Radiation Oncology Physics Research Articles

Slides collection. Radiation Oncology Physics: A Handbook for Teachers and Students

Slides collection. Radiation Oncology Physics: A Handbook for Teachers and Students Podgorsak E. B. and Hartmann G. H. Based on the IAEA publication, ISBN: 92‐0‐107304‐6, Vienna, Austria. Free access at: http://www‐naweb.iaea.org/nahu/dmrp/slides.shtm.

The shortage of radiation oncology physicists is addressable through remote treatment planning combined with periodic visits by consultant physicists

The shortage of radiation oncology physicists is addressable through remote treatment planning combined with periodic visits by consultant physicists

Radiation Oncology Physics: A Handbook for Teachers and Students

This book, published in 2005 by the International Atomic Energy Agency, is a comprehensive compendium of all of the topics that should be covered by a radiation oncology physics course, from basic physics to dosimetry, commissioning and quality assurance of equipment, treatment planning and radiation protection and safety. It has an extensive section on brachytherapy, some basic radiation biology and a chapter on special procedures and techniques. As a handbook, as opposed to a textbook, it contains a large number of useful data tables and basic formulae, but in places it does not go deep enough into the issues that are of current concern in the radiotherapy physics community. It has a comprehensive review of various calibration methods for both photon and electron beams, but it does not reproduce the basic tables of the most recent protocols. It also has a reasonably up to date review of the various radiation distribution algorithms employed by modern treatment planning systems, but it does not discuss the advantages and disadvantages of the various approaches. In general, it is a little disappointing that such a recent publication is not more focused on new developments in radiotherapy and their implications for the physicists' workload. The section on radiation producing equipment is historically inclusive of somewhat outdated models, but it hardly touches on the newer developments, such as cyclotrons or synchrotrons for proton therapy. Multi-leaf Collimators are not even included in this chapter, despite their wide availability, confining them to the special techniques chapter. Virtual simulators are presented alongside conventional ones, but their impact on the treatment planning process is not discussed. The Intensity Modulated Radiation Therapy Section in the otherwise comprehensive section on special procedures is inadequate. Given its great and wide impact on recent practice, one would have expected the Intensity Modulated Radiation Therapy Section to warrant a chapter of its own, with a detailed discussion on the associated quality assurance and its analysis. References to the up and coming heavy particle therapy, such as neutrons, protons and carbon ions, and their physical characteristics, are very sparse. In summary, this book is a worthwhile addition to the library of any university or hospital department of medical physics, but has a slightly dated feel despite its age.

The American Board of Radiology perspective on maintenance of certification: Part IV: Practice quality improvement in radiologic physics

Recent initiatives of the American Board of Medical Specialties (ABMS) in the area of maintenance of certification (MOC) have been reflective of the response of the medical community to address public concerns regarding quality of care, medical error reduction, and patient safety. In March 2000, the 24 member boards of the ABMS representing all medical subspecialties in the USA agreed to initiate specialty-specific maintenance of certification (MOC) programs. The American Board of Radiology (ABR) MOC program for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated with full implementation for all three disciplines beginning in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. The four component parts to the MOC process are: Part I: Professional standing, Part II: Evidence of life long learning and periodic self-assessment, Part III: Cognitive expertise, and Part IV: Evaluation of performance in practice (with the latter being the focus of this paper). The key components of Part IV require a physicist-based response to demonstrate commitment to practice quality improvement (PQI) and progress in continuing individual competence in practice. Diplomates of radiologic physics must select a project to be completed over the ten-year cycle that potentially can improve the quality of the diplomate's individual or systems practice and enhance the quality of care. Five categories have been created from which an individual radiologic physics diplomate can select one required PQI project: (1) Safety for patients, employees, and the public, (2) accuracy of analyses and calculations, (3) report turnaround time and communication issues, (4) practice guidelines and technical standards, and (5) surveys (including peer review of self-assessment reports). Each diplomate may select a project appropriate for an individual, participate in a project within a clinical department, participate in a peer review of a self-assessment report, or choose a qualified national project sponsored by a society. Once a project has been selected, the steps are: (1) Collect baseline data relevant to the chosen project, (2) review and analyze the data, (3) create and implement an improvement plan, (4) remeasure and track, and (5) report participation to the ABR, using the template provided by the ABR. These steps begin in Year 2, following training in Year 1. Specific examples of individual PQI projects for each of the three disciplines of radiologic physics are provided. Now, through the MOC programs, the relationship between the radiologic physicist and the ABR will be continuous through the diplomate's professional career. The ABR is committed to providing an effective infrastructure that will promote and assist the process of continuing professional development including the enhancement of practice quality improvement for radiologic physicists.

