doctorate of medical physics handbook in radiation...
TRANSCRIPT
Doctorate of Medical Physics Handbook
in Radiation Oncology Physics
Program Director:
Niko Papanikolaou, Ph.D. Professor and Chief
Phone: 210-450-5664
Fax: 210-450-1076
Email: [email protected]
Associate Program Director:
Sotirios Stathakis, Ph.D. Associate Professor
Phone: 210-450-1010
Fax: 210-450-1076
Email: [email protected]
Last updated on 5 April 2017 by P. Candia
UTHSCSA-Division of Medical Physics Page 2/93 Resident Handbook
Contents SECTION 1: GENERAL INFORMATION ...................................................................................................................... 5
1.1 INTRODUCTION ................................................................................................................................................... 5
1.1.A: Training Facilities in Collaboration with UTHSCSA ..................................................................................... 5
1.1.B: Licensure/Liability/Risk Management ............................................................................................................ 5
1.1.C: Educational Objectives .................................................................................................................................... 6
1.1.D: Resident Supervision Policy ........................................................................................................................... 6
1.1.E. Reading Requirements ..................................................................................................................................... 6
1.2: GENERAL ORGANIZATION OF THE RESIDENT STAFF ............................................................................... 6
1.3: VACATION AND LEAVE FOR ACADEMIC PURPOSES ................................................................................ 7
1.3.A: Leave Policy.................................................................................................................................................... 7
1.3.B: Scientific Meetings .......................................................................................................................................... 7
1.3.C: Family Leave/Sick Leave ................................................................................................................................ 8
1.3.D: Maternity and Paternity Leave ........................................................................................................................ 8
1.3.E: Workers' Compensation/Holiday ..................................................................................................................... 8
1.4: MOONLIGHTING ................................................................................................................................................. 8
1.5: DRESS CODE..................................................................................................................................................... 8
1.6: SMOKING .............................................................................................................................................................. 9
1.7: EVALUATION AND ADVANCEMENT ............................................................................................................. 9
1.8: RESIDENTS' BENEFITS INFORMATION .......................................................................................................... 9
1.8.A: Parking ............................................................................................................................................................ 9
1.8.B: Uniforms ......................................................................................................................................................... 9
1.8.C: Identification Cards ......................................................................................................................................... 9
1.8.D: Educational Loan Deferment ........................................................................................................................ 10
1.9: RESIDENT GRIEVENCES, DISCIPLINARY POLICY & APPEAL PROCEDURE ........................................ 10
1.9.A: Levels Of Discipline .................................................................................................................................... 10
1.9.B: Formal Grievance Procedure ......................................................................................................................... 11
1.9C: Hearing ........................................................................................................................................................... 11
SECTION 2: EDUCATION ............................................................................................................................................ 12
Requirements for Successful Program Completion ..................................................................................................... 12
Clinical Rotation 1 Schedule and Objectives ................................................................................................................... 15
Objectives Master Checklist ........................................................................................................................................ 15
References .................................................................................................................................................................... 15
Introduction to Radiation Oncology Nursing Worksheet (NEW PATIENT) .......................................................... 16
Introduction to Radiation Oncology Nursing Worksheet (ON-TREATMENT PATIENT) .................................... 17
Introduction to Radiation Oncology Nursing Worksheet (FOLLOW-UP PATIENT) ............................................ 18
Introduction to Radiation Oncology—LINAC Checklist (Form R.1.A) .................................................................. 19
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Introduction to Radiation Oncology – CT SIMULATION (Form R.1.B) ............................................................... 20
Introduction to Radiation Oncology—LINAC Engineer Checklist (Form R.1.D) .................................................. 23
Introduction to Radiation Oncology—MU CALCULATIONS Checklist (Form R.1.E) ........................................ 24
Clinical Rotation 2 Schedule and Objectives ................................................................................................................... 25
Objectives Master Checklist ........................................................................................................................................ 25
References: ................................................................................................................................................................... 25
In vivo/patient specific dosimetry Checklist (Form R.2.A) ..................................................................................... 27
Air Chamber and Electrometer Checklist (Form R.2.B) .......................................................................................... 28
HDR Checklist (Form R.2.C) .................................................................................................................................. 29
On Board MV and kV Imaging Checklist (Form R.2.D) ......................................................................................... 30
IMRT QA Checklist (Form R.2.E) .......................................................................................................................... 32
TREATMENT PLANNING Proficiencies (Form R.2.F) ........................................................................................ 33
CT simulator checklist (Form R.2.G) ...................................................................................................................... 36
Treatment Planning Terms 1 (Form R.2.H) ............................................................................................................. 37
Treatment Planning Terms 2 (Form R.2.I) ............................................................................................................... 38
Clinical Rotation 3 Schedule and Objectives ................................................................................................................... 40
Objectives Master Checklist ........................................................................................................................................ 40
References: ................................................................................................................................................................... 40
ExacTrac (kV) (Form R.3.A) ................................................................................................................................... 41
Total Skin Electron Treatment (Form R.3.B) .......................................................................................................... 42
Total Body Radiation Therapy (Form R.3.C) .......................................................................................................... 43
Intensity Modulated Radiation Therapy (IMRT) Planning(Form R.3.D) ................................................................ 44
Annual Linac QA (Form R.3.E) ............................................................................................................................... 45
TG-51 Calibration Checklist (Form R.3.F) .............................................................................................................. 46
Informatics (Form R.3.G) ........................................................................................................................................ 47
Objectives Master Checklist ........................................................................................................................................ 48
References: ................................................................................................................................................................... 48
Normal Tissue Tolerance Checklist (Form R.4.A) (cont’from Rotation 2 and 3) ................................................... 49
Low Dose Rate (LDR) Brachytherapy Checklist (Form R.4.C) .............................................................................. 51
Radiation Protection Checklist (Form R.4.D) .......................................................................................................... 52
Patient Safety (Form R.4.E) ..................................................................................................................................... 55
Clinical Rotation 5 Schedule and Objectives ................................................................................................................... 56
Objectives Master Checklist ........................................................................................................................................ 56
References .................................................................................................................................................................... 56
LINAC Design and Function Checklist (Form R.5.A) ............................................................................................ 57
Treatment plan and patient chart checks (Form R.5.B) ........................................................................................... 58
Brachytherapy Checklist (Form R.5.C) ................................................................................................................... 59
COMS Eye Plaque Applicator Checklist (Form R.5.D) .......................................................................................... 62
Clinical Rotation 6 Schedule and Objectives ................................................................................................................... 63
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Objectives Master Checklist ........................................................................................................................................ 63
References .................................................................................................................................................................... 63
Stereotactic Body Radiation Therapy Checklist (Form R.6.A) ................................................................................ 64
Stereotactic Radiosurgery Checklist (Form R.6.B) .................................................................................................. 65
Stereotactic Radiosurgery Checklist (Form R.6.C) .................................................................................................. 66
Treatment planning system QA (Form R.6.D) ......................................................................................................... 67
Clinical Rotation 7 Schedule and Objectives ................................................................................................................... 69
Objectives Master Checklist ........................................................................................................................................ 69
References .................................................................................................................................................................... 69
Imaging List (Form R.7.A) ...................................................................................................................................... 70
Linac Selection/Acceptance/Commissioning (Form R.7.B) ................................................................................... 72
CT simulator Selection/Acceptance/Commissioning (Form R.7.C) ........................................................................ 73
Clinical Rotation 8 Schedule and Objectives ................................................................................................................... 74
2.1 DESCRIPTION OF EDUCATIONAL EXPERIENCE ............................................................................................. 75
2.1.A: Research Experience ......................................................................................................................................... 75
2.1.B: Facilities ............................................................................................................................................................ 75
2.1.C: Work Hours Policy ............................................................................................................................................ 75
2.2: EDUCATIONAL CONFERENCES ......................................................................................................................... 75
2.3: RESIDENT ROOM and LIBRARY ROOM ........................................................................................................... 75
2.4 Radiation Oncology New Employee Orientation Checklist ....................................................................................... 76
2.5: Department Organizational Chart ............................................................................................................................ 77
2.6: Oral Exam Evaluation ............................................................................................................................................... 78
2.7: Evaluation Forms ...................................................................................................................................................... 83
2.7.1: In-service Presentation Evaluation ..................................................................................................................... 83
2.7.2 Course Evaluation Form ..................................................................................................................................... 83
2.7.3: Residency Curriculum Evaluation Form ............................................................................................................ 86
2.7.4 Resident Evaluation Form ................................................................................................................................... 87
2.7.5: Residency Mentor Evaluation Form .................................................................................................................. 88
2.7.6: Medical Conferences Attendance Log ............................................................................................................... 89
2.7.7 Program Evaluation Form ................................................................................................................................... 91
2.7.8 Milestones Agreement Form……………………………………………………………………………………92
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SECTION 1: GENERAL INFORMATION
1.1 INTRODUCTION
Welcome to the Medical Physics Residency Program in the Department of Radiation Oncology at
the University of Texas Health Science Center at San Antonio (UTHSCSA). The faculty and staff
hope that the time you spend with us will be both educational and enjoyable. This handbook serves
as a guide for our medical physics residents and third/fourth year graduate students in the Doctor of
Medical Physics (DMP) program. Hereforth, in this document the word “resident” shall refer to both
Medical Physics Residents and DMP students. In addition to clinical assignments, this handbook
contains general information which pertains to the policies of the department of radiation oncology
at the University of Texas Health Science Center and the Cancer Therapy and Research Center.
Residents are responsible for familiarizing themselves with and adhering to the policies and
guidelines contained in this manual. Ad hoc additions and clarifications may become available via
email from the Program Director and are considered policy.
Mission Statement: The mission of the Department of Radiation Oncology is to conduct high quality
education with state-of-the-art radiotherapy equipment, and cutting-edge basic and clinical research
and to provide excellent quality patient care. Our residency program offers education and training
for medical physicists to become skillful professionals in the practice of clinical radiation physics.
Our Division, the Department of Radiation Oncology and UTHSCSA are committed to serve the
needs of the citizens of Texas, the Nation, and the world through clinical, educational and research
programs of excellence.
1.1.A: Training Facilities in Collaboration with UTHSCSA
The University of Texas Health Science Center at San Antonio (UTHSCSA) is the major source of
health professions education and life science research and a major center for patient care in South
Texas. UTHSCSA has enjoyed innovative partnerships within the community and has excelled at
fostering mutually beneficial, collaborative arrangements with its primary teaching hospitals in San
Antonio - the University Hospital and clinics of the University Health System, the Audie L.
Murphy Division of the South Texas Veterans Health Care System (VA) and Christus Santa Rosa
Hospital and its military partners - Wilford Hall and the Brooke Army Medical Center. The Cancer
Therapy and Research Center (CTRC) is part of the UTHSCSA and is the NCI designated cancer
center of the University.
1.1.B: Licensure/Liability/Risk Management
It is expected that all residents shall obtain a temporary Texas Medical Physics License prior to or
during the first rotation of the Radiation Oncology Physics Residency Training Program. It is the
responsibility of the physics resident to ensure that the license remains current throughout the two
year training program. UTHSCSA practices a no tolerance rule if the license is to lapse during the
training period. This may also affect Visa status.
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1.1.C: Educational Objectives
The objective of a medical physics residency training program is to educate and train medical
physicists to a level of competency sufficient for them to become qualified for independent,
professional practice in their subfield of medical physics. To accomplish this goal the appropriate
facilities, staff, patient mix and educational environment must be provided.
The program emphasizes a close personal working relationship between the faculty and the resident
as well as the other specialties in our department. Knowledge, skills and other resident characteristics
are evaluated and informally addressed by faculty on an on-going basis and formally reported through
scheduled evaluations.
Residents are expected to participate in research activities during their training. Special effort is made
to identify and mentor those who have the interest and talent to pursue careers in academic radiation
physics.
1.1.D: Resident Supervision Policy
The educational program is designed to provide close supervision of residents' clinical activities by
designated faculty. The resident is assigned to a designated faculty for a period of three months. At
the end of the assigned period, the resident will be evaluated and will rotate with another faculty until
the completion of the twenty-four month program. Regular communication between residents and
attending faculty is one of the key factors in quality learning. Any clinical issues must be brought to
the attention of the supervising faculty.
1.1.E. Reading Requirements
Reading is an essential part of learning in Radiation Oncology Physics. Self-discipline and good
study habits are required. All residents should set up a study schedule and adhere to it.
1.2: GENERAL ORGANIZATION OF THE RESIDENT STAFF
Annually, a chief resident will be designated by the faculty. The chief resident should guide
the junior resident(s) by serving as a role model and mentor. He/she may delegate
responsibilities to other residents:
CHIEF RESIDENT MAJOR DUTIES:
a. Acts as liaison between faculty/residents
i. holds meetings with residents as necessary
ii. meets regularly with Program Director to discuss areas of concern
b. Coordinates medphys resident coverage for the TBI and TSE program
c. Coordinates the IMRT patient QA validation assignments
d. Attends departmental meetings as the resident representative as directed by the
division chief
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e. Helps orient new residents, post-doctoral researchers and medical physics graduate
students
1.3: VACATION AND LEAVE FOR ACADEMIC PURPOSES
The leave policy for the DMP students in the didactic years (years 1 and 2) follows that of the
UTHSCSA academic holiday calendar. However, for the DMP students in clinical rotations
(years 3 and 4) the leave policy follows the clinical coverage guidelines of the department that
the DMP student is assigned. Pursuant to the CAMPEP guidelines for the clinical residency
requirements, the DMP students in clinical rotations will have to provide coverage any time
the clinics are open. A coverage schedule will be posted ahead of time to provide adequate
coverage on those special occasions.
1.3.A: Leave Policy
The general policy in the Department of Radiation Oncology is to grant DMP students 12 days per
year vacation leave and 3 days per year of Personal leave. This includes actual vacation time and
time for attending meetings for scientific purposes. Doctor of Medical Physics students are allowed
three additional days a year if they present an abstract at a meeting. As a general rule, only one week
of vacation is allowed at any given time, exceptions must be discussed with the respective attending
faculty and Program Director well in advance. In general, only one DMP students is allowed to take
vacation at a time unless under special circumstances. First preference is given to those who are
presenting or attending meetings. All other times are on a first- come, first-serve basis. Additionally,
no more than one week of vacation may be taken during any three-month rotation period. Exceptions
must be discussed with the assigned faculty and Program Director well in advance. All vacation and
meeting time must be arranged at least one month in advance. The faculty of that rotation should sign
off on it to indicate their awareness. Actual approval is granted by the Program Director.
Manage your time off well, especially during your final year. All time spent at academic meetings,
job interviews, house hunting, etc. is taken from the overall 3-week yearly allotment of
vacation/meeting time and must be taken in the academic year in which it is accrued; unused time
may not be carried forward into the following year.
Any DMP student who is absent without leave (AWOL) will be subject to disciplinary action which
may include expulsion from the program. Timely communication with the Program Director can
avoid disciplinary actions of this magnitude.
1.3.B: Scientific Meetings
In general, only one DMP student may be on leave at any time. However, under special
circumstances, up to two DMP students may attend meetings with the Program Director’s approval.
For attending any meeting, priority is given first to those as follows: oral presentations, poster
presentations, and senior DMP students who have not attended any and other DMP students.
For DMP students presenting at a meeting, an additional three days of leave is allocated per year
(also no carry-over).
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1.3.C: Family Leave/Sick Leave
DMP students are eligible for family leave as outlined in the UTHSCSA family leave policy. Any
requests for family leave must be reviewed by the Program Director and the Administration Office.
The Administration Office will obtain the appropriate information/forms. A DMP student may
request from his/her department family and medical leave for the birth of the DMP student’s own
child, for the placement of an adopted or foster child with the DMP student, for the DMP student’s
own serious health condition, or for the serious health condition of the DMP student’s parent, spouse,
or child. The duration of the family medical leave is governed by UTHSCSA policy.
