Answering the "Who, What, & Why" Questions
Several years back, it was put forth that having a mid-level provider (physician extender) in radiology would help a department become more efficient and allow radiologists / nuclear medicine physicians to concentrate on readings without interruption while maintaining the atmosphere of excellent patient care. Radiology Assistants (RA) and Radiology Physician Assistants (RPA) are now a reality here, and are being utilized more and more every year.
It’s been a bumpy road, queue the old adage “nothing easy was ever worth doing,” but it should be no surprise that nuclear medicine and molecular imaging would follow suit. In fact, when you look at the direction health care is going, we see the mid level physician extender in all facets of medicine. The question should not be “do we need them” - that question has already been answered. The question should now be “how do we effectively utilize them”?
It should be understood that there are differences between Physician Assistants (PAs), Nurse Practitioners (NP), and Nuclear Medicine Advanced Associates (NMAA). One of the common mistakes made is to think that there is no need for the NMAA or RA; rather, that the PA or NP can fulfill that role. Although PAs and NPs have extensive medical training, they are focused in primary care first and they lack the specialty training associated with imaging - training that the NMAA and RA possess. This is specifically why these roles were created, to fill that void. And, to be clear, I would not place an NMAA in the role of a PA that works in family medicine since that would not be a good fit, not to mention outside their scope of practice.
So what does an NMAA do? How can they be applied to enhance the nuclear medicine and molecular imaging department? The best evidence is to ask those who already utilize them. We speculated that efficiency and reduction of error would result from having a mid level provider in the nuclear medicine arena by increasing productivity, for both the technologist and the physician by taking the burden of higher level mundane functions that the reading physician no longer has time for.
This is exactly what is happening in multiple institutions that now employ the NMAA. For instance, in large metropolitan centers a variety of scans take place simultaneously, usually with a lead technologist making sure quality patient exams are produced; however, for those questions such as adding SPECT imaging, performing stress testing, physical exams and limited histories, ordering adjunct imaging or labs, and making the decision to terminate the exam or acquire delayed imaging, the physician still needs to be interrupted.
Furthermore, with an increasingly complex reading schedule and a litigious society, four eyes and two brains interpretating exams is always beneficial. This is where the NMAA steps in as the physician extender. Similarly, in small rural areas where there is intermittent physician coverage, telemedicine, or inexperienced radiologists, the NMAA could serve as the physician extender and advanced technologist, thereby allowing for Nuclear Medicine to be accessible for patients who might otherwise have to travel to the nearest metropolitan center. Below is the current NMAA scope of practice:
What we do know is that since 2009 there has been a steady decline in nuclear medicine residents. The combined residency pathway has been promoted as a way to energize ABNM certified physicians as well as make new residents more attractive to radiology administrators.
This way of thinking permeates through not just physician training, but in the technologist’s world as well, where we see those with multiple credentials and training more marketable than those who are sub specialized. With those dual ABR / ABNM physicians, radiology administrators can utilize them to cover call and general radiology instead of just focused on nuclear medicine.
But that leaves a vacancy. When will these physicians be able to see patients and interact with them, now that they are covering more duties? Where does the technologist go for expert opinion, medically, when the physician is not available and is above the lead technologists’ scope of practice? The answers of course, in my opinion, are obvious.
How does one become a NMAA? Currently there is one program with a consortium of four universities. These include the University of Missouri at Columbia (UMC), Saint Louis University (SLU), Georgia Regents University (GRU), and the University of Arkansas for Medical Sciences (UAMS). UAMS is considered the home for the program and upon completion defers a Masters of Imaging Sciences degree.
To enter the program, the candidate must have a Bachelor’s degree in any field of study from a regionally accredited college or university, completed an accredited program in nuclear medicine technology, hold current certification in nuclear medicine technology by the NMTCB, ARRT, or CAMRT, and completed a minimum of two (2) years of full-time equivalent clinical experience in imaging sciences following certification. Since you will be expected to perform on an advanced level, it is necessary to have experience and training outside of academia before trying to obtain this degree.
Prior to the application, keep in mind that it will also be necessary to have preceptors (physician clinical instructors) who agree to mentor you throughout your internship. It is advisable to have multiple preceptors and possibly multiple institutions from which to obtain clinical knowledge. Each institution you train at and each preceptor who plans on mentoring must sign an agreement with the program prior to the start of your internship; this portion of the application process can take months as these forms tend to be scrutinized by the institutions.