SU‐FF‐P‐06: Use of a Website for Support of a Clinical Rotation in Radiation Oncology Physics

Purpose: The purpose of the present work is to demonstrate how a website can be incorporated into the support of a clinical rotation course in radiation oncology physics in a graduate medical physics training program. Materials and Methods: A website was developed consisting of a home page with a list of contacts and a class schedule. Linked to this home page were websites for specific clinical rotations. On each rotation website were listed specific objectives and tasks with links to appropriate teaching materials, examinations, and forms. Results: Use of the website simplified management of the clinical rotation course and made all course materials easily accessible to all the students. Conclusions: Success with the website supporting the clinical rotation course has encouraged the development of websites for additional courses in our graduate program.

TU-EE-A2-06: Theoretical Investigation of the Pencil Beam Solution From the Fermi-Eyges Partial Differential Equation

Purpose: To demonstrate the rigorous mathematical derivation of the Fermi‐Eyges partial differential equation for the pencil beam solution and to compare with the original Eyges solution.Method and Materials: In the radiation therapy community, there is a debate about the solution of the Fermi‐Eyges equation presented by the original Eyges paper as to whether the equations are correct or not. But nobody has presented the detailed solution of this equation and compared with the original Eyges solution yet. In this manuscript, we present the rigorous mathematical derivation of the Fermi‐Eyges equation for the distribution function. Several standard mathematical techniques such as two dimensional Fourier transform, change of variables by introducing the transformation function, different boundary conditions and use of the Jacobean to separate the coupled variables have been implemented to calculate the closed‐form solution of the distribution function for the electron transport of the pencil beam algorithm. Also the derivation and the solution of the Fermi‐Eyges equation have been compared with the original Eyges solution at the different check points. Results: Examination of the detailed derivation of the Fermi‐Eyges partial differential equation indicates that there is an error in the equation (14) of the original Eyges solution.Conclusion: We have demonstrated the rigorous derivation for the pencil beam solution of the Fermi‐Eyges equation. In radiation oncology physics, it's always important to fully understand the theoretical basis and the limitations of the solution of the Fermi‐Eyges equation because this is the only deterministic solution for the pencil beam algorithm to calculate electron dose distribution. And, it's also important in order to develop the theory further and to apply it successfully in the clinical practice.

TU-E-BRB-03: Meet the Expert - Therapy Research

Research, be it radiation therapy or imaging, requires manpower. In the past, clinical resources were relatively generous and significant research could be conducted using clinical funds. Decreased clinical resources means that research groups will need to develop funding strategies that involve extramural funding, generally divided in to corporate, foundation, and governmental funding. Corporate funding can provide significant resources for research. The scope of such grants will span fundamental research to product development and evaluation. In most cases, corporate grants are closely tied to the company's profit goals and a good fit is essential to securing and maintaining funding. There is often a “marketing” component to the grant, in that the company benefits by keeping the grantee happy. However, this should not be construed as a rationale for the grant, nor should it be considered when determining the scope of work. Only the highest quality research and development will lead to a long-term grant relationship. Unlike governmental grants, a good personal relationship between the researchers and the company representatives is essential. Effective and regular communication will keep the projects on track and flexibility will often be required as technology develops and the company strategy changes. Corporate funding also tends to be less stable than governmental funding, first because it relies heavily on personal relationships, and second because the corporate environment can change rapidly. While it is less stable than governmental funding, it is often much easier to acquire. Corporate applications are typically much shorter than for governmental grants and a rigorous scientific approach and stellar scientific track record are not as important as for governmental grants. Governmental grants, including from the National Institutes of Health, the National Science Foundation, and the Department of Defense, can provide a stable source of research support, but they typically require long, detailed applications as well as the development of a team of experts to meet the specific aims. These grants are very competitive and are peer-reviewed, so obtaining one of these grants is very valuable to a CV, and many universities have written or unwritten tenure guidelines that require the faculty member to be the principal investigator on a major government grant. While there are many sources of governmental funding, I will concentrate on the National Institutes of Health. The major investigator-initiated grant is called the R01, which has no specific limit on funding per year (although the rules change as the amounts increase), but typically has a maximum funding period of 5 years (with a 1-year extension if some funds remain uncommitted). The methods for submission, review, and funding of an R01 will be presented. Guidance for developing a plan to successfully submit a major grant, such as an R01 will be described. This forum will allow aspiring researchers the ability to discuss these issues with Dr. Daniel Low, Director of Medical Physics and a Professor in the Department of Radiation Oncology at Washington University. Dr. Low earned his Ph.D. in 1988 in the field of experimental Nuclear Physics from Indiana University and spent two years as a postdoctoral fellow at M.D. Anderson Cancer Center. In 1991, Dr. Low joined the faculty at Washington University in radiation oncology physics at what was then the Mallinckrodt Institute of Radiology. Dr. Low spent the next 10 years developing his medical physics research skills before getting his first NIH R01. Since then, Dr. Low has been the PI on two additional R01s and an R21 and has coauthored more than 90 peer-reviewed publications. Dr. Low was instrumental in the clinical development of IMRT and is now engaged in research into modeling human breathing motion for purposes of radiation therapy treatment planning, imaging, and delivery, and the development of a small-animal experimental conformal irradiator, called microRT. Dr. Low is a member and fellow of the AAPM. Educational Objectives: 1. Understand corporate grants, including pros and cons of corporate funding. 2. Understand governmental grant submission, review, and funding processes. 3. Be able to generate a plan for developing a funded research program.

