for that work. Quality Assurance or performance testing completed by a supervised individual must be reviewed, approved, and signed by the QMP.
The QMP should also have control over physics-related work  Participates in operations management (e.g., establish client expectations, allocate personnel, ensure expectations are met) x 1 , 2 Participates in staffing and budget discussions and decisions that impact clinical medical physics services x 1 , 2 Participates in initial and ongoing facility planning (e.g., facility layout optimization, life cycle management of imaging equipment) x 1 , 2 , 3 Consults on selection of new equipment prior to purchase, including review and comparison of equipment specifications and performance x 3 Supervises medical physics staff, including physicists, medical physicist assistants, medical physics residents, and medical physics students in compliance with all relevant regulatory requirements and appropriate professional documents (e.g., AAPM reports) x 1 , 2 , 4 Ensures that all local and national regulations and accreditation requirements as relating to medical physics are met and maintained x Oversees quality assurance and quality control programs to meet local and national regulations, accreditation organization(s) standards, and national recommendations x 3 Serves as the radiation safety officer for the facility x 17 Serves as a member of the institution's Radiation Safety Committee x 17 Develops procedures for the initial and continuing evaluation of radiation protection equipment and procedures Acts as the facility's MR Safety Expert or MR Safety Officer x 20 Develops an MRI safety program x 10, 12 Additional information may be found in the following resources Participates in or oversees the safe use of radiopharmaceuticals or radionuclides during therapeutic procedures (e.g. Y-90) Provides consultation regarding patient safety in MRI, such as SAR considerations, prevention of patient burns, implanted devices, etc.
x Provides consultation regarding patient safety in ultrasound, such as thermal and mechanical index considerations x Evaluates appropriate imaging protocols for diagnostic and interventional imaging and simulation and image-guided radiotherapy x 16, 17,18,19 Ensures the safe and appropriate implementation and use of imaging procedures and equipment as they pertain to diagnostic and interventional equipment and radiotherapy (simulation, treatment planning, and treatment delivery) Provides written reports as needed to assure accurate and appropriate choice of dose delivery for radiation therapy x Is involved with the development and delivery of special radiotherapy procedures Additional information may be found in the following resources  Participates in developing policies and procedures for electronic medical information security and privacy x 1, 2, 3, 4, 5 Develops and manages a quality assurance program for data transfer between clinical systems in radiation oncology x 1 , 6 , 7 Additional information may be found in the following resources Ensures all medical physics tasks and duties are in compliance with all applicable regulations related to the use of ionizing and nonionizing radiation x Is involved with the recommended action and patient health effects analysis from radiation medical events or near misses x 1 , 2 Participates in an ongoing peer-to-peer review program. This may be performed with another QMP within the practitioner's institution or an extramural QMP x 3 , 4 , 5 Serves on institutional committees (e.g., Risk Management, Quality Assurance, and Professional Staff) as needed to provide relevant information related to medical physics x 6,7,8,9,10 Consults in developing policies and procedures related to the appropriate clinical use of radiation for imaging purposes (e.g., advantages and disadvantages of various imaging techniques) x Provides imaging protocol consultation with radiologists and other health care providers x 11, 12, 13 Works with radiologists and technologists to optimize imaging protocols, including technical scan parameters and appropriate use of dose-optimization features available on equipment (e.g., automatic tube current modulation, iterative reconstruction, pulsed fluoroscopy, etc.) x Works with technologists and radiologists to establish reference levels for monitoring radiation dose in general radiography, fluoroscopy, and CT-guided interventions x (direct) 11, 12, 16 Works with technologists and radiologists to set dose alert levels for diagnostic imaging procedures x (direct) 12 Analyzes dose indices of aggregate data to guide imaging optimization efforts x Oversees or participates in evaluation, maintenance, and utilization of radiation dose index monitoring software x (general) Quality Tasksapplicable to therapy medical physics QMP subspecialty Develops and manages a comprehensive Quality Management Program that monitors, evaluates, and optimizes radiation oncology processes