Personnel Qualifications

Interpreting Physician Personnel Qualifications [1]

• Must meet country’s qualification requirements

• Must meet one of the following Continuing Experience requirements:

• Currently meets the Maintenance of Certification (MOC) requirements for the ABR, ABNM, ABIM or the Osteopathic Continuous Certification (OCC) for AOBR.

• Read a minimum of 200 studies/3 years in nuclear medicine/PET

• PET Only: Physicians reading organ-system-specific exams (i.e. body, abdominal, musculoskeletal, head) across multiple modalities must interpret a minimum of 60 organ-system-specific PET exams in 36 months; however, they must interpret a total of 200 cross-sectional imaging (MRI, CT, PET/CT and ultrasound) studies over the prior 36 months

• Must meet one of the following Continuing Education requirements:

• Currently meets the Maintenance of Certification (MOC) requirements for the ABR, ABNM, ABIM or the Osteopathic Continuous Certification (OCC) for AOBR.

• 150 hours CME (including 75 hours category 1) in the prior 36 months pertinent to the physician's practice patterns (see the ACR Practice Parameter for Continuing Medical Education).

• 15 hours CME (half of which must be category 1) in the prior 36 months specific to the imaging modality or organ system.

In addition, all physicians supervising and/or interpreting nuclear medicine examinations must satisfy all applicable local regulations, as well as any institutional policies that pertain to the in vivo use of radiopharmaceuticals, the use and dosage of contrast, if applicable, the performance of imaging procedures and the safe handling of radioactive materials.

Facilities monitoring cardiac stress studies must have one individual that has current Advanced Cardiac Life Support (ACLS) certification present during the stress testing.

Medical Physicist Personnel Qualifications

• Must meet country qualification requirements

• Must perform 2 NM/PET (as relevant) unit surveys within 24 months

• Must meet one of the following Continuing Education requirements:

• Currently meets ABR Maintenance of Certification requirements for medical physics or 

• Completes 15 CEU/CME (1/2 Cat 1) in the prior 36 months (must include credits pertinent to the recognized modality)

• The qualified medical physicist is responsible for the conduct of all surveys of the nuclear medicine/PET equipment. 

• The medical physicist may be assisted by properly trained individuals in obtaining data. These individuals must be approved by the medical physicist in the techniques of performing tests, the function and limitations of the imaging equipment and test instruments, the reasons for the tests, and the importance of the test results. 

• The medical physicist must be present or in general supervision of properly trained assistants (and accessible by phone) during the surveys; review, interpret, and approve all data; and provide a report of the conclusions with his/her signature.

• Data collected by an assistant for nuclear medicine and PET may be done under general supervision (if the supervisor is accessible by phone). The ACR Accreditation Committees believe that Nuclear Medicine and PET are sufficiently unique in personnel needs and execution of ACR testing to require a different set of performance conditions than the other areas. Some ACR phantoms require the use of short lived (2 hours – FDG, 6 hours – Tc-99m, 3 days – Ga-67 & Tl-201) radionuclides in areas with restricted access; often tests are performed during the day between patient scans. Many medical physicists are not comfortable drawing dose in the hot lab (many sites restrict access to the pharmaceuticals). Thus, a technologist is required for drawing the dose, making the measurements, loading the phantom and setting up the acquisition. However, the medical physicist must review and approve the data by interpreting and analyzing the images.

Technologist Personnel Qualifications

• Must meet country qualification requirements

• Must have 24 hours of continuing education every 2 years

• CE must be relevant to imaging and the radiologic sciences, patient care

• CT must include credits pertinent to technologist’s clinical practice

• Must satisfy all applicable state and federal regulations, as well as any institutional policies that pertain to the in vivo use of radiopharmaceuticals, performance of imaging procedures and safe handling of radioactive materials

• Must have knowledge of radiation safety/protection; handling of radiopharmaceuticals; all aspects of performing examinations; operation of equipment; handling of medical and radioactive waste; patient safety; and applicable rules and regulations.

NM/PET Equipment Quality Control (QC)

All ACR Internationally recognized Nuclear Medicine facilities and those applying for accreditation must maintain a documented quality control (QC) program and must comply with the minimum frequencies of testing outlined in the 2024 ACR NM Quality Control Manual. All ACR Internationally recognized Nuclear Medicine and/or PET facilities must maintain a documented quality control (QC) program. For PET, it is recommended that the quality control (QC) testing be performed in accordance with the ACR Technical Standard for Medical Nuclear Physics Performance Monitoring of PET Imaging Equipment, as applicable. At this time, the ACR strongly recommends quarterly testing of each PET system with an appropriate ACR-approved phantom such as described below in addition to other tests recommended by the vendor. At a minimum, testing with the appropriate phantom must be performed semi-annually, but quarterly testing is strongly recommended. 

Acceptance Testing

Acceptance tests must be performed on systems when they are installed. Initial testing of imaging equipment must be performed upon installation and should be completed before clinical use. This testing should be more comprehensive than periodic performance testing and should be consistent with current acceptance testing practice.

