Physics Residency Brochure

Medical Physics Residency
Training Program
2007-2009

Mayo Mail Code 494
420 Delaware St. S.E.
Minneapolis , Minnesota 55455
Voice: (612) 626-2440
Fax: (612) 626-7060
E-mail: cblasing@umn.edu

PROGRAM GOALS

The program is intended to provide comprehensive training and experience in radiation oncology physics to candidates with a Ph.D. degree in physics, medical physics or a closely related field. The training will involve full participation of the physics resident in the clinical routine, under the supervision of the Program Director and the program faculty. Comprehensive training and experience will be provided in the broad areas of equipment calibration, radiation dosimetry, treatment planning, radiation shielding, facility design, radiation protection and quality assurance. The program is designed in accordance with the essentials and guidelines contained in the residency document of the American Association of Physicists in Medicine (AAPM). After successful completion of this training program, the candidate should have covered the essential curricula for the board certification examination in radiation oncology physics.

DESCRIPTION OF PROGRAM

1. Entry Requirements

   Candidate must have completed their Ph.D. degree in Physics, Medical Physics, or a closely related discipline before acceptance into the program. The applicant's undergraduate and graduate education should demonstrate knowledge acquired in the following areas:

   1. Fundamental physics

   2. Advanced mathematics

   3. Advanced atomic and nuclear physics

   4. Electronics

   5. Computers

   6. Physical chemistry

2. Length of Training and Orientation

   The length of training will be two years for a medical physics graduate. The training calendar will normally start on July 1. During the first three months, the physics resident will receive orientation lectures and demonstrations in the clinic. The resident will work with a staff physicist to observe and participate in treatment planning, treatment simulations, patient dosage calculations, calibrations, clinical dosimetry, quality assurance, and other physical and technical tasks performed in the clinic. During this time the resident should develop an overall understanding of the physicist's role in the clinic.

3. Didactic Training

   Starting with the fall semester, the physics resident will receive didactic instruction (if not a medical physics graduate) in the radiation oncology physics, diagnostic radiology physics, nuclear medicine physics, radiation biology, radiation oncology, anatomy and physiology. The following courses offered at the University of Minnesota will cover these areas:

   TRAD 7170 Basic Radiological Physics

   TRAD 7172 Radiation Biology

   TRAD 7173 Physics of Radiation Therapy

   BPHY 5171 Medical and Health Physics of Imaging I

   BPHY 5174 Medical and Health Physics of Imaging II

   RTT 3581 Principles and Practices of Radiation Therapy I (Tech School)

   RTT 4581 Principles and Practices of Radiation Therapy II (Tech School)

   Seminars: Fundamentals of Clinical Oncology

   The resident will be given time to attend the above classes and must pass the examinations associated with these courses. The results of these exams will be placed on record in the resident's file.

4. Practical Experience

   In parallel to the didactic course work, the physics resident will be assigned to a staff physicist by rotation to perform clinical tasks under his/her supervision. At the end of each rotation (e.g. 3 months), the staff physicist will hold a review session with the resident. The resident will identify and list procedures or tasks performed during the previous rotation and will be given a mock oral test in those areas. Additional literature reading assignments may be given at this time to strengthen theoretical understanding of various clinical procedures. A resident evaluation form will be completed and put in the resident's file.

The following broad areas will be covered during the two years of residency period. Normally, most of these procedures are encountered routinely in the clinic and the resident will perform these tasks repeatedly as the need arises for patients. However, the Program Director will augment training in areas which may not be practiced with sufficient frequency in the department. Also, additional areas may be added to the list if deemed essential to the professional needs of the resident. At the end of two years, the resident should be competent in the following areas:

1. Treatment Equipment (Teletherapy)

   Calibration: calibration according to protocol, acceptance testing, commissioning, beam data input into the computer, verification of computer isodose distributions, surface doses, buildup dose distributions, determination of parameters for monitor set calculations.

   Radiation Protection: head leakage, neutron contamination, area survey, design specifications, facility design.

   Quality assurance: daily, weekly, monthly and annual checks.

2. Simulator/CT Scanner

   Testing:acceptance testing and commissioning.

   Radiation Protection:beam quality, head leakage, and area survey.

   Quality assurance: mechanical, radiation, fluoroscopic, and processor.

3. Dosimetric Equipment

   Ion chambers: use of Farmer Chamber, plane parallel chamber, survey meter (calibration and use), radiation field scanner (water phantom).

   TLD: annealing procedures, calibration, use of capsules, chips, in vivo dosimetry.