1.3.D: Maternity and Paternity Leave
The DMP student shall be entitled to parental leave without pay for up to twelve (12) weeks after
one year of employment in accordance with the Family and Medical Leave Act. The DMP student
will be responsible for completing the rotation competencies upon return and complete the 24 month
mandatory clinical training.
1.3.E: Workers' Compensation/Holiday
Refer to policies outlined in UTHSCSA operating procedures http://www.uthscsa.edu/hop2000/
and UTHSCSA Calendar http://www.uthscsa.edu/hr/inside/holiday.asp
1.4: MOONLIGHTING
In general, the practice of moonlighting is not allowed, but under certain circumstances a waiver can
be obtained from the Program Director. If a resident is allowed to moonlight, they have to do so on
their personal time. Note: University malpractice insurance will not cover a resident engaged in either
locum tenens or moonlighting activities.
1.5: DRESS CODE
The overall appearance of personnel in the Department of Radiation Oncology must reflect
professional standards and departmental attitude. Professional attire is required at all clinical areas.
All members of the staff must have a clean, professional appearance. Men should wear collared shirts,
tie, slacks and closed toe shoes. Women should wear blouse/skirt or dress (at least knee length) or
Blouse/slacks (ankle length). No sandals, jeans, t- shirts, or shorts are allowed and no open toe shoes
in procedure areas. Halters, leotard tops, T- shirts, tube tops, shorts, sweatshirts, sweat pants, and
excessive ornamental earrings, necklaces and bracelets are not permitted; simple rings, earrings and
necklaces are appropriate. Hair longer than shoulder length must be tied back during direct patient
care. Hats, scarves, large colorful hair ornaments and headbands worn around the forehead are not
allowed. Head coverings for ethnic, or religious reasons are permitted. Should the attending faculty
object to a resident's grooming or clothing, the Program Director will be responsible for counseling
that resident.
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1.6: SMOKING
Smoking is prohibited in any area of the Department, CTRC, VA or UTHSCSA.
1.7: EVALUATION AND ADVANCEMENT
Residents in the program will be given graded responsibility under appropriate supervision according
to their level of training, ability and experience. A resident's progress during residency training is
evaluated formally, in writing, by the resident's attending faculty at the end of their respective
rotation. Every effort is made to help residents with any problem during the rotation.
The Program Director will discuss as needed residents' performance and progress with residents
individually. They will be reviewed with the faculty at least annually at a residency review committee
meeting. Yearly advancement within the training program is contingent on evidence of satisfactory
professional growth of the resident, including demonstrated ability to assume graded responsibility.
Increased responsibilities include assignment of additional specific skill tasks over the course of the
residency. The annual reappointment and promotion of a resident is not automatic and requires a
demonstration of competence at each educational level. Failure to advance to the next level may
result in dismissal from this residency program. If it becomes apparent that a resident is having
trouble with a rotation, he/she should make an appointment to discuss the problem with his/her staff
and the Program Director.
Residents will also be asked to evaluate each faculty member confidentially at the end of rotation
and these evaluations will be submitted to the Program Director.
1.8: RESIDENTS' BENEFITS INFORMATION
1.8.A: Parking
Parking is under the auspices of the UTHSCSA police department and the residents can purchase a parking tag. This permit is valid on all UTHSCSA campus locations (with the exception of spaces that are numerically marked as reserved). The program coordinator can assist you in obtaining a parking permit.
1.8.B: Uniforms Hospital white laboratory coats are ordered in advance by one of the department administrative
assistants. The department provides residents with a standard laboratory coat at the start of their
residency.
1.8.C: Identification Cards Residents are required to have UTHSCSA identification cards and wear them at all times when on any UTHSCSA campus sites. The program coordinator will facilitate obtaining the ID cards from the police department.
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1.8.D: Educational Loan Deferment For the residents that qualify, loan deferment forms, may be obtained from the department administrator.
1.9: RESIDENT GRIEVENCES, DISCIPLINARY POLICY & APPEAL PROCEDURE
This department adheres to the policy established by the Graduate Medical Education Committee.
Dismissal or non-renewal of appointment could occur because of failure to comply with the resident’s
responsibilities or failure to demonstrate progress in acquiring appropriate medical physics
knowledge or skill as determined by the program's supervising faculty. This appeals mechanism is
open to all residents subject to dismissal or non-renewal. Formal disciplinary action is reportable to
credentialing and licensing agencies.
1.9.A: Levels Of Discipline
If indicated, the initial level of discipline can be probation or dismissal
1. Informal counseling minor
For minor issues, counsel is given, no record is kept (i.e. Dress code adherence).
2. Informal counseling moderate
For issues not considered serious enough for defined, disciplinary action, a memo will
be placed in a file outside of the resident’s record for reference and tracking by the Program
Director (Timeliness of assigned clinical tasks (e.g. IMRT QAs, missing conferences, and
tardiness).
3. Administrative Status Letter
Although not considered formal disciplinary action, the delivery of an administrative
status letter should be seen as a strong warning that the resident is on unsteady ground and
that the next step is formal disciplinary action. A copy of this letter and any documents related
to its resolution are kept in the resident’s file for the duration of the residency. This is the last
step that is considered non-reportable (considered an informal, intradepartmental matter). The
administrative status letter outlines the problem and a plan for remediation and a designated
time frame. For the lack of resolution (such as ongoing clinical problems, repeated tardiness),
the progression would lead to formal probation.
4. Probation.
This is the last opportunity for correction before dismissal. A formal record is kept of
the violation, a plan for remediation with measurement criteria and a time frame. Failure to
meet the goals and requirements within the prescribed time frame is cause for dismissal. This
record is maintained permanently in the residents file.
5. Immediate dismissal
It would be unusual to dismiss a resident without a probationary period except in
instances of flagrant misconduct. Immediate dismissal would be for conduct beyond that
which is not considered professionally acceptable and in any way denigrates or endangers an
individual or the reputation of the Department or Institution. Examples include, and are not
limited to: being under the influence of intoxicants or drugs; disorderly conduct, harassment
of other employees (including sexual harassment), or the use of abusive language on the
premises; violation of medical record privacy; fighting, encouraging a fight, or threatening,
attempting, or causing injury to another person(s) on the premises.
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1.9.B: Formal Grievance Procedure
In the event that a resident is to be dismissed or his/her contract is not renewed, he/she may initiate
a formal grievance procedure. The resident shall present the grievance in writing to the Department
Chair within thirty (30) calendar days after the date of notification of termination or non-renewal.
The grievance shall state the facts upon which the grievance is based and requested remedy sought.
The Department Chair shall respond to the grievance with a written answer no later than fifteen (15)
calendar days after he/she receives it. If the resident is not satisfied with the response, he/she may
then submit, within fifteen (15) days of receipt of the Department Chair’s response, a written request
for a hearing.
1.9C: Hearing The hearing procedure will be coordinated by the Department Chair, who will preside at the hearing, but will not be a voting participant. The hearing will be scheduled within thirty (30) days of the resident's request for a hearing. The hearing panel will consist of at least three (3) members of the faculty. The Department Chair will determine the time and site of the hearing in consultation with the resident and program leadership. The resident shall have a right to self-obtained legal counsel at his/her own expense; however, retained counsel may not actively participate or speak before the hearing participants, nor perform cross-examination. The format of the hearing will include a presentation by a departmental representative; an opportunity for a presentation of equal length by the house officer; an opportunity for response by the representative, followed by a response of equal length by the house officer. This will be followed by a period of questioning by the hearing panel. The Department Chair in consultation with the departmental representatives and the resident will determine the duration of the presentations and the potential attendees at the hearing. The resident will have the right to request documents for presentation at the hearing and the participation of witnesses. The Department Chair at his/her discretion will invite the latter, following consultation with the hearing panel. A final decision will be made by a majority vote of the hearing panel and will be communicated to the resident within ten (10) working days after the hearing. This process will represent the final appeal within the Health Science Center.
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SECTION 2: EDUCATION
Requirements for Successful Program Completion
The UTHSCSA Medical Physics Residency is a two-year program. To complete the Residency
Program, the resident must:
1. Successfully complete all eight clinical rotations as defined in the “Clinical Rotation Schedule and
Objectives (CRSO)” (see rotations in following section). The rotation schedule has been structured
to include all clinical topics in radiation oncology physics. For each rotation, the resident is assigned
a mentor from the physics staff and performs clinical tasks under the mentor’s direct supervision. A
rotation is considered complete when all rotation assessments have been signed off by the mentor
and resident. Failure to complete a rotation or unsatisfactory progress in a rotation will be reviewed
by the residency committee. The resident will be notified in writing of their probationary status and
will be given a plan for remediation. The resident will have one month to complete the remediation
plan. Failure to complete the remediation plan will be grounds for termination.
2. Successfully complete the didactic courses on Treatment Planning Techniques (RADI 7005 and
RADI 7006) and the AAPM task group review courses (RADI 6031 and RADI 6035). The courses
are offered during the fall and spring semester of each academic year. Passing grade is considered to
be a grade of “B“ or higher. The program director can issue a course waiver upon request by the
resident, provided the resident can prove that they have taken the equivalent course at another
institution. If a resident does not obtain a passing grade for any of the courses, they will be presented
with a plan for remediation.
3. The Medical Physics resident must complete a learning module on ethics and professionalism as
specified in AAPM Report 159. The resident is expected to complete the
ABR/ACR/RSNA/AAPM/ASTRO/ARR/ARS, Online Module on Ethics and Professionalism
anytime during the rotation one of residency program.
(http://www.aapm.org/education/onlinemodules.asp)
4. Secure a passing grade for twenty one (21) monthly written exams on the assigned topics that will
be covered during each rotation (see table 3). Each exam is two hours long, and has up to 50 multiple
choice questions. Passing grade is considered to be a score above 70%. In case of a failing exam
grade, a second exam will be given within 7 days. After a second failed attempt, the resident will be
given a plan for remediation that has to be completed before the next examination.
5. Complete a comprehensive oral examination every 6 months. The topics of all oral examinations
are listed below. See Table 4 for the specific topics of each exam. Oral examinations are considered
complete when the oral evaluation form has been signed by the appropriate faculty mentor and
student. A blank oral evaluation form is included in the Appendix. The resident will be given
feedback on their performance and it is possible that the examining committee will ask the resident
to be prepared to answer question on the same topics (in addition to the new ones) for the next oral
examination. A minimum of two faculty members must be present during the examination or else
the examination will be rescheduled.
6. Attend the new patient QA conference and didactic lectures that are given by the faculty. The
expectation is that the residents will make a best effort to attend 50 of such conferences and will
document in their portofolio log a minimum of 50 attendances for the duration of the residency. The
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attendance log will be reviewed at the end of each rotation and a remediation plan will be presented
if the resident has not attended the required number of conferences.
7. Residents are required to teach a minimum of two lectures per year in one of our degree programs
(medical physics program, medical dosimetry program) or the medical residents physics course. An
evaluation will be completed for each lecture.
8. Complete twenty-four months of clinical training at which time a certificate of training will be
awarded to the resident.
9. Milestones Agreement Form 2.7.8
Table 1. Monthly Exam topics
August Written Exam 1 Radiation Safety, Patient CT Simulation
September Written Exam 2 MU Calculations
October Written Exam 3 Periodic Linac QA
November Written Exam 4 Dosimeters, IMRT QA
December Written Exam 5 OBI MV and kV Imaging
January Written Exam 6 CT Sim QA, HDR Daily QA
February Written Exam 7 TSET, TBI
March Written Exam 8 Annual Linac QA, ExacTrac
April Written Exam 9 TG 51
May Written Exam 10 Patient Safety, Tissue Dose Tolerance
June Written Exam 11 LDR planning for Prostate Seed Implants
July Written Exam 12 Radiation Protection
August Written Exam 13 Linac Design
September Written Exam 14 Chart Checks
October Written Exam 15 Brachytherapy
November Written Exam 16 SBRT/SRS delivery and Planning, Narrow Field Dosimetry
December Written Exam 17 Treatment Planning System QA
January Written Exam 18 Imaging in Radiation Therapy
February Written Exam 19 Acceptance and Commissioning of Linac
March Written Exam 20 Acceptance and Commissioning of CT Simulator
May Written Exam 21 Comprehensive
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Table 2. Summary of oral and written exams
Rotation Month Oral Exam topics
1
1. Simulation and patient setup
Monitor Unit Calculations
In-vivo and patient specific dosimetry
Dosimeters
AAPM Task Group-51 Calibration
2.
3.
2
4.
5.
6.
3
7. AAPM Task Group 142 QA
kV and MV other position verification technologies and QA
AAPM Task Group 25, Electrons
Treatment Planning
Total Body Irradiation (TBI) and Total Skin Electrons (TSE)
8.
9.
4
10.
11.
12.
5
13. HDR/LDR
LINAC design and function
Shielding Design and Accepted Dose Limits
Normal tissue tolerance and dose response models
Eye plaques
Pregnant patients/Pacemakers/Hip Replacements
14.
15.
6
16.
17.
18.
7
19.
Stereotactic Radiosurgery (AAPM TG 101)
Comprehensive
20.
21.
8
22.
23.
24.
Clinical Rotation 1 Schedule and Objectives
Chief Mentor:______________________ (Year 1, July-Sept)
Objectives Master Checklist
Activity Employee Orientation
Radiation Oncology Orientation
HIPAA Training
Introduction to Radiation Protection.
Introduction to Nursing.
Introduction to Simulation.
Introduction to LINACs.
LINAC QA and warm up.
Monitor Unit Calculations.
Electronic Medical Record orientation.
Regulations, Professionalism and Ethics
References i. AAPM's "The Roles, Responsibilities, and Status of the Clinical Medical Physicist”
ii. AAPM Report No. 38, "Statement on the Role of a Physicist in Radiation Oncology"
iii. AAPM Report No. 79, "Academic Program Requirements for Graduate Degrees in Medical
Physics”
iv. AAPM Report No. 90, "Essentials and Guidelines for Hospital-Based Medical Physics Residency
Training Programs"
v. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21, Issue 4)
(1994) Radiation Therapy Committee Task Group #40
vi. Task Group 142 report: Quality assurance of medical accelerators Medical Physics, Vol 36, Issue 9
vii. AAPM Code of Practice for Radiotherapy Accelerators (Reprinted from Medical Physics, Vol. 21,
Issue 7) (1994) Radiation Therapy Task Group #45
viii. Medical Accelerator Safety Considerations (Reprinted from Medical Physics, Vol. 20, Issue 4)
(1993) Radiation Therapy Committee Task Group #35.
ix. Title 25 Texas Administrative Code, Part 1, Department of State Health Services, Chapter 289:
Radiation Control, Subchapters C-F
x. Texas Department of State Health Services, Texas Health & Safety Code; Subtitle D. Nuclear and
Radioactive Materials; Chapter 401. Radioactive Materials and Other Sources of Radiation.
xi. Requirements of the Texas Board of Licensure for Professional Medical Physicists
xii. Nuclear Regulatory Committee regulations 10 CFR 19, 10 CFR 20, and10 CFR 35.
xiii. NCRP Reports 151, 79, 116, and 147
xiv. NRC Regulatory Guide 8.13, "Instructions Concerning Prenatal Radiation Exposure"
xv. NRC Regulatory Guide 8.39, "Release of Patients Administered Radioactive Material"
xvi. Khan, “The Physics of Radiation Therapy” 4th Edition.
xvii. Verification of monitor unit calculations for non-IMRT clinical radiotherapy: Report of AAPM
Task Group 114 Medical Physics, Vol 38, Issue 1
xviii. ESTRO booklet #3 “Monitor unit calculation for high energy photon beams”, 1997
UTHSCSA-Division of Medical Physics Page 16/93 Resident Handbook
Introduction to Radiation Oncology Nursing Worksheet (NEW PATIENT)
Observe and assist in at least three new patient exams from three different services.
