education and training of medical physicists james a. purdy, ph.d. professor and director division...

EDUCATION AND TRAINING EDUCATION AND TRAINING OF MEDICAL PHYSICISTSOF MEDICAL PHYSICISTS

James A. Purdy, Ph.D.James A. Purdy, Ph.D.Professor and DirectorProfessor and Director

Division of Radiation PhysicsDivision of Radiation Physics Department of Radiation OncologyDepartment of Radiation Oncology

Washington University School of Washington University School of MedicineMedicine

St. Louis, Missouri, USASt. Louis, Missouri, USAEvolving Strategies in Radiation Oncology

Rome, Italy, June 3-5, 2004

EDUCATION AND TRAININGEDUCATION AND TRAINING

•Education of the clinical radiation oncology Education of the clinical radiation oncology physicist can be divided into three stages.physicist can be divided into three stages.

– 1st Stage: 1st Stage: University education in University education in physics, engineering, mathematics, and physics, engineering, mathematics, and other relevant topics (B.S.).other relevant topics (B.S.).

– 2nd Stage: 2nd Stage: Graduate education leading Graduate education leading to M.S. or Ph.D. (Medical physics courses to M.S. or Ph.D. (Medical physics courses may be introduced into curriculum). may be introduced into curriculum).

– 3rd Stage: 3rd Stage: Physics residency training in Physics residency training in a clinical environment.a clinical environment.

EDUCATION AND TRAININGEDUCATION AND TRAININGFirst StageFirst Stage

•Bachelors degree in physics or Bachelors degree in physics or equivalent. equivalent. – Medical physicists should be Medical physicists should be

educated primarily as physicists educated primarily as physicists (or biomedical engineers?) and be (or biomedical engineers?) and be qualified and competent to apply qualified and competent to apply the many branches of physics to the many branches of physics to continually evolving problems and continually evolving problems and situations which occur in medical situations which occur in medical environs of hospitals and clinics.environs of hospitals and clinics.

EDUCATION AND TRAININGEDUCATION AND TRAININGSecond StageSecond Stage

•Graduate degree ( Masters or Graduate degree ( Masters or Doctorate ) in physics or Doctorate ) in physics or medical physics. medical physics. – Masters program: typically, Masters program: typically,

about 2 calendar years required. about 2 calendar years required. – Doctoral program: typically Doctoral program: typically

about 4 to 5 years required.about 4 to 5 years required.• emphasis on developing research emphasis on developing research

capabilities of individualcapabilities of individual

EDUCATION AND EDUCATION AND TRAINING: Second StageTRAINING: Second Stage

•Note! Note! If medical physics If medical physics Masters and Doctorate degree Masters and Doctorate degree program, it should be subjected program, it should be subjected to the same scrutiny and to the same scrutiny and approval requirements as all approval requirements as all other graduate degree other graduate degree programs of the University.programs of the University.

EDUCATION AND TRAININGEDUCATION AND TRAINING Third Stage Third Stage

•Formal comprehensive training and Formal comprehensive training and experience in areas of clinical experience in areas of clinical dosimetry, treatment planning, dosimetry, treatment planning, treatment aid design and treatment aid design and fabrication, brachytherapy, radiation fabrication, brachytherapy, radiation safety, special procedures, machine safety, special procedures, machine calibration, and quality assurance. calibration, and quality assurance.

•Length of clinical physics residency Length of clinical physics residency training period should be 2 years or training period should be 2 years or longer.longer.

EDUCATION AND TRAININGEDUCATION AND TRAINING Third Stage Third Stage

•Note!Note! Graduate degree in physics or Graduate degree in physics or medical physics is no longer medical physics is no longer adequate by itself in order to work adequate by itself in order to work independently in a clinical situation.independently in a clinical situation.

•Note!Note! Informal “on-the-job” training Informal “on-the-job” training working under the tutelage of a working under the tutelage of a more senior medical physicist is no more senior medical physicist is no longer adequate.longer adequate.