   Film: film dosimetry for electrons and photons, sensitometric curve, and film

   badges.Quality Assurance: Chamber calibration and intercomparisons, TLD quality control, and survey meter calibration checks.

4. Treatment Planning

   Equipment: Acceptance testing and commissioning of treatment planning computer, digitizer, plotter and other auxiliary devices.

   Software: Check of computer algorithms for isodose generation, blocking, inhomogeneity and other benchmark tests.

   Imaging: Check of CT and MRI images for accuracy of contour delineation, magnifications; CT numbers vs. electron density curve.

   Isodose Plans: Treatment technique design and optimization, plan display and evaluation.

   Quality Assurance: Point dose verification by manual calculation.

5. Treatment Aids

   Field Shaping: Custom blocking, multileaf collimators, half-value thickness blocks, gonadal shields, eye shields, and internal shields with electrons.

   Bolus: Material and thickness.

   Compensators: Design of missing tissue compensators and dosimetry check.

   In vivo Dosimetry: Use of TLD chips, diodes (if available).

   Patient Positioning: Immobilization devices, body position, leveling, and anatomic landmarks.

   On-line Imaging: Verification of portal images in comparison with simulation images.

6. Special Techniques

   TBI: Establishing dosimetry protocol for total body irradiation technique including dose calculation formalism, compensation and dosimetric verification.

   TSI : Establishing total skin irradiation technique including treatment parameters, dosimetry and in vivo checks.

   Electron Arc Therapy: Treatment planning and technique for electron arc therapy, and special dosimetry.

   Intraoperative Electron Therapy (if available): Acceptance testing, commissioning, and complete dosimetry of applicators and other treatment conditions specific to IORT.

7. Stereotactic Radiosurgery

   Specifications: Acceptance testing and commissioning of radiosurgery apparatus, beam data acquisition for small fields, data input into the treatment planning computer, and testing of dose calculation algorithm by head-phantom dosimetry.

   Treatment Planning: Acquisition of CT, MRI, angiographics data; planning of isodose distributions in 3-D, plan evaluation, generation of treatment parameters.

   Quality Assurance: QA checks before each case.

8. Patient Dose Calculations

   Dosimetric Quantities: Percent depth dose, TPR, TMR, TAR, etc. and their relationship.

   Monitor Unit Calculation: Calculations for different treatment conditions and techniques, verification of calculation formalism using bench mark problems.

9. Brachytherapy

   Calibration: Acceptance testing and commissioning of brachytherapy sources, applicators, and HDR.

   Source Preparation: Preparation of sources and applicators for implantation.

   Radiation Protection: Radiation surveys, leak testing and other requirements of regulatory agencies.

   Treatment Planning: Computer isodose distributions, check of dose calculation algorithm, implant system rules and dose specification.

   NRC-Mandated Quality Management Program: Detailed Review of QMP document, implementation and audit.

10. Quality Assurance Program

    Design or review of physical quality assurance program for the department, including the NRC mandated Quality Management Program, AAPM Report (TG-40), JCAHO guidelines, etc.

SPECIAL REPORTS

In addition to the above practicum as part of the routine clinical operation, the physics resident will be required to prepare a detailed report on selected practical projects which will include the following as a minimum:

1. Theory and operation of:

   Radiation detectors

   Ion chambers/triaxial cables/electrometer

   Thermoluminescent dosimeters (TLD)

   Film (XV2, EDR2)

   Diodes

2. Calibration of:

   Superficial x-ray unit

   Orthovoltage x-ray unit

   Megavoltage x-ray and electron beam unit

3. Acceptance testing and commissioning of:

   Simulator

   Linear accelerator

   Treatment planning computer

4. Room shielding design for:

   Simulator

   Linear accelerator

   Radioisotope storage

5. Radiation Protection Survey of:

   Megavoltage facility

   Simulator

   Radioisotope room

6. Acceptance testing and commissioning of brachytherapy apparatus and sources.

CONFERENCES

The physics resident will participate in all departmental conferences which the physics staff is required to attend. Presently these include:

New patient presentations (2/week).

Treatment planning (1/week).

Quality assurance (1/week).

Complications (1/month).

Special lectures and Seminars (as scheduled).

The department will provide funds for travel to one AAPM annual meeting.

STAFF

The department currently has six board certified radiation oncology physicists, eight board certified radiation oncologists, one radiation biologist and other cancer research faculty. The following will participate in the training of medical physics residents.