Identify the patient’s name, diagnosis, stage of disease, and treatment techniques to be used. Note
the anatomical structures of interest.
New Patient Exam
1. Patient’s initials: _____________________________________
2. Diagnosis: __________________________________________
3. Stage of disease: _____________________________________
4. Describe treatment to date and the proposed treatment technique:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
___________________
Faculty/staff: __________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_________________________________________________________________
UTHSCSA-Division of Medical Physics Page 17/93 Resident Handbook
Introduction to Radiation Oncology Nursing Worksheet (ON-TREATMENT PATIENT)
Observe and assist in at least three on-treatment patient exams from three different services.
Identify the patient’s name, diagnosis, stage of disease, treatment technique, number of treatments
received, cumulative dose, and reactions noted.
Current Patient Exam
1. Patient’s initials: _____________________________________
2. Diagnosis: __________________________________________
3. Stage of disease: _____________________________________
4. Describe treatment to date and the proposed treatment technique:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_______________________________________________
5. Number of treatments and dose received to date:
_________________________________________________________________________
_________________________________________________________________________
_______________________________________________________
6. Description of reaction (tumor response and/or normal tissue)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_______________________________
Faculty/staff: __________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_________________________________________________________________
UTHSCSA-Division of Medical Physics Page 18/93 Resident Handbook
Introduction to Radiation Oncology Nursing Worksheet (FOLLOW-UP PATIENT)
Observe and assist in three follow-up patient exams from three different services. Identify the
patient’s name, diagnosis, stage of disease, treatment technique and current status of patient’s
health.
Follow-up Exam
1. Patient’s initials: __________________________
2. Diagnosis: _______________________________
3. Stage of disease: __________________________
4. Describe treatment technique and area(s) treated:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________
5. Total dose received:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________
6. Discuss the current status of patient’s health and any past and/or present side effects due
to treatment:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_____________________________________
Faculty/staff: __________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
______________________________________________________________________
UTHSCSA-Division of Medical Physics Page 19/93 Resident Handbook
Introduction to Radiation Oncology—LINAC Checklist (Form R.1.A)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of the warm-up of treatment units.
Demonstrate an understanding of pre-treatment chart checks
Demonstrate an understanding of pre-port procedures
Demonstrate an understanding of checking of MLC blocked fields
Demonstrate an understanding of port film acquisition, analysis and
approval
Demonstrate an understanding of the pertinent recommendations for
quality assurance of linear accelerators used in radiation therapy;
Demonstrate an understanding of in-house quality assurance
documentation and procedures;
Perform and be competent in routine (daily/weekly/monthly) quality
assurance tests of external beam treatment units;
Perform and be competent in the analysis of routine quality assurance
tests of external beam treatment units;
Demonstrate an understanding of the basis of accepted tolerances for
routine quality assurance tests performed on treatment units and required
actions should any of the checks fall out of tolerance;
Demonstrate an understanding of the operation of the linac and the
interlock codes;
Perform and be competent in end-to-end checks of patient treatment
plans using phantom images and data;
Demonstrate an understanding of MOSAIQ / 4D Console
Demonstrate an understanding of grouping/auto sequencing of fields and
remote movement of gantry and collimator.
Observe/assist in the treatment of TBI patient (when available)
Observe/assist in the treatment of a Total Skin Electron patient(when
available)
Observe/assist in acquisition of TLD/OSL readings (when available)
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 20/93 Resident Handbook
Introduction to Radiation Oncology – CT SIMULATION (Form R.1.B)
Competencies Resident
Initials
Mentor
Initials**
Demonstrate an understanding of morning warm-up and QA of equipment
Demonstrate an understanding of positioning of the patient for simulation
Demonstrate an understanding of placement of BB’s or other radiographic
markers
Demonstrate an understanding of in the selection of an isocenter and the
transfer of the isocenter to the treatment planning system
Demonstrate an understanding of what treatment information needs to be
recorded in the patient’s chart during simulation
Demonstrate an understanding on how CT scans are transferred to the
treatment planning computers
Review the differences of CT simulators versus diagnostic CT scanners
(e.g. lasers, table top and indexing, localization software, bore size);
Demonstrate an understanding of the theory of CT image reconstruction
and operation of a CT simulator;
Demonstrate an understanding of the major subsystems and components
of a CT simulator;
Demonstrate an understanding of the room shielding and other radiation
protection requirements of a CT-simulator.
Understand the reasons for using contrast in imaging
Faculty/staff: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 21/93 Resident Handbook
Intro to Radiation Oncology-RADIATION PROTECTION CHECKLIST (Form R.1.C)
Activity Resident
Initials
Mentor
Initials**
Participate in receipt, assay, inventory and disposal of radioactive
material, such as 32P and 131I. The resident shall accompany a radiation
safety technician three mornings during the receipt of radioactive
material by the Radiation Safety Office.
Participate in survey meter calibration
Demonstrate an understanding of the operation/limitations of a hand-held
survey meter
Demonstrate an understanding of DOT regulations for transport and
labeling or radioactive material by attending Radioactive Materials
Certification Course
Demonstrate an understanding of the room preparation for 131I and 32P
patients
Demonstrate an understanding of regulations for labeling rooms
containing radioactive sources: radiation area, high radiation area, very
high radiation area
Demonstrate an understanding of function/limitations of a personnel
monitoring badge
Demonstrate an understanding of concepts of: time, distance and
shielding
Demonstrate an understanding of definitions for: dose equivalent,
effective dose equivalent, deep dose equivalent, committed dose
equivalent, quality factors, organ dose weighting factors, planned special
exposure, declared pregnant worker, occupational dose
Demonstrate an understanding of Nuclear Regulatory Commission
(NRC) and/or state licensing (by-product materials and x-ray producing
devices);
Demonstrate an understanding of the appropriate regulations for radiation
protection and dose limits for radiation workers and members of the
general public;
Explain the ALARA (As low as reasonably achievable) concept;
Discuss the role and significance of the Joint Commission;
Discuss the role and responsibility of a radiation safety committee;
Discuss the role and responsibility of a radiation safety officer;
Discuss the significance of ACR, ASTRO, and AAPM
recommendations;
Demonstrate an understanding of release of patients (with sealed or
unsealed sources).
UTHSCSA-Division of Medical Physics Page 22/93 Resident Handbook
Activity Resident
Initials
Mentor
Initials**
Demoinstrate and understanding of the following concepts:
Failure mode effects analysis (FMEA) principles/applications
Root cause analysis (RCA) principles/applications
Sealed source storage/safety/protection
Sealed source inventory/check in/out procedures
Sealed source packaging/transportation (e.g. Title 19 CFR)
Calibration of sealed sources
Exposure and contamination surveys
Radiation signage
Definition and reporting requirements for medical events
Radiation safety of personnel during radionuclide therapy
Patient release criteria following radionuclide therapy and radiation
safety for the public
Safety policies/procedures
Compliance audits
Occupational and public dose limits
National and state regulations
Radiation exposure to the public
Site design and shielding (primary and secondary barrier computations)
Neutron shielding
Facility radiation surveys
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are
scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have
demonstrated adequate knowledge of the topic
UTHSCSA-Division of Medical Physics Page 23/93 Resident Handbook
Introduction to Radiation Oncology—LINAC Engineer Checklist (Form R.1.D)
Activity Resident
Initials
Mentor
Initials**
Observe/participate in the daily start-up of each of the treatment
units with a service engineer. Prints detailed operating parameters of
the LINAC and understand the use of this data.
Observe/participate in the daily shut-down of each of the treatment
units with a service engineer. Record machine logs and understand
the use of this data.
Be able to identify and explain the function of linac mechanical
components and geometry
Be able to identify and explain the general clinical fault indicators,
causes and reset levels
Demonstrate understanding of laser alignment geometry and
verification
Demonstrate understanding of tomographic geometry and laser
systems for the CTs.
Observe and assist in a linac MLC motor change.
Observe and participate in a linac MLC PM
Observe and participate in a single modality (low energy) gantry PM
Observe and participate in a multimodality (high energy) collimator
PM
Observe and participate in a linac digital readout calibration
Observe and participate in linac beam tuning
Demonstrate understanding of linac anatomy
Demonstrate understanding of machine ionization systems and self-
calibration
Demonstrate understanding of tolerances and what to do if they are
exceeded.
Observe/understand operation of linac oscilloscope signals
Observe/understand OBI preventive maintenance
Faculty/Staff: __________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 24/93 Resident Handbook
Introduction to Radiation Oncology—MU CALCULATIONS Checklist (Form R.1.E)
Competency Resident
Initials
Mentor
Initials**
1) Demonstrate an understanding of the following factors:
a. Percent depth dose (PDD)
b. Tissue-air ratio (TAR)
c. Tissue-maximum ratio (TMR)
d. Tissue-phantom ratio (TPR)
e. Scatter factors (Sc, Sp, Scp)
f. Off-axis factors
g. Inverse square factors
h. Calibration factor (MU reference conditions)
i. Standard wedge factors
j. Virtual and dynamic wedge factors
k. Compensator factors
l. Tray and other insert factors
2) Perform MU calculations for photon and/or electron beams with the
following configurations:
a. SSD setup
b. SAD setup
c. Extended distance setup
d. Off-axis calculation points
e. Rotational beams
Demonstrate an understanding and perform MU calculations using
heterogeneity corrections;
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 25/93 Resident Handbook
Clinical Rotation 2 Schedule and Objectives
Chief Mentor: (Year 1, Oct-Dec)
Objectives Master Checklist
Activity
Monthly LINAC QA.
IMRT QA.
EPID QA.
QA of the HDR unit.
CT Simulator QA.
LDR brachytherapy.
2D/3D External Beam Planning (RADI7005).
In vivo/patient specific dosimetry and Dosimetry
References: i. Protocol for Clinical Dosimetry of High-Energy Photon and Electron Beams ( Reprinted from
Medical Physics, Vol. 26, Issue 9) (1999) Radiation Therapy Committee Task Group #51
ii. A protocol for the determination of absorbed dose from high energy photon and electron beams.
(Reprinted in Medical Physics, Vol. 10, Issue 6, 1983). Radiation Therapy Committee Task Group #21
iii. ICRU 50, Prescribing, recording, and reporting photon beam therapy.
iv. ICRU 62, Supplement to ICRU 50
v. Pinnacle manuals as needed.
vi. Diode In Vivo Dosimetry for Patients Receiving External Beam Radiation Therapy. AAPM report #87
(2005). Radiation Therapy Committee Task Group #62.
vii. Introduction to Radiological Physics and Radiation Dosimetry. F.H. Attix, 1986. (Good for TLD)
viii. The Essential Physics of Medical Imaging. Second Edition. Bushberg 2002. (Good for film).
ix. Clinical electron beam dosimetry. Med Phys, Vol. 18, Issue 1, (1991). Radiation Therapy Committee
Task Group #25. (good summary of electron detectors)
x. Khan, “The Physics of Radiation Therapy” 4th Edition.
xi. Halvorsen PH. Dosimetric evaluation of a new design MOSFET in vivo dosimeter. Med Phys 32, 110
– 117 (2005).
xii. Dosimetry of Interstitial Brachytherapy Sources. Report of AAPM Radiation Therapy Committee Task
Group 43. Reprinted from Medical Physics, Vol. 22, Issue 2, 1995.
xiii. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose
calculations. Medical Physics, Vol. 21, Issue 3, 2004.
xiv. Permanent Prostate Seed Implant Brachytherapy. Report of AAPM Radiation Therapy Committee Task
Group 64. Reprinted from Medical Physics, Vol. 26, Issue 10.
xv. Report of TG142 (Quality Assurance of Medical Accelerators) Med. Phys. Volume 36, Issue 9, pp.
4197-4212, September 20093
xvi. The Calibration and Use of Plane-Parallel Ionization Chambers for Dosimetry of Electron Beams
(Reprinted from Medical Physics, Vol. 21, Issue 8) TG#39
xvii. Radiochromic Film Dosimetry (Reprinted from Medical Physics, Vol. 25, Issue 11) Radiation Therapy
Committee Task Group #55
xviii. Clinical use of electronic portal imaging (Reprinted from Medical Physics, Vol. 28, Issue 5) Radiation
Therapy Committee Task Group #58
xix. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: A report of the
AAPM TG-179 Medical Physics, Vol 39, Issue 4
xx. The Role of In-Room kV X-Ray Imaging for Patient Setup and Target Localization: Report of AAPM
Task Group 104
xxi. Radiation Therapy Committee Task Group #58, Clinical use of electronic portal imaging (Reprinted
from Medical Physics, Vol. 28, Issue 5)
xxii. Radiotherapy Portal Imaging Quality Radiation Therapy Committee Task Group #28
xxiii. Khan. “treatment Planning in Radiation Oncology.
xxiv. IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from AAPM
UTHSCSA-Division of Medical Physics Page 26/93 Resident Handbook
Task Group 119 Medical Physics, Vol 36, Issue 11
xxv. Emami, B. et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991
May 15;21(1):109-22.
xxvi. Lyman, JT. Complication probability as assessed from dose-volume histograms. Radiat. Res. 104:S-13 –
S-19; 1985.
xxvii. Kutcher GJ and Burman C. Calculation of complication probability factors for nonuniform normal tissue
irradiation: the effective volume method. Int J Radiat Oncol Biol Phys. 104:1623-1630; 1989.
xxviii. Kutcher G J, Burman C, Brewster L, Goitein M, Mohan R. Histogram reduction method for calculating
complication probabilities for three-dimensional treatment planning evaluations. Int J Radiat Oncol Biol
Phys. 21:137-146; 1991.
UTHSCSA-Division of Medical Physics Page 27/93 Resident Handbook
In vivo/patient specific dosimetry Checklist (Form R.2.A)
Competency Resident
Initials
Mentor
Initials**
TLD
1) Demonstrate an understanding of the physical mechanisms involved in the process
of radiation detection and readout using thermoluminescent dosimeters, including
Randall-Wilkins theory, intrinsic sensitivity, linearity, energy dependence, chemical
composition, physical forms, and TLD reader design and operation;
2) If possible, perform TLD measurements and readout including calibration using
standard irradiation;
3) Demonstrate understanding of the method and rationale for TLD annealing;
4) Discuss the advantages and disadvantages of TLDs including their limitations of use.
Diodes
1) Demonstrate an understanding of the physical mechanisms involved in the process
of radiation detection and readout using semiconductor dosimeters;
2) If possible, perform diode measurements including investigation of angular and dose
rate dependence, temperature sensitivity, etc.;
3) Discuss the advantages and disadvantages of diodes, including the inherent
limitations of diodes.
Film (silver bromide, radiochromic)
1) Demonstrate an understanding of the physical mechanisms involved in the process
of radiation detection and measurement using film, including measurement of the
optical density and its characteristics as a function of absorbed dose, and dependence
on radiation energy and on film handling and processor conditions;
2) If possible, perform film dosimetry including creation of calibration curve;
3) Discuss the advantages and disadvantages of using film, including the inherent
limitations of film.
MOSFET detectors
1) Demonstrate understanding of the physical mechanisms involved in the process of
radiation detection and readout using Metal Oxide Semiconductor Field Effect
Transistor dosimeters;
2) Discuss the advantages and disadvantages of using MOSFETs, including their
limitations of use.
OSLD
1) Demonstrate an understanding of the physical mechanisms involved in the process
of radiation detection and readout using optically stimulated luminescent dosimeters;
2) Discuss the advantages and disadvantages of using OSLDs, including their
limitations of use.
