The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists

Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014 [1]; [2]) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) [3] and the International Basic Safety Standards (BSS) [4]. It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time.This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD.     

Role of Semen Cryobanking in American Medicine

In the United States there is little public policy regulating the activities of semen cryobanks. The medical profession has also been conspicuously silent on this aspect of medical practice. The potential benefits of semen cryobanking are enormous, yet like all other technologies its application (particularly commercially) may produce unexpected and unwanted consequences. It is suggested that a co-operative effort is needed between public officials and the medical profession to establish standards and guidelines which would maximize the benefits of this technique.     

Occupational injuries,illness affect 1 in 13 Canadians.

One in every 13 Canadian workers has experienced a work-related illness or injury, federal data indicate. Occupational-health clinics in Ontario report a growing number of cases of sick-building syndrome, repetitive-strain injury, asthma and chemical exposure, as well as injuries related to the use of construction equipment. In the past the medical profession assumed that men incurred most work-related injuries, but today, says an occupational-health specialist, "work-related illness and injuries are just as likely to happen to women or to white-collar professionals."     

Doing what the patient orders: maintaining integrity in the doctor-patient relationship

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician....I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment....     

The clinical psychologist; his role in private medical practice

The independent diagnosis and treatment of mental and nervous disorders according to California law constitutes practicing medicine. By this yardstick, an increasing number of clinical psychologists are entering the private practice of medicine. The medical profession has not provided through its leadership the opportunity for clinical psychologists to utilize their skills in a legitimate and supervised way in the treatment of private patients, nor has the medical profession taken sufficient interest in modern methods of treating patients with psychogenic disorders. If the psychiatric team is a feasible and practical approach to spreading the base of psychiatric treatment in hospitals and clinics, it should be applicable to private practice settings too. In the team setting, the psychologist can render great assistance to the physician in the diagnosis and treatment of patients with psychogenic disorders without compromising the principle that the primary responsibility for the patient is the physician's. By virtue of his training and experience, it is the psychiatrist who is best qualified to supervise the work of the psychologist; and until such time as the medical profession is better acquainted with psychotherapeutic techniques, the employment of psychologist assistants should be (according to good medical practice) left to the psychiatrist. The need for some regulation of the use of the title "psychologist" is increasing in order to protect the public from quacks who pose as psychologists. However, any law which is directed toward elimination of the quack should specifically define psychotherapy and contain provisions for its use under adequate medical supervision. The medical profession is obligated to take its traditional role in providing the best possible treatment for patients who are in need of it, and psychotherapy is an inherent part of treatment.     

Application of Dual Modality Contrast Agent Combined with Multi-Scale Representation in Ultrasound-Magnetic Resonance Imaging Registration Scheme

To achieve the image registration/fusion and perfect the quality of the integration, with dual modality contrast agent (DMCA), a novel multi-scale representation registration method between ultrasound imaging (US) and magnetic resonance imaging (MRI) is presented in the paper, and how DMCA influence on registration accuracy is chiefly discussed. Owing to US’s intense speckle noise, it is a tremendous challenge to register US with any other modality images. How to improve the algorithms for US processing has become the bottleneck, and in the short term it is difficult to have a breakthrough. In that case, DMCA is employed in both US and MRI to enhance the region of interest. Then, because multi-scale representation is a strategy that attempts to diminish or eliminate several possible local minima and lead to convex optimization problems to be solved quickly and more efficiently, a multi-scale representation Gaussian pyramid based affine registration (MRGP-AR) scheme is constructed to complete the US-MRI registration process. In view of the above-mentioned method, the comparison tests indicate that US-MRI registration/fusion may be a remarkable method for gaining high-quality registration image. The experiments also show that it is feasible that novel nano-materials combined with excellent algorithm are used to solve some hard tasks in medical image processing field.     

Alternative models of organisation are needed.

Anyone considering a fundamental rethink of the role of consultants risks exposing tensions in the medical profession that have characterised the development of medical practice since the 18th century. That tense story was one of beds and money, power and domination. Rethinking the role of consultants must now take into account the relationship between consultants and their specialist colleagues and general practitioners; examine the distribution of work between consultants and junior doctors; and relate the contribution of the consultant as specialist to that of other health professionals. After half a century of a national health service characterised by equity of access to care, we urgently need to debate the roles of those who work in it and in doing so to focus primarily on the needs of patients.     

Newly registered elderly patients: who are they and why such delay in the transfer of their medical records?