EDUCATION AND TRAINING EDUCATION AND TRAINING AccreditationAccreditation

•Accreditation of graduate educational Accreditation of graduate educational programs in Medical Physics programs in Medical Physics – program conforms with standards that program conforms with standards that

should result in its graduates being should result in its graduates being qualified for more specialized training or qualified for more specialized training or professional practice in clinic medical professional practice in clinic medical physics. physics.

•Establishes minimum levels of Establishes minimum levels of educational and training opportunities educational and training opportunities that must be offered by program.that must be offered by program.

EDUCATION AND EDUCATION AND TRAINING: AccreditationTRAINING: Accreditation

•Clinical Physics Clinical Physics Residency Residency Programs are Programs are based on AAPM based on AAPM Report No. 36Report No. 36

EDUCATION AND EDUCATION AND TRAINING: AccreditationTRAINING: Accreditation

•Commission on Accreditation of Commission on Accreditation of Medical Physics Education Medical Physics Education Programs, Inc. (CAMPEP) Programs, Inc. (CAMPEP) – degree programs in medical degree programs in medical

physics (11)physics (11)– clinical physics residency programs clinical physics residency programs

(6)(6)

CAMPEP ACCREDITED CAMPEP ACCREDITED DEGREE PROGRAMSDEGREE PROGRAMS

•McGill UniversityMcGill University•University of Alberta - Cross Cancer InstituteUniversity of Alberta - Cross Cancer Institute•University of British ColumbiaUniversity of British Columbia•University of California - Los AngelesUniversity of California - Los Angeles•University of FloridaUniversity of Florida•University of Kentucky Medical CenterUniversity of Kentucky Medical Center• The University of Texas - Houston Health Science Center (M. The University of Texas - Houston Health Science Center (M.

D. Anderson Cancer Center)D. Anderson Cancer Center)•University of Texas HSC - San AntonioUniversity of Texas HSC - San Antonio•University of Wisconsin-MadisonUniversity of Wisconsin-Madison•Vanderbilt University School of MedicineVanderbilt University School of Medicine•Wayne State UniversityWayne State University

CAMPEP ACCREDITED RADIATION CAMPEP ACCREDITED RADIATION ONCOLOGY CLINICAL PHYSICS ONCOLOGY CLINICAL PHYSICS

RESIDENCY PROGRAMSRESIDENCY PROGRAMS

•Washington University/Barnes-Jewish Hospital St. Washington University/Barnes-Jewish Hospital St. Louis (1997, 2003)Louis (1997, 2003)

•University of Minnesota Medical School (2000)University of Minnesota Medical School (2000)

•University of Florida (2000)University of Florida (2000)

•McGill University (2000)McGill University (2000)

•Mayo Clinic (2003)Mayo Clinic (2003)

•University of Louisville School of Medicine (2003) University of Louisville School of Medicine (2003)

EDUCATION AND EDUCATION AND TRAINING: CertificationTRAINING: Certification

•Certification board performs several Certification board performs several functions:functions:– evaluates qualifications of candidates evaluates qualifications of candidates

requesting examination in specific medical requesting examination in specific medical physics subspecialties.physics subspecialties.

– arranges, controls, and conducts certification arranges, controls, and conducts certification examinations. examinations.

– grants and issues certificates in to applicants grants and issues certificates in to applicants who have been found to be qualified by the who have been found to be qualified by the board. board.

– maintains registry of holders of such maintains registry of holders of such certificates.certificates.

– serves medical and lay public by providing lists serves medical and lay public by providing lists of names of certified medical physicists.of names of certified medical physicists.