3) Demonstrate an understanding of the following components of an in vivo dosimetry
program.
a. Acceptance, commissioning, calibration, and ongoing quality assurance
procedures for in vivo dosimetry systems;
b. Use of in vivo dosimetry systems for patient specific measurement;
c. Limitations of specific in vivo dosimetry systems.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
UTHSCSA-Division of Medical Physics Page 28/93 Resident Handbook
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are
scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have
demonstrated adequate knowledge of the topic
Air Chamber and Electrometer Checklist (Form R.2.B)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of absorbed dose calculation and measurement;
Demonstrate an understanding of Bragg-Gray, Spencer-Attix, and Burlin cavity theories;
Demonstrate an understanding of dosimeter design considerations including detection
mechanism, sensitivity, size, shape, thickness of sensitive volume and wall, materials,
energy dependence, detector/phantom media matching, dose and dose rate range, stability
of reading.
Demonstrate an understanding of design considerations for cylindrical ionization
chambers including size, shape, materials, electrical characteristics, etc.;
Demonstrate an understanding of design considerations for parallel-plate ionization
chambers including size, shape, materials, electrical characteristics, use for measuring
dose in the buildup region, etc.;
Demonstrate an understanding of advantages and disadvantages of each ionization
chamber design, including detector limitations;
Demonstrate an understanding of ionization chamber measurement techniques including
electrometer, operational amplifiers, triaxial cable and connections, etc.;
Perform acceptance testing for ionization chamber and electrometer including
measurements of leakage and evaluation of relevance, polarity effects, and stem effects;
Perform ionization chamber measurements using Farmer, parallel-plate, scanning
chambers, and large volume survey ionization chambers;
Demonstrate understanding of ion chamber correction factors including PTP, Ppol, Pelec,
Pion, Pwall, Pgrad, Pfl, and Pcel. Calculate corrected charge reading for ion chamber
measurement using TG-51 formalism;
Demonstrate an understanding of ion chamber calibration process through NIST/ADCL;
Demonstrate an understanding of design and characteristics of monitor chambers.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 29/93 Resident Handbook
HDR Checklist (Form R.2.C)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of HDR morning QA procedures, tests
performed, level of accuracy required
Demonstrate an understanding and performance of comprehensive periodic
QA (daily, monthly, annually) of remote afterloader ;
Discuss and perform periodic treatment planning QA;
Demonstrate an understanding of implant specific QA.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 30/93 Resident Handbook
On Board MV and kV Imaging Checklist (Form R.2.D)
On Board imaging (MV and kV) Resident
Initials
Mentor
Initials**
Discuss the different detector technologies that have been used for on-board
MV and kV imaging;
Discuss the imaging dose associated with on-board MV and kV imaging
technologies;
Discuss the different measures of radiographic image quality.
Demonstrate an understanding of the quality assurance processes and
frequencies for on-board MV and kV imaging, including cone-beam CT (e.g.,
image quality, image integrity, safety and mechanical checks, network
connectivity, imaging dose, and localization software, and isocenter
calibration).
General
Demonstrate an understanding of the basic imaging principles behind CT;
Define the 4 generations of CT imaging systems;
Demonstrate an understanding of the detector technology, e.g., scintillation
detectors, xenon gas chamber;
Demonstrate an understanding of the basic principle of reconstruction algorithms
(i.e. filtered back-projection);
Demonstrate an understanding of image artifacts that may arise in CT images
and be able to identify their causes;
Discuss how to perform density calibration of a CT scanner, and how this
calibration is used for tissue density corrections in treatment planning systems;
Discuss the differences between a free–breathing helical CT and 4D-CT;
Discuss the differences between prospective versus retrospective image
acquisitions, and cine versus helical scanning techniques;
Discuss the imaging dose associated with various CT protocols;
Discuss how 4D data is used for target definition and describe MIPs, averaged,
maximum inhale and exhale scans.
Quality Assurance
Demonstrate an understanding of the quality assurance processes and
frequencies for CT-simulators (e.g., image quality, image integrity, safety and
mechanical checks, network connectivity, imaging dose, localization software,
and CT#).
Image Registration/Fusion
Discuss the motivation as well as the advantages/challenges of image registration
and image fusion;
Define the image features on which registration can be based (i.e. landmarks,
segments, intensities);
Define the different forms of registration (i.e. rigid, affine, deformable), and
discuss their advantages/limitations;
Define similarity metrics used to assess quality of registration (i.e. squared
intensity differences, cross-correlation, mutual information);
UTHSCSA-Division of Medical Physics Page 31/93 Resident Handbook
Discuss how to commission imaging modalities such as MRI, PET-CT, and
diagnostic CT for the purpose of image registration to a radiation oncology
planning CT;
Discuss issues associated with the transfer of images (i.e. connectivity and image
dataset integrity);
Discuss issues associated with patient positioning (i.e. bore size, couch-top,
lasers, compatibility of immobilization devices, differences in patient
position/organ filling and motion).
Discuss issues associated with image acquisition technique (i.e. length of scan,
slice thickness, FOV, kV and mAs).
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 32/93 Resident Handbook
IMRT QA Checklist (Form R.2.E)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of commonly used QA procedures and
guidelines, delivery and dosimetry equipment, and QA analysis
techniques;
Demonstrate an understanding of verification plans creation within the
treatment planning system along with independent checks with
secondary MU calculation software;
Demonstrate an understanding of IMRT delivery QA measurements
using 2D/3D array, film, and/or ion chamber techniques, including
analysis of these results and determination of passing criteria (including
familiarity with the concept of gamma analysis);
Demonstrate an understanding of acquisition and analysis of MLC QA
measurements designed for accelerators used for IMRT;
Perform review of individual patient-specific QA results with staff
physicists and physicians.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 33/93 Resident Handbook
TREATMENT PLANNING Proficiencies (Form R.2.F)
Competency Resident
Initials
Mentor
Initials**
Register a new patient and import imaging studies,
Be able to export a treatment plan and import to MOSAIQ
Be familiar with IMRT concepts and have a basic idea of IMRT planning.
Review the Pinnacle Physics manual and become familiar with the
commissioning data requirements and beam modeling.
Beam Properties
Demonstrate an understanding of photon and electron percent depth dose in tissue
and other media;
Demonstrate an understanding of electron ranges (Rp, R80, R90, and dmax) for
different energies;
Demonstrate an understanding of proton percent depth dose in tissue and other
media and proton ranges for different energies (e.g. stopping and scattering power
and range);
Demonstrate an understanding of the potential uncertainties in dose deposition in
proton radiotherapy;
Demonstrate an understanding of flatness and symmetry of photon and electron
beams;
Demonstrate an understanding of the differences between an SAD and SSD
treatment.
Compare electron and photon therapy, their advantages and disadvantages;
Discuss the impact of dose and fractionation on normal and tumor tissues;
Demonstrate an understanding of the impact of beam quality (e.g. LET) on the
RBE of different forms of ionizing radiation (e.g. electrons, photons, and
protons);
Discuss the uncertainties related to electron and photon therapy (e.g. physics,
biology, machine, and patient related) and how they may be detected and
mitigated during the planning and delivery process.
Beam Modifiers
Demonstrate an understanding of the effect of beam modifiers (wedges,
compensators, etc.) on the dosimetric characteristics of the incident beam;
Demonstrate an understanding of wedges (wedge angle, hinge angle), and the
different style wedges clinically utilized (physical, universal, dynamic);
Demonstrate an understanding of the design of the different commercially
available MLCs;
Demonstrate an understanding of blocking and shielding for therapy beams;
Demonstrate an understanding for the use of custom bolus;
Demonstrate an understanding of the design and use of tissue compensators;
UTHSCSA-Division of Medical Physics Page 34/93 Resident Handbook
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
______________________________________________________________________________*A
sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Treatment simulation techniques
Demonstrate an understanding of common patient positioning and immobilization
devices;
Demonstrate an understanding of when and how to use specific treatment devices
for specific treatments;
Discuss how to account for beam attenuation from patient positioning and
immobilization devices in treatment planning.
Tumor localization and normal tissue anatomical contouring:
Perform region of interest contouring on CT data sets;
Perform region of interest contouring on MRI data sets;
Perform region of interest contouring on PET and PET/CT data sets;
Perform region of interest contouring on SPECT and SPECT/CT data sets;
Demonstrate an understanding of target volume determination, including the
design of ICRU target structures (e.g. GTV, CTV, ITV, PTV, and PRV).
Demonstrate an understanding of how 4D data is used for target definition and
relevant radiation treatment prescription parameter such as GTV, PTV, CTV and
ITV;
Demonstrate an understanding of the role of MIP images in the treatment
planning process;
Demonstrate an understanding of the role of DRR images in the treatment
planning process;
Demonstrate an understanding of and perform image registration and fusion of
data sets, including CT/CT, CT/MRI, CT/PET, deformable registration, and
image/dose registration.
Plan evaluation
Define and discuss each of the following treating planning evaluation tools,
including their limitations:
Dose volume histograms (V(dose), D(volume), mean dose) (cumulative and
differential)
Conformity index
Homogeneity index
Biological evaluators (e.g. gEUD, EUD, NTCP, TCP)
Discuss dose tolerances for various normal tissue structures along with relevant
volume effects
UTHSCSA-Division of Medical Physics Page 35/93 Resident Handbook
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 36/93 Resident Handbook
CT simulator checklist (Form R.2.G)
Competency Resident
Initials
Mentor
Initials**
Quality assurance
Perform and be competent in routine quality assurance test processes for CT-
simulators and understand their relationship to acceptance testing and
commissioning measurements;
Understand the basis of recommended measurements and their tolerances
specified by the AAPM, ACR and other professional bodies for CT-simulators;
Understand, perform and be competent in determining the geometric accuracy
of laser alignment, couch motion, gantry motion, and CT-simulator images for
both static and moving objects;
Understand, perform and be competent in assessing image quality for CT-
simulators in any mode of operation and image reconstruction. Be able to
discuss the impact of image artifacts and distortion on treatment planning;
Understand the connectivity requirements of a CT-simulator to other computer
systems that form part of a modern radiation therapy treatment process as well
as be familiar with the internet and DICOM RT image data transfer protocols.
CT protocols
Demonstrate an understanding of the following parameters, their typical
values, and how these parameters are combined in CT protocols: slice
thickness, pitch, kV, mAs, FOV, and scan length;
Demonstrate an understanding of how CT protocols consider multi-slice
capabilities, tube heating, and max scan time;
Demonstrate an understanding of the relationship between image quality and
patient dose from examination;
Demonstrate an understanding of the need to define dose optimized imaging
protocols for various body parts and sizes of patient;
Demonstrate an understanding of image artifacts that may arise in CT images.
Be able to identify their causes, and assess or mitigate their impact on radiation
treatment planning;
Understand the different imaging protocols used in tumor motion management
(e.g. voluntary breath hold, active breathing control, shallow breathing by
compression, free–breathing helical CT and 4D-CT);
Understand the different CT image acquisition modes available with a modern
CT-simulator (prospective, retrospective, cine, helical, 4D and image sorting
based on breathing phase and breathing amplitude).
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 37/93 Resident Handbook
Treatment Planning Terms 1 (Form R.2.H)
Define the terms below giving examples and mathematical formulas where applicable.
Attach additional sheets as necessary.
1. Air Gap
2. Attenuation
3. Beam Hardening
4. dmax
5. Obliquity Factor
6. Effective Field
7. Equivalent Square; A/P
8. Radiation Dose (Gy)
9. Fluence
10. Hot Spots
11. HVL
12. Isodose Curve
13. Radiographic Magnification Factor
14. Electron Output Factor
15. Maximum/Minimum Target Dose
16. Orthogonal Films
17. PDD or %DD
18. Penumbra
19. Build-up bolus
20. Primary Radiation
21. Scatter Radiation
22. Skin Sparing
23. Bolus
24. SAD Technique
25. SSD Technique
26. PTV/CTV/GTV/ITV/IV/TV/SM/PRV
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 38/93 Resident Handbook
Treatment Planning Terms 2 (Form R.2.I)
Define the terms below giving examples and mathematical formulas where applicable.
Attach additional sheets as necessary.
1. Absorbed Dose
2. Activity
3. Attenuation Coefficient
4. Buildup Region
5. Decay Constant
6. Dynamic Wedge
7. Entrance Dose
8. Exit Dose
9. Skin Gap Calculation (Craniospinal treatments)
10. GM Meter
11. Sensitometric Curve
12. Tissue Heterogeneity
13. Independent Jaw
14. ICRU
15. Irregular Field
16. Manchester Method
17. Mass Attenuation Coefficient
18. MLC
19. IMRT
20. 3D conformal
21. Paterson-Parker Method
22. Pig (not the animal)
23. Quimby Method
24. SAR
25. Sc
26. Sp
27. TMR
28. TLD
29. Normal Tissue Tolerance
30. Wedge Angle
31. Hinge Angle
32. DVH
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are
scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have
demonstrated adequate knowledge of the topic
UTHSCSA-Division of Medical Physics Page 39/93 Resident Handbook
Transperineal Ultrasound Guided Prostate Brachytherapy Checklist (Form R.2.J)
Volume study Treatment plan Procedure Post plan:
Date:
Date:
Date:
Activity Resident
Initials
Mentor
Initials** Participate in volume study including discussion of stepper function and slice
spacing
Participate in treatment plan including discussion of Rx dose, normal tissue
constraints and peripheral loading
Participate in ordering of seeds including different loading options for seed
applicators (loose seeds, preloaded needles, suture-mounted sources, MICK
cartridges)
Participate in receipt, calibration, leak testing and inventory of radioactive
material including discussion of applicable state regulations
Learn DOT regulations for transport and labeling or radioactive material Participate in preparation of procedure room including discussion of
regulations for signage on rooms containing radioactive sources, radiation area,
high radiation area, very high radiation area
Participate in brachytherapy procedure including discussion of position
verification, seed accountability
Participate in post-insertion cystoscopy including discussion of how to handle
seeds in the bladder or urethra
Participate in patient and room survey pre- and post-procedure including
discussion of lost seeds
Participate in release of patient with radioactive materials Participate in post-procedure treatment planning including discussion of seed
migration and prostate edema
Participate in disposal of radioactive material including discussion of
applicable state regulations
Discuss function/limitations of a personnel monitoring badge including energy
discrimination
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are
scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have
demonstrated adequate knowledge of the topic
UTHSCSA-Division of Medical Physics Page 40/93 Resident Handbook
Clinical Rotation 3 Schedule and Objectives
Chief Mentor: (Year 1, Jan-Mar)
Objectives Master Checklist
Activity
On Board MV and kV Imaging
ExacTrac design and function.
ExacTrac Daily, Monthly QA
Linac Annual QA
The RPC: The resident knows what the RPC is/does.
TBI and TSE.
IMRT Planning. (RADI 7006)
References: i. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21, Issue 4) (1994) Radiation
Therapy Committee Task Group #40
ii. Report of TG142 (Quality Assurance of Medical Accelerators) Med. Phys. Volume 36, Issue 9, pp. 4197-4212,
September 2009
iii. The Calibration and Use of Plane-Parallel Ionization Chambers for Dosimetry of Electron Beams (Reprinted from
Medical Physics, Vol. 21, Issue 8 (1994) Radiation Therapy Committee Task Group #39; 10 pp.
iv. AAPM protocol for 40-300 kV x-ray beam dosimetry in radiotherapy and radiobiology. Medical Physics, Vol.28,
Issue 6, (2001). Radiation Therapy Committee Task Group #61.
v. A primer on theory and operation of linear accelerators in radiation therapy. 2nd ed., Karzmark and Morton, Medical
Physics Publishing, 1998.
vi. The Physical Aspects of Total and a Half Body Photon Irradiation (1986) Radiation Therapy CommitteeTask Group
#29; 55 pp.
vii. Total Skin Electron Therapy: Technique and Dosimetry. Report of AAPM Radiation Therapy Committee Task
Group 30 (1987)
viii. Clinical use of electronic portal imaging (Reprinted from Medical Physics, Vol. 28, Issue 5) (2001) Radiation
Therapy Committee Task Group #58; 26 pp.
ix. Quality assurance for CT simulators and the CT simulation process. AAPM report #83. (Reprinted in Medical
Physics, Vol. 30, Issue 10, 2003). Radiation Therapy Committee Task Group #66.
x. Khan. “Treatment Planning in Radiation Oncology”
xi. Mellenberg DE, Dahl RA, Blackwell CR. Acceptance testing of an automated scanning water phantom. Med Phys.
