Physics Residents Research Articles

SU‐F‐E‐18: Training Monthly QA of Medical Accelerators: Illustrated Instructions for Self‐Learning

Purpose:To develop and test clear illustrated instructions for training of monthly mechanical QA of medical linear accelerators.Methods:Illustrated instructions were created for monthly mechanical QA with tolerance tabulated, and underwent several steps of review and refinement. Testers with zero QA experience were then recruited from our radiotherapy department (1 student, 2 computational scientists and 8 dosimetrists). The following parameters were progressively de‐calibrated on a Varian C‐series linac: Group A = gantry angle, ceiling laser position, X1 jaw position, couch longitudinal position, physical graticule position (5 testers); Group B = Group A + wall laser position, couch lateral and vertical position, collimator angle (3 testers); Group C = Group B + couch angle, wall laser angle, and optical distance indicator (3 testers). Testers were taught how to use the linac, and then used the instructions to try to identify these errors. A physicist observed each session, giving support on machine operation, as necessary. The instructions were further tested with groups of therapists, graduate students and physics residents at multiple institutions. We have also changed the language of the instructions to simulate using the instructions with non‐English speakers.Results:Testers were able to follow the instructions. They determined gantry, collimator and couch angle errors within 0.4, 0.3, and 0.9degrees of the actual changed values, respectively. Laser positions were determined within 1mm, and jaw positions within 2mm. Couch position errors were determined within 2 and 3mm for lateral/longitudinal and vertical errors, respectively. Accessory positioning errors were determined within 1mm. ODI errors were determined within 2mm when comparing with distance sticks, and 6mm when using blocks, indicating that distance sticks should be the preferred approach for inexperienced staff.Conclusion:Inexperienced users were able to follow these instructions, and catch errors within the criteria suggested by AAPM TG142 for linacs used for IMRT.

SU‐F‐E‐15: Initial Experience Implementing a Case Method Teaching Approach to Radiation Oncology Physics Residents, Graduate Students and Doctorate of Medical Physics Students

Purpose:Case Method Teaching approach is a teaching tool used commonly in business school to challenge students with real‐world situations—i.e. cases. The students are placed in the role of the decision maker and have to provide a solution based on the multitude of information provided. Specifically, students must develop an ability to quickly make sense of a complex problem, provide a solution incorporating all of the objectives (at time conflicting) and constraints, and communicate that solution in a succinct, professional and effective manner. The validity of the solution is highly dependent on the auxiliary information provided in the case and the basic didactic knowledge of the student. A Case Method Teaching approach was developed and implemented into an on‐going course focused on AAPM Task Group reports at UTHSCSA.Methods:A current course at UTHSCSA reviews and discusses 15 AAPM Task Group reports per semester. The course is structured into three topic modules: Imaging QA, Stereotactic Radiotherapy, and Special Patient Measurements—i.e. pacemakers, fetal dose. After a topic module is complete, the students are divided into groups (2–3 people) and are asked to review a case study related to the module topic. Students then provide a solution presented in an executive summary and class presentation.Results:Case studies were created to address each module topic. Through team work and whole‐class discussion, a collaborative learning environment was established. Students additionally learned concepts such vendor relations, financial negotiations, capital project management, and competitive strategy.Conclusion:Case Method Teaching approach is an effective teaching tool to further enhance the learning experience of radiation oncology physics students by presenting them with though‐provoking dilemmas that require students to distinguish pertinent from peripheral information, formulate strategies and recommendations for action, and confront obstacles to implementation.

SU‐F‐E‐12: Elective International Rotations in Medical Physics Residency Programs

Purpose:The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy.Methods:The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1‐month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place in Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time.Results:We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross‐disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource‐limited settings – one of which is currently being pursued in collaboration with a vendor.Conclusion:The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially conscious and equip them with the clinical and problem solving skills required to deliver effective treatments in resource limited settings?

SU‐E‐E‐03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

Purpose:Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training.Methods:Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents.Results:By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab‐oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident‐initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily.Conclusion:By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident‐initiated changes in didactic practice have led to improved learning and joint research. A strong social support system has developed, embedding physics residents into a larger peer group.

MO‐DE‐BRA‐02: From Teaching to Learning: Systems‐Based‐Practice and Practice‐Based‐Learning Innovations in Medical Physics Education Programs

Purpose:The increasing complexity in the field of radiation medicine and concomitant rise in patient safety concerns call for enhanced systems‐level training for future medical physicists and thus commensurate innovations in existing educational program curricula. In this work we report on the introduction of three learning opportunities to augment medical physics educational programs towards building systems‐based practice and practice‐based learning competencies.Methods:All initiatives were introduced for senior ‐level graduate students and physics residents in an institution with a newly established medical‐physics graduate program and therapeutic‐physics residency program. The first, centered on incident learning, was based on a spreadsheet tool that incorporated the reporting structure of the Radiation Oncology‐incident Learning System (ROILS), included 120 narratives of published incidents and enabled inter‐rater variability calculations. The second, centered on best‐practices, was a zero‐credit seminar course, where students summarized select presentations from the AAPM virtual library on a weekly basis and moderated class discussions using a point/counterpoint approach. Presentation styles were critiqued. The third; centered on learning‐by‐teaching, required physics residents to regularly explain fundamental concepts in radiological physics from standard textbooks to board certified physics faculty members.Results:Use of the incident‐learning system spreadsheet provided a platform to recast known accidents into the framework of ROILS, thereby increasing awareness of factors contributing to unsafe practice and appreciation for inter‐rater variability. The seminar course enhanced awareness of best practices, the effectiveness of presentation styles and encouraged critical thinking. The learn‐by‐teaching rotation allowed residents to stay abreast of and deepen their knowledge of relevant subjects.Conclusion:The incorporation of systems‐driven initiatives broadens comprehension of the wider systems context of medical physics, enhances awareness of resources for innovation, communication and sustained learning while maintaining a metric‐driven focus on patient safety within the formative phase of student careers. The initiatives were well‐received, feasible, and utilized available or shared‐resources translatable across educational programs.

