American Nuclear Society

Recently, the U.S. Food and Drug Administration (FDA) approved 18F-labeled flurpiridaz as another PET myocardial perfusion imaging (MPI) radiotracer for clinical use in adult patients with known or suspected coronary artery disease (CAD). This decision was based on recent results of a second phase 3

The fear of radiation has been present almost since the discovery of radiation, but has intensified since the "dawn of the atomic age" over 75 y ago. This fear has often served as an impediment to the safe and beneficial uses of radiation and radioactive material. The underlying causes of such fear are varied, can be complex, and are often not associated with any scientific knowledge or understanding. The authors believe that a clear understanding of the current scientific knowledge and understanding of the effects of radiation exposure may be useful in helping to allay some of the fear of radiation. This manuscript attempts to (1) address several scientific questions that we believe have contributed to the fear of radiation, (2) review the data derived from research that can be used to address these questions, and (3) summarize how the results of such scientific research can be used to help address the fear of low-dose and low-dose-rate radiation. Several examples of how fear of radiation has affected public perception of radiological events are discussed, as well as a brief history of the etiology of radiation fear. Actions needed to reduce the public fear of radiation and help fulfill the full societal benefits of radiation and radioactive materials are suggested.

The American College of Cardiology (ACC) Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of stress testing and anatomic diagnostic procedures for risk assessment and evaluation of known or suspected chronic coronary disease (CCD), formerly referred to as stable ischemic heart disease (SIHD). This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging, stress echocardiography (echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. As with the prior version of this document, rating of test modalities is provided side-by-side for a given clinical scenario. These ratings are explicitly not considered competitive rankings due to the limited availability of comparative evidence, patient variability, and the range of capabilities available in any given local setting1–4.This version of the AUC for CCD is a focused update of the prior version of the AUC for SIHD4. Key changes beyond the updated ratings based on new evidence include the following: 1.Clinical scenarios related to preoperative testing were removed and will be incorporated into another AUC document under development.2.Some clinical scenarios and tables were removed in an effort to simplify the selection of clinical scenarios. Additionally, the flowchart of tables has been reorganized, and all clinical scenario tables can now be reached by answering a limited number of clinical questions about the patient, starting with the patient's symptom status.3.Several clinical scenarios have been revised to incorporate changes in other documents such as pretest probability assessment, atherosclerotic cardiovascular disease (ASCVD) risk assessment, syncope, and others. ASCVD risk factors that are not accounted for in contemporary risk calculators have been added as modifiers to certain clinical scenarios.The 64 clinical scenarios rated in this document are limited to the detection and risk assessment of CCD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines.5 These clinical scenarios do not specifically address patients having acute chest pain episodes. They may, however, be applicable in the inpatient setting if the patient is not having an acute coronary syndrome and warrants evaluation for CCD.Using standardized methodology, clinical scenarios were developed to describe common patient encounters in clinical practice focused on common applications and anticipated uses of testing for CCD. Where appropriate, the scenarios were developed on the basis of the most current ACC/American Heart Association guidelines. A separate, independent rating panel scored the clinical scenarios in this document on a scale of 1 to 9, following a modified Delphi process consistent with the recently updated AUC development methodology. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented, midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is rarely appropriate.

At Excelsior College, one particularly unique dimension of student assessment is the Integrated Technology Assessment (ITA). This portfolio-based assessment method is a capstone experience for Engineering Technology students, documenting their ability to integrate knowledge from various technical and general education areas and apply it in a meaningful way.

Research Professor Emeritus, Washington State University Tri-Cities, Richland, WA Sr. Technical Advisor, US Department of Energy (retired), Richland, WA Past-President, American Nuclear Society, Peshastin, Washington, WA The authors declare no conflicts of interest.

The stimulus to create this document was the recognition that ionizing radiation-guided cardiovascular procedures are being performed with increasing frequency, leading to greater patient radiation exposure and, potentially, to greater exposure for clinical personnel. Although the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure. The American College of Cardiology leadership concluded that it is important to provide practitioners with an educational resource that assembles and interprets the current radiation knowledge base relevant to cardiovascular procedures. By applying this knowledge base, cardiovascular practitioners will be able to select procedures optimally, and minimize radiation exposure to patients and to clinical personnel. Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness is a comprehensive overview of ionizing radiation use in cardiovascular procedures and is published online. To provide the most value to our members, we divided the print version of this document into 2 focused parts. Part I: Radiation Physics and Radiation Biology addresses the issue of medical radiation exposure, the basics of radiation physics and dosimetry, and the basics of radiation biology and radiation-induced adverse effects. Part II: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection covers the basics of operation and radiation delivery for the 3 cardiovascular imaging modalities (x-ray fluoroscopy, x-ray computed tomography, and nuclear scintigraphy) and will be published in the next issue of the Journal.

A nuclear facility is arguably the most difficult industrial facility to site, especially with regard to public acceptance. Public resistance to such facilities is a complex blend of emotion-laden imagery coupled with a risk perception process that is diametrically opposed to the scientific process by which scientists define nuclear risks. While much of the literature that deals with risk perception and public acceptance considers the problem (and any offered solutions) for a single societal standpoint, the issue becomes more complex when the community is made up of many different cultures—especially when the set of cultures includes aboriginal people (“Aboriginal,” for the purposes of this paper, is meant to represent all First People, regardless of what they or their governments call them, including Native Americans and Eskimos (US), First Nations and Aboriginal People (Canada), the Maoris of New Zealand, the Aborigines of the Australian Outback and any other culture that predates Western discovery. No disrespect is intended by this simplification.) for whom there is a traditional and spiritual relationship with the land. The level of success that owners have when attempting to site a nuclear facility appears to be correlated with the homogeneity of the host community population. This paper offers insights for successful public outreach and acceptance when dealing with more diverse local cultures, based on lessons learned, in part, from the efforts of Ontario Power Generation’s permit to construct and operate a Deep Geologic Repository (DGR) for low- and intermediate-level waste at the Bruce Nuclear Site in the Municipality of Kincardine, Ontario, Canada.