1990; 17(2):311-4.
xii. Emami, B. et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991 May
15;21(1):109-22.
xiii. Lyman, JT. Complication probability as assessed from dose-volume histograms. Radiat. Res. 104:S-13 – S-19; 1985.
xiv. Kutcher GJ and Burman C. Calculation of complication probability factors for nonuniform normal tissue irradiation:
the effective volume method. Int J Radiat Oncol Biol Phys. 104:1623-1630; 1989.
xv. Kutcher G J, Burman C, Brewster L, Goitein M, Mohan R. Histogram reduction method for calculating complication
probabilities for three-dimensional treatment planning evaluations. Int J Radiat Oncol Biol Phys. 21:137-146; 1991.
xvi. Varian manuals for OBI and conebeam CT
xvii. Jaffray DA, Drake DG, et. al. A radiographic and tomographic imaging system integrated into a medical linear
accelerator for localization of bone and soft-tissue targets. Int J Radiat Oncol Biol Phys. 45:7731337-789; 1999.
xviii. Jaffray DA, Siewerdsen JH, Wong JW, and Martinez AA. Flat-panel cone-beam computed tomography for image-
guided radiation therapy. Int J Radiat Oncol Biol Phys. 53:1337-1349; 2002.
xix. Groh BA, Siewerdsen JH, et. al. A performance comparison of flat-panel imager based MV and kV cone-beam CT.
Med Phys 29, 967-975 (2002).
xx. Balter JM, Wright JN, et. al. Accuracy of a wireless localization system for radiotherapy. Int J Radiat Oncol Biol
Phys. 61:933-937; 2005.
UTHSCSA-Division of Medical Physics Page 41/93 Resident Handbook
ExacTrac (kV) (Form R.3.A)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of the function of the ExacTrac System
Demonstrate an understanding of how are images acquired
Demonstrate an understanding of the image reconstruction
Demonstrate an understanding of ExacTrac QA (Daily, Monthly,
Annual)
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 42/93 Resident Handbook
Total Skin Electron Treatment (Form R.3.B)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of Simulation Measurements / technique
determination
Demonstrate an understanding of Hand calculations for treatment
Demonstrate an understanding of Chart preparation and diagrams
Demonstrate an understanding of Calibration of TSE setting in LINAC
Discuss the rationale of TSET treatments (e.g. malignant and benign
conditions treated with TSET);
Demonstrate an understanding of TSET delivery techniques, issues
related to the clinical commissioning and maintenance of a TSET
program;
Discuss and demonstrate an understanding of the significance of beam
modifiers commonly used during TSET treatments (shields, beam
spoilers);
Participate in all aspects of a TSET treatment (simulation, planning, plan
verification, treatment, treatment verification, and in vivo
measurements). (Recommended but not required)
Demonstrate an understanding of TSE Program
a) Field size determination
b) Field flatness determination, gantry angle matching
c) Relative output determination at the patient plane
d) Dose variation around the periphery of patient/phantom
e) Absolute determination of dose per monitor unit at
patient plane
f) Boost field dose determination
g) Shielding considerations for eyes, nails, top of feet
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 43/93 Resident Handbook
Total Body Radiation Therapy (Form R.3.C)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of Simulation Measurements / technique
determination
Demonstrate an understanding of Hand calculations for treatment
Demonstrate an understanding of Chart preparation and diagrams
Demonstrate an understanding of Calibration of TBI beam
Demonstrate an understanding of TBI prescription and delivery
techniques, issues related to the clinical commissioning and maintenance
of a TBI program;
Discuss and demonstrate an understanding of the significance of beam
modifiers commonly used during TBI treatments (lung/kidney blocks,
beam spoilers);
Participate in all aspects of a TBI treatment (simulation, planning, plan
verification, treatment, treatment verification, and in vivo
measurements). (Recommended but not required)
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 44/93 Resident Handbook
Intensity Modulated Radiation Therapy (IMRT) Planning(Form R.3.D)
Competency Resident
Initials
Mentor
Initials**
Inverse planning
a) Demonstrate an understanding of the use of objective functions for
IMRT optimization;
b) Demonstrate an understanding of the optimization processes involved in
inverse planning;
c) Perform inverse planning optimization for a variety of treatment sites in
sufficient number to become proficient in the optimization process;
d) Demonstrate an understanding of commonly used planning procedures
and guidelines, and optimization and dose calculation algorithms.
IMRT delivery
a) Demonstrate an understanding of various IMRT delivery techniques (e.g.
compensators, static field IMRT, and rotational delivery techniques),
including their relative advantages and disadvantages;
b) Discuss the differences between DMLC and SMLC leaf sequencing
algorithms in terms of delivery parameters and dose distributions;
c) Participate in IMRT delivery for patients with a variety of treatment sites
and demonstrate an understanding of the techniques and requirements
for patient setup, immobilization, and localization.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 45/93 Resident Handbook
Annual Linac QA (Form R.3.E)
Competency Resident
Initials
Mentor
Initials**
Perform and be competent in the mechanical, safety, and radiation tests
required during accelerator acceptance and commissioning;
Demonstrate an understanding of the process for defining the treatment
beam isocenter of a gantry based particle accelerator and its relation to the
gantry’s mechanical isocenter and any on-board imaging isocenters;
Discuss how to perform treatment unit head radiation leakage and
shielding adequacy tests;
Independently setup and perform water tank scans for photon and electron
beam measurements that calibrate and characterize those external beams
to facilitate computerized treatment planning and hand calculations of
radiation dose to a point;
Analyze water tank scans and demonstrate an understanding of the results
from these scans, including typically accepted tolerances for each test
performed;
Demonstrate an understanding of acceptance, commissioning and on-
going annual QA requirements for radiation treatment planning system
modules dealing with external beam treatments.
Demonstrate an understanding and use of the instrumentation (i.e. theory
of operation, limitations) and protocols that may be employed in the
process of calibration of radiation treatment beams of energy in the
megavoltage and kilovoltage range;
Demonstrate an understanding of how and why phantoms are utilized for
physical measurements;
Demonstrate an understanding of the correction factors utilized for photon
and electron calibration measurements;
Perform and be competent in the calibration of megavoltage and
kilovoltage external beams of photons and electrons using a recognized
national or international protocol
Perform and be competent in photon calibration hand calculations;
Perform and be competent in electron particle calibration hand
calculations.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 46/93 Resident Handbook
TG-51 Calibration Checklist (Form R.3.F)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of TG 51 protocol
Calibrate photon and electron beams using TG 51
Discuss and/or demonstrate the following:
a) energy range covered by TG-51
b) standard calibration equation: define each term for photons and
electrons
c) measurement corrections: define Pion, Pelec, Ppol, CTP
d) calibration conditions: field size, SSD, depth of reference
dosimetry
e) specification of beam energy
f) point of measurement: define for cylindrical and parallel chambers
g) How is %DD10x determined for low and high energy photons?
h) How is R50 determined for low and high energy electrons?
i) How do you determine kQ, kecal, k’R50?
j) What is beam quality Qecal?
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 47/93 Resident Handbook
Informatics (Form R.3.G)
Topics Resident
Initials
Mentor
Initials**
Beam data acquisition/management
Beam modeling
Treatment planning algorithms
Validation of imported images
PACS systems and their integration
HL7
DICOM standards
DICOM in radiation therapy (DICOM-RT)
Information acquisition from PACS/images o Quality/maintenance of
imaging workstations
Evaluation of viewing conditions
Image registration, fusion, segmentation, processing
Quantitative analysis
Record and verify systems
Treatment record design/maintenance
IHE – Radiation Oncology (IHE-RO)
Network integration/management, and roles of physics and information
technology staff
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 48/93 Resident Handbook
Clinical Rotation 4 Schedule and Objectives
Chief Mentor: (Year 1, Apr-Jun)
Objectives Master Checklist
Activity
LDR planning.
Eye plaque process
Patient Safety
Learn shielding techniques for CT, kV imaging, LINAC and isotopes.
References: i. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21, Issue 4) (1994) Radiation
Therapy Committee Task Group #40. 37 pp.
ii. AAPM Code of Practice for Radiotherapy Accelerators (Reprinted from Medical Physics, Vol. 21, Issue 7) (1994)
Radiation Therapy Committee Task Group #45. Report #47.
iii. High dose rate brachytherapy treatment delivery. Med Phys, Vol. 25, Issue 4 (1998). Radiation therapy committee
task group #59. Report #61.
iv. Dosimetry of 125I and 103Pd COMS eye plaques for intraocular tumors: Report of Task Group 129 by the AAPM
and ABS Medical Physics, Volume 39, Issue 10
v. Niemierko A. Reporting and analyzing dose distributions: A concept of equivalent uniform dose. Med Phys. 24,
103-110 (1997).
vi. Wu Q, Mohan R, Niemierko A, and Schmidt-Ullrich R. Optimization of intensity modulated radiotherapy plans
based on the equivalent uniform dose. Int J Radiat Oncol Biol Phys. 52:224-235; 2002
vii. Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group: Third-party brachytherapy
source calibrations and physicist responsibilities Medical Physics, Vol 35, Issue 9
viii. Hall, Eric J. Radiobiology for the radiologist.
ix. UTHSCSA tissue tolerance planning guidelines for SBRT
x. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N. Int J Radiat Oncol Biol Phys. 2000 May
1;47(2):291-8. PMID: 10802351 [PubMed - indexed for MEDLINE]
xi. RTOG 90-05: the real conclusion. Buatti JM, Friedman WA, Meeks SL, Bova FJ. Int J Radiat Oncol Biol Phys.
2000 May 1;47(2):269-71.
xii. A dosimetric uncertainty analysis for photon-emitting brachytherapy sources: Report of AAPM Task Group No. 138
and GEC-ESTRO Medical Physics, Vol 38, Issue 2
xiii. QUANTEC data for radiation does tolerances
xiv. Neutron Measurements Around High Energy X-Ray Radiotherapy Machines (1986) Radiation Therapy Committee
Task Group #27; 34 pp.
xv. NCRP 49: Structural Shielding Design and Evaluation for Medical Use of X-rays and Gamma Rays of Energies up
to 10 MeV
xvi. NCRP 51: Radiation Protection Design Guidelines for 0.10 MeV Particle Accelerator Facilities
xvii. NCRP 79: Neutron Contamination from Medical Electron Accelerators
xviii. NCRP 102: Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment
Design, Performance and Use (Supersedes NCRP Report No. 33)
xix. NCRP 147: Structural Shielding Design for Medical X-Ray Imaging Facilities
xx. NCRP 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy
Facilities
xxi. Shielding Techniques for Radiation Oncology Facilities. Patton H. McGinley.
xxii. Fetal Dose from Radiotherapy with Photon Beams (Reprinted from Medical Physics, Vol. 22, Issue 1) (1995)
Radiation Therapy Committee Task Group #36.
xxiii. NRC Regualtory Guide 8.13, "Instructions Concerning Prenatal Radiation Exposure"
xxiv. Management of Radiation Oncology Patients with Implanted Cardiac Pacemakers(Reprinted from Medical Physics,
Vol. 21, Issue 1) (1994) Task Group #34; 6 pp. Also be aware of ERRATUM published by Stovall, et al., Med Phys
22(8), August 1995.
xxv. Dosimetric considerations for patients with hip prostheses undergoing pelvic irradiation. Med Phys Volume 30, Issue
6, (2003). Radiation therapy task group committee #63.
UTHSCSA-Division of Medical Physics Page 49/93 Resident Handbook
Normal Tissue Tolerance Checklist (Form R.4.A) (cont’from Rotation 2 and 3)
Topic Resident
Initials
Mentor
Initials**
Retina, optic nerves, chiasm and lens: fractionated and single dose
Brain: fractionated
Brainstem: single dose
Spinal cord: fractionated and single dose
Parotid: fractionated
Lung: fractionated
Kidney: fractionated
Small bowel: fractionated
Large bowel: fractionated
Heart: fractionated
Liver: fractionated
Bladder: fractionated
Rectum: fractionated, prostate implant
Urethra: prostate implant
Femoral Head: fractionated
Skin: fractionated
Lyman-Kutcher model for calculation of NTCP
Definition and understanding of gEUD
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are
scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have
demonstrated adequate knowledge of the topic
UTHSCSA-Division of Medical Physics Page 50/93 Resident Handbook
PINNACLE Treatment Planning Cases Checklist (Form R.4.B) (cont’from Rotation 2 and 3)
Topic Resident
Initials
Mentor
Initials**
Irregular Fields
Lung 3D
Pelvis 3D
Pancreas 3D
Brain 3D
Larynx 3D
GYN 3D
Abdomen (seminoma)
Prostate 3D
Breast 3D
Lung IMRT
Pelvis IMRT
Pancreas IMRT
Brain IMRT
Larynx IMRT
GYN IMRT
Prostate IMRT
Breast IMRT
Electron fields
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 51/93 Resident Handbook
Low Dose Rate (LDR) Brachytherapy Checklist (Form R.4.C)
Competency Resident
Initials
Mentor
Initials**
Discuss the program requirements for control of radioactive material,
isotope room layout, logout-login procedures for Cs-137, Ir-192, I-131
Demonstrate an understanding of TG-43 formalism and update
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate knowledge
of the topic
UTHSCSA-Division of Medical Physics Page 52/93 Resident Handbook
Radiation Protection Checklist (Form R.4.D)
Competency Resident
Initials
Mentor
Initials**
Megavoltage photons (linear accelerators and/or cobalt-60 units) and
electrons, kilovoltage, superficial x-rays, and/or protons
Demonstrate an understanding of the Nuclear Regulatory Commission (NRC)
and/or state licensing (by-product materials and x-ray producing devices);
Explain the principles behind a radiation protection program, including the
rationale for the dose limits for radiation workers and members of the general
public;
Demonstrate an understanding of NRC and/or state, local, and institutional
regulatory requirements;
Explain the ALARA (As low as reasonably achievable) concept;
Demonstrate an understanding of site planning and how to supervise
construction (key elements to monitor);
Demonstrate an understanding of structural shielding designs for a radiotherapy
department (e.g. NCRP 151) and discuss the key parameters necessary to
perform a shielding calculation;
Perform shielding calculations for an accelerator vault. Calculations should
include primary and secondary barrier transmission calculations;
Discuss the shielding requirements for the maze and door of a high energy
room;
Perform radiation survey of a facility including low energy (4–6 MV) and high
energy (15–25 MV) units;
Discuss advantages and disadvantages of various materials that may be used for
shielding;
Discuss how special procedures such as TBI and SBRT may impact shielding
parameters.
IMRT
Demonstrate understanding of effects of IMRT delivery on leakage radiation
and its potential effects on patients and personnel exposure;
Demonstrate understanding of the effects of different IMRT delivery techniques
on the amount of leakage radiation produced;
Demonstrate understanding of effects of IMRT delivery on vault shielding
requirements.
Conventional Simulator (Radiographic/Fluoroscopic)
Demonstrate an understanding of state licensing (x-ray producing devices);
Explain the principles behind a radiation protection program, including the
rationale for the dose limits for radiation workers and members of the general
public;
Discuss the key parameters necessary to perform a shielding calculation;
Demonstrate an understanding of structural shielding designs for a conventional
simulator and perform a shielding calculation (walls, ceilings, floor, and control
area);
Demonstrate an understanding of film processing and darkroom design.
