Medical Physicists and Quality of Care in Radiology

October 9, 2014

Medical physicist contributions to quality care often go unseen by patients, but are paramount to their safety.

When it comes to having an imaging study, patients can identify most of the team members. They recognize the radiologist, the technologist, and the nurses involved. But the one team member they might not know exists – the medical physicist – is the one who often plays the biggest role in keeping them safe.

In the United States, there are approximately 8,000 medical physicists working in hospitals and clinics. However, even in 2014, not every state requires that a medical physicist be part of a diagnostic imaging management team. Currently, according to the American Association of Physicists in Medicine (AAPM), 19 states offer neither licensure nor registration for this profession.

“A lot of people don’t know what medical physicists do. We’re very behind the scenes,” said Jessica Clements, medical physics director and radiation safety officer for Texas Health Presbyterian Hospital in Dallas. “Radiation is all over the hospital, so we play an important role because of the widespread use of medical imaging and radiation.”

And, while the medical physicist job affects the technical intricacies of diagnostic imaging services, much of what these individuals do also has both a direct and indirect impact on patient care and satisfaction, she said.

Who Are Medical Physicists?
At the core, medical physicists apply physics to providing clinical services in diagnostic, nuclear, therapeutic, and mental health physics. They’re in charge of managing the technological components of radiology, radiation oncology, and nuclear medicine.[[{"type":"media","view_mode":"media_crop","fid":"28354","attributes":{"alt":"medical physicist","class":"media-image media-image-right","id":"media_crop_6935257819263","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2864","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

In fact, they’re solely responsible for making sure the equipment used to provide imaging studies is calibrated and being used correctly.

“It’s necessary for every radiology department or practice to have a medical physicist examine their equipment annually, at least, for accreditation purposes,” said Richard Morin, PhD, professor of medical physics at Mayo Clinic. “Now-a-days, that accreditation is important because otherwise, it means the facility might not be paid for services rendered by Medicare.”

These check-ups are particularly important for mammography facilities, he said. Those that aren’t inspected yearly could not only lose their accreditation, but they could also lose their certification, accrue fines, or face imprisonment.

But medical physicists’ impact goes further than checking machines. On a daily basis, they take steps to improve patient care.

Creating Quality Care
The AAPM identifies three fundamental roles a medical physicist plays, whether they work in a neuroradiology department or a musculoskeletal clinic. They teach, they participate in research, and, most importantly, they are active in clinical care.

According to Clements, it’s their responsibilities with the imaging machines that are the most important. Measuring the radiation dose of all modalities and examining the image quality directly affects patient safety.

“It might seem like a small function, but that one piece touches hundreds of patients – a CT scanner may be used on 100 patients a day,” she said. “Making sure the dose and protocols are optimized and the image quality is good has a huge impact.”

Medical physicists also play a vital role in selecting equipment, Morin said. Frequently, practices bring a medical physicist in as a consultant to guide them through purchasing decisions. It’s a tactic that helps practices make the wisest decisions with their funds available for capital expenditures.

“When a practice decides to buy new equipment, they want someone to translate for them what they hear from vendors into what they need to know before spending the millions of dollars that equipment will cost,” he said. “As a third party, a medical physicist can assist the practice in knowing whether a vendor is saying something that may be partially correct but that won’t work the same way for that particular practice.”

As the radiation safety officer for a facility or practice, medical physicists are also responsible for educating patients and other providers about how pervasively radiation can affect the body. For instance, if an unknown pregnancy is discovered during a study, the medical physicist would counsel the radiologist or referring physician on the best way to address the subject with the patient.

But, Clements said, there are also instances where medical physicists talk with patients one-on-one. Patients undergoing treatment for thyroid cancer often have a post-surgery, follow-up procedure where they receive injections of radioiodine. By collecting in any leftover thyroid tissue, the radioisotope identifies any remaining cancer in the body. However, only 5% of the radioiodine collects in the thyroid tissue, leaving the patients bodily fluids radioactive for three days and restricting them to complete isolation.

“This is where the medical physicist steps in. We connect to them and talk with them about their home life to make sure they understand what they can and cannot do safely,” Clements said. “Not only does it protect them and the people they live with, but it protects the general public, as well.”

Being a Team Player
Although a medical physicist’s role is fundamental to patient safety, these professionals can’t do the job alone. They must partner with radiologists and technologists to ensure imaging protocols are designed properly, Clements said. They work together like a check-and-balance – the radiologist or technologist will tell the medical physicist if a certain action isn’t possible with a particular scanner.

If they don’t collaborate, she said, there’s a danger of over-exposing a patient or using too little radiation to secure a good image, making a duplicate image necessary.

“Protocol management takes all three members of the team,” she said. “The radiologist has to say what image he or she wants, the technologist acquires it, and the medical physicist is the go-between, helping them optimize imaging dose and quality.”

There’s also a growing push, Morin said, to increase the medical physicist role with information technology (IT) departments. Although IT professionals control the movement of an image from equipment to reading station, it’s the medical physicist who understands how the image is acquired.  A 2009 study published in the Journal of Applied Clinical Medical Physics reported medical physicist involvement is particularly important with intensity-modulated therapy, image-guided radiation therapy, 4-D radiation therapy, electronic medical records, and paperless clinics.

“Data integrity from one step to the next must be preserved. The data is used often and must be available in real time at the treatment machines,” the authors wrote. “The medical physicist understands the workflow and the data transactions, and must, therefore, be involved in all IT decisions that affect patient care.”

Basically, Morin said, radiology practices should think of the medical physicist as the quarterback of image management – the player who brings together the skill sets of all other individuals involved in radiology patient care.

“The idea is team work, and often the medical physicist is the person who can assemble the team and provide the direction so a practice can be assured that things will go well,” he said. “Their presence makes it possible, that if patients have any questions about the amount of radiation, for facilities to say that they have someone watching out for and over their patients.”