MEDICAL PHYSICS TRAINING IN THE PHILIPPINES IAEA/RCA National Project Coordinators' Meeting to Review the Status of Medical Physics in