CT Simulator
Demonstrate an understanding of state licensing (x-ray producing devices);
UTHSCSA-Division of Medical Physics Page 53/93 Resident Handbook
Explain the principles behind a radiation protection program, including the
rationale for the dose limits for radiation workers and members of the general
public;
Discuss the key parameters necessary to perform a shielding calculation;
Discuss the significance of an isodose distribution plot for the CT simulator;
Demonstrate an understanding of structural shielding designs for a CT
simulator and perform a shielding calculation (walls, ceilings, floor, and control
area);
Demonstrate an understanding of film processing and darkroom design.
Brachytherapy
Demonstrate an understanding of shielding calculations for primary and
secondary barriers (i.e. NCRP 151);
Discuss the key parameters necessary to perform a shielding calculation;
Discuss and/or perform a shielding calculation for a brachytherapy vault;
Discuss and/or perform a radiation survey for a brachytherapy vault;
Discuss requirements for personal radiation safety badges;
Discuss labeling, shipping, and receiving requirements for radioactive material;
Discuss management of isotope inventory;
Discuss patient-release criteria for radioactive patients (i.e. patients with
temporary or permanent implants and radiopharmaceuticals);
Discuss how to handle changes in medical status for radioactive patients (i.e.
medical emergency or death, NCRP 155);
Explain the key concepts of Title 10 of the Code of Federal Regulations parts
19, 20, and 35;
Demonstrate how to safely operate a remote afterloader unit, including
emergency procedures.
Regulations/recommendations/licensing
Demonstrate an understanding of Nuclear Regulatory Commission (NRC)
and/or state licensing (by-product materials and x-ray producing devices);
Demonstrate an understanding of the appropriate regulations for radiation
protection and dose limits for radiation workers and members of the general
public;
Demonstrate an understanding of NRC and/or state, local, and institutional
regulatory requirements;
Explain the ALARA (As low as reasonably achievable) concept;
Discuss the role and significance of the Joint Commission;
Discuss the role and responsibility of a radiation safety committee;
Discuss the role and responsibility of a radiation safety officer;
Discuss the significance of ACR, ASTRO, and AAPM recommendations;
Demonstrate an understanding of release of patients (with sealed or unsealed
sources).
Survey meters (ionization chamber, Geiger Müller (GM), scintillation)
Discuss the operation and appropriateness of different survey instruments (i.e.
Geiger-Muller counter, ionization survey meters, and scintillation counter);
Performs battery and constancy checks. Understands the allowable deviation
from baseline reading;
Understands how a survey meter is calibrated, who may calibrate a meter (i.e.
ionization versus GM) and the required frequency of calibration;
Personnel monitoring
UTHSCSA-Division of Medical Physics Page 54/93 Resident Handbook
Demonstrates an understanding of the physical mechanisms involved in the
process of radiation detection and readout of personnel monitors (film, TLD,
and OSLD).
Understands the rationale for occupational dose limits and the federal/state
limits;
Understands the definition of a “declared pregnant woman”;
Understands the federal/state personnel monitoring requirement;
Understands the rationale for ALARA investigation levels;
Understands the role and responsibility of physics in developing a radiation
safety culture;
Understands the requirements for providing personnel monitoring reports to
staff;
Reviews and discusses the results of personnel monitoring reports.
Guidelines and instructions for personnel
Understands the roles and responsibilities of a radiation worker (i.e. NRC Form
3).
Understands the requirements and frequency of radiation safety refreshers for
staff;
Understands the personnel radiation safety hazards specific to the uses of
radiation in a therapeutic setting (e.g. linear accelerator, brachytherapy,
radioisotope handling);
Demonstrates the ability to tailor a radiation safety training program for the
intended audience (e.g. physicists, therapists, dosimetrists, nurses, physicians,
physician residents, students, and maintenance staff).
Hazards of low levels of radiation
Understands the linear no-threshold (LNT) hypothesis, its origins and
limitations;
Understands the collective dose theory as it applies to large populations;
Understands the potential biological effects associated with prolonged exposure
to low levels of radiation;
Knows the major natural sources of background radiation;
Knows the major man-made sources of background radiation.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 55/93 Resident Handbook
Patient Safety (Form R.4.E)
Competency Resident
Initials
Mentor
Initials**
General
Understand the principles behind the development of a general patient and staff
safety management program within the hospital;
Discuss the physicist’s role in developing and overseeing an overall quality
assurance program both for equipment and for procedures, including a discussion of
allocation and management of resources necessary to carry out these tasks,
incorporation of tools and techniques, and inclusion of various groups within the
structure of the radiation oncology department;
Discuss the principles and rationale of the Joint Commission Universal Protocol and
discuss the use of pre-procedure verification and time-outs for the prevention of
treatment errors;
Discuss the implementation of a continuous quality improvement (CQI) program,
including the use of both internal review and external audits/peer review for the
assurance of high quality care;
Discuss the concept of a Failure Mode and Effect Analysis (FMEA), how to design
and implement an FMEA, and how to use the results for error prevention
minimization of risks to patients and staff;
Discuss charting systems for prescription, delivery, and recording of treatment
information, standardization of such systems, and the use of such systems within a
record and verify / electronic medical record system;
Discuss mechanisms for independent checking of treatment information.
Equipment
Discuss the implementation of an effective set of equipment operating procedures
including preventative maintenance and repair, maintenance and repair records,
emergency procedures, and systematic inspection of interlock systems;
Discuss the development of a program to prevent mechanical injury by the machine
or accessory equipment, including the need for visual and audio contact with the
patient while under treatment;
Understand potential patient safety hazards related to the use of blocks, block trays,
wedges, and other ancillary treatment devices and accessories and mechanisms to
minimize these risks;
Understand potential patient safety hazards related to patient support and
immobilization systems and mechanisms to minimize these risks;
Understand the potential patient safety hazards with respect to potential gantry–
patient collision and mechanisms to minimize this risk.
Other Patient/Staff Safety Issues
Understand potential electrical hazards to patients and staff;
Understand potential hazards of strong magnetic fields to patients and staff;
Understand the mechanisms of ozone production and potential hazards to patients
and staff;
Understand potential hazards to patients and staff from the use of cerrobend.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 56/93 Resident Handbook
Clinical Rotation 5 Schedule and Objectives
Chief Mentor: (Year 2, July-Sept)
Objectives Master Checklist
Activity
Treatment plan checks.
Brachytherapy
Eye Plaque
Weekly Chart Checks.
LINAC Design.
Assume primary oversight of all QA, operations and service activities on Novalis. The resident
shall not make any adjustments to their LINAC without faculty supervision.
References i. Quality Assurance for Clinical Radiotherapy Treatment Planning (Reprinted from Medical Physics, Vol. 25,
Issue 10) (1998) Radiation Therapy Committee Task Group #53; 57 pp.
ii. Bortfeld T et al, X-ray field compensation with multileaf collimators. Int J Radiat Oncol Biol Phys. 28(3):723-
30, 1994.
iii. Bortfeld T et al, Realization and verification of three-dimensional conformal radiotherapy with modulated
fields. Int J Radiat Oncol Biol Phys. 30(4):899-908, 1994.
iv. Ezzell G et. al., Guidance document on delivery, treatment planning, and clinical implementation of IMRT:
Report of the IMRT subcommittee of the AAPM radiation therapy committee, Med. Phys. 30(8):2089-2115,
2003.
v. S Webb, Intensity Modulated Radiotherapy, Institute of Physics Publishing, 2001.
vi. Intensity Modulated Radiation Therapy, A Clinical Perspective, Mundt AJ and Roeske JC Eds. BD Decker Inc,
2005.
vii. Intensity Modulated Radiation Therapy Collaborative Working Group, Intensity- Modulates Radiotherapy:
Current Status and Issues of Interest, Int. J. Radiation Oncology Biol. Phys., 51(4): 880–914, 2001.
viii. Philips Pinnacle3 P3IMRT Instructions for Use.
ix. High dose rate brachytherapy treatment delivery. Med Phys, Vol. 25, Issue 4 (1998). Radiation therapy
committee task group #59. Report #61.
x. A primer on theory and operation of linear accelerators in radiation therapy. 2nd ed., Karzmark and Morton,
Medical Physics Publishing, 1998.
UTHSCSA-Division of Medical Physics Page 57/93 Resident Handbook
LINAC Design and Function Checklist (Form R.5.A)
Competency Resident
Initials
Mentor
Initials**
LINAC Design: discuss schematic of major components
Klystrons and Magnetrons
Circulator
Waveguide
Modulator
Accelerator structure: Standing wave, traveling wave
Buncher and side couple cavities
Bending magnet
Treatment head: primary collimator, monitor chamber, flattening filter,
jaws, MLCs, electron foils, x-ray target
Electron gun
Mechanism for energy change: photons and electrons
Mechanism for dose rate change
Mechanism for change between photon and electron mode
Can you identify a picture of all components above
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 58/93 Resident Handbook
Treatment plan and patient chart checks (Form R.5.B)
Competency Resident
Initials
Mentor
Initials**
Perform treatment plan verification including:
Review of patient history (including prior radiotherapy and potential overlap
with current treatment), disease, course of treatment, and dose prescription;
Review of appropriateness of treatment plan and dose distribution to achieve
goals of treatment course;
Review of simulation (e.g. patient positioning and immobilization), planning,
imaging, and treatment field parameters;
Review of monitor unit or time calculations;
Review of images to be used for patient positioning and/or monitoring;
Review of transfer of plan parameters and images to record and verify system
and any other patient monitoring systems.
Perform ongoing review of treatment records (chart checks) including
verification of delivered treatments;
Perform ongoing review of patient imaging and/or tracking using:
a) Film
b) Electronic portal imaging device (EPID)
c) Real time planar imaging
d) Cone beam CT (CBCT)
e) Ultrasound (US)
f) External fiducial and/or surface tracking
g) Internal radiofrequency beacon tracking
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 59/93 Resident Handbook
Brachytherapy Checklist (Form R.5.C)
Competency Resident
Initials
Mentor
Initials**
SOURCES
Sealed Radionuclide Sources
Demonstrate an understanding of how commonly used sources are
generated;
Discuss the decay, decay energies (mean energy), and half-life of
commonly used sources;
Discuss the form and construction of sealed sources;
Discuss and define the different units of source strength that have been
used, past and present;
Perform a decay calculation, total dose delivered for temporary and
permanent implants;
Discuss personal protection techniques (time, distance, and shielding) and
safe handling of sealed sources;
Discuss the appropriate methods of storage of radioactive material
(security and accountability);
Perform routine receipt procedure and check-out and check-in temporary
and permanent sources into inventory;
Perform a source room survey and quarterly inventory;
Discuss and/or perform leak checks on sealed sources;
Demonstrate an understanding of and gain hands-on experience of
radioactive material packaging and transportation (Title 49 of the Code of
Federal Regulations);
Demonstrate an understanding of the equipment used to calibrate sealed
sources;
Discuss the process by which sealed sources are calibrated;
Discuss the process by which measurement equipment (i.e. electrometers,
well ionization chambers) is calibrated;
Explain the theory of operation of a well ionization chamber;
Discuss and/or perform an assay for sealed sources;
Demonstrate an understanding of licensing issues and requirements (i.e.
NUREG 1556);
Discuss the operation and appropriateness of different survey instruments
(i.e. Geiger-Muller counter, ionization survey meters, and scintillation
counter);
Demonstrate an understanding of the regulatory requirements for sealed
sources (i.e. state regulations or 10 CFR 35).
Unsealed radionuclide sources
Demonstrate an understanding of how commonly used
radiopharmaceuticals (i.e. I-131, P-32, Sm-153, Sr-89) are generated;
Demonstrate an understanding of the decay, decay energies (mean energy),
and half- life of commonly used radiopharmaceuticals;
Discuss personal protection techniques (time, distance, and shielding) and
safe handling of unsealed sources;
Discuss the process by which unsealed sources are calibrated;
Discuss the process by which measurement equipment (i.e. dose
calibrator) is calibrated;
UTHSCSA-Division of Medical Physics Page 60/93 Resident Handbook
Discuss and if possible, perform an assay for unsealed sources;
Demonstrate an understanding of licensing issues and requirements (i.e.
NUREG 1556);
Discuss the operation and appropriateness of different survey instruments
(i.e. Geiger-Muller counter, ionization chamber, and scintillation counter);
Demonstrate an understanding of the regulatory requirements for unsealed
sources (i.e. state regulations or 10 CFR 35);
CLINICAL APPLICATIONS
Discuss the various brachytherapy sources that have been used, past and
present, clinically. Discuss the rationale for source selection.
Discuss the how a brachytherapy program is developed.
Discuss in detail the use and operation of different brachytherapy
modalities, including their advantages and disadvantages.
Low dose-rate (LDR)
High dose-rate (HDR)
Pulsed dose-rate (PDR) (optional)
Electronic
Discuss and perform source strength (Air Kerma Rate, Sk) verification and
comparison between measured and vendor’s specification;
Discuss radiation protection for radiation workers and visitors;
Demonstrate an understanding of commissioning and acceptance of
Remote After Loaders (RAL);
Demonstrate an understanding of GYN and GU anatomy;
Demonstrate an understanding of the treatment of cervical and endometrial
cancer with LDR, HDR, and PDR (recommended);
Demonstrate an understanding of prostate cancer and the treatment with
HDR and LDR;
Treatment planning
Perform brachytherapy treatment plans for a cylindrical applicator;
Perform brachytherapy treatment plans for a cervical applicator (e.g.
tandem and ovoids, tandem and ring);
Discuss the differences between point and volume based treatment
planning (ICRU 38 and the GEC ESTRO recommendations);
Perform interstitial brachytherapy treatment plans (e.g. prostate,
gynecologic, sarcoma);
Perform a brachytherapy treatment plan for an eye plaque (Recommended
but not required);
Perform a brachytherapy treatment plan for microsphere therapy
(Recommended but not required).
Demonstrate an understanding of applicator acceptance, commissioning,
and performance of periodic quality assurance;
Demonstrate an understanding and performance of daily QA;
Describe emergency training requirements (10CFR35);
Demonstrate an understanding of Quality Management Program (QMP) as
required by the federal/state for auditing;
Discuss the criteria and subsequent handling of recordable and reportable
events.
UTHSCSA-Division of Medical Physics Page 61/93 Resident Handbook
IMAGING
Demonstrate an understanding of the mathematics of localization of target
volume and catheter reconstruction by orthogonal films (2D);
Demonstrate an understanding of CT/MRI/US/PET based localization of
Region of Interests (ROIs) and catheter reconstruction.
TREATMENT PLANNING
Demonstrate an understanding of source strength of radioactive sources;
Discuss dose rates and dose calculation formalisms (HEBD, LEBD);
Demonstrate an understanding of the performance of computerized
planning of various imaging modalities of LDR and HDR;
Discuss in details the advantages and disadvantages of dose optimizations;
Discuss and perform secondary calculations as a QA check for
computerized planning.
Demonstrate an understanding testing of new sealed sources
Discuss the calibration check of new sealed sources
Discuss the calibration check of well chambers
Discuss the elongation factor determination for well chambers (LDR
Ir-192)
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 62/93 Resident Handbook
COMS Eye Plaque Applicator Checklist (Form R.5.D)
Competency Resident
Initials
Mentor
Initials**
Demonstrate an understanding of seed strength determination
Process for ordering seeds
Demonstrate re-planning using actual seed strength
Source logging and calibration
Perform Implant preparation including gathering of required
equipment
Demonstrate an understanding of eye plaque sterilization procedure
Participate in all OR activities for an eye plaque
Perform the Recovery room Radiation Protection survey and
documentation
Discuss the home radiation precautions or hospital room precautions
Participate in OR applicator removal procedures
Perform Post implant Radiation protection survey of OR
Discuss End of implant duties, source inventory, seed removal from
plaque
Demonstrate an understanding of proper disposal of seeds
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are
scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have
demonstrated adequate knowledge of the topic
UTHSCSA-Division of Medical Physics Page 63/93 Resident Handbook
Clinical Rotation 6 Schedule and Objectives
Chief Mentor: (Year 2, Oct-Dec)
Objectives Master Checklist
Activity
Stereotactic Treatment Planning Concepts
Stereotactic Quality Assurance
Daily
Monthly
Annual
Participate in all aspects of SBRT treatment
Treatment planning QA.