EDUCATION AND EDUCATION AND TRAINING: CertificationTRAINING: Certification

•American Board of Radiology American Board of Radiology – Radiological Physics Radiological Physics – Therapeutic Radiological PhysicsTherapeutic Radiological Physics– Medical Nuclear PhysicsMedical Nuclear Physics– Diagnostic Radiological PhysicsDiagnostic Radiological Physics

•American Board of Medical American Board of Medical Physics Physics – Radiation Oncology PhysicsRadiation Oncology Physics– Diagnostic Imaging PhysicsDiagnostic Imaging Physics– Hyperthermia PhysicsHyperthermia Physics– Medical Health PhysicsMedical Health Physics– Magnetic Resonance ImagingMagnetic Resonance Imaging

EDUCATION AND EDUCATION AND TRAINING: LicensureTRAINING: Licensure

• In addition to training program In addition to training program accreditation and individual physicist accreditation and individual physicist certification, licensure for clinical medical certification, licensure for clinical medical physicists is recognized as an added physicists is recognized as an added means to credential and ensure that the means to credential and ensure that the clinical medical physics profession is clinical medical physics profession is practiced by competent professionals. practiced by competent professionals.

•Only three states, Texas, Florida, and New Only three states, Texas, Florida, and New York, have passed legislation requiring York, have passed legislation requiring licensure of medical physicists, and much licensure of medical physicists, and much work remains. work remains.

EDUCATION AND EDUCATION AND TRAINING: TRAINING:

Continuing EducationContinuing Education•Attendance at seminars, scientific Attendance at seminars, scientific

meetings, and advanced training courses meetings, and advanced training courses is essential to maintaining professional is essential to maintaining professional competency.competency.– Provides opportunities for obtaining deeper Provides opportunities for obtaining deeper

knowledge in special branches of medical knowledge in special branches of medical physics.physics.

– Necessary due to increased specialization Necessary due to increased specialization among clinical physicists and continuing among clinical physicists and continuing technological advances. technological advances.

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY PROGRAMSRESIDENCY PROGRAMS

•Object of residency training Object of residency training program is to train physicists program is to train physicists in the clinical practice of in the clinical practice of radiation oncology physics. radiation oncology physics.

•To accomplish this goal, the To accomplish this goal, the following must be provided:following must be provided:– adequate organizationadequate organization– staff staff – facilities facilities – patient resourcespatient resources– educational environmenteducational environment

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: Program RESIDENCY: Program

DirectorDirector•Certified in Radiation Oncology PhysicsCertified in Radiation Oncology Physics•Full-time staff member, qualified in and Full-time staff member, qualified in and

practicing radiation oncology physicspracticing radiation oncology physics•Contribute sufficient time to program to Contribute sufficient time to program to

insure adequate directioninsure adequate direction•Responsible for training program:Responsible for training program:

– Instruction/supervision of physics residentsInstruction/supervision of physics residents– insure adequate facilities, teaching staff, clinical insure adequate facilities, teaching staff, clinical

resources and educational resourcesresources and educational resources– selection of physics residents (must insure that the selection of physics residents (must insure that the

appointed residents meet eligibility requirements).appointed residents meet eligibility requirements).

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: Faculty and RESIDENCY: Faculty and

StaffStaff

•Faculty must include at least the Faculty must include at least the following:following:– 2 full-time radiation oncology physicists, 2 full-time radiation oncology physicists,

both certified by the American Board of both certified by the American Board of Radiology or its equivalent.Radiology or its equivalent.

– 1 full-time radiation oncologist certified 1 full-time radiation oncologist certified by the American Board of Radiology or its by the American Board of Radiology or its equivalent.equivalent.

– accessibility to 1 full time radiation accessibility to 1 full time radiation biologist .biologist .

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: Faculty and StaffRESIDENCY: Faculty and Staff

•Faculty must be qualified in Faculty must be qualified in those areas in which they those areas in which they instruct/supervise physics instruct/supervise physics residents.residents.

•Must have a real interest in Must have a real interest in teaching and devote necessary teaching and devote necessary time/effort to residency time/effort to residency program.program.