MO‐E‐BRB‐07: IAEA Activities in Medical Radiation Physics

Purpose: Although well known for its work in dosimetry, the IAEA requires experts in medical radiation physics to assist with projects in developing countries such as commissioning radiotherapy machines and treatment planning systems. Consultants are used also to draft documents and provide advice on divergent topics such as quality assurance for IMRT and PET‐CT, and a methodology for comprehensive auditing in radiotherapy. Method and Materials: Through its publications, the IAEA's attention in developing countries is focused on redressing the dual gaps in access to basic technology using radiation medicine and in advanced technology that attempts to increase the fraction of patients treated with curative intent. Results: DMRP has produced information of relevance to the practice of medical physics in any centre of limited resources irrespective of geographic location. In educating medical physicists, the handbook for teachers and students in Radiation Oncology Physics has been supplemented by a β‐version of a set of 2,500 slides to assist in self‐directed studies, recently posted on the DMRP web site for comments and feedback. A syllabus for medical physics in diagnostic radiology has been prepared and co‐authors are being recruited to write individual chapters. TRS‐430 on QA for treatment planning systems has been supplemented by two additional documents on type tests to be done by the supplier, and acceptance and commissioning tests to be done on‐site. A methodology for comprehensive auditing of radiotherapy centres and a more specific document on physics auditing in radiotherapy have been prepared. A new document describing a basic radiotherapy facility including its human resources component has completed technical editing. Conclusion: New projects and up‐coming opportunities, and the process to become an IAEA consultant will be described in the hope that AAPM members will be encouraged to offer their services to strengthen the practice of medical physics internationally.

WE‐D‐BRB‐01: Support for Staffing and Assuring Quality in Radiation Oncology

Standards for commissioning and quality control of radiation therapy equipment have traditionally been established through the consensus of “experts”. The recently implemented Canadian approach to standards (medphys.ca) has broadened the expert panel to include the entire Canadian medical physics community through web‐based consultation. This process and the standards so developed will be discussed. A limitation is that while such standards developed to date in Canada and in many other jurisdictions undoubtedly have made major contributions to the safety and quality of radiation therapy, they could not be described as being evidence based. An approach to “evidence based” commissioning of a treatment planning system, in which the Equivalent Uniform Doses of targets and organs at risk are used as outcome surrogates, will be discussed. The resulting Quality Control Standards, whether using the novel Canadian approach or the more traditional AAPM Task Group approach, require a determinable amount of time that must be performed by medical physicists. Staffing at appropriate levels to accomplish these tasks is the focus of all activities in medical physics. Proper staffing is therefore crucial to patient care, and necessary to meet regulatory requirements. The results from the Abt study of medical physicist work values for radiation oncology physics services: round III may be used to justify personnel and defend staffing to administration for a number of venues of practice. A work model is created to allow the medical physicist to defend QMP work based on both routine and special procedures service mix. The model may be used to develop a cost‐justification report for setting charges for radiation oncology physics services.Objectives:1. Understand alternative options to develop Quality Control Standards for Radiation Oncology Physics.2. Understand what new information will be provided in the Abt III study.3. Understand how to use the Abt studies to justify medical physicist work and staffing.