References i. Quality Assurance for Clinical Radiotherapy Treatment Planning (Reprinted from Medical Physics, Vol.
25, Issue 10) (1998) Radiation Therapy Committee Task Group #53; 57 pp
ii. Stereotactic body radiation therapy: The report of AAPM Task Group 101 (2010) Treatment Delivery
Subcommittee Task Group #101 Med. Phys. 37 (8)
iii. Stereotactic Radiosurgery. http://aapm.org/pubs/reports/RPT_54.pdf
iv. Novalis, and Eclipse manuals as needed.
UTHSCSA-Division of Medical Physics Page 64/93 Resident Handbook
Stereotactic Body Radiation Therapy Checklist (Form R.6.A)
Competency Resident
Initials
Mentor
Initials**
Participate in shaping of Body Frame immobilization device
Demonstrate an understanding of various mechanisms monitoring
respiratory motion
Demonstrate an understanding of various mechanisms for respiratory
motion mitigation
Participate in 4D CT image acquisition
Perform retrospective binning of 4D CT data
Generate MIP images and transfer to treatment planning computer
Participate in SBRT treatment planning
Demonstrate an understanding of mechanisms of SBRT localization at the
linac
Participate in cone-beam CT patient setup
Participate in SBRT patient treatments
Discuss the rationale for SBRT treatments, what are the common treatment
sites, and typical dose and fractionation schemes;
Discuss immobilization and localization systems for SBRT treatments;
Discuss use of simulation imaging for SBRT target definition, including
multi-modality imaging and 4D imaging for cases requiring motion
management;
Discuss treatment planning objectives for SBRT treatments, including
OAR dose limits, dose heterogeneity, dose gradient and fall-off, and beam
geometry;
Discuss treatment verification and delivery for SBRT treatments, and use
of in-room imaging.
Discuss TPS validation tests including tissue inhomogeneity corrections
and small-field dosimetry measurements.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 65/93 Resident Handbook
Stereotactic Radiosurgery Checklist (Form R.6.B)
Competency Resident
Initials
Mentor
Initials**
Participate in shaping of SRS mask
Discuss fluoro-guided motion assessment
Participate in CT image acquisition
Import of imaging sets to Treatment planning system
Perform fusion of image sets
Participate in SRS treatment planning
Understand mechanisms of SRS localization at the linac
Participate in ExacTrac patient setup
Participate in SRS patient treatments
Discuss rationale of SRS treatments, examples of malignant and non-
malignant lesions treated with SRS, and typical dose and fractionation
schemes for linac-based and Co-60 SRS techniques;
Describe, in general, the components of commissioning for an SRS
system (accurate localization, mechanical precision, accurate and optimal
dose distribution, and patient safety);
Discuss the stereotactic localization of a target (i.e. from angiography
versus CT and MRI) and how the accuracy of this localization is
measured;
Describe the alignment of coordinate systems (i.e. target frame of
reference to linac frame of reference) and how the mechanical precision of
this alignment is measured;
Describe issues associated with dosimetry measurements for an SRS
system (i.e. choice of dosimeter, phantom geometry, etc.);
Describe the components of pre-treatment QA for an SRS system,
including linac-based and Co-60 SRS techniques.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 66/93 Resident Handbook
Stereotactic Radiosurgery Checklist (Form R.6.C)
Topic Resident
Initials
Mentor
Initials**
Simple spherical targets (cones)
Non-spherical targets (microMLC)
Multiple targets
Arteriovenous Malformations (AVM)
Trigeminal Neuralgia
Image fusion
Monitor Unit Calculations
Physics
Scatter Factor Measurements (cone and mlc)
TMR measurements
OAR measurements
Isocentric accuracy (Winston-Lutz)
Targeting accuracy (image guidance)
Daily QA
Monthly QA
Annual QA
Imaging
CT scanner accuracy
MR scanner accuracy
Angiographic localizer accuracy
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 67/93 Resident Handbook
Treatment planning system QA (Form R.6.D)
Competency Resident
Initials
Mentor
Initials**
Data acquisition
Explain the connection between linac commissioning and the data required
for operation of a treatment planning system;
For a particular treatment planning system, describe the required linac data
needed for:
i. Photon beams
ii. Electron beams
iii. IMRT and VMAT
Acceptance testing
Describe what tests of the treatment planning system need to be performed
before patient specific planning can commence for:
iv. Photon beams
v. Electron beams
vi. Brachytherapy sources
Quality assurance
Describe the accuracy of the above tests that need to be performed
Describe accuracy checks for input devices:
vii. Digitizers
viii. Film scanners
ix. Imported images from CT scanners, MRI scanners, etc., and PACs
systems
Describe accuracy checks for output devices:
x. Printers
xi. Record and verify systems
xii. DICOM output
Computer algorithms (models)
Describe how the computer algorithm calculates dose for at least one major
treatment-planning system for:
xiii. Photon beams
xiv. Electron beams
xv. Brachytherapy calculations
xvi. Proton beams (optional)
Describe the advantages and disadvantages of the various treatment-
planning calculation algorithms;
Describe how the computer algorithm determines the number of monitor
units per beam or segment (for step-and-shoot IMRT).
Plan Normalization
Describe the numerous normalization capabilities available on a treatment
planning system;
Describe how different normalization schemes affect final isodose curve
representation;
Describe how the computer plan normalization relates to the calculation of
monitor units for patient treatments.
Inhomogeneity (heterogeneity) corrections
UTHSCSA-Division of Medical Physics Page 68/93 Resident Handbook
Describe the type of data that needs to be taken on a CT scanner in
preparation for treatment-planning using inhomogeneous material;
Describe how this CT data is converted into inhomogeneity data usable in a
treatment planning system;
Describe how computerized treatments planning system takes
inhomogeneities into account;
Describe where the computer algorithm calculates dose with acceptable
accuracy and in what regions the calculational accuracy is suspect;
Describe how you would check the accuracy of the inhomogeneity
corrections performed by a treatment planning system.
Beam modeling
Completely model at least one photon beam energy for a treatment planning
system;
Completely model at least one electron beam energy for a treatment
planning system;
Completely model at least one proton beam energy for a treatment planning
system (optional);
Test the accuracy of your modeling for the beams and be able to describe
the criteria for acceptability of the modeling.
Imaging tests
Describe to tests that you would perform to ensure that the imported image
data is correct;
Demonstrate that you can import images from CT, MR, and PET or
PET/CT scanners;
Demonstrate the you can accurately fuse the above imaging sets with the
primary treatment planning image set;
Describe the different image fusion algorithms available on a treatment-
planning system and which method is most accurate for which fusions (i.e.
CT-CT, CT-MR, CT-PET) and why.
Secondary monitor unit check computer programs
Describe what input data needs to be acquired;
Describe the checks of that input data that need to be performed to ensure
that the monitor unit check program is working correctly
Describe how imported data from treatment-planning systems is handled in
a monitor unit check program;
Describe how the monitor unit check program calculates the number of
monitor units for off central-axis normalization points;
Describe how the monitor units check program calculates monitor units for
treatments involving inhomogeneous material.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
UTHSCSA-Division of Medical Physics Page 69/93 Resident Handbook
Clinical Rotation 7 Schedule and Objectives
Chief Mentor: (Year 2, Jan-Mar)
Objectives Master Checklist
Activity
Dosimetry Rotation (6-8weeks)
Imaging
Acceptance and Commissioning of Major equipment
References
i. The Essential Physics of Medical Imaging. Second Edition. Bushberg 2002.
ii. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21,
Issue 4). Radiation Therapy Committee Task Group #40
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Imaging List (Form R.7.A)
Competency Resident
Initials
Mentor
Initials**
Magnetic Resonance Imaging (MRI)
General
Demonstrate an understanding of the basic imaging principles behind MRI;
Discuss the advantages and limitations of MRI versus CT for treatment planning;
Demonstrate an understanding of the role of MRI for radiation therapy applications,
providing examples.
Quality Assurance
Demonstrate an understanding of the quality assurance processes and frequencies for
MR-simulators, e.g., image quality, image integrity, safety and mechanical checks,
and network connectivity.
Ultrasound (US)
General
Demonstrate an understanding of the basic imaging principle behind US imaging;
Demonstrate an understanding of the role of US for external beam and
brachytherapy treatments using trans-rectal versus trans-abdominal probes,
providing examples.
Quality Assurance
Discuss methods for QA of US imaging probes prior to clinical use, i.e., prostate
implants, prostate external beam therapy.
Positron Emission Tomography (PET)
General
Demonstrate an understanding of the basic imaging principles behind PET;
Discuss the advantages and limitations of PET versus CT for treatment planning;
Demonstrate an understanding of the role of PET for radiation therapy applications,
providing examples.
Quality Assurance
Demonstrate an understanding of the quality assurance processes and frequencies for
PET-CT simulators (e.g., image quality, image integrity, safety and mechanical
checks, and network connectivity).
SPECT
General
Demonstrate an understanding of the basic imaging principles behind SPECT;
Discuss the advantages and limitations of SPECT versus CT for treatment planning;
Demonstrate an understanding of the role of SPECT for external beam and
radiopharmaceutical therapy applications, providing examples.
Quality Assurance
Demonstrate an understanding of the quality assurance processes and frequencies for
SPECT-CT simulators (e.g., image quality, image integrity, safety and mechanical
checks, and network connectivity).
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
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Linac Selection/Acceptance/Commissioning (Form R.7.B)
Competency Resident
Initials
Mentor
Initials**
Selection
Demonstrate an understanding of the theory of operation of megavoltage
electron and proton accelerators currently used in radiation oncology treatment
and their limitations (e.g. linac, synchrotrons, cyclotrons);
Demonstrate an understanding of the theory of operation of kilovoltage x-ray
treatment units currently used in radiation oncology treatment;
Demonstrate an understanding of the major subsystems and use of cobalt units;
Demonstrate an understanding of the major subsystems and components of
megavoltage accelerators;
Review the steps required to select a new electron linear accelerator (linac) for
use in radiation oncology - performance specification and feature comparison;
Review and demonstrate an understanding of the development process for a
Request For Proposal (RFP) aimed at vendors of a linac or other major radiation
treatment unit;
Review and discuss mechanical/architectural considerations when installing a
new particle accelerator in both a new vault and an existing vault (including
discussion on HVAC openings, cabling for communication and dosimetry
systems, electric ports, plumbing and skyshine);
Acceptance/commissioning
Perform and be competent in the mechanical, safety, and radiation tests required
during accelerator acceptance and commissioning;
Demonstrate an understanding of the process for defining the treatment beam
isocenter of a gantry based particle accelerator and its relation to the gantry’s
mechanical isocenter and any on-board imaging isocenters;
Discuss how to perform treatment unit head radiation leakage and shielding
adequacy tests;
Independently setup and perform water tank scans for photon and electron beam
measurements that calibrate and characterize those external beams to facilitate
computerized treatment planning and hand calculations of radiation dose to a
point;
Analyze water tank scans and demonstrate an understanding of the results from
these scans, including typically accepted tolerances for each test performed;
Demonstrate an understanding of acceptance, commissioning and on-going
annual QA requirements for radiation treatment planning system modules
dealing with external beam treatments.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________ **A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
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CT simulator Selection/Acceptance/Commissioning (Form R.7.C)
Competency Resident
Initials
Mentor
Initials**
Selection
Review the steps required to select a new CT simulator - performance
specification and feature comparison;
Review and demonstrate an understanding of the process to develop a Request
For Proposal (RFP) for a CT simulator;
Review and understand the mechanical/architectural considerations when
installing a new CT simulator in both a new room and an existing room.
Acceptance testing
Demonstrate an understanding of the mechanical tests performed during a CT
simulator acceptance procedure;
Demonstrate an understanding of the tests of image quality and characteristics
for a CT image and digitally reconstructed radiograph for a CT simulator;
Demonstrate an understanding of the measurement of dose and CTDIs from a
CT simulator for different body sites;
Demonstrate an understanding of the measurement of CT number versus
density calibration with kVp and its use in treatment planning systems;
Demonstrate an understanding of the alignment of internal and external laser
systems for a CT simulator;
Demonstrate an understanding of network connectivity tests between other
systems used in the radiation oncology process (e.g. treatment planning
systems, treatment verification systems, and PACS);
Demonstrate an understanding of the validation tests for transfer of CT imaged
objects to treatment planning systems.
Dose calculations
Understand the physical basis of the use of CT-simulator images in treatment
planning as the current standard for dose calculations and the calibration of
these images for use in computing radiation dose deposition in different tissues.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a
Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate
knowledge of the topic
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Clinical Rotation 8 Schedule and Objectives
Chief Mentor: (Year 2, Apr-Jun)
Note: the comprehensive oral exam should be completed in the first month to allow time for
catch up in areas of weakness.
The resident shall:
1. Complete a final oral exam. The final oral exam will be comprehensive and structured
similar to an ABR oral exam.
2. Complete any unfinished topics/check sheets. All objectives need to be completed to
receive a certificate of completion for this residency.
3. Contribute to clinical service as guided by the Program Director. A resident should be
capable of performing all the tasks of a clinical medical physicist with little supervision by
the end of rotation #8.
Faculty: ______________________________________________ Date
Resident: _____________________________________________ Date
Comments:______________________________________________________________________
_________________________________________________________________
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2.1 DESCRIPTION OF EDUCATIONAL EXPERIENCE
2.1.A: Research Experience
Residents are encouraged to participate in clinical research. There are several areas of research in
which the medical physics group is engaged, including: image guided delivery techniques, IMRT
optimization, radio-biological optimization and scoring, novel QA techniques, Monte Carlo
simulation.
2.1.B: Facilities
The residents have access to a several laboratories including: (1) a dosimetry instrumentation lab in
the physics research area; (2) a brachytherapy lab in the Brachytherapy Suite; and (3) other research
labs and offices in the Clinical Science Research Building. In all, the availability of dosimetry and
clinical treatment areas and equipment is more than adequate to serve the needs of the residency
training program. Procedures are in place that (1) allow the resident reasonable access time to clinical
equipment, (2) provide residents sufficient training and technical support to ensure safe and proper
use of equipment, and (3) to ensure equipment is left in the proper state for clinical use.
Treatment planning and external beam delivery equipment utilized in the training program include
4 Varian LINACs, 1 Novalis Tx unit, 2 GE 4D CT-simulators (16-slice and 4-slice large bore
scanners), 15 PINNACLE TP workstations, 1 Varian Eclipse workstation, iPlan workstation.
Specialized equipment includes DMLC-IMRT delivery, linac-based stereotactic radio-
surgery/therapy and image guidance via on-board x-ray imaging and portal imaging. We also
maintain a comprehensive in vivo dosimetry program with OSLD and TLD.
2.1.C: Work Hours Policy
All residents are expected to be in the clinic promptly by 8:00 AM which is when most morning
conferences begin. Often, special tumor conferences, didactic lectures, or other educational and
clinical activities may require that the residents come at work earlier or stay later than normal work
hours, which are from 8:00 AM to 6:00 PM except for the resident(s), who are assigned to the patient
QAs and machine QAs services that are performed afterhours. Medical physics duties often require
the faculty and the residents to work on evenings and on weekends
2.2: EDUCATIONAL CONFERENCES Educational conferences include the New Patient conference (twice a week), numerous tumor boards and the medical physics QA and clinical meetings. Tumor Board Schedules and New Patient Conference times will be distributed by the program coordinator. Residents are expected to make every effort to attend such conferences. 2.3: RESIDENT ROOM and LIBRARY ROOM Neatness, courtesy and order are essential in keeping the resident’s room a pleasant workplace. The library contains some past journals and texts. Current journals are available online to all the residents. The departmental library should be considered a quiet area for reading and study. Again, keep this room neat and place journals back neatly where they belong. Material cannot be removed from the library room.
