ML20052H035

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Responds to Forwarding Kr Weeks Comments on Reg Guide 10.8 Re Proposed Training & Experience Criteria for Physicians Engaged in Nuclear Medicine Practice Licensed by NRC
ML20052H035
Person / Time
Issue date: 04/19/1982
From: Dircks W
NRC OFFICE OF THE EXECUTIVE DIRECTOR FOR OPERATIONS (EDO)
To: Baucus M
SENATE
References
FRN-47FR3228, RTR-REGGD-10.008 47FR3228-36, NUDOCS 8205190287
Download: ML20052H035 (2)
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01 The Honorable Max Baucus 00C'1T NU:'?M United States Senator ngggg3ggpgL3M'-Misc,. Ob 2708 1/2 First Avenue North Billings, Montana 59101 Qy27

Dear Senator Baucus:

i This is in response to your le'tter of March 16, 1932, which transmitted a letter from Dr. Weeks concerning the Nuclear Regulatory Comission's proposed training and experience criteria for physicians who engage in nuclear medicine practice licensed by the Nuclear Regulatory Comission (NRC).

A Federal Reaister notice that the new criteria were under consideration and that public 'coments were invited was published on January 22,1932 (47 FR 3228, fcopy enclosed).

adoption of the criteria has not been made yet. A final decision on

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The revised criteria evolved f' rom proposals initiated by the medical comunity to reflect the training believed necessary for a physician to use licensed materials safely for protection of workers, the public and patients.

These criteria are in. addition to any clinical skills a physician must have to practice medicine in his or her medical specialty.

The proposed criteria are base'd on the recommendations of the NRC's Advisory Comittee on Pedical.Uses of Isotopes.

of recognized experts in nuclear medicine with specialties in areas suchThe C F

as internal medicine, diagnostic and therapeutic ' radiology, medical h

physics, etc.

These specialized skills provide a broad range of medical L._

expertise focused on HRC policies and regulations pertaining to nuclear E

medicine.

Selections of cembe'rs of the Comittee are ordinarily based on recommendations or nominations from professional cedical organizations.

c For example, one present member of the Comittee was nominated by the F

Ararican College of Cardiology.

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The proposed training criteria' appear to have a substantial support in the medical comunity.

American Board of Nuclear !Mdicine, the American College of Nuc E!

Physicians, the Society of Nuclear Medicine, the knerican Osteopathic College of Radiology and the Federated Council of Nuclear Medicine Organiza tions.

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Dr. Weeks' letter will be included with the coments received on the proposed criteria and Will be, considered in making a final decision on the criteria.

Sincerely,,

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31gned)T.iRshm William J. Dircks Executive Director for Operations

Enclosure:

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i us SELECT COM MITTEE ON March 16, 1982 Carlton Kammerer Director Office of Congressional Affairs Nuclear Regulatory Cornission 1717'H Street, N.W.

Washington, D.C. 20555 RE:

Eeith R. Weeks, M.D.

Dear Mr. Kammerer:

I am enclosing correspondence by the above-mentioned constituent regarding the field of nuclear medicine.

I would appreciate your addressing Dr. Weeks ' statement regarding your physician advisor group nd the absence of a a

cardiologist on the board.

Please address your response and any questions to my Billings field office, 320 Securities Building, 2708 First Avenue North, Billings, Montana, 59101, FTS: 585-6790.

I look forward to your response.

Tith best regards, I am Sincerely, b

i Enclosure j

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MONTANA 1231 NORTH 29TH STREET * #312/#315

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The Honorable Senator Max Baucus U.S. Senate 1107 Dirksen Office Building Washington, D.C.

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Dear Senator Baucus:

Enclosed are my comments for the Nuclear Regulatory Agency. This agency and its physician advisors seem bent on limiting competition in the field of nuclear medicine. They are trying, in this case, to lengthen the requirements for licensure.

In this case, I feel we are totally a captive to their physician advisor group.

50% of all nuclear medicine studies done are cardiac in nature, and they have no cardiologist on their board.

The people they do have on their board have no training in cardiology, and yet are willing to sit in judgement on others.

I urge your help in' this, as I feel it is representative of what is happening in medicine as physicians try to protect their turf in ways that are detrimental to the public in large.

Thank you for your interest.

Sincerely,

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Keith R. Veeks, M.D.

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HEART INSTITUTE February 8, 1982 Secretary of the Commission U.S. Nuclear Regulatory Commission Washington, D.C. 20005 ATT ENTI ON: Docketing and Service Branch

Dear Sirs:

This is in comment to your proposed changes concerning cardiology and nuclear medicine as published in the Federal Register of January 21, 1982.

-l wish to corrrnent on your acceptable training experience for medical uses of

.a by product material, specifically Category 5, Training for Diagno,stic Procedures.

I would use as reference your own supplemental information which states, "by way of-background NRC's objective is to ensure that authorized physician users have sufficient training experience to handle safely -the by product material used in nuclear medicine." To my way of thinking, this background information states that the NRC's responsibility is to ensure that physicians who use the material have training in the handling and safe use of by product material.

This certainly is the objective of the " training for basic radioisotope handling techniques, which is 200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br />,"

if the categories refer to training i.n the actual. handling and to training in the interpretation.

One could no't' quibble with the fact that trainin'g is needed in the handling.

What is training becomes a question.

Is training ' observation of a technique and' drawing up material and watching that material being given, or is it the actual drawing up of material by the physician, measuring the doses and then giving it himself.

I think it can clearly be stated in most institutions that the technician will do most of the work.

A physician may observe these in his training program, but he is not going to observe 500 hours0.00579 days <br />0.139 hours <br />8.267196e-4 weeks <br />1.9025e-4 months <br /> worth.

I believe the above can be stated unequivocally and does not warrant further conrnen t.

In other words, I believe that the 500 hour0.00579 days <br />0.139 hours <br />8.267196e-4 weeks <br />1.9025e-4 months <br /> requirement is much too long for adequate learning, specifically in view of the fact that the physician has had adequate training with the initial 200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br /> of basic.

The second category of training under supervision of a skilled practitioner who will teach the physician how to interpret films, certainly is outside of the limits.of what you have stated as your own objective.

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'Szeretsry of the ' Commission.

February 8, 1982 However, if you are to take that as your responsibility to en'sure that physicians know what they are reading,,then I would think that you would want to ensure that they know something about cardiology. Nowhere in yo'ur rules is there any provisal for a cardiology fellowship which would be be necessary to interpret isotope examinations at the tine that they are being done. This would include physiology, pharmacology and anatomy.

None of the physician groups that you have included as being acceptable for safe handling of by product material are trained or have knowledge cf the above.

Therefore, I suggest that all of your regulations he rethought and put before a nonpartisan group. Your ACMUl group certainly has its own axe to grind and-certainly is trying to exclude everyone who might be a competitor.

I would note that this is a standard procedure of a business which wishes to inhibit competition.

I would note also that this is a standard way by'which businesses do not grow. The history of nuclear medicine woulc tend to agree with this, it has been unnecessarily stunted and now it is fated to die a slow dea'th because of this committee. Other techniques will take over and much of nuclear medicine 'as it pertains to cardiology will be lost.

I -believe this is an inappropriate thing as nuclear medicine has much to offer for cardiology and for many other fields.

It needs skilled physiologists to interpret them and most of those people are not found in training disciplines which emphasize anatomy.

I strongly believe that the whole field needs to be opened up for strong competition and then there will be a real possibility that nuclear medicine will survive.

Thank you for your attention.

Yours truly, Q

WD Keith R. Weeks, M.D.

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