Diagnostic Medical Physicists Research Articles

The Role of Diagnostic Medical Physics in Medicine: An Overview

This paper provides a thorough overview of the vital role diagnostic medical physicists play in the medical field, focusing on diagnostic radiology. This paper investigates the relationship between medical practices and physics highlights the fundamental role that physics plays in understanding the cosmos and outlines the numerous applications of physics, including medical physics. The paper's main focus is on the many applications of medical physics, especially in diagnostic imaging, which includes nuclear medicine, radiation therapy, MRIs, CT scans, X-rays, and ultrasound. There is an in-depth discussion of specialized fields such as radiation protection, nuclear medicine, diagnostic radiology, and radiotherapy physics. The authors stress the importance of medical physics in the prevention, diagnosis, and treatment of disease, providing new technologies such as Positron-Emission Tomography (PET) that provide insights into structural and biological changes. The article outlines the duties of diagnostic medical physicists, including quality assurance and control as well as equipment evaluation and compliance. The critical role that radiation treatment programs play in preserving patient, staff and public safety is emphasized. The authors discuss how modern radiation therapy is becoming more complex and how important strong protocols are for patient safety. The important role that medical physicists play in guaranteeing the highest standards of medical care is highlighted, along with the European Union's efforts to standardize radiotherapy treatments among its member states. It is recommended that the health care system needs medical physicists to ensure the safety and protection of both patients and medical/ x-ray staff.

Requirement for diagnostic medical physicists in Vietnam

This paper mentions the status of diagnostic medical physicists, estimating the lack of this work in Vietnam. The evaluation method is based on International Atomic Energy Agency documents and typical hospital models in Vietnam. In 2021, there were no diagnostic medical physicists. The roles and responsibilities of diagnostic medical physicists are currently performed by radiologists, biomedical engineers, and medical physicists in radiation oncology or nuclear medicine. This job is still a potential profession in Vietnam.

Lutetium-177 Radiopharmeceutical Therapy Extravasation Lessons Learned.

Lutetium-177 ( 177 Lu) dotatate has been offered at Fox Chase Cancer Center since 2017 as part of a clinical trial and then in 2018 as a commercially available cancer therapy, and we thought we were prepared for most 177 Lu issues by the fall of 2020. A single phone call identified that the Radiation Safety Department had not been prepared to address extravasations. Fortunately for the patient and Radiation Safety, the 177 Lu therapies are administered by an infusion nurse and Fox Chase Cancer Center has a robust infusion center. The expertise of our infusion center team helped to quickly identify specific mitigation efforts to employ. A team of radiation safety and diagnostic medical physicists worked together to estimate a tissue dose. Research was also started with the aim of identifying therapeutic 177 Lu extravasations as early as possible. The lessons we learned and plans for future early identification of 177 Lu dotatate extravasations are the basis of this paper.

ASSESSMENT OF OCCUPATIONAL RADIATION DOSES IN DIFFERENT DIAGNOSTIC, INTERVENTIONAL AND THERAPEUTIC RADIOLOGY AND MOLECULAR IMAGING SERVICES IN OMAN.

This study aimed at assessing occupational radiation doses in different diagnostic, interventional and therapeutic services. Personal dose equivalent, Hp(10), of 116 medical radiation workers, all with 3 y of dose records (2015-18), were collected from the TLD dosimetry service at the Sultan Qaboos University Hospital-a 700-bed tertiary care teaching hospital in Oman. The doses were measured using calibrated thermo-luminescence dosemeters (TLD-100 (LiF:Mg,Ti)). Five occupational groups, diagnostic radiology, interventional radiology, nuclear medicine, medical physicists and nurses, were considered. Average, maximum and median cumulative doses were estimated and compared against the annual dose limit (20mSv per y) and the local dose investigation level (DIL) (6mSv per y). Personal doses (average:maximum:median) for diagnostic radiology, interventional radiology, nuclear medicine, medical physicists and nurses group were found to be 0.05:0.90:0.00, 0.05:0.50:0.00, 1.20:7.40:0.40, 0.16:1.40:0.00 and 0.10:2.10:0.00mSv, respectively. The findings of this study suggest, at the exception of nuclear medicine, lower DILs for all occupational groups.

A diagnostic medical physicist’s guide to the American College of Radiology Fluoroscopy Dose Index Registry

A diagnostic medical physicist’s guide to the American College of Radiology Fluoroscopy Dose Index Registry

Radiation dose optimization in diagnostic and interventional radiology: Current issues and future perspectives.

