Colorado’s Go-To Fluoroscopy Training Gets a Critical Overhaul
When the original Rocky Mountain AAPM fluoroscopy training was launched in 2010 (original authors Steve Jones and Doug Pfeiffer), it quickly became a widely adopted solution for meeting Colorado’s regulatory requirements for operator and supervisor education. Over the next 14 years, more than 10,000 users, ranging from physicians and technologists to staff unfamiliar with medical physics, completed the training. Healthcare facilities regularly asked, “Do you have your Rocky Mountain AAPM certificate for fluoroscopy?” It became the gold standard across hospitals and clinics in the state.
But in 2024, the training was at risk of disappearing.
With the national AAPM sunsetting the legacy software platform where the module was hosted, Colorado facilities were left without access to one of their most relied-upon resources. The chapter officers explored alternative hosting options but found them prohibitively expensive. As word spread about its removal on June 30, 2024, desperate requests poured in from across the state. Renee Butler alone received 50 emails in just three to four months seeking alternatives.
That’s when Butler, a diagnostic physicist with CAMP and Rocky Mountain chapter member, stepped up to lead a collaborative effort to build a modern replacement.
A Statewide, Cross-Organizational Response
Butler, along with CAMP physicist Stephanie Franz and a diverse team of five medical physicists from across Colorado, convened in spring 2024 to address the critical gap. The group included medical physics subject-matter experts from UCHealth and consulting firms throughout the state. Their goal is to create a neutral, up-to-date, and freely accessible fluoroscopy training solution that complies with Colorado’s regulations.
“We really tried to get a good cross-section across the community in Colorado,” Butler explained.
From the outset, the project was shaped by collaboration, not only among physicists but also with regulatory leaders at the Colorado Department of Public Health and Environment (CDPHE). The team met with Kathy Lieberman, CDPHE’s X-ray Certification Unit leader, and James Grice (CDPHE Radiation Control Program Manager) to ask detailed questions and align the new training with the 2022 updates to state regulations and real-world feedback from radiation safety officers (RSOs) across Colorado.
This partnership proved invaluable, as the state was simultaneously updating its guidance document on fluoroscopy training. The team’s grassroots input helped inform clearer regulatory direction on acceptable forms of equipment-specific training.
What’s New in the 2024 Fluoroscopy Training
The revised training, now available on the Rocky Mountain AAPM website, includes several key updates that address both regulatory changes and practical implementation needs:
- Updated Regulation-Aligned Content: The didactic slide deck incorporates new requirements that went into effect January 2022, plus refreshed literature and references
- Device-Specific Training Component: Unlike the original 2010 version, the new training acknowledges that facilities must also provide system-specific instruction per Sections 5C and 5J of the regulation (6 CCR 1007-1 2.6.1.5), recognizing that “for fluoroscopy-guided intervention (FGI) systems, the Siemens Artis Zee is not equivalent to the Philips Azurion”
- Universal Competency Checklist: A customizable two-page Word document allows facilities to document hands-on competency with specific fluoroscopy systems, beneficial for onboarding or technologists working across different service lines
- Flexible Implementation Options: Training slides can be integrated into existing Learning Management System (LMS) platforms, and RSOs may choose whether to use the included attestation forms
- Recognition of Existing Qualifications: ABR certification in diagnostic or interventional radiology, and ARRT certification in specific disciplines, satisfy requirements without additional training
- Grandfathering Provisions: The medical director or department leader can attest to system-specific training for current staff and providers who use existing equipment
Importantly, the training is not the only solution to satisfy Colorado fluoroscopy training, but the RMAAPM 2024 Revised Fluoroscopy Training is state-recognized and one way to meet the regulatory requirements. The state guidance document lists various acceptable alternatives, including documented training from another state (with training syllabus and certificate), vendor training, peer-to-peer instruction, residency training, or physician attestation, as long as documentation is retrievable.
Maintaining Neutrality and Long-Term Sustainability
A key principle throughout the five-month project was maintaining neutrality. The training materials are not tied to any single organization or group of physicists, ensuring broad acceptance across Colorado’s medical physics community. The program remains completely free, continuing the tradition established in 2010.
Thanks to strong coordination with the Rocky Mountain AAPM chapter officers, the updated materials are now permanently hosted on the chapter website. Butler emphasized the importance of this independence:
“We wanted to create something neutral—something anyone in Colorado could use, regardless of where they work.”
To streamline ongoing questions and support implementation, the project team established a dedicated monitored email managed by Butler, Megan Brown, and Grace Ellison, preventing these inquiries from overwhelming chapter officers who may not have diagnostic radiology expertise.
A Model for Other States
During the chapter meeting where the training was unveiled, both President-Elect Olivier Blasi and national AAPM leaders acknowledged the broader impact of this work.
“This is a big deal,” said Olivier Blasi. “There’s been right around 10,000 people in the state of Colorado that have taken this program—people all over the hospital who probably couldn’t even tell you who a medical physicist is have learned about radiation safety, fluoroscopy, and medical physics.”
Robin Miller, President-Elect of the national AAPM, encouraged the team to publish their approach in the national newsletter: “What you’ve done is an enormous service. This should be scalable, and you’re providing a huge service that other states can use as a model.”
The Colorado experience offers valuable lessons for other states facing similar challenges:
- Early stakeholder engagement: Involving state regulators from the beginning ensures alignment and mutual benefit
- Cross-organizational collaboration: Drawing expertise from diverse practice settings strengthens the final product
- Flexible implementation: Recognizing varying facility capabilities and needs increases adoption
- Sustainable support structure: Establishing clear ongoing support responsibilities prevents future disruptions
- Maintaining neutrality: Independence from any single organization ensures broad acceptance
Looking Forward
The team maintains ongoing communication with national AAPM leadership about the broader need for fluoroscopy training resources. As the national AAPM LMS platform evolves, there may be opportunities to transition to more sophisticated hosting solutions while maintaining the program’s accessibility and neutrality.
This project exemplifies the collaborative spirit of the medical physics community. Seven physicists completed this comprehensive work while maintaining their regular professional responsibilities, driven by a commitment to serving their colleagues and ensuring patient safety.
The Rocky Mountain AAPM fluoroscopy training program continues to serve as a vital resource for Colorado healthcare facilities, ensuring that the legacy of radiation safety education and professional excellence that began in 2010 remains strong in 2025 and beyond.
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This resource communicates information to the public in accordance with the AAPM Code of Ethics. The content presented is based on one or more of the following: scientific studies, expert consensus, and professional experience in diagnostic and therapeutic medical physics.
Last updated: August 2025