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: Faculty and StaffRESIDENCY: Faculty and Staff

•Faculty should ALSO be engaged Faculty should ALSO be engaged in scholarly activities such as:in scholarly activities such as:– participation in national scientific participation in national scientific

societiessocieties– participation in their own participation in their own

continuing educationcontinuing education– scientific publications and scientific publications and

presentationspresentations– active involvement in radiation active involvement in radiation

oncology physics development and oncology physics development and research.research.

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: FacilitiesRESIDENCY: Facilities

•Space. Space. – There must be space adequate for the There must be space adequate for the

conduct of a good clinical physics conduct of a good clinical physics practice and training program.practice and training program.

•Clinical ResourcesClinical Resources– Training program must provide Training program must provide

sufficient patient volume and variety of sufficient patient volume and variety of cancer patients for adequate resident cancer patients for adequate resident experience. experience.

– Number of patients treated per year at Number of patients treated per year at least 500.least 500.

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: FacilitiesRESIDENCY: Facilities

•Equipment Required:Equipment Required:– Two or more multi-modality megavoltage linacsTwo or more multi-modality megavoltage linacs

– Desirable, superficial/orthovoltage x-ray unitsDesirable, superficial/orthovoltage x-ray units

– Dedicated therapy simulatorand CT-simulatorDedicated therapy simulatorand CT-simulator

– Interstitial & intracavitary brachytherapy equip.Interstitial & intracavitary brachytherapy equip.

– Computerized treatment planning systemComputerized treatment planning system

– Equipment to construct special treatment aidsEquipment to construct special treatment aids

– Physics dosimetry equipmentPhysics dosimetry equipment

– Availability of electronics and machine shopsAvailability of electronics and machine shops

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: Educational RESIDENCY: Educational

EnvironmentEnvironment•Environment that encourages exchange Environment that encourages exchange

of knowledge and experience among of knowledge and experience among physics residents and with clinical physics residents and with clinical residents located in the same institution.residents located in the same institution.•Library ResourcesLibrary Resources

– Sufficient variety of journals, reference Sufficient variety of journals, reference books, and resource materials pertinent to books, and resource materials pertinent to radiation oncology physics and associated radiation oncology physics and associated fields in oncology and basic sciences must be fields in oncology and basic sciences must be immediately accessible for resident study.immediately accessible for resident study.

– Access to a general medical library.Access to a general medical library.


EnvironmentEnvironment•ConferencesConferences

– Conferences and teaching rounds must Conferences and teaching rounds must provide for progressive resident provide for progressive resident participation. participation.

– Adequate frequency of conferences and Adequate frequency of conferences and attendance by physics residents, attendance by physics residents, radiation oncology physicists, radiation radiation oncology physicists, radiation oncologists and other staff should be oncologists and other staff should be documented.documented.

– Adequate conference room and audio-Adequate conference room and audio-visual facilities must be provided.visual facilities must be provided.


EnvironmentEnvironment•ConferencesConferences

– New Patient conferencesNew Patient conferences– Weekly Chart Reviews & Weekly Chart Reviews &

Problem Case ConferencesProblem Case Conferences– Physics/Dosimetry Physics/Dosimetry

ConferenceConference– Morbidity ConferenceMorbidity Conference– Radiation Biology Radiation Biology

ConferenceConference– Journal Review ConferenceJournal Review Conference

CLINICAL PHYSICS CLINICAL PHYSICS RESIDENCY: Requirements RESIDENCY: Requirements

for Completionfor Completion•Complete a series of clinical rotations (3 Complete a series of clinical rotations (3

months each)over 2 year period.months each)over 2 year period.•Pass a set of special training sessions Pass a set of special training sessions

and didactic courses.and didactic courses.•Participate in clinical conferences and Participate in clinical conferences and

special lectures.special lectures.•Prepare handouts and make presentation Prepare handouts and make presentation

for 3 assigned topics each year.for 3 assigned topics each year.•Pass Year 1 Oral ExamPass Year 1 Oral Exam•Pass Year 2 Oral ExamPass Year 2 Oral Exam

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAMPROGRAM

•Washington University/Barnes-Washington University/Barnes-Jewish Hospital (WUBJH) Radiation Jewish Hospital (WUBJH) Radiation Oncology Center formalized their Oncology Center formalized their previous "post-doctoral" training previous "post-doctoral" training approach and established Radiation approach and established Radiation Oncology Physics Residency Program Oncology Physics Residency Program in 1992. in 1992.

