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Legal and ethical issues in medical physics

July 17, 2008 -- The legal and ethical issues facing medical physicists are numerous and complex -- perhaps more so than some other areas of medicine. Certain activities, such as handling radioactive materials, are highly regulated by the federal and state governments. Other activities, such as minimum education and training standards and licensure requirements vary from state to state.

A number of distinguished speakers will help dissect these ethical and regulatory issues at the American Association of Physicists in Medicine (AAPM) 50th meeting in Houston, Texas from July 27 to July 31. AAPM is the largest association of medical physicists in the world, composed of both research medical physicists who develop cutting-edge technologies in the laboratory and clinical medical physicists who use these technologies in hospitals and clinics. AAPM works to ensure that there are minimum educational standards for individuals who practice in any of the medical physics subspecialties.

AAPM is also committed to educating medical physicists and helping them understand the legal and ethical nuances of their profession. This news release describes some of these nuances.

Journalists are invited to cover the AAPM meeting remotely or in person. In the coming week, additional news releases detailing specific scientific highlights of the meeting will be available. All news releases will be hosted on the AAPM Virtual Press Room (see link at the end).


1) How Technology Contributes to Healthcare Woes
2) Legal Issues: What Every Medical Physicist Should Know
3) More Legal Issues: Liability and Regulation
4) New Guidelines for Ethical Behavior in Medical Physics
5) Professional Training: Are Medical Physicists Prepared for Workplace Politics?
6) The Image Gently™ Campaign


Physics-based technology has benefited many patients, but it conversely adds to growing costs that have made health care insurance unattainable for many others. The United States spends twice per capita on health care compared to other advanced nations, yet it ranks comparatively low in length of life, infant mortality and other public health statistics. In the President's Symposium, Dr. Arnold Relman of Harvard Medical School ( will explore why Americans do not seem to be getting their money's worth.

The root of the U.S. health care problem may be the dominant influence of entrepreneurial institutions. Large profits for inventors and manufacturers, coupled with powerful marketing and automatic insurance reimbursements, have led to what many see as an overuse of medical technology. In countries with less privatization, emphasis is placed on greater access to doctors and hospitals, with less spending on unproven or marginal use of technology.

The cost of high-tech medical procedures in the U.S. runs into the hundreds of billions of dollars -- a substantial fraction of the nation's $2.5 trillion health care bill. To avoid bankrupting the system, Relman recommends that the medical community enact reforms that ensure the continued introduction and availability of worthwhile new technology, while excluding procedures that cannot be rigorously justified. He invites the AAPM to be part of the vanguard of reform.

Relman's talk, "Technology and the Crisis in the U.S. Health Care System" (MO-C-AUD B-1) will be during The President's Symposium: Science, Medicine, and Society at 10:00 a.m. on Monday, July 28, 2008 in Auditorium B. Abstract:


Medical physicists wear many different hats -- as employees, colleagues, independent contractors, safety officers, and mentors. Each of these roles comes with its own set of ethical, professional, or legal responsibilities, and keeping straight the distinctions between these roles is not always easy.

One aspect of vital importance is safety. Medical physicists are often responsible for the proper use of radioactive materials. With ongoing concerns over terrorism, the United States Nuclear Regulatory Commission (NRC) has beefed up its rules, and it behooves medical physicists to be aware of their legal commitments. Farah Bagne ( of Mercury Medical Systems in Bloomfield Hills, MI, will discuss current NRC regulations and other legalities in the medical physics profession. Wearing both the hats of a medical physicist and a lawyer, Bagne is especially qualified to delineate wherein duty lies.

Bagne's talk, "Ethical Versus Legal Issues in the Practice of Medical Physics" (TU-D-350-1) will be at 1:30 p.m. on Tuesday July 29, 2008 in Room 350. Room: 350. Abstract:


Another aspect of legal issues faced by medical physicists involves federal and state regulation and enforcement. Currently the NRC is in charge of setting regulations governing the use of radioactive material. It also enforces these rules, determines if infractions are willful or not, and engages in mediation to settle disputes over NRC rules and violations.