The department is staffed with 7 registered therapy technologists, two certified medical dosimetrists, one maintenance engineer supported by the Hospital Biomedical Engineering department, one computer systems specialist, two nurses, two radiation oncology administrators, one physics program coordinator and other secretarial and clerical staff for the clinic.

FACILITIES

1. Treatment Machines: Currently the department has:

   Varian Clinac 2300 CD, with multileaf collimators, x-ray beams of 6 MV and 25 MV and electron beams of 6, 9, 12, 15, 18, and 22 MeV.

   Varian Clinac 6-100 linear accelerator with x-ray beam of 6 MV;

   Varian Clinac 2100C with x-ray beams of 6 MV and 18 MV and electron beams of 6, 9, 12, 16, and 20 MeV.

2. Simulator:Varian Ximatron C./CT Scanner, Siemens

3. Brachytherapy: 137Cs for GYN implants, 192Ir and 125I for interstitial implants and a Varian HDR unit.

4. Stereotactic Radiosurgery Unit: Varian Zmed system with BRW frame, SRS apparatus and Radionics XKnife-4 treatment planning system.

5. Hyperthermia: Thermotron RF Model 8 treating at 8 MHz.

6. Dosimetry Equipment:Wellhofer water phantom, calibration water phantom, plastic phantoms, Rando phantom, electron arc dosimetry phantoms; three Farmer type 0.6 cc ion chambers, extrapolation chamber, three plane-parallel chambers, four Keithley electrometers; diodes, LiF-TLD system, film dosimetry system; ion chamber survey meter, neutron meter, G.M. counter, dose calibrator, scintillation well-counter; mercury barometer, aneroid barometer, thermometers, hyperthermia thermometry system.

7. Electronics lab, treatment aid and machine shop; hospital scientific apparatus shop.

8. Well-equipped radiation oncology clinic.

9. Well-equipped radiation biology and immunology labs.

10. Treatment planning computer systems:

    3-D treatment planning system (ADAC), Varian Eclipse & IMRT System, Theratronics external beam/ brachytherapy treatment planning system, Radionics XKnife 4 Stereotactic treatment panning system, two Unix workstations: DEC 3000/500 AXP Alpha with high performance graphics. Approximately 25 Macintosh and IBM compatible computers. All computers networked with on-line access to Internet.

11. Access to imaging equipment (CT, MRI , US , etc.) through Diagnostic Radiology Department. Images available on Ethernet.

12. Varian Varis record and verify system (being replaced with Varis).

13. Library: Department library for radiation oncology literature, medical school library and other University libraries on campus.

CLINICAL RESOURCES

A wide variety of cancer patients are treated, including total body irradiation, total skin irradiation, brachytherapy of cancer of the cervix, stereotactic radiosurgery, brain implants, head and neck cancers, breast, Hodgkin's disease, lung, prostate, leukemias, sarcomas, etc. Patient load varies between 500 to 600 patients treated per year.

INSTITUTIONAL SUPPORT

Support is available for administration, budget, space, clinical and educational resources. The department also has a medical residency program and radiation therapy technology school.

EVALUATIONS

Evaluation forms have been developed to monitor resident's performance and progress throughout the training period. The assigned faculty grades the performance of the resident at the end of each rotation and reports are filed in the resident's record. The Program Director meets with the resident at the end of each rotation to evaluate the overall effectiveness of the program and discuss any areas of concern. It is the Program Director's responsibility to advise, censure or dismiss residents, after due process, who fail to demonstrate adequate progress or competence.

ADMISSION PROCEDURE

Qualified applicants are requested to submit their application material (listed below) as soon as possible. A transcript of undergraduate and graduate work, a personal statement, along with three reference letters must accompany the application. A Selection Committee consisting of medical physics faculty and a staff radiation oncologist grade the applications and select three or more candidates for interview. Interview expenses are borne by the candidate. Final evaluation of the candidates is made by the Selection Committee on the basis of the candidate's educational background, special experiences, letters of reference and interview performance.

STIPENDS

Stipends and benefits provided to Physics Residents and their dependents are, in general, in accordance with the AAPM guidelines. However, the funding levels are updated annually and adjusted appropriately to reflect local situations.

DISCIPLINARY AND GRIEVANCE PROCEDURES

(Please refer to Part A for Medical School Policy on the following: Discipline/Dismissal of Residents/Fellows, Regents' Student Academic Grievance Policy, University Senate Policy on Sexual Harassment, Resident Procedure for Reporting Sexual Harassment and Discrimination, and Sexual Assault Victim's Rights Policy)

GRIEVANCE AND DUE PROCESS

Refer to Part A Manual