UTHSCSA-Division of Medical Physics Page 76/93 Resident Handbook
2.4 Radiation Oncology New Employee Orientation Checklist
Name:
Start Date:
1. Radiation Safety Officer and employee Health
( ) Film badge and explanation
( ) Personal Protective Equipment
( ) Hepatitis B Vaccine
( ) TB testing
( ) Incident Reporting
( ) Schedule of new employee orientation
2. Tour of Facility (any staff member)
3. Review of Responsibilities with Medical Physics Director
( ) Received and reviewed Resident Handbook
( ) Who to notify for sickness or tardiness
( ) Lab coat REQUIRED - No blue jeans, shorts or cut-offs, the gentleman of
the Department will wear ties.
( ) Foot wear - (no open toe shoes or sandals)
( ) Introductions to Medical Staff- Organizational chart
( ) CPR Certification – optional
( ) Reporting structure, job description and work hours/schedules
4. Administrative Assistant
( ) Parking and ID (with police)
( ) Pager
( ) Office and PC usage
( ) Keys
( ) Supplies
( ) Picture for Directory and email distribution
( ) Computer access – UTHSCSA and CTRC
I certify that I have review the above items with my supervisor or designated person(s) and I
understand each of the items designated by a () mark.
Signature of Resident Date:
SUPERVISOR OR DESIGNATED PERSON(S)
I certify that the above resident has been instructed in each of the previously listed items.
Signature Date:
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2.5: Department Organizational Chart
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2.6: Oral Exam Evaluation
This evaluation document should be updated by the resident’s mentor and shared with the resident.
A completed copy must be submitted to the Program Director.
Oral Exam I
Date: ___________________________
Evaluators: _________________________________ Resident: __________________
Topics:
Topic Score
Simulation and patient setup
Monitor Unit Calculation
In-vivo and patient specific dosimetry
Dosimeters
AAPM Task Group-51 Calibration Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail
Scores less than 3 will require remediation to be outlined in comments section below
Overall Score: _________________
Comments:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Program Director: ____________________________ Resident: ____________________
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Oral Exam II
Date: ___________________________
Evaluators: _________________________________ Resident: __________________
Topic Score
AAPM Task Group 142 QA
kV and MV verification technologies/QA
AAPM Task Group 25, Electrons
Treatment Planning
TBI & Total Skin Electrons Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail
Scores less than 3 will require remediation to be outlined in comments section below
Overall Score: _________________
Comments:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Program Director: ____________________________ Resident: ____________________
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Oral Exam III
Date: ___________________________
Evaluators: _________________________________ Resident: __________________
Topic Score
LDR
Linac design and function
Shielding design and dose limits
Normal Tissue Tol. & Response Models
Pregnant patients/Pacemakers/ Hip Repl Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail
Scores less than 3 will require remediation to be outlined in comments section below
Overall Score: _________________
Comments:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Program Director: ____________________________ Resident: ____________________
UTHSCSA-Division of Medical Physics Page 81/93 Resident Handbook
Oral Exam IV
Date: ___________________________
Evaluators: _________________________________ Resident: __________________
Topic Score
AAPM Task Group 101 (SBRT/SRS)
HDR
Eye Plaque
Comprehensive Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail
Scores less than 3 will require remediation to be outlined in comments section below
Overall Score: _________________
Comments:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Program Director: ____________________________ Resident: ____________________
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Written Exams Log Sheet
Month Exam Topic Score
August 1 Radiation Safety, Patient CT Simulation
September 2 MU Calculations
October 3 Periodic Linac QA
November 4 Dosimeters, IMRT QA
December 5 OBI MV and kV Imaging
January 6 CT Sim QA, HDR Daily QA
February 7 TSET, TBI
March 8 Annual Linac QA, ExacTrac
April 9 TG 51
May 10 Patient Safety, Tissue Dose Tolerance
June 11 LDR planning for Prostate Seed Implants
July 12 Radiation Protection
August 13 Linac Design
September 14 Chart Checks
October 15 Brachytherapy
November 16 SBRT/SRS delivery and Planning, Narrow Field
Dosimetry
December 17 Treatment Planning System QA
January 18 Imaging in Radiation Therapy
February 19 Acceptance and Commissioning of Linac
March 20 Acceptance and Commissioning of CT Simulator
May 21 Comprehensive
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2.7: Evaluation Forms
2.7.1: In-service Presentation Evaluation
Presenter: _____________________________ Evaluator: ______________________________
Category 1 2 3 4 Score
Organization
Cannot understand because of no sequence of information
Difficulty following presentation because
presenter jumps around
Information presented in
logical sequence
Information presented in
logical, interesting sequence
Subject Knowledge
No grasp of presentation information,
cannot answer questions
Uncomfortable with information and only
providing vague answer responses
Presenter at ease with expected answers to all questions, but
fails to elaborate
Full knowledge by answering
questions and elaborating
Graphics Use of superfluous
graphics or no graphics
Occasional use of graphics that rarely supports text and
presentation
Graphics related to text and
presentation
Graphics explain and reinforce
screen text and presentation
Mechanics
Presentation has four or more
spelling/ grammatical errors
Presentation has three spelling/
grammatical errors
Presentation has two spelling/ grammatical
errors
Presentation has no spelling/
grammatical errors
Eye Contact Presenter reads all of report with no
eye contact
Presenter occasionally uses eye
contact, but most reads
Presenter maintains eye
contact most of the time but
frequently returns to notes
Presenter maintains eye contact with
audience, seldom returning to notes
Elocution
Presenter mumbles, incorrectly
pronounces terms, and speaks too
quietly
Presenter’s voice is low, incorrectly
pronounces terms, difficulty hearing
Presenter’s voice is clear, most
words pronounced
correctly.
Presenter’s voice is clear and correct,
precise pronunciation of
terms for all audience can hear
TOTAL SCORE (Best 24 points)
Comments:
______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________
Staff Sig._______________Date___________Resident Sig._______________Date___________
2.7.2 Course Evaluation Form
UTHSCSA-Division of Medical Physics Page 84/93 Resident Handbook
Instructor: _____________________________ Course: ______________________________
1. Course Evaluation:
Excellent Good Fair Poor Very Poor
1. The course as a whole was: 1 2 3 4 5
2. The course content was: 1 2 3 4 5
3. Course organization was: 1 2 3 4 5
4. Quality of questions or problems raised
by the instructor was: 1 2 3 4 5
5. Answers to student questions were: 1 2 3 4 5
6. Availability of extra help when needed was: 1 2 3 4 5
7. Amount you learned in the course was: 1 2 3 4 5
8. Relevance and usefulness of course content
were: 1 2 3 4 5
9. Evaluative and grading techniques were: 1 2 3 4 5
10. Clarity of student responsibilities and
requirements were: 1 2 3 4 5
2. Instructor Evaluation:
Excellent Good Fair Poor Very Poor
1. Instructor’s contribution to the course was: 1 2 3 4 5
2. Instructor effectiveness in teaching the
subject matter was: 1 2 3 4 5
3. Explanations by instructor were: 1 2 3 4 5
4. Instructor use of examples and illustration was: 1 2 3 4 5
5. Instructor spoke clearly: 1 2 3 4 5
6. Instructor’s enthusiasm was: 1 2 3 4 5
7. Instructor’s interest in whether students
learned was: 1 2 3 4 5
3. How did you feel overall about the course? Please comment on any aspects you felt may need improvement or
could be better taught.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
UTHSCSA-Division of Medical Physics Page 85/93 Resident Handbook
4. Additional comments or specific changes you would like to see made to improve the instructor and/or the
course:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
UTHSCSA-Division of Medical Physics Page 86/93 Resident Handbook
2.7.3: Residency Curriculum Evaluation Form
This evaluation document must be completed by the resident once per year. Please submit to the
Program Director.
Date:_____________
Please answer the following questions:
1. Do you feel the objectives and assessments of the residency curriculum are clear? If no,
please elaborate.
2. Do you feel that the residency curriculum has excluded important clinical topics? If Yes,
please elaborate.
3. Do you feel that the residency curriculum is efficient? If no, please elaborate
4. Do you have suggestions to improve the residency curriculum? If yes, please elaborate.
Comments_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
UTHSCSA-Division of Medical Physics Page 87/93 Resident Handbook
2.7.4 Resident Evaluation Form
Resident: _______________________ Date: __________________
Evaluated Rotation: _________________________________________
Faculty Reviewer: ________________________________________________________
Rotation Assessment
Yes No
Has the resident comp
Was the resident sufficiently engaged in this rotation?
Oral Assessment
Comments:
________________________________________________________________________
________________________________________________________________________
Signed,
____________________________________ ______________________________
Faculty Name Signature
____________________________________ ______________________________
Faculty Name Signature
I have read the above evaluation outlined by the faculty members involved in my end of rotation evaluation.
I believe the evaluation is an accurate representation of my oral review.
I believe the evaluation is an inaccurate representation of my oral review.
Comments:
______________________________________________________________________________________
______________________________________________________________________________________
Print Name:____________________________________________________________________________
Signature:____________________________________________ Date:____________________________
High Pass Pass Conditional Pass Fail
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2.7.5: Residency Mentor Evaluation Form
Complete one for each rotation (eight in total)
Rotation: _____________________________________________
Mentor(s): _____________________________________________
Dates: _____________________________________________
Sufficient time was allotted to this rotation: □ Yes □ No
Very
Poor Fair Good Good Excellent
1 2 3 4 5
The rotation achieved the outlined objectives:
The faculty mentor(s) actively and effectively participated in the rotation training:
The faculty mentor(s) invited questions and discussion:
The faculty mentor(s) treated me professionally:
The faculty mentor(s) teaches effectively:
Comments:______________________________________________________________________________________
_____________________________________________________________________________ ______________
What are the strengths of this rotation (including faculty)?
_______________________________________________________________________________________________
___________________________________________________________________________________________
What are the weaknesses of this rotation (including faculty)?
_______________________________________________________________________________________________
___________________________________________________________________________________________
General comments:
_______________________________________________________________________________________________
___________________________________________________________________________________________
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2.7.6: Medical Conferences Attendance Log
UTHSCSA Medical Physics Residency
Medical Conferences Attendance Log
Resident: _________________________________________
# Date Conference Topic
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
UTHSCSA-Division of Medical Physics Page 91/93 Resident Handbook
2.7.7 Program Evaluation Form Work Experience Importance for Leaving
(Only for residents who leave before they
graduate the residency.)
1. Work Place Evaluation Not at all Somewhat Very
Satisfied Satisfied Satisfied Not at all Somewhat Very
Important Important Important
a. Orientation/Training 1 2 3 4 5 1 2 3 4 5
b. Professional Development 1 2 3 4 5 1 2 3 4 5
c. Teamwork 1 2 3 4 5 1 2 3 4 5
d. Relations with colleagues 1 2 3 4 5 1 2 3 4 5
e. Relations with supervisor 1 2 3 4 5 1 2 3 4 5
f. Relations with Medical staff 1 2 3 4 5 1 2 3 4 5
g. Adequate job autonomy 1 2 3 4 5 1 2 3 4 5
h. Work place stress 1 2 3 4 5 1 2 3 4 5
i. Challenges at work
1 2 3 4 5 1 2 3 4 5
j. Opportunity for career growth 1 2 3 4 5 1 2 3 4 5
k. Utilization of my skills and/or
experience
1 2 3 4 5 1 2 3 4 5
l. Barriers in the work place 1 2 3 4 5 1 2 3 4 5
Program Director /Co-Director Rotation Mentors
2. Director’s/Mentor’s Support Not at all Somewhat Very
Satisfied Satisfied Satisfied Not at all Somewhat Very
Satisfied Satisfied Satisfied
a. Supported my professional growth 1 2 3 4 5 1 2 3 4 5
b. Was open to ideas and concerns 1 2 3 4 5 1 2 3 4 5
c. Had the ability to give
feedback in a constructive and
caring manner
1 2 3 4 5 1 2 3 4 5
d. Kept me informed about issues
important to my job
1 2 3 4 5 1 2 3 4 5
e. Gave me ideas on how to do a better
job
1 2 3 4 5 1 2 3 4 5
f. Listened to my concerns
and took action to improve things
1 2 3 4 5 1 2 3 4 5
g. Was accessible if needed 1 2 3 4 5 1 2 3 4 5
h. Overall, I was satisfied 1 2 3 4 5 1 2 3 4 5
3. Would you recommend the University of Texas Health Science Center Radiation Oncology Physics Residency
program?
___ Yes ___ No
4. As you think about your work environment, what has contributed the most to your satisfaction?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
5. If you could change one thing about your work environment, what would it be?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
-THANK YOU FOR COMPLETING THIS SURVEY-
UTHSCSA-Division of Medical Physics Page 92/93 Resident Handbook
2.7.8 Milestones Agreement Form
Milestones Agreement Form
Doctor of Medical Physics
This form is provided for the purpose of informing students about the academic milestones that they will
be expected to reach in order to earn their Doctor of Medical Physics (DMP) degree as well as when they
are expected to complete these milestones. Students are expected to reach each milestone within the
specified time period in order to make satisfactory progress through the program. Students who are not
making satisfactory progress may lose funding (if applicable), be placed on academic probation, or be
dismissed from the program.
Academic Advising
Upon entering the Doctor of Medical Physics (Therapy and Diagnostic Track), all students will be assigned
an advisor. The advisor will be a full member of the program department. After notification of their
advisor, the student is asked to schedule an initial meeting with them. At least once a year but preferably
twice a year the student is asked to meet and discuss their progress with their advisor. Each student has
the option at any time of changing faculty advisor simply by requesting the action by submitting the
Change of Faculty Advisor form to the Committee on Graduate Studies (COGS) for approval.
Academic advising includes the following elements that are designed to ensure that students remain in
good academic standing and make satisfactory progress through the program. Advisors are responsible for
the following:
• Ensuring that annual reviews between student and advisor. The results of this review will be
included in the program’s annual doctoral progress report.
• Providing suggestions on course selection. (Program may require course selection to be
entered by student.)
• Reviewing the student’s progress to determine if the student is meeting the expectations of
the program and reaching milestones according to the timeline provided on this form; working
with the DMP Committee on Graduate Studies (COGS) and student to determine if
modifications are necessary.
• Clarifying the timetable for completing any remaining course requirements, examinations, and
other requirements.
• Providing the student with experiences and information that will optimize the student’s career
opportunities and success.
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Requirements for all DMP Students
Milestone
Target Date
Review of student’s progress with advisor using Annual Student Review Form
followed by COGS approval
At the end of each Semester,
Annually on February
Successful completion of oral and/or written qualifying exam Year 1, May
Coursework successfully completed Year 2 June
Successful Completion of Clinical Rotation 1 Year 3 December
Successful Completion of Clinical Rotation 2 Year 3 June
Successful Completion of Clinical Rotation 3 Year 4 December
Successful Completion of Clinical Rotation 4 Year 4 June
Complete and submit SED to the Graduate Dean’s Office
Submit exit survey to Dr. Blake in Graduate Dean’s Office Year 4 June
Degree Completion Checklist for Students
• Maintain active student status by registering for courses every fall and spring semesters
• Complete Milestones Agreement Form with your advisor no later than the last class day of the Fall semester
• Complete all required organized coursework
• Schedule and successfully complete required qualifying exams
• Successfully complete all clinical rotations in years 3 and 4
• Submit required documentation to the Graduate School for completion and graduation I have read this form and have had the opportunity to discuss the information contained in it with my advisor. I understand the academic milestones that I am expected to reach in order to successfully complete the Doctor of Medical Physics program, as well as the expected timeline for completing these milestones. Student’s Signature Date Advisor’s Signature Date