The time taken to transfer the records of elderly patients registering with a new general practice was investigated. Thirty five (5%) of a total of 671 patients aged 75 and over were entered as new patients on to the age-sex register of an urban group practice during one year. Twenty nine had moved into the area and six had changed their general practitioner for personal and other reasons. An average of 141 (range 71-296) days elapsed before dispatch of their medical records to the new practice. During this period an average of 3·5 (range 0-15) consultations with a general practitioner were recorded, indicating the need of such patients for medical care. The long delays were caused by the processing of medical records at the central register and the transfer of records between family practitioner committees and general practitioners. Delays were most apparent in the time taken for general practitioners to dispatch the necessary documents to the family practitioner committees, and these should be minimised.The use of a summary card written and updated by the general practitioner and retained by the patient would facilitate continuing care should patients change to a new practice. Meanwhile, assessment of elderly patients after registration with a new practice by a member of the primary health care team may identify problems before the records have been transferred and may help the resettlement of these high risk elderly patients.     

Artificial intelligence and the medical physics profession - A Swedish perspective

BackgroundThere is a continuous and dynamic discussion on artificial intelligence (AI) in present-day society. AI is expected to impact on healthcare processes and could contribute to a more sustainable use of resources allocated to healthcare in the future. The aim for this work was to establish a foundation for a Swedish perspective on the potential effect of AI on the medical physics profession.Materials and methodsWe designed a survey to gauge viewpoints regarding AI in the Swedish medical physics community. Based on the survey results and present-day situation in Sweden, a SWOT analysis was performed on the implications of AI for the medical physics profession.ResultsOut of 411 survey recipients, 163 responded (40%). The Swedish medical physicists with a professional license believed (90%) that AI would change the practice of medical physics but did not foresee (81%) that AI would pose a risk to their practice and career. The respondents were largely positive to the inclusion of AI in educational programmes. According to self-assessment, the respondents’ knowledge of and workplace preparedness for AI was generally low.ConclusionsFrom the survey and SWOT analysis we conclude that AI will change the medical physics profession and that there are opportunities for the profession associated with the adoption of AI in healthcare. To overcome the weakness of limited AI knowledge, potentially threatening the role of medical physicists, and build upon the strong position in Swedish healthcare, medical physics education and training should include learning objectives on AI.     

Laboratory technicians; the Clinical Laboratory Law and its meaning to private physicians

The present laws and regulations relating to clinical laboratories in California are the outcome of over a quarter century of cooperative development. The medical profession, public health department, laboratory workers, and the legislature have worked together in this development.At first the system of certifying technicians and laboratories was on a voluntary basis. The clinical laboratory law in effect legalized and made generally applicable a system which had already been accepted voluntarily. The application of the clinical laboratory law provides physicians a reasonable assurance that competence and reliability will prevail in clinical laboratory operation. Of great importance is the conduct of proper training programs by approved laboratories. Since modern medical practice is so dependent on accurate clinical laboratory work it is essential that special effort be directed by physicians toward influencing young people to enter the profession of medical technology.     

Great Expectations: Teaching Ethics to Medical Students in South Africa

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves.     

Do most practices have an age-sex register? Results of the West Midlands age-sex register study.

A cross sectional study based on all (1260) general practices in the West Midlands was conducted in late 1984 and early 1985. Responses to a postal questionnaire were received from 762 (60.5%) practices, and of these, 387 (50.8%) stated that they had an age-sex register; 104 (13.6%) practices replied that they had definite plans to establish an age-sex register within six months, and a random sample of these was later telephoned to see if the plans had come to fruition. A random telephone sample was also made from the 498 (39.5%) non-responders. It was concluded that the current prevalence of age-sex registers in the West Midlands is 52% (+/- 5% for 95% confidence) of all practices. A register has now been established of 422 practices (35.5% of the total number in the West Midlands) that have an age-sex register. This is being used as a database for other research. The most common reason stated for not having an age-sex register was that it would be too time consuming. Most of the practices that had one stated that it was used for research, disease recording, screening, surveillance, or health education, which implies that the registers are being used.     

Hierarchical Rigid Registration of Femur Surface Model Based on Anatomical Features

Existing model registration of individual bones does not have a high certainly of success due to the lack of anatomic semantic. In light of the surface anatomy and functional structure of bones, we hypothesized individual femur models would be aligned through feature points both in geometrical level and in anatomic level, and proposed a hierarchical approach for the rigid registration (HRR) of point cloud models of femur with high resolution. Firstly, a coarse registration between two simplified point cloud models was implemented based on the extraction of geometric feature points (GFPs); and then, according to the anatomic feature points (AFPs) in two level namely shape features and structure features, the fine weight-based registration was performed to achieve anatomical alignment; finally, the origin source model was automatically transformed by applying the obtained coarse matrix and fine one in sequence. Experimental results show that the hierarchical registration method can rapidly and accurately register point clouds of individual femurs, and achieves the medical semantic alignment, and provides a basic tool for the understanding and comparison of femur anatomy and structure.     