•Became first physics residency Became first physics residency program to be accredited by program to be accredited by CAMPEP in Oct. 1997.CAMPEP in Oct. 1997.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Clinical RotationsPROGRAM: Clinical Rotations

•Provides for physics resident’s participation in Provides for physics resident’s participation in clinical and technical subjects pertinent to clinical and technical subjects pertinent to radiation oncology physics including:radiation oncology physics including:– Megavoltage photon and electron beam therapyMegavoltage photon and electron beam therapy– Superficial x-ray therapySuperficial x-ray therapy– Simulation/CT-simulationSimulation/CT-simulation– 2D and 3D computerized dose planning2D and 3D computerized dose planning– Treatment aidsTreatment aids– Calibration and periodic QA of therapy equipmentCalibration and periodic QA of therapy equipment– Brachytherapy Interstitial and intracavitary Brachytherapy Interstitial and intracavitary

Radiopharmaceutical therapyRadiopharmaceutical therapy– Radiation safety proceduresRadiation safety procedures– Special procedures (IMRT, radiosurgery, TBI, etc)Special procedures (IMRT, radiosurgery, TBI, etc)

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical RotationsPROGRAM: Year 01 Clinical Rotations

• JulyJuly Orientation/Team 1 Treatment PlanningOrientation/Team 1 Treatment Planning • AugustAugust ““• SeptemberSeptember ““• OctoberOctober Team 2 Treatment PlanningTeam 2 Treatment Planning• NovemberNovember ““• DecemberDecember ““• JanuaryJanuary Special Procedures incl. IMRT PlanningSpecial Procedures incl. IMRT Planning • FebruaryFebruary ““•MarchMarch ““• AprilApril BrachytherapyBrachytherapy•MayMay ““• JuneJune Chart CheckingChart Checking ( (plan, calculations)plan, calculations)

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 02 Clinical PROGRAM: Year 02 Clinical

RotationsRotations• JulyJuly External Beam/RadiosurgeryExternal Beam/Radiosurgery• AugustAugust ““• SeptemberSeptember ““• OctoberOctober External Beam & IMRT External Beam & IMRT • NovemberNovember ““• DecemberDecember ““• JanuaryJanuary External Beam & Brachytherapy External Beam & Brachytherapy • FebruaryFebruary ““•MarchMarch ““• AprilApril External Beam External Beam •MayMay ““• JuneJune ““

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Training Sessions & PROGRAM: Training Sessions &

Didactic CoursesDidactic Courses

•Orientation Course (first 2 weeks of year Orientation Course (first 2 weeks of year 01)01)

•Radiation Safety Exam (within 30 days Radiation Safety Exam (within 30 days beginning year 01)beginning year 01)

•Physics Didactic Course (Sep-Mar. year 01)Physics Didactic Course (Sep-Mar. year 01)

•Cancer Biology Didactic Course (Mar-June Cancer Biology Didactic Course (Mar-June year 01 or year 02)year 01 or year 02)

•Clinical Oncology Conference ( 1 hr lecture Clinical Oncology Conference ( 1 hr lecture every Friday for 2 years)every Friday for 2 years)

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: ConferencesPROGRAM: Conferences

•Patient Management Conference Patient Management Conference (3 times a week for 2 years) (3 times a week for 2 years)

