The Scope of Practice of a Medical Dosimetrist and Practice Standards for the Medical Dosimetrist documents have been extensively reviewed and updated by a Task Group comprised of radiation oncology professionals including medical dosimetrists, radiation oncologists and medical physicists. We appreciate their time and efforts in these important documents that reflect the current clinical practice of the medical dosimetry profession.
These documents have been endorsed by the American Association of Physicists in Medicine (AAPM).
The Scope of Practice of a Medical Dosimetrist is designed to assist the Qualified Medical Dosimetrist (QMD) in defining their role in the technical services they provide in patient care. This document defines a QMD, their basic responsibilities, and addresses the educational requirements, board certification, and requirements for maintenance of certification. Statements are included on supervision by and of the QMD; stressing the importance that the QMD be an active participant in the collaborative team approach to patient care; and that effective communication with the radiation oncology team is essential for providing quality patient care and patient safety.
In addition, this Scope of Practice is designed to educate professionals in the fields of health care, education, the general public, and other communities of interest regarding the expectations of the QMD. This document can be used by individual facilities to develop job descriptions and practice parameters.
The Practice Standards for the Medical Dosimetrist are designed to assist Qualified Medical Dosimetrists (QMDs) in defining their roles in the technical services that they provide in radiation oncology. This document stresses that it is essential that the QMD be an active participant in the collaborative team approach to patient care and that effective communication with the radiation oncology team is essential for providing quality patient care.
The American Association of Medical Dosimetrists (AAMD) and the Medical Dosimetrist Certification Board (MDCB) recently reviewed the American Society of Radiologic Technologists (ASRT) Practice Standards posted for public comment. Both organizations are concerned that the standards as stated, both text highlighted for change and text not highlighted for change, do not adequately reflect the medical dosimetry profession. We find the language to be dated and not accurately indicative of current medical dosimetry practice.
To alleviate confusion, there should be one standard for any profession. This standard is the standard developed by the professional medical dosimetry society, the AAMD, as referenced in the AAMD Scope of Practice. The Scope of Practice has been thoroughly researched. It identifies the basic responsibility of the “Qualified Medical Dosimetrist” and “addresses education, certification, continuing education and maintenance of certification.” In addition, the Scope of Practice is designed to educate professionals in the fields of health care, education, other communities of interest and the general public regarding the expectations of the Qualified Medical Dosimetrist. One of its intended uses is for “individual facilities to develop job descriptions and practice parameters.”
The AAMD Scope of Practice is the basis of the AAMD Curriculum Guide, which is endorsed by the Joint Review Committee on Education in Radiologic Technology (JRCERT) and followed in the development of JRCERT accredited medical dosimetry educational programs. Graduation from a JRCERT accredited program is the only vehicle through which a medical dosimetrist can achieve certification in medical dosimetry.
Certification in any field represents a recognized standard of knowledge and education and measures knowledge in a standardized and comprehensive way. Both the American Society for Radiation Oncology (ASTRO) and the American College of Radiology (ACR) recognize MDCB Certification, a certification based on the AAMD Scope of Practice, as a significant aspect for the medical dosimetrist on the radiation oncology team.
Patient safety and consistent quality of care is a recognized touchstone of all three (3) organizations – AAMD, ASRT and MDCB – as referenced in each of their individual mission statements. Quality patient care can only result from clarity by adherence to one definitive standard. The standard for medical dosimetry is the one developed by the professional society dedicated to medical dosimetry – AAMD – and is the one on which medical dosimetry certification is predicated. Medical dosimetry certification by the MDCB is recognized by authorities in the radiation oncology field – ASTRO, ACR and JRCERT.
The AAMD and MDCB respectfully request that the ASRT adopt the AAMD Scope of Practice as the definitive scope of practice for medical dosimetry.
Respectfully submitted by:
AAMD. (2013). Practice Standards for the Medical Dosimetrist. Retrieved from www.medicaldosimetry.org.
ASTRO. (2012). Safety is No Accident. Retrieved from https://www.astro.org/uploadedFiles/Main_Site/Clinical_Practice/Patient_Safety/Blue_Book/SafetyisnoAccident.pdf.
ASTRO. (2014). APEx Program Standards. Retrieved from https://www.astro.org/uploadedFiles/_MAIN_SITE/Daily_Practice/Accreditation/Content_Pieces/ProgramStandards.pdf.
Council, A. (2014). ACR ASTRO Practice Parameter for Radiation Oncology. Retrieved from https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards.
The Medical Dosimetrist Certification Board (MDCB) 2016 Certified Medical Dosimetrist (CMD) Survey indicated that many medical dosimetrists are being asked to contour clinical target volumes (CTVs) and gross target volumes (GTVs).1 Medical dosimetrists should be aware that requests to determine CTVs and GTVs are outside the scope of practice for medical dosimetrists. Further, the medical dosimetrist who is certified and submits to requests to execute contours of CTVs and GTVs is in violation of MDCB Ethical Standard 12,2 "A CMD shall not practice beyond the scope he or she is competent to perform as defined in" American Association of Medical Dosimetrists' The Scope of Practice of a Medical Dosimetrist.
The literature regarding scope of practice is definitive. Both ASTRO publications, Safety is no Accident3 and the APEX Practice Standards,4 indicate that the role of each member of the Radiation Oncology Practice is delineated by the individual profession's scope of practice. ” Other publications are clear on the specific contouring function. Determining CTVs and GTVs are the responsibility of the radiation oncologist.5
Most health-care professions develop a scope of practice document to define the procedures, actions and processes that a health-care practitioner is permitted to undertake. The scope of practice endeavors to assure proficient performance that reflects ongoing professional training. For those dedicated to the ever more complex radiation oncology field, safe and competent delivery of care is achieved through adherence to the guidelines outlined. Medical dosimetrists must not practice beyond the boundaries outlined in The Scope of Practice of a Medical Dosimetrist.
Finally, members of a radiation oncology team should recognize the obligation to voice concerns regarding patient care and safety without fear of reprimand.6 No matter how small a facility the ultimate concern is delivering safe patient care.7
1 2016 MDCB CMD Survey
2 MDCB Ethical Standards
3 Safety is No Accident – page 11
4 APEX Practice Standards – page 4
5 Safety is No Accident – page 6; ACR-ASTRO Practice Parameter for Radiation Oncology, page 3
6 Safety is No Accident – page 19
7 Safety is No Accident – page 1