Legal developments concerning active euthanasia on request in the Netherlands

The author describes social and legal developments in the debate over active euthanasia in the Netherlands. There, as in all of Western Europe, euthanasia is a crime. Although the medical profession in several European countries has rejected efforts to change the situation, the Dutch Medical Association in 1984 issued a statement indicating an increased willingness to accept euthanasia under stringent guidelines. Some court decisions have been lenient in applying penal law to doctors acting at the wish of their patients. The Netherlands State Commission on Euthanasia published a 1985 report advocating modification of the Penal Code. [An English summary of the report appears in the same issue of Bioethics]. An emotional debate is underway in medical and legal journals and in the mass media, but the Council of State has advised against any legislative change for now. Meanwhile, euthanasia continues to occur in the Netherlands at an estimated rate of 5,000 to 8,000 cases a year.     

London after Tomlinson. Care in the capital: what needs to be done.

One of the aims of the Tomlinson report is to shift more care from the secondary to the primary sector in London. But the primary sector is already underresourced and overloaded. The capital has a heterogeneous population which often makes inappropriate demands on general practitioners. Many premises are inadequate and there are insufficient support staff. David Metcalfe emphasises that London is special and that the shift will not become a reality unless these problems are tackled. He suggests the establishment of different models of practice centres which could treat some of the patients who now go to accident and emergency departments. Some would be the night emergency service base, some would have primary care beds, and each would have a different mix of specialist support.     

Promoting organ donation registration with the priority incentive: Israeli transplantation surgeons' and other medical practitioners' views and ethical concerns

Because the number of organs available for transplantation does not meet the needs of potential recipients, some have proposed that a potentially effective way to increase registration is to offer a self-benefit incentive that grants a 'preferred status' or some degree of prioritization to those who register as potential donors, in case they might need organs. This proposal has elicited an ethical debate on the appropriateness of such a benefit in the context of a life-saving medical procedure. In this paper we review arguments and ethical concerns raised by scholars, and studies of views of members of the public regarding the prioritization incentive system. We also report on our study of the views of those involved in organ transplant and of other medical professionals in Israel, as over half a decade ago Israel implemented a prioritization incentive system. Bioethicists propose that key stakeholders' views can provide additional arguments and perspectives on controversial issues. Proponents justify the prioritization incentive drawing mainly on arguments related to its potential effectiveness, reciprocity and fairness. Opponents point to the fact that registering is not binding and not an actual donation, and raise concerns regarding equity, autonomy and gaming the system. Ethical concerns raised by the practitioners in the study were examined in light of scholars' arguments and actual registration and donation data. Practitioners involved in transplantation raised ethical concerns corresponding to those raised by scholars as well as additional concerns. They also challenged proponents' assumptions regarding the utility of the incentive system from their own experience and argued that proponents obscure the meaning of reciprocity.     

Alberta euthanasia survey: 2. Physicians' opinions about the acceptance of active euthanasia as a medical act and the reporting of such practice.

OBJECTIVE: To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p < 0.01). CONCLUSIONS: This survey about active euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians'' obligations to society.     

Volunteer health professionals and emergencies: assessing and transforming the legal environment

Volunteer health professionals (VHPs) are essential in emergencies to fill surge capacity and provide needed medical expertise. While some VHPs are well-organized and trained, others arrive spontaneously at the site of a disaster. Lacking organization, training, and identification, they may actually impede emergency efforts. Complications involving medical volunteers in New York City after September 11, 2001, led Congress to authorize federal authorities to assist states and territories in developing emergency systems for the advance registration of volunteer health professionals (ESARVHP). Through advance registration, volunteers can be vetted, trained, and mobilized more effectively during emergencies. The use of VHPs, however, raises multiple legal questions: What constitutes an emergency, how is it declared, and what are the consequences? When are volunteers liable for their actions? When may volunteers who are licensed or certified in one state legally practice their profession in another state? Are volunteers entitled to compensation for harms they incur? This article examines the legal framework underlying the registration and use of volunteers during emergencies and offers recommendations for legal reform, including: (1) establish minimum standards to facilitate interjurisdictional emergency response, improve coordination, and enhance reciprocity of licensing and credentialing; (2) develop liability provisions for VHPs that balance their need to respond without significant fear of civil liability with patients' rights to legal recourse for egregious harms; and (3) provide basic levels of protections for VHPs harmed, injured, or killed while responding to emergencies.     

Law as Clinical Evidence: A New ConstitutiveModel of Medical Education and Decision-Making

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model is supported on the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion.     

Making women visible in the embryo experimentation debate

Rowland contends that threats to the welfare of women have received too little attention in discussions about embryo experimentation. The first group of egg donors for this purpose would be women in in vitro fertilization programs, women who are vulnerable to emotional coercion by doctors interested in superovulation for the purpose of gaining spare embryos. Furthermore, the masculine emphasis on control and dominance that characterizes science will inevitably lead ?researchers to transplant experimental embryos to check on the results of their manipulations. Other elements of the social context that raise the potential for abuse of women's bodies are the increasing commercialization of reproductive technologies and the increasing control by the male-dominated medical profession over the process of procreation. Finally, there is danger that it will become routine policy to screen all embryos for abnormalities and to "improve" them if abnormalities are found.