•Current Case QA Review Conference Current Case QA Review Conference (once a week 3-4:30 PM for 2 years)(once a week 3-4:30 PM for 2 years)

•Morbidity Conference Morbidity Conference (once a month 12:00 - 1:00 pm, 2 years(once a month 12:00 - 1:00 pm, 2 years

•Current Topic Conference Current Topic Conference (once a month 4:30- 5:40 pm for 2 years)(once a month 4:30- 5:40 pm for 2 years)

•Research Seminar Research Seminar (once a month 5:00 - 6:00 pm, 2 years)(once a month 5:00 - 6:00 pm, 2 years)

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: ConferencesPROGRAM: Conferences

•Treatment Planning/QA Conference Treatment Planning/QA Conference (once a month for 2 years)(once a month for 2 years)

•Physics Resident Seminars Physics Resident Seminars (once a month Sep.-June for 2 years)(once a month Sep.-June for 2 years)

•Treatment Machine Operation Labs Treatment Machine Operation Labs (1st year)(1st year)

•Simulation Labs Simulation Labs (1st year)(1st year)

•Annual Radiation Safety Review Annual Radiation Safety Review (one lecture a year)(one lecture a year)

•Annual Fire, Chemical, Biohazards ReviewAnnual Fire, Chemical, Biohazards Review(once a year)(once a year)


RotationsRotations•WUBJH operates one of the most WUBJH operates one of the most

comprehensive external beam comprehensive external beam services in the country (Over 2000 services in the country (Over 2000 patients treated annually: patients treated annually: – traditional 2D photon and electron traditional 2D photon and electron

beam approachesbeam approaches– advanced 3D conformal radiation advanced 3D conformal radiation

therapy approachestherapy approaches– inverse planning and IMRT.inverse planning and IMRT.– stereotactic radiosurgerystereotactic radiosurgery– total body photon irradiationtotal body photon irradiation


RotationsRotations•Each physics resident spends a 9 Each physics resident spends a 9

month rotation in Treatment month rotation in Treatment Planning working mainly with Planning working mainly with medical dosimetrists. medical dosimetrists. •Rotation is focused on learning:Rotation is focused on learning:– basic treatment planning and basic treatment planning and

dosimetry skillsdosimetry skills– developing familiarity with all clinical developing familiarity with all clinical

procedures performed.procedures performed.


RotationsRotations•Emphasize developing Emphasize developing

communication skills with all communication skills with all personnel involved with radiation personnel involved with radiation therapy treatment procedurestherapy treatment procedures


RotationsRotations

•Participates in simulation Participates in simulation procedures. procedures.


RotationsRotations

•Treatment aid (beam Treatment aid (beam shielding blocks, shielding blocks, compensating filter, compensating filter, immobilization/repositiimmobilization/repositioning devices, etc) oning devices, etc) design and design and fabrication, and fabrication, and treatment machine treatment machine quality assurance quality assurance tests are acquired.tests are acquired.


RotationsRotations

•Patient Treatment Patient Treatment Plan Data AcquisitionPlan Data Acquisition

•Monitor Unit Monitor Unit CalculationsCalculations

•Point Dose Point Dose CalculationsCalculations


RotationsRotations

•Dosimetry Dosimetry Instrumentation and Instrumentation and MeasurementsMeasurements

•Daily, Weekly, Monthly, Daily, Weekly, Monthly, Yearly QA checksYearly QA checks

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Conferences & PROGRAM: Year 01 Conferences &

SeminarsSeminars

•Attends and participates Attends and participates in patient conferences.in patient conferences.