The curriculum includes; patient assessment, statistics and research methods, clinical pharmacology, pathophysiology and clinical correlation I & II, clinical internship I-V, health care systems in America, research projects I & II, as well as an elective. The course curriculum can be curtailed to be taken full time or part time each semester; however, the total must be done within a 5year time frame and the semesters must be consecutive. The didactic course work is internet based with a mixture of conference calls, self assessment, and oral and written testing, peer review, and online lecture.
The clinical portion places goals on the intern to achieve competency in all aspects of nuclear medicine and molecular imaging; hence, why it may be advantageous to set up multiple institutional and preceptor agreements. During the clinical internships, besides completing the didactic components, it is desired that the intern and preceptor(s) work closely together on achieving the intern’s benchmarks such as applying the pathophysiological knowledge to image assessment and/or providing training on clinical skills such as physical assessment, patient management, and clinical correlation. The following is a link to the current course description:
Once the program is completed and the director has verified the clinical internship requirements you will be eligible to sit for the NMAA boards offered by the NMTCB. These boards are offered only twice a year, January and June. The content outline is daunting to say the least and does reflect the approved curriculum as the boards are a culmination of what a new mid-level provider would be expected to know in the workforce.
Suffice it to say, like any other board exam, I would recommend sitting for the boards as soon as possible due to the anxiety and pressure board exams usually manifest. With the designation still in its infancy licensure and; therefore, credentialing are, for the most part, non-existent. This not a reflection on the value a NMAA can offer in practice but rather an issue regarding numbers. We simply have not achieved a “critical mass” to warrant professional license or credentialing; however, institutions can independently weigh the benefits of the NMAA and give them privilege to perform the tasks set forth in their scope of practice. This has happened in several institutions, the first of which occurred within six months of the first graduating class entering the workforce.
Hopefully, soon, the medical community will better realize the importance of the NMAA and their counterpart the RA. We need to be flexible enough to change with the new health care paradigm, while maintaining a high level of quality in our field. This is why we need highly motivated individuals with a passion for nuclear medicine. If you have that passion and are motivated click here: https://online-apps.uams.edu/chrp/.
Congratulations to the newest group of NMTCB(CT) technologists.
A group of 83 newly certified CT individuals may now call themselves "NMTCB(CT)" after they passed the April 17, 2015 exam.
At present, there are 185 total NMTCB(CT) technologists nationwide!
Call for Directors
NMTCB is seeking applicants to serve on its Board of Directors. This is an excellent opportunity to become involved in one of the more challenging and important areas of your profession – establishing standards of professional competency. The candidates for technologist member of the Board must be qualified in nuclear medicine technology by high professional standards as reflected by clearly demonstrated educational background and academic qualifications.
Director Application Forms are available to download from the NMTCB website under the “Resources” tab, located at: http://www.nmtcb.org/resources/directorApp.php
Completed applications must be received by August 15, 2015. Candidates will be reviewed at the fall NMTCB Board meeting. The four-year term for the newly elected director begins on January 1, 2016.
Interested certified nuclear medicine technologists (CNMT) may request an application from Katie Neal, Executive Director at 800/659-3953 or email firstname.lastname@example.org.
"What It Meant To Me"
Insight from a Previous NMTCB Director
Robert Pagnanelli, CNMT, NCT
Interested individuals who wish to serve on the NMTCB Board of Directors may request an application form by emailing email@example.com.
Chief Technologist, Nuclear Imaging
Duke University Medical Center
Looking back on my experience as an NMTCB Director and Chair, I am grateful to have had the opportunity. The time that I spent as a Director gave me a more thorough understanding of our field and a respect for all of those who served prior to me in the role.
Having had the opportunity to serve on several other boards and committees related to nuclear medicine, the Nuclear Medicine Technology Certification Board was by far the most productive. Every member was enthusiastic to advance nuclear medicine and molecular imaging through psychometrically sound exams.
It was great to be a part of the NCT and PET exams transitioning from paper-and pencil delivery to online and finally to being on-demand at testing centers available worldwide. It was also exciting to build the first NMAA exam and certification program. Most importantly, I continue to enjoy the friendships I made while on the NMTCB Board with other technologists, physicists, pharmacists, and physicians that participated. I encourage technologists to consider the experience.
EXECUTIVE DIRECTOR'S REPORT
I have been very pleased to see so much public interest shown towards NMTCB's certification examination for computed tomography (CT)! Our most recent CT credentialing exam was delivered on Friday, April 17, 2015. I am happy to report that a total of 83 individuals passed their examination attempt and those technologists are now able to call themselves NMTCB(CT)s.
