AAPM TG103 Report

ADMINISTRATIVE QUESTIONNAIRE

The reviewer will sit down with the incumbent physicist and discuss the level of administrative support for the clinical physics program. The following is a general outline only.

DATE:

Facility Name:	Physicist name:

To whom does the physicist report directly?

Medical Director of radiation oncology	Radiation oncology manager

Executive level administrator	Other:

Do the dosimetrists report directly to the physicist?

Yes	No	Joint reporting

Does the physicist have a formal role in the facility’s budget process?

Yes	No. Describe:

Does the present physicist coverage provide adequate time during normal clinic hours for the physicist to consult with the treatment team regarding specific patient issues?

Yes	No. Describe:

Does the present physicist coverage provide adequate time during normal working hours to plan and prepare for the implementation of new services?

Yes	No. Describe:

Who is responsible for physics coverage during a physicist absence?

Describe:

Are any new clinical physics services planned for the coming year?

Yes	No

Does the facility provide adequate physics instrumentation and resources to effectively support the facility’s clinical services?

Yes	No. Describe:

Any other issues / comments:

Privileged and Confidential Peer Review

AAPM PICR - TG103 Report

Mechanisms for Peer Review in Clinical Radiation Oncology Physics

Peer review, professional

Per H Halvorsen

2005-03-17

Ravi Rao