•Assigned to deliver 3 Assigned to deliver 3 seminars per year on seminars per year on various subjects that various subjects that range from a detailed range from a detailed review of AAPM Task review of AAPM Task Group's 21, 25, 35, 40 and Group's 21, 25, 35, 40 and 45 Reports to site specific 45 Reports to site specific treatment planning treatment planning reviews. reviews.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Didactic LecturesPROGRAM: Year 01 Didactic Lectures

•Expected to master Expected to master Resident's Physics course, Resident's Physics course, which is a formal lecture which is a formal lecture series with assignments series with assignments and examinations. and examinations. – Course utilizes the textbook Course utilizes the textbook

by Faiz Khan, Radiation by Faiz Khan, Radiation Therapy Physics, 3rd Ed, Therapy Physics, 3rd Ed, published by Williams and published by Williams and Wilkins plus handouts from Wilkins plus handouts from the lecturers. the lecturers.

– Core readings are assigned to Core readings are assigned to the trainees.the trainees.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Brachytherapy RotationsPROGRAM: Brachytherapy Rotations

•WUBJH has an active clinical brachytherapy WUBJH has an active clinical brachytherapy service, encompassing intracavitary service, encompassing intracavitary brachytherapy, temporary interstitial brachytherapy, temporary interstitial implants, permanent interstitial implants, implants, permanent interstitial implants, and therapeutic radiopharmaceutical and therapeutic radiopharmaceutical administrations. administrations. – Manual afterloading, remote-afterloaded Manual afterloading, remote-afterloaded

low dose-rate and high dose-rate low dose-rate and high dose-rate treatments. treatments.

– Over 350 brachytherapy and Over 350 brachytherapy and radiopharmaceutical procedures are radiopharmaceutical procedures are executed annually. executed annually.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Brachytherapy PROGRAM: Brachytherapy

RotationsRotations•Each physics resident Each physics resident

rotates through the rotates through the Brachytherapy Physics Brachytherapy Physics Service twice during Service twice during their two year program. their two year program. – First year: 3 month First year: 3 month

rotation which is focused rotation which is focused on learning basic skills, on learning basic skills, background reading and background reading and procedure familiarity. procedure familiarity.

– Second year: 2 month rotation which Second year: 2 month rotation which emphasizes a more independent emphasizes a more independent performance as a brachytherapy physicist.performance as a brachytherapy physicist.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Brachytherapy PROGRAM: Year 01 Brachytherapy

RotationRotation•Basic skills and concepts Basic skills and concepts

are emphasized. are emphasized.

•Trainee assigned to work Trainee assigned to work with the Brachytherapy with the Brachytherapy Technologists during Technologists during GYN implant days for 4-6 GYN implant days for 4-6 weeks. weeks.

•Trainee learns to prepare applicators, Trainee learns to prepare applicators, assist physicians in the OR, perform assist physicians in the OR, perform daily QA on afterloading equipment, daily QA on afterloading equipment, perform surveys, fill out required perform surveys, fill out required forms and records, and handle and forms and records, and handle and prepare sources.prepare sources.


RotationRotation•About 50% of first About 50% of first

rotation is spent rotation is spent working alongside an working alongside an experienced staff clinical experienced staff clinical physicist learning to physicist learning to perform basic treatment perform basic treatment planning, chart checking planning, chart checking and QA tasks. and QA tasks.

•Computer treatment planning skills are Computer treatment planning skills are acquired during previous Dosimetry acquired during previous Dosimetry Rotation. Rotation.

•On completion, trainee is expected to On completion, trainee is expected to function as on-call physicist to handle function as on-call physicist to handle after-hours emergencies with backup after-hours emergencies with backup from faculty physicist. from faculty physicist.


RotationRotation•Resident expected to function independently as Resident expected to function independently as a clinical physicist (within certain limits). a clinical physicist (within certain limits).