Francis "Chip" Cameron, president of Zero Gravity Group LLC, will examine the legal liability issues faced by facilities and individual medical physicists who violate these regulations or who take actions that may be viewed as negligent. He will also look at how these issues impact medicine today and examine how the NRC resolves enforcement issues, including using mediation to settle enforcement disputes.

Most states do not require licensure of medical physicists but instead require a practicing medical physicist to register with the state prior to practicing in specific subspecialties. New NRC and state regulations require a medical physicist to sign a "preceptor" statement prior to a colleague from practicing in a specific modality. Does signing such a statement expose the sponsors to liability for the negligent acts of those they sponsor? Do states like Texas and Florida that have licensing frameworks make a difference? Does licensure give a medical physicist extra legal protection?

Symposium TH-SAM-AUD B-1, "The Good, the Bad and the Ugly - A Regulatory Update" takes place from 10:00 a.m. to noon on Thursday, July 31, 2008 in Auditorium B. Abstract: Contact Email:


The line where "ethically obliged" crosses over into "legally bound" is difficult to draw in most professions, and medical physics is no exception. Medical physicists strive to support the members of their profession, but what happens when the safety of patients or the financial interests of the hospital are jeopardized by the actions of a colleague? Chris Serago ( of the Mayo Clinic in Jacksonville, FL will discuss what medical physicists can do when faced with these sorts of ethical quandaries.

Now is a good time to review these issues, as the AAPM has recently written a new code of ethics, which is broader in scope than the previous code. Serago, who is the chair of the AAPM ethics committee, will highlight some of the changes and provide some hypothetical cases involving sexual harassment, student discrimination, and substance abuse.

Serago's talk, "Civil Law, Ethics and the Medical Physicist" (TU-D-350-2) will be at 1:30 p.m. on Tuesday, July 29 in Room 350. Abstract:


Medical physicists are important in clinical decision-making, but unlike the doctors and other medical personnel who treat patients, they have not historically been required to receive formal, standardized clinical training before becoming certified. As a result, they often apply the same analytical tools taught in school to the messy politics of a modern hospital setting. A special panel will discuss how this sometimes goes badly and what medical physicists can do to comport themselves more professionally.

Although they deal with some of the most complex procedures in all of medicine, the training of medical physicists has never been completely formalized, as many of its practitioners come to it indirectly through scientific research. In contrast, medical doctors are required not only to learn the skills of their profession, but also spend time as a resident, seeing how the actual business of being a doctor is performed.

Without this sort of training, medical physicists may tend to rely too heavily on their problem-solving skills when interacting with their peers. This can lead to a medical physicist being overlooked by hospital administrators and doctors who may prize their colleague's technical knowledge but feel he or she does not have a full grasp of the big picture. However, sidelining medical physicists in this way can hurt a hospital, especially when important decisions about equipment purchases and optimization are made without the input of their expertise.

This may change as medical physicists will be required in 2012 to have clinical training before sitting for board certification. To discuss this new development and other issues of professionalism, a distinguished panel has been assembled comprising a medical physicist with 35 years of experience bridging the gap with doctors and administrators, a trainer of health care professionals who specializes in overcoming barriers to change, a seminar leader and consultant who helped form the "Men's Movement," and the president of a medical physics service company who himself was clinically trained.

Session MO-D-350-1 "Professional Comportment: Professional Is as Professional Does" takes place from 1:30 p.m. to 3:20 p.m. on Monday July 28, 2008 in Room 350. Abstract: Contact:


AAPM is a founding member of the Alliance for Radiation Safety in Pediatric Imaging, the organization that launched the Image Gently™ campaign on January 22, 2008. The Campaign has promoted change in individual practices by reassessing CT protocols for children. Visit the campaign website ( to see the protocols. The Alliance has grown to 23 organizations this year and its cause was recently recognized by resolution introduced in the U.S. House of Representatives on May 20, 2008. Designated "H.RES.1216," the resolution supports "the efforts to reduce unnecessary radiation exposure through computed tomography scans for children, and for other purposes." See:

If you have any questions regarding the Image Gently™ campaign, please contact Lynne Fairobent, AAPM's Manager of Federal and Legislative Affairs at


Contact: Jason Bardi
American Institute of Physics

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