American Board of Radiology Perspective on Maintenance of Certification: Part IV—Practice Quality Improvement for Diagnostic Radiology

1All authors: The American Board of Radiology, 5441 E Williams Blvd., Tucson, AZ 85711. Address correspondence to J. L. Strife. he American public expects safe, predictable, high-quality care and assumes that physicians work to remain current and competent. The American Board of Radiology (ABR) encourages each board-certified diagnostic radiologist to understand his or her professional responsibilities and to participate in continuous quality improvement and lifelong learning. In the United States health care system, quality of care, medical error reduction, and patient safety represent continuing themes that dominate public concern [1–3]. Maintenance of Certification (MOC), the overarching program of the American Board of Medical Specialties (ABMS) and its member boards, is the response of U.S. physicians to address these concerns [4–8]. Although advances in medical science, technology, and biomedical research continue to accelerate, other barriers prevent rapid dissemination and adoption of evidence-based, recommended care [9]. A RAND Corporation study has estimated that only 50–54% of the care Americans receive is care that has been recommended on the basis of evidence-based medical literature [3]. Much of what radiologists do is not evidence based [10]. Outcomes and costs to diagnose and treat specific diseases vary widely among physicians, hospitals, health care providers, and regions of the country [10]. To address challenges in the medical system and the public’s concerns, the ABMS, composed of 24 member boards representing all medical subspecialties in the United States, mandated in March 2000 that each board initiate specialty-specific MOC programs [4–8]. Diplomates are no longer granted lifetime certification but rather must demonstrate evidence of professionalism, continuing medical education and knowledge, as well as a commitment to practice improvement. The MOC program, including “Part IV: Practice Quality Improvement,” for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. There are four component parts to the MOC process: “Part I: Professional Standing,” “Part II: Lifelong Learning and Periodic Self-Assessment,” “Part III, Cognitive Expertise,” and “Part IV: Evaluation of Practice Performance” [11–15]. The ABR program for self-evaluation of practice performance is linked to a process of continuing quality improvement and is titled “Practice Quality Improvement” (PQI).

Thirty year celebration of journal publications on radiation oncology medical physics

The Australasian Physical & Engineering Sciences in Medicine Journal (APESM) is an avenue for the profession to report scientific work in medicine; provide a facility for the publication of current work, new research and new techniques developed or reviewed; report on professional news from elsewhere and; publish the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) policies and protocols. The journal is a vital instrument within the ACPSEM organisation with a worldwide circulation. This review of APESM on medical physics in radiation oncology is meant to be a progress summary of work in that specialty. Even so, it has become a lengthy appraisal due to the many years involved. In considering publications related to medical physics in radiation oncology, this review has shown the progression of the College journal to an international journal. There is an increase in the number of papers contributed from Asia and other countries world wide for this discipline. Growth in the number of contributions should continue to rise. In order to provide some appreciation of where the present medical physics activity arose from, this article commences its discussion in 1959 and progresses towards the present, describing along the way, from radiation oncology papers published in APESM, the use of linear accelerators, brachytherapy, the medical physics workforce, the formation of the ACPSEM, and the more modern developments in radiotherapy such as 3-D treatment planning and IMRT.

A survey of the Australasian clinical medical physics and biomedical engineering workforce

A survey of the medical physics and biomedical engineering workforce was carried out in 2006. 495 positions (equivalent to 478 equivalent full time (EFT) positions) were captured by the survey. Of these 268 EFT were in radiation oncology physics, 36 EFT were in radiology physics, 44 were in nuclear medicine physics, 101 EFT were in biomedical engineering and 29 EFT were attributed to other activities. The survey reviewed the experience profile, the salary levels and the number of vacant positions in the workforce for the different disciplines in each Australian state and in New Zealand. Analysis of the data identifies staffing shortfalls in the various disciplines and demonstrates the difficulties that will occur in trying to train sufficient physicists to raise staffing to an acceptable level.

The current role of imaging for prostate brachytherapy

Prostate brachytherapy is a radiotherapy technique for early stage prostate cancer that uses imaging guidance to place radioactive sources directly into the prostate gland. Transrectal ultrasound is used to facilitate a template-guided transperineal approach to the prostate and permits a highly conformal method of prostate radiotherapy with doses far higher than can be achieved with other radiation techniques. Maturing data has validated this technique as an acceptable treatment option with favourable and durable biochemical outcomes. The radiologist has a major role to play in the process: patient selection, guiding source delivery and follow-up after treatment all require close collaboration with colleagues in Radiation Oncology and Medical Physics. This review emphasises the specific contribution of imaging in the context of currently reported outcomes data.