•Trainee can be authorized to independently: Trainee can be authorized to independently: – review treatment plans/manual calculationsreview treatment plans/manual calculations– order radioactive materialorder radioactive material– check in and calibrate radioactive check in and calibrate radioactive

sources/materialssources/materials– cover Brachytherapy Physics Service for short cover Brachytherapy Physics Service for short

periods. periods. •More extensive clinical projects expected (e.g. More extensive clinical projects expected (e.g.

developing written procedures for new developing written procedures for new treatment, commissioning new devices and treatment, commissioning new devices and instruments, or performing brachytherapy dose instruments, or performing brachytherapy dose measurements.measurements.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Methods of PROGRAM: Year 01 Methods of

EvaluationEvaluation• Informal evaluation on monthly/continuing Informal evaluation on monthly/continuing

basis including completion/ understanding of basis including completion/ understanding of assigned reading and exercises. assigned reading and exercises. – Evaluating staff include faculty physicists, Evaluating staff include faculty physicists,

dosimetrists, and attending radiation dosimetrists, and attending radiation oncologistsoncologists

•Pass Radiation Safety Exam during first monthPass Radiation Safety Exam during first month•Treatment planning and dose calculation skills Treatment planning and dose calculation skills

are monitored through review of completed are monitored through review of completed tasks.tasks.

•Communication skills are evaluated by informal Communication skills are evaluated by informal discussion with dosimetry and physician staff. discussion with dosimetry and physician staff.

•Pass written and oral exam at end of yearPass written and oral exam at end of year

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Year 02 Methods of PROGRAM: Year 02 Methods of

EvaluationEvaluation•Evaluated on month-by-month basis. Evaluated on month-by-month basis. •Must be able to perform treatment plan Must be able to perform treatment plan

checking and chart checking without direct checking and chart checking without direct supervision. supervision.

•Expected to perform physics tasks Expected to perform physics tasks independently. independently.

•Must be able to carry out an independent Must be able to carry out an independent annual review and calibration of a dual energy annual review and calibration of a dual energy linac.linac.

•Must be capable of conducting her/himself with Must be capable of conducting her/himself with confidence in the clinic (input of physicians and confidence in the clinic (input of physicians and dosimetrists is pertinent in this determination). dosimetrists is pertinent in this determination).

•Pass 2nd year oral exam. (Questions Pass 2nd year oral exam. (Questions encompass entire two year training).encompass entire two year training).

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Developmental ProjectsPROGRAM: Developmental Projects

•Physics resident is expected to Physics resident is expected to participate in clinical implementation participate in clinical implementation projects. projects. – Examples are acceptance testing and Examples are acceptance testing and

commissioning multi-leaf collimator system, commissioning multi-leaf collimator system, enhanced dynamic wedge, and IMRT systems.enhanced dynamic wedge, and IMRT systems.

•Physics resident is encouraged to Physics resident is encouraged to perform an independent clinical physics perform an independent clinical physics project suitable for submission as an project suitable for submission as an abstract for AAPM annual meeting. abstract for AAPM annual meeting.

WUBJH PHYSICS RESIDENCY WUBJH PHYSICS RESIDENCY PROGRAM: Developmental ProjectsPROGRAM: Developmental Projects

•Any special developmental Any special developmental projects or assignments outside projects or assignments outside the norm of clinical physics the norm of clinical physics support must be approved in support must be approved in advance by the Program Director advance by the Program Director with the understanding that all with the understanding that all such projects must be clinically such projects must be clinically oriented and will benefit the oriented and will benefit the trainee's clinical experience.trainee's clinical experience.

SUMMARYSUMMARY

•Training program Training program accreditation accreditation

•Physics residency program Physics residency program

•Board certification Board certification

•LicensureLicensure

CONCLUSIONCONCLUSION

•As the various medicines in which As the various medicines in which physicists participate clinically continue to physicists participate clinically continue to become more complex, pathway for become more complex, pathway for clinical physics profession should become clinical physics profession should become more formalized.more formalized.– graduation from an accredited medical physics graduation from an accredited medical physics

degree program degree program – followed by clinical physics training in an followed by clinical physics training in an

accredited physics residency program accredited physics residency program – subsequent board certification. subsequent board certification.

Thank you for your attention.Thank you for your attention.

education and training of medical physicists james a. purdy, ph.d. professor and director division...

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