A Life of Service: Lawrence Williams (Larry) Berkley.

The JACMP has lost a dear friend, Larry Berkley. Among his many other services to the medical physics community, Larry was the Chair of the JACMP Journal Business Management Committee for almost ten years, first under the ACMP, and then under the AAPM. He leaves a heritage of knowledge, integrity, and passion for open-access publishing. Larry and I go back to the 1969 summer “Rat Camp” at Georgia Tech. I have known him longer than any other medical physicist. I thank Joe Grant for this tribute to Larry’s life and legacy. – Michael D. Mills, Editor-in-Chief

Sci-Fri PM: Topics - 05: Experience with linac simulation software in a teaching environment

Medical linear accelerator education is usually restricted to use of academic textbooks and supervised access to accelerators. To facilitate the learning process, simulation software was developed to reproduce the effect of medical linear accelerator beam adjustments on resulting clinical photon beams. The purpose of this report is to briefly describe the method of operation of the software as well as the initial experience with it in a teaching environment. To first and higher orders, all components of medical linear accelerators can be described by analytical solutions. When appropriate calibrations are applied, these analytical solutions can accurately simulate the performance of all linear accelerator sub-components. Grouped together, an overall medical linear accelerator model can be constructed. Fifteen expressions in total were coded using MATLAB v 7.14. The program was called SIMAC. The SIMAC program was used in an accelerator technology course offered at our institution; 14 delegates attended the course. The professional breakdown of the participants was: 5 physics residents, 3 accelerator technologists, 4 regulators and 1 physics associate. The course consisted of didactic lectures supported by labs using SIMAC. At the conclusion of the course, eight of thirteen delegates were able to successfully perform advanced beam adjustments after two days of theory and use of the linac simulator program. We suggest that this demonstrates good proficiency in understanding of the accelerator physics, which we hope will translate to a better ability to understand real world beam adjustments on a functioning medical linear accelerator.

WE-D-19A-01: Clinical Training of Physics Residents: How Do We Efficiently Teach Residents to Become Excellent Clinical Physicists?

AAPM TG-197 and 197S provide the general framework for physics residencies. For CAMPEP approved programs, the self-study will refine the framework to define core competencies and clinical rotation schedules. However, effectively teaching physics residents to develop competent, critically Critical thinking and clinical proficiency is a skill which all residency mentors need to learn and continuously improve. In this course, experienced residency directors from different programs will share teaching tools that have proven to be effective. Special attention will be paid on how to establish a good mentor-mentee relationship, and how to help residents who may be struggling with the transition from student to clinical professional. Learning Objectives: 1. How to measure clinical proficiency and effectively teach it 2. Building an effective mentor-mentee relationship to establish mutual trust needed for effective critical performance feedback 3. Database tools to efficiently track progress of resident learning, giving both resident and mentor effective performance feedback

Point/counterpoint. Medical physics residents should be placed using a matching program.

Point/counterpoint. Medical physics residents should be placed using a matching program.

Core Physics Competencies for Proton Therapy Training of Radiation Oncology and Medical Physics Residents and Fellows

Core Physics Competencies for Proton Therapy Training of Radiation Oncology and Medical Physics Residents and Fellows Brian Winey, PhD,* Helen A. Shih, MD,* Narayan Sahoo, PhD,y Andrew Lee, MD,y Neha Vapiwala, MD,z and Stefan Both, PhDz *Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; yUniversity of Texas, MD Anderson Cancer Center, Houston, Texas; and zUniversity of Pennsylvania, Philadelphia, Pennsylvania

TU-E-M100J-01: Diagnostic Radiology Resident Medical Physics Education Update

Medical physics education for diagnostic radiology residents is undergoing major challenges, and a number of significant changes are being considered. In January of 2006, a Forum on Physics Education was held to examine medical physics education of diagnostic radiology residents, radiation oncology residents and medical physics residents. At that time, a new draft syllabus for diagnostic radiology resident medical physics education was presented. A followup Physics Education Conference was held in February of 2007 at which time a more fully developed physics syllabus was presented for review and comment. Since the meeting, the syllabus has undergone further revisions and is now nearing publication. Meanwhile the American Board of Radiology has been evaluating a number of different possible scenarios for improving the evaluation of medical physics education. The Radiology Review Committee of the Accreditation Council for Graduate Medical Education has recently passed sweeping new rules relating to resident education with an effective date of July of 2008. These rules include a number of provisions relating to medical physics education. This symposium is designed to inform physicists about these potential changes in resident education and will include four speakers, each of which will address one of the four educational objectives. Educational Objectives: 1. Review the findings of the Physics Education Conference held in Dallas in February, 2007. 2. Discuss the new AAPM syllabus for diagnostic radiology residents. 3. Comprehend the different examination pathways being considered by the American Board of Radiology for residents. 4. Understand the new ACGME requirements and how they will impact medical physics resident education.

RADIATION, PHYSICS, AND BIOLOGY COURSE FOR RESIDENTS

RADIATION, PHYSICS, AND BIOLOGY COURSE FOR RESIDENTS