James C. Blankenship Brian G. Abbott Joann Lindenfeld Susan E. Wiegers Ken Rosenfield Decades ago, it would have been enough. But as medical sub-specialization has become common, the importance of sub-specialty organizations has increased. Now, more often than not, expertise in one's field of practice is demonstrated by fellowship in a medical sub-specialty organization. However, medical society membership is expensive. You have to ask yourself: Is it worth it? For our societies, the answer is an emphatic “Yes!”. Physicians cite recognition, education, and advocacy as the most important benefits of membership in professional societies. Sub-specialty societies offer the most bang for the buck in all three of these areas. In this era, membership in the American College of Cardiology (ACC) is routine for cardiologists. It implies competence in general cardiology. However, cardiology has become a discipline of sub-specialists, and most physicians expect a higher level of competence when they refer patients for specialized cardiology services. Membership in the relevant sub-specialty organization implies that special expertise. If a cardiologist claims special expertise in a particular sub-specialty of cardiology but is not a member of that sub-specialty's society, colleagues or patients may question whether the physician is truly dedicated to that field. On the other hand, membership should result in recognition of special expertise in that field. Sub-specialty societies also offer opportunities for recognition based on work within the sub-specialty. Members can work on committees and rise to leadership positions, serve on writing committees for consensus papers and guidelines, and lecture at society educational conferences. Members can represent their society at Food and Drug Administration Panels, Centers for Medicare & Medicaid Services (CMS) panels, state technology assessment panels, third party payer advisory groups, inter-society guidelines writing groups, appropriate use panels, and American Medical Association (AMA) committees. All of these provide valuable learning opportunities and the chance to gain recognition among peers. Finally, sub-specialty societies often recognize members' scientific or societal contributions through awards, fellowships, training grants, and research funding. In many cases these significant achievements would go unnoticed by larger medical societies. The second big benefit of sub-specialty membership is educational opportunities. Sub-specialty societies are in the best position to assess members'; sub-specialty educational needs and design programs to meet them. Within cardiology, the fields of electrophysiology, intervention, and heart failure have recently gained status as independent specialties based on their unique bodies of knowledge. The advanced imaging modalities have become so technical that few can master all of them 1. In addition, metrics of quality of care, appropriateness, and clinical effectiveness are often specific to a sub-specialty and can be most effectively communicated within the sub-specialty context. Hands-on simulation of procedures or work-station reconstruction of images will increasingly be used for education. In all of these cases, sub-specialty societies are in a unique position to develop and provide access to conferences and on-line educational opportunities needed to stay current in these areas. Sub-specialty societies also offer more intimate educational opportunities. Attendees at sub-specialty national meetings often cite the opportunity to interact with world-class physicians in small groups in an intimate setting as one of the biggest benefits. Many sub-specialty societies offer special programs for trainees and early career members to obtain special education, research mentorship, or leadership training. Because of their smaller size, these can be more intimate, nimble, and focused than programs offered by large medical societies. Sub-specialty journals offer additional opportunities for publishing, and are focused on the area of sub-specialty interest. While some general cardiology journals have recently developed “daughter” sub-specialty journals, journals of the sub-specialty societies provide the most traditional and focused source of information to their members. The third major benefit of sub-specialty membership is advocacy focused on the concerns of that sub-specialty. In some areas of advocacy, large medical societies may be paralyzed by competing interests within the society. In contrast, sub-specialty societies can focus on advocacy interests specific to their members with much greater effect. By virtue of their smaller size, sub-specialty societies are more nimble. Advocacy challenges can be addressed more quickly and efficiently. Examples include the designation of electrophysiology and interventional cardiology by CMS as independent specialties, allowing members to bill referrals from other cardiologists as consults. This recognition by CMS resulted from the tireless advocacy efforts of the three societies. Similarly, recognition by the AMA as independent specialties allows them to have representatives at the AMA CPT Editorial Panel, the AMA Relative Value Update Committee, and the AMA House of Delegates. Sub-specialty societies routinely have representatives on ACC/American Heart Association guideline writing groups and appropriate use criteria writing and rating panels. Sub-specialty societies can recognize and deal with needs for advocacy-oriented position papers and consensus documents in niche areas that larger medical societies cannot address. Sub-specialty societies can also offer opportunities for recognition, education, and advocacy to cardiovascular non-physician professionals. Most of these professionals would not be eligible for membership in larger physician-dominated medical societies, but due to close working relationships with physicians who understand their value to sub-specialty teams, these professionals can be brought into sub-specialty societies and offered their own opportunities for leadership, education, and advocacy oriented toward the needs of these professionals. Perhaps the most compelling reason of all to join a sub-specialty society is to have a medical home. Batlivala notes “Having a professional home where you are a member of a group can provide a sense of community, of belonging, and of unified purpose” 2. He advises early career physicians to find such a medical home. We would argue that it is important for all physicians to have a medical home where they can find that sense of intimate community. Sub-specialty societies offer opportunities to engage with smaller groups of like-minded people, find a common passion, work together for good purposes, renew each other, and improve the care we provide to our patients. Sub-specialty societies are intimate, nimble, and responsive to members'; needs. They allow opportunities for engagement, leadership, and recognition; opportunities for specific and useful education; and effective and focused advocacy efforts. Your sub-specialty society is the place to find your medical home.