I n the 1970's, nuclear medicine technology was still a relatively new imaging modality. Despite Hal Anger's introduction of the gamma camera in the late 1950's, by 1973 there were still twice as many rectilinear scanners in the field than gamma cameras. There were very few nuclear medicine technology education programs at the time and many; if not most of the pioneer nuclear medicine technologists in practice came from a background of radiography or medical technology.
However, as the technology evolved and more complicated procedures were introduced, it became apparent that the knowledge and skills necessary to be successful were beyond the training of a medical technologist or radiographer. At the same time, members of the Society of Nuclear Medicine (now renamed Society of Nuclear Medicine and Molecular Imaging) Technologist Section started to express concerns about the credentialing of nuclear medicine technologists.
In the 70's, the credentialing of NMTs was being offered by two different organizations, the American Registry of Radiologic Technologists (ARRT) and the American Society for Clinical Pathology (ASCP). However, each of these organizations served a very large primary constituency, radiographers and medical technologists, respectively. The Technologist Section was concerned that these groups were not putting as much focus and energy into the discipline of nuclear medicine technology as they felt was appropriate. This concern manifested itself into a second concern; the perception that neither "parent" credentialing body was keeping pace with the scope of practice and requisite knowledge and skills of the nuclear medicine technologist of the day.
These concerns came to a head on June 10, 1976, when a motion was made at the meeting of the Technologist Section's governing body, the National Council. This motion read:
The Greater New York Chapter moves that the new Executive Committee, to be convened on June 10, 1976, in Dallas, Texas, appoint a committee to explore fully the implementation of an Independent Nuclear Medicine Technology Examination Board. This committee shall be required to report back to the National Council Meeting to be held in Las Vegas, Nevada, in January of 1977.
The motion passed and the Executive Committee proceeded to appoint an exploratory task force that same day. The task force included some rather famous names in nuclear medicine technology at the time, some names many of us recognize even today; including Mark Muilenburg, Jim Langan, Barbara Horton, Sue Weiss, Jim Kellner, Tony Mazzola, Vi Custer, George Alexander, Joan Herbst, Glenn Moran and Susan Hemingway.
This task force met on the weekend of September 21-22, 1976. They first agreed on the general assumption that "preparedness to practice"¯ could be determined by measuring the application of knowledge and skills on selected job functions. They then determined that, at that time, the domain of nuclear medicine technologistsā€™ job functions (tasks) had not been completely described. No data existed on which tasks were the most important in daily practice and no definition of nuclear medicine technology competency had been developed. Having discovered this, the task force defined the steps required to develop their vision of a nuclear medicine technology certification exam.
- Perform a task analysis to identify the skills and/or knowledge required to perform nuclear medicine procedures.
- From the task analysis, determine desired actual examination content.
- Develop "items"¯: questions and both correct (keyed responses) and incorrect (distractors) answers.
- Analyze items: check that the questions and answers are well phrased (using an outside service expert in examination psychometrics).
- Select which questions and how many are to be administered in an examination.
- Determine a pass/fail point for the examination.
The task force proceeded to develop a task analysis survey that was distributed to several thousand nuclear medicine technologists. In the meantime, they met again on January 25, 1977. They determined that an independent Nuclear Medicine Technology Examination Board was both feasible and appropriate, and made the following recommendations to the National Council:
- The name of the Board will be the Nuclear Medicine Technology Certification Board (NMTCB).
- The NMTCB should be formed as soon as possible.
- The eleven members of the task force plus one physician appointed by the SNM will serve as the initial Board members.
- Eligibility requirements for the new certification examination will include:
- Recognition of prior certification
- Graduation from an AMA approved school
- A mechanism to be established for persons trained on the job
After reviewing the results of the task analysis at the March 16, 1977 meeting of the task force, a test specification matrix was developed that divided the new examination in the following manner:
- 23% Nuclear Instrumentation
- 10% Dose Calibration and Administration
- 24% Imaging Procedures
- 10% Radiopharmacy
- 10% Radiation Protection
- 23% Non-Imaging Procedures (RIA)
Also at their March meeting, bylaws for this new "NMTCB" were amended and approved. They also decided to pretest their new examination with recent graduates of nuclear medicine technology education programs, including those who have previously taken (passed or failed) one or both of the other certification examinations. Lastly, they agreed that the Board "may issue a certificate to any applicant holding current certification in Nuclear Medicine Technology with the ARRT and/or ASCP which was issued prior to the initial examination."
On June 17, 1977, only one year and seven days after the initial resolution, the NMTCB was incorporated.
They had a formal organization, they had a plan, and they had a task analysis that described the knowledge and duties required of a nuclear medicine technologist. The next step was to develop items (questions) for the first examination. At the first meeting of the NMTCB Board, on June 24, 1977, it was determined that more than 300 items would need to be developed in order to put together a good examination. Because of other commitments, George Alexander was replaced by Don Bernier and Glenn Moran was replaced by Fran Kontzen. Also, James Conway was appointed the Medical Advisor to the Board. Item writing assignments were as follows for those initial items, all written by Board members:
- Nuclear Instrumentation: J. Langan, M. Muilenburg
- Dose Calibration: J. Herbst
- Imaging Procedures: S. Weiss, D. Bernier, B. Horton
- Radiopharmacy: S. Hemingway
- Radiation Protection: J. Kellner
- Non-Imaging Procedures: F. Kontzen, V. Custer, T. Mazzola
These items were formulated, edited, revised and integrated into a written examination that was administered in a pretest format on February 11, 1978. Pre-testers must have taken another registry within past two years, and included some who failed one of the other registries. One hundred volunteers, with 25 at each of four sites; Chicago, Los Angeles, New York and Birmingham, were administered this pretest. Well over 200 items were identified as statistically strong and appropriate for inclusion on the final examination.
Armed with a fully prepared certification exam, the NMTCB made plans for its administration. Twenty-two examination sites spread across the United States were identified, including one in Puerto Rico. An examination date was to be September 15, 1978, and the examination fee was set at $30.00. More than 650 examinees sat for that first examination and 33 that registered did not show. Sixty percent of those who took the first examination passed. The examination consisted of 200 items, with a maximum score of 174, a mean of 117, and a minimum score of 56. That same year, 1,674 technologists were granted reciprocal certification because they held current certification in nuclear medicine technology with the ARRT and/or ASCP, which was issued prior to the initial examination. Of those 2,074 individuals granted certification in 1978:
- 634 continue to be Active
- 145 hold Emeritus status
- 221 hold Retired status
- 116 are Inactive
- 890 let certification lapse
- 636 are deceased
- 10 have had their certification revoked for failure to comply with the NMTCB CE Policy that was implemented January 1, 2006.
This entire process, from writing items to pretesting them to putting together a new examination, was repeated for 1979 and the second examination was administered on September 30, 1979. Of the 950 applications the NMTCB received, 27 were incomplete, 26 were rejected, 44 were withdrawn by the applicant and 28 that were accepted did not show up on exam day. In all, there were 780 examinees and 69% passed. The 1979 examination consisted of 225 items (25 were pretest items). The maximum score was 179, the mean was 130, and the minimum score was 27 (that is 27 correct out of 200 questions). In addition, 941 technologists were granted reciprocal certification because they held current certification in Nuclear Medicine with the ARRT and/or ASCP which was issued prior to the initial examination. Of the 1,479 individuals certified in 1979, 587 still hold active certification.
Watch for our Fall Newsletter for more about the History of the NMTCB.