Annual Physicist Survey

A physics survey must be performed on each nuclear medicine and PET unit at least annually. The ACR realizes that surveys cannot usually be scheduled exactly on the anniversary date of the previous survey; therefore, a period of up to 14 months between surveys is acceptable. These tests do not need to be as rigorous as acceptance tests but must be a comprehensive suite of individual measurements that ensure adequate sensitivity for detecting detrimental changes in performance. A practicing qualified medical physicist (QMP) may perform these tests. Alternatively, the tests may be performed by properly trained individuals approved by the medical physicist using National Electrical Manufacturers Association (NEMA) protocols and/or other appropriate testing protocols developed and approved by the QMP. The test results must be reviewed by the QMP and documented in the annual survey report. As a part of this annual survey the QMP should meet with the supervising physician and the QC technologist to review the results of the survey and the effectiveness of the technologist QC program, and to recommend any corrective action or repairs that are needed. The supervising physician is responsible for assuring compliance with the recommendations of the medical physicist. 

All QC testing must be carried out in accordance with the methods outlined in the 2024 ACR NM Quality Control Manual. The annual physics survey must include, but not be limited to, the following performance tests:

Continuous Quality Control

Nuclear medicine and PET technologists are responsible for verifying day-to-day operation of instruments and performing a few additional tests on a quarterly basis. These requirements represent the standard of practice and are in compliance with requirements and recommendations of The Joint Commission (TJC) and state and federal agencies. Documentation of compliance with all quality control tests and corrective action is required as part of the application process.

The Nuclear Medicine technologist QC program must include, but not be limited to, the following:

The PET technologist QC program must include, but not be limited to, the following:

Preventative Maintenace

Preventive maintenance must be scheduled, performed, and documented by a qualified service engineer on a regular basis. Service performed to correct system deficiencies must also be documented and service records maintained by facility.

Clinical Image Evaluation and Labeling

Facilities must review typical clinical examination from each module performed and attest to meeting the ACR clinical image quality and labeling requirements found in the links below. 

Exam Requirements

Planar Module: NM

SPECT Module: NM

Nuclear Cardiology Module: NM

PET Oncology

• Sites are required to review two separate oncology studies for each unit, one of which must be abnormal. The second exam can be either normal or abnormal.

  Whole Body exams are considered to be eyes to thighs or head to toe. 

  The blood glucose level should be documented for FDG PET studies. Blood glucose levels are not required for other PET tracers.  

PET Brain

• Sites are required to review two separate brain exams for each unit to be recognized, one of which must be abnormal.  The second exam can be either normal or abnormal. Both exams should be attenuation corrected (AC) image files. 

PET Cardiac

• Sites are required to review two separate cardiac exams (AHA/ACC standard views) for each unit to be recognized, one of which must be abnormal. The second exam can be either normal or abnormal.

  The site may select myocardial perfusion and/or myocardial viability exams.

  For stress and rest perfusion submissions, gated images must include the time activity or volume curve depicting the ejection fraction. In addition, the images depicting the ROIs (end-systole and end-diastole) used to generate the EF must be submitted. If ED/ES ROIs are not available for display on the processing system, 3D surface rendered images (with or without cage overlay) may be substituted. Images MUST show ED and ES and be clearly labeled as such. 

  For viability submissions, FDG slices are required along with rest perfusion images (this can be SPECT or PET perfusion images). Gated images are not required for viability submissions.

Exam Identification and Labeling

The following image identification must be displayed on each image or available in the DICOM header:

• First and last name

• Medical record number

• Institution name

• Date and time of examination

• Date-of-birth or age

• Type of examination

• Time of acquisition (indicated or easily calculated)

• Technologist initials (recommended)

• Images labeled as to laterality and orientation: The Nuclear Medicine Accreditation Committee has determined that all images for all submitted studies must be labeled for laterality and orientation. This requirement is necessary to reduce the number of serious treatment errors resulting from the lack of appropriate labeling and to address quality patient care issues raised by the recent focus on patient safety in medicine.

Policies and Procedures

In addition to the general policies and procedures noted in the instruction article, the facility must also have the following Nuclear Medicine/PET specific policies and procedures:

• Sites recognized in the cardiology module for nuclear medicine or PET, must have at least one ACLS certified staff member. (If applicable)

Physican Quality Assurance

Facilities must meet the Physician Quality Assurance requirements found in Physician QA Requirements: CT, MRI, Nuclear Medicine/PET, Ultrasound (Revised 1-3-2024): Accreditation Support (acr.org).

Footnotes:

[1] Occasional readers who are providing imaging services to and for the practice readers are not required to meet continuing experience requirements.  However, the reads of all occasional readers combined should not exceed 5% of the total volume of reads per practice and per modality. There must be an active written review process in place at the institution for occasional readers based on each institution’s credentialing requirements.