After this second delivery of the CT examination, NMTCB now credentials a total of 185 NMTCB(CT) individuals across the nation, further solidifying that computed tomography is a part of an NMT's scope and that CT can be competently and capably performed by credentialed nuclear medicine technologists. We look forward to offering the next NMTCB(CT) examination on Friday, November 20, 2015. The application deadline for this exam will be October 1, 2015.
As a reminder, you must be certified or registered as a nuclear medicine technologist prior to taking the NMTCB's CT exam. Many employers are requiring nuclear medicine technologists to be certified in CT in order to be able to perform computed tomography as a nuclear medicine technologist. The NMTCB Board decided that in order to live up to its vision and its responsibilities in ensuring the safe delivery of care, offering an examination in CT for nuclear medicine technologists was necessary. To see the full eligibility requirements to sit for the NMTCB(CT) exam, please go to CT Exam page on the NMTCB website, available here: http://www.nmtcb.org/CT/CTexam.php
I am also excited to report that NMTCB will be updating our website (www.NMTCB.org) in the next few weeks. As part of our efforts to improve your experience when accessing our site, we are updating the webpage in order to make it much more user-friendly for smart phone and tablet users. Stayed tuned for the NMTCB website to have a fresh new look, better navigation and performance, and many more enhancements to help you maintain your certification or find exactly what you need!
NMTCB is also looking forward to being in attendance at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting in Baltimore, Maryland in June. If you have plans to attend the meeting in Baltimore, please stop by the Exhibit Hall and visit us at Booth #1247.
Also, if exercising happens to be your thing, quite a few NMTCB representatives will be taking part in the Inaugural “Hot Trot 5K” run/walk that will take place on Saturday morning, June 6th of the annual meeting. Whether you chose to "race" the event, or just take a leisurely walk, the Hot Trot 5K is bound to a fun time for everyone. Proceeds from the 5K will benefit the advancement of molecular and nuclear medicine technologists through professional development via the SNMMI-TS Professional Development and Education Fund. A portion of the registration proceeds will also support a local charity. Come do some cardio with us!
In closing, I would like to take this opportunity to thank the NMTCB Board of Directors for entrusting me with the responsibilities of the Executive Director position. I am looking forward to addressing the challenges and opportunities that are ahead for NMTCB in the months and years to come. NMTCB is fortunate enough to have a dedicated Board of Directors, a competent and capable office staff, and the support of many stakeholders in the nuclear medicine field. My plan is to continue to strengthen and evolve NMTCB’s certification programs, ensuring that we maintain our position as the premier certification board for nuclear medicine technologists.
We appreciate your feedback!
Since 1978, NMTCB has proudly offered certification examinations solely for the field of nuclear medicine technology- resulting in valid, high-quality professional credentials for qualified technologists. During this rapid change in healthcare procedures and policies, it is now more important than ever to keep your credentials up to date. Whether a technologist maintains a CNMT, NMTCB(CT), PET, NCT, or an NMAA credential – that particular credential is intended to be considered the “gold standard” for this profession.
Please let us know if we can be of assistance to you.
We welcome your questions, suggestions, and feedback.
Feel free to email the NMTCB board at firstname.lastname@example.org.
Chair of the Board
Marcia Hess Smith, CNMT
Cindi Luckett-Gilbert, CNMT, PET
Jon Baldwin, DO
Cybil Nielsen, CNMT
Alicia Baldwin, DO
Jon Baldwin, DO
Amy Brady, CNMT
Jimel M. Carpenter, CNMT, NCT
Ada Courtney, CNMT, PET
Misty Ehret, CNMT
Mary Beth Farrell, CNMT, NCT
Bennett Greenspan, MD
Marcia Hess Smith, CNMT
George Hinkle, RPh, BCNP
Cindi Luckett-Gilbert, CNMT, PET
Angela Macci Bires, Ed. D, MPM, CNMT
Cybil Nielsen, CNMT
Gregory G. Passmore, PhD., CNMT
James Patton, PhD
Jon Shepard, MS
Richard Siska, CNMT, NCT, NMAA
Steven Wozniak, CNMT, PET
Katie Neal, BS, MS
Alfred L. Shellman
Certificant Services Manager
Elizabeth Rhodes, BS, MBA
Barbara T. Dixon
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