Radiation Oncology Physicists Will Need to Better Understand Medical Imaging

Imaging is affecting radiation oncology at a dramatically advancing pace and scale and is likely to create a transformation to individualized, biologically conformal radiation therapy. Deploying and improving imaging technologies and ensuring their correct uses in treatment planning and delivery are the responsibilities of radiation oncology physicists. The potential magnitude of errors arising from the incorrect use of imaging may be far greater than that resulting from typical errors in dose calibration. A major effort is required for radiation oncology physicists to raise the quality assurance of image guidance to a level comparable with that achieved in the maintenance of dosimetric performance. Most radiation oncology physicists lack adequate knowledge to assume this emerging responsibility. Their knowledge of imaging must be enhanced, in most cases through on-the-job training and self-learning. Effective learning strategies include routine interactions with diagnostic radiology and nuclear medicine physicists and physicians and the use of educational opportunities provided by professional organizations and vendors.

Book reviewRadiation Oncology Physics: A Handbook for Teachers and Students, E.B. Podgorsak (Ed.), International Atomic Energy Association, Vienna, Austria (2005), 657 pages, Euro 65, paperbound, ISBN 92-0-107304-6

The purpose of this book is clearly stated in its foreword and preface and dictated the style and contents. This is indeed a handbook that “aims at providing the basis for the education of medical physicists initiating their university studies in the field” (from the foreword) and “to serve as a factual supplement to the various textbooks on medical physics and to provide basic radiation oncology physics knowledge in the form of a syllabus” (from the preface). Therefore, by design, this handbook covers a comprehensive range of basic material in somewhat superficial depth.

TH‐C‐330D‐02: The Forum On Medical Physics Education: Outcomes and Directions for the Future

Medical physics education leaves much to be desired. The depth and breadth of education of radiologists in the fundamental physics of their profession is simply inadequate when contrasted with the complexity of imaging technologies and the sophistication of imaging procedures. The use of image guidance and complex treatment delivery systems and algorithms in radiation oncology calls for a substantial increase in the level of understanding of physics and its applications by radiation oncologists. These needs provide excellent opportunities for medical physicists to improve their contributions to the education of their physician colleagues, and through this process improve the care of patients in radiology and radiation oncology. Before these opportunities can be exploited to their fullest, however, the education of medical physicists in the clinical applications of radiology and radiation oncology must be improved. In January, 20–22, 2006 a forum on the physics education of radiologists, radiation oncologists and medical physicists was held in Atlanta. The meeting was hosted by the American Association of Physicists in Medicine, and representatives of 30 radiology, radiation oncology and medical physics organizations attended the meeting. Participants examined the guidelines for education of specialists in all 3 fields, together with expectations of accrediting agencies (eg CAMPEP and ACGME‐RRC) and certification organizations (ABR, ABMP), and developed a number of consensus recommendations on how the various organizations could communicate and work more closely together to improve the physics education of individuals in all 3 specialties. These recommendations will be presented for discussion in this forum, with the purpose of seeking feedback on the recommendations and encouraging implementation of the recommendations in the participants' institutions.

Radiation Oncology Physics: A Handbook for Teachers and Students

Medical PhysicsVolume 33, Issue 6Part1 p. 1920-1920 Books and publications Radiation Oncology Physics: A Handbook for Teachers and Students Kristofer Kainz Ph.D, Kristofer Kainz Ph.DSearch for more papers by this author Kristofer Kainz Ph.D, Kristofer Kainz Ph.DSearch for more papers by this author First published: 30 May 2006 https://doi.org/10.1118/1.2201870Citations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue6Part1June 2006Pages 1920-1920 RelatedInformation

Radiation Oncology Physics: A Handbook for Teachers and Students

211 East 70th Street, New York, NY 10021, [email protected] (The opinions expressed in this section are those of the authors and do not represent the official opinion or position of the Journal, the Health Physics Society, or the authors’ institutions.)

10 CFR Part 35: Changes to the NRC Rule Governing the Medical Use of Radioisotopes and Implications for Radiologic Practice

In the spring of 2005, the US Nuclear Regulatory Commission completed its revision of Title 10, Part 35, of the Code of Federal Regulations, its regulatory framework for the medical use of radioisotopes. Because of the complexity of the regulation and the lengthy period over which the revisions were accomplished, many radiologists remain uninformed regarding changes in the rule. This article highlights some of the more important of these changes as they relate to the practice of radiology, radiation oncology, nuclear medicine, and medical physics.

AAPM Task Group 103 report on peer review in clinical radiation oncology physics

AAPM Task Group 103 report on peer review in clinical radiation oncology physics