Initial Certification for Medical Physics

Structured Mentorship in Therapeutic Medical Physics

General Orientation: During the orientation period, the resident will learn basic radiation and biohazard safety and will be exposed to radiation oncology simulation, planning, and treatment delivery activities. The resident also will meet regularly with core members of the resident committee.
Clinical Physics Rotations: During the clinical physics service rotations, the resident will be fully trained in all clinical activities of therapeutic medical physics (including chart checks, plan checks, machine QA, and special procedures) and dosimetry (including site-specific patient planning procedures). Training requires independent interaction with the attending physicians to the maximum extent possible.
Note: Table 1 suggests a schedule for a clinical rotation that is structured around major pieces of equipment. Table 2 organizes the rotation by clinical service. If the rotation is structured as described in Table 1 (i.e., according to pieces of equipment), Table 2 can be used as a checklist to assure that the resident participates in a sufficient number of clinical procedures while focusing on the different pieces of equipment. In this case, the suggested durations given in Table 2 can be ignored. However, in larger departments where the staff is organized by clinical service, the resident should be instructed to follow the schedule shown in Table 2 and to use Table 1 as a checklist to ensure that he or she gains experience with all important pieces of equipment. In this case, the durations recommended by Table 1 can be ignored.
Table 1: Suggested clinical rotations organized by major pieces of equipment.
Activity

Minimum Length

Number Required

Linac QA and QC:

6 months

  • Annual QA, including absolute calibration

1

  • Monthly QA

6

  • Patient-specific QA for IMRT, SRS, SBRT, or IGRT procedures

6

External beam treatment planning:

6 months

  • Patient treatment plans (variety of cases and beam modalities)

20

  • Monitor unit calculations (computerized and manual)

20

  • Review of treatment plans performed by others

20

  • Review of patient treatment records (weekly chart checks)

120

Simulator (R/F or CT):

3 months

  • QA

3

  • Supervision of simulation procedures

100

Brachytherapy:

3 months

  • Source calibrations, leak tests, other QC

4

  • Treatment planning (computerized and manual calculations)

12

  • Treatment supervision, QA, and radiation safety

12

  • Therapeutic use of radionuclides

2

Maintenance of physics equipment:

1 month

  • In-house comparison of ionization chambers

2

  • Calibration and testing of dosimetry systems, such as diodes, TLD/OSLD, scanning water phantom, ion chamber, or diode array

2

Radiation protection:

2 months

  • Linac shielding design

1

  • Linac protection survey

1

Other (for example, ethics and patient confidentiality training, experience with other treatment modalities, acceptance testing and commissioning of new equipment, commissioning and QA of imaging systems, etc.)

3 months

Table 2:  Suggested clinical rotations organized by clinical service, with recommended activities and representative equipment.
Training Rotation Description/Equipment Duration
Breast CT-simulation, field placement, field-in-field planning, wedged fields 2 months
GU IMRT, IGRT, prostate implants, IMRT QA 3 months
Thoracic 3-D conformal planning; IMRT; 4DCT; SBRT; IGRT 3 months
GI IORT-HDR; GI treatment planning and IMRT; GI 4DCT, gated/breath hold treatment delivery 2 months
Head & Neck 3-D conformal planning, IMRT 4 months
Lymphoma/Melanoma/Sarcoma TBI, TSET 1 month
QA TPS commissioning and QA, IMRT QA. 2 months
CNS/ Peds/SRS/SRT CNS/ Peds: 3-D non-coplanar planning, proton for CNS planning and delivery SRS/SRT: CT+MRI registration; SRS QA, extracranial SRT; SRS planning Equipment: Accelerator, Stereotactic planning and delivery systems 3 months
Brachy/GYN Routine brachy procedures, LDR, HDR, Mammosite, T&O, COMS, Gliasite Equipment: Brachy applicators, remote afterloader machines, Brachy planning system 3 months
Misc Ethics, patient confidentiality training, job hunting and additional rotations in other areas as determined by the program director and the resident. 1 months
Additional requirements: The candidate must complete three PQI projects, and reports must be included in the portfolio.
References
  1. AAPM Report 90: Education and Training of Medical Physics Committee Subcommittee on Residency Training and Promotion, 2006.
  2. IAEA Training Course Series 37: Clinical Training of Medical Physicists Specializing in Radiation Oncology, 2009.
  3. AAPM Report 197S: Education and Training of Medical Physicists Committee, 2011.

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