The medical radiological imaging technological evolution and wide availability has resulted in the exponential increase in utilization. Evidence for a risk of cancer arising from radiation doses of lower than 100mSv is still limited. There is a need for patient dose optimization. A literature review was conducted to identify the reasons why optimization is important and the steps to be followed for a successful optimization process in digital radiology, Computed Tomography, interventional radiology and mammography. Based on recent literature, 5 steps for a dose optimization process are proposed. These steps are: 1) establishment of a quality assurance programme; a mistake, misuse or malfunction of an X-ray machine can potentially affect the health or life of thousands of people, 2) establishment of a dose optimization team consisting of a radiologist, medical physicist and radiation technologist, 3) determination of baseline dose levels and image quality as well as comparisons with benchmarks to decide which exam protocols should be optimized, 4) modification of protocols by the medical physicist and 5) evaluation of the optimization process and its effect on patient dose and image quality. The optimization process should include joint efforts focused on 1) equipment performance 2) exam protocol customization and 3) staff behaviour. Manufacturers should provide detailed descriptions of exam protocols and training on the use of dose reduction features. The diagnostic radiology medical physicist should emerge and take a proactive lead in the everyday clinical routine in order to promote the value of optimization process.

Physics Teaching of Radiology Residents: How Much Is Too Much?

At the beginning of each academic year, you may hear “complaints” from some diagnostic medical physicists who struggle to get more physics teaching time. Their efforts should be appreciated. Looking from the other side, radiology faculty members and residency program directors may also wonder, “How many time slots should be allocated for physics teaching?” To date, there is no clear answer, and to our knowledge, the answer still depends on individual programs and/or departments according to their perceptions of the value of physics teaching.

Comparison of computed tomography shielding design methods using RadShield

Purpose. To comprehensively compare four computed tomography (CT) scanner shielding design methods using RadShield, a Java-based graphical user interface (GUI). Methods. RadShield, a floor plan based GUI, was extended to calculate air kerma and barrier thickness using accepted methods from the National Council on Radiation Protection and Measurements (NCRP), the British Institute of Radiology, and a method using isodose maps, for spatially distributed points beyond user defined barriers. For a stationary CT scanner, the overall shielding recommendations found using RadShield were also compared to those found by American Board of Radiology certified diagnostic medical physicists using the conventional NCRP dose length product method and the isodose map method. Results. The results between methods differed significantly for calculation point locations beyond the gantry and to the rear of the gantry. Overall shielding design recommendations across the four methods yielded similar average air kerma and thickness values for the barriers. Conclusions. RadShield was extended to perform CT shielding design and proved reliable using four methods.

TH‐E‐201‐01: Diagnostic Radiology Residents Physics Curriculum and Updates

The ABR Core Examination stresses integrating physics into real‐world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints.Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program. The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands‐on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective.The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspectiveJ. Zhang, This topic is partially supported by RSNA Education Scholar Grant

TH‐E‐201‐02: Hands‐On Physics Teaching of Residents in Diagnostic Radiology

The ABR Core Examination stresses integrating physics into real‐world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints.Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program. The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands‐on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective.The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspectiveJ. Zhang, This topic is partially supported by RSNA Education Scholar Grant

TH‐E‐201‐00: Teaching Radiology Residents: What, How, and Expectation

The ABR Core Examination stresses integrating physics into real‐world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints.Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program. The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands‐on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective.The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspectiveJ. Zhang, This topic is partially supported by RSNA Education Scholar Grant

TH‐E‐201‐03: A Radiology Resident's Perspectives of Physics Teaching

The ABR Core Examination stresses integrating physics into real‐world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints.Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program. The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands‐on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective.The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspectiveJ. Zhang, This topic is partially supported by RSNA Education Scholar Grant

Radiation dose measurement for patients undergoing common spine medical x-ray examinations and proposed local diagnostic reference levels

