By Thomas J. Petrone
The goal of both medical physicists and biomedical engineers is to keep radiation equipment operating safely and effectively while minimizing risk to patients and workers.
Yet the two professionals come at this task from different angles. Medical physicists are oriented toward image quality, dose, and compliance, while biomedical engineers take a primarily operational approach, ensuring machines meet the manufacturer’s specifications. Physicists and engineers have also taken quite different educational paths to get where they are. These differences might naturally result in differing professional perspectives.
Could these distinctions in training and orientation be impeding clinical or operational value at the facilities they serve? Would a focused effort to align the work of these professionals result in a beneficial synergy for the facility?
The short answers are no and yes, respectively. The differences between medical physicists and biomedical engineers rarely cause conflict on the ground, and almost never threaten operational or clinical value. That said, a strong and direct working relationship between these professionals stands to preserve value by limiting equipment down time, especially for high use applications that are also highly regulated—mammography is a good example. When biomedical engineers and medical physicists can communicate with one another directly, for instance, they can fix, evaluate, and certify a mammography unit more efficiently than if there’s a third party “managing” the multi-step interaction.
Buffalo, NY-based Kaleida Health’s director of Clinical Engineering, Edward Bauerlein, has collaborated with many medical physicists over the years. He asserts that “more than just committee-level interaction is needed to cement a truly productive working relationship — but in today’s digital age we can use information exchange to power and accelerate that engagement.” Just as clinical staff work closely together virtually, using the EMR, he observes, so too can medical physicists and biomedical engineers use technologies for collecting, sharing, and analyzing their data. “We’re already leveraging data to improve, predict, and manage patient outcomes and patient populations,” says Bauerlein, “so it’s a fair expectation that we would also use data to manage equipment critical to care.”
Problems versus opportunities
Minimizing equipment down time (i.e., the problem side of things) has obvious and potentially sizable impacts for an organization’s workflow, clinical operations, and revenue. But the real value in the medical physicist/biomedical engineer relationship — a value that’s still broadly unrealized — is in the opportunities it presents.
Specifically, this value resides in the massive amounts of data regularly collected by these two professionals, and in the insights to be derived from combining and analyzing them. “The use of predictive data and early warning scores is becoming the norm in clinical care,” Bauerlein points out, but has yet to become the norm in equipment management and optimization. Largely untapped, these data streams promise answers to perennial questions about parts replacement frequency and associated costs; the relative wisdom of switching manufacturers; and the concrete effects of changes to operational or clinical protocols. (While most of these questions pertain to the diagnostic side of medical radiation equipment, applications in oncology would also benefit from the answers.)
The most immediately useful knowledge to be gained from the medical physicist/biomedical engineer relationship comes from its dual perspectives on specific key performance indicators. The most basic data analysis would flag an increase in a KPI like the number of hours equipment is down, while a more sophisticated analysis could help track the increase back to its cause, such as a generator miscalibration or recurring mechanical issue. It is important to have both data sets — the operational data of the engineer and the compliance data of the physicist — in order to clarify the origin of the problem. Can the fault be traced back to the equipment, its parts, or its operators? Or is it the result of changing regulations or some other external factor?
From technical service to detective work
How would such value look in the real world? A recent experience at an eleven-hospital medical corporation in the American northeast provides one illustration.
This year, the organization’s medical physicist service noticed that the facilities’ x-ray tubes seemed to need replacement more frequently than in the past. Because the service had to confirm that the machines were functioning properly after each replacement, records indicated that the physicist’s hunch was right: the hospitals were going through CT tubes faster than usual.
In most cases, there are no “next steps” beyond this insight, particularly when the medical physicist is not an in-house employee. But by comparing notes with the biomedical engineer at the corporation, the physicist was able to corroborate the change and then trace it back to the organization’s decision to change manufacturers, a decision made without input from either service line. Digging deeper, this ad hoc team found out that daily quality control indicator drift was unusual, compared with units that utilized the new OEM tubes. These discoveries led to a change in practice: this KPI is now monitored by the facilities’ biomedical staff as a predictor of tube malfunction, whereas it had previously been considered a compliance activity alone. In other words, the medical physicist/biomedical engineer relationship shifted a reactive approach to tube replacement to a proactive one.
The point here is not that these two experts weren’t consulted in the decision to change tube suppliers, but rather that they have information that could improve the decision-making. This information may not have altered the decision in any way, but it would go a long way in quantifying its effects. “The use of predictive data and early warning scores in clinical care is becoming an expectation, if it isn’t one already,” says Bauerlein. A similar emphasis on prediction would benefit high-tech equipment utilization as well.
Here are a handful of questions that could be answered with combined medical physicist/biomedical engineer KPI data:
- Are the new manufacturer’s tubes so much more inexpensive than the old manufacturer’s that the change is still worth it, even considering the increase in downtime?
- Are labor hours or other costs included in this calculation? What are the pertinent costs here beyond equipment downtime and replacement unit cost?
- How does the downtime affect patient service targets or other organizational goals? Do those goals have reputational or financial implications?
Determining the total cost of an equipment purchase, manufacturer change, or other operational shift is a complicated matter. Mining all possible data sources for insights can help leaders make the best decisions for their staff, their bottom line, and their patients. These professionals are fonts of valuable data to be tapped to improve operations.
What a data-based partnership can do
As working biomedical engineers and medical physicists already know, 90 percent of the time they come to the same conclusions about the radiation equipment they’re monitoring. The remaining 10 percent requires slightly more back-and-forth, but both the technical nature of the issue and the two professionals’ shared sense of urgency usually mean they reach a solution quickly, even in areas of initial disagreement. This state of the partnership is immensely important, and should be fostered further through committee work, team-building, and direct contact.
Sitting on committees together may indeed help cement trust across professional lines. But there’s a world of value to be created here beyond a smooth working relationship. That value can only really be charted when we leave our siloes, share our data, and exercise our powers of analysis alongside our experience and expertise.
About the author: Thomas J. Petrone, Ph.D., DABR, is the chief medical physicist and CEO of Petrone Associates. In practice for more than 30 years Petrone Associates delivers comprehensive consulting services to numerous healthcare organizations and facilities throughout the entire country.