The main purposes of this study were to investigate patient dose in Spine radiographic examinations, as high dose procedures and propose the first LDRLs (Local Diagnostic Reference Levels) in Khuzestan region, southwest of Iran. ESD (Entrance Skin Dose) values of patients who underwent six spine radiographic procedures containing cervical (AP/LAT), thoracic (AP/LAT) and lumbar (AP/LAT), as high dose procedures, were evaluated. Patient doses were calculated from patient's individual anatomical data (weight, height and organ thickness) and exposure parameters (kVp, mAs, FFD and projection) based on the IAEA (International Atomic Energy Agency) Technical Report Series No.457. Indirect dosimetry method was conducted on 412 standard patients (57% men and 43% women) at seven high-patient-load hospitals. This survey reveals significant variations in the radiological practice. Despite large discrepancies found in the tube loadings (3–128 for lumbar AP and 3–200 for lumbar LAT), ESDs in all examinations were lower than the IAEA and EC (European Commission) DRLs (Diagnostic Reference Levels), 1.30, 1.65, 2.29, 3.09, 5, 7.5 mGy for cervical AP, cervical LAT, thoracic AP, lumbar AP, thoracic LAT and lumbar LAT respectively. Optimization of radiological practice could be accelerated by updating clinical audits and patient dose considerations, adequate training of students, implementation of systematic QA and QC programs and the use of qualified diagnostic medical physicists in the imaging sections. It is advisable that DRLs obtained in this study can be used as local DRL and dose surveys must be performed in all regions to establish NDRLs (National Diagnostic Reference Levels) in Iran. Also, national authorities must review periodically reference levels to ensure that it remains appropriate.

Meaningful Data or Just Measurements? Differences Between Ionization Chamber and Solid-State Detectors

One of the principal responsibilities of a clinical diagnostic medical physicist is to ensure good image quality at an appropriate dose. To determine dose, three quantities must be known for the x-ray beam: peak tube potential, half-value layer (HVL) and air kerma (AK), formerly known as exposure. Instrument and equipment setup (ie, geometric factors) are also important in finding the desired value. The gold standard for clinical exposure or AK measurements uses a calibrated air ionization chamber (IC), which is used with aluminum filters to determine HVL from additional measurements. A separate instrument is required to find the peak tube potential. Solidstate detectors (SStDs) are now available for use in diagnostic physics measurements in mammography, general radiography, and fluoroscopy. The advantage of these alternative instruments is that they can acquire measurements for multiple quantities simultaneously and record them directly into a computer database. The question is, how reliable are these measurements compared with the gold standard? Consider the following situation: You perform an image quality and dose assessment as part of your annual mammography medical physics survey. You have your trusted gold-standard instruments and a new

MO‐AB‐207‐04: ACR Update in Mammography

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up‐to‐date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements.Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole‐body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.

MO‐AB‐207‐01: ACR Update in CT

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up‐to‐date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements.Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole‐body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.

MO‐AB‐207‐02: ACR Update in MR

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up‐to‐date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements.Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole‐body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.

MO‐AB‐207‐03: ACR Update in Nuclear Medicine

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up‐to‐date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements.Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole‐body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.

MO‐AB‐207‐00: ACR Update in MR, CT, Nuclear Medicine, and Mammography

A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up‐to‐date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, computed tomography, nuclear medicine, and mammography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements.Learning Objectives: To understand the requirements of the ACR MR Accreditation program. The discussion will include accreditation of whole‐body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process. To understand the requirements of the ACR nuclear medicine accreditation program, and the role of the physicist in annual equipment surveys and the set up and supervision of the routine QC program. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program.

Degradation of CT Low-Contrast Spatial Resolution Due to the Use of Iterative Reconstruction and Reduced Dose Levels.

To determine the dose reduction that could be achieved without degrading low-contrast spatial resolution (LCR) performance for two commercial iterative reconstruction (IR) techniques, each evaluated at two strengths with many repeated scans. Two scanner models were used to image the American College of Radiology (ACR) CT accreditation phantom LCR section at volume CT dose indexes of 8, 12, and 16 mGy. Images were reconstructed by using filtered back projection (FBP) and two manufacturers' IR techniques, each at two strengths (moderate and strong). Data acquisition and reconstruction were repeated 100 times for each, yielding 1800 images. Three diagnostic medical physicists reviewed the LCR images in a blinded fashion and graded the visibility of four 6-mm rods with a six-point scale. Noninferiority and inferiority-superiority analyses were used to interpret the differences in LCR relative to FBP images acquired at 16 mGy. LCR decreased with decreasing dose for all reconstructions. Relative to FBP and full dose, 25%-50% dose reductions resulted in inferior LCR for vendors 1 and 2 for FBP and 25% dose reductions resulted in inferior and equivalent performance for vendor 1 and equivalent and superior performance for vendor 2 at moderate and strong IR settings, respectively. When dose was reduced by 50%, both IR techniques resulted in inferior LCR at both strength settings. For radiation dose reductions of 25% or more, the ability to resolve the four 6-mm rods in the ACR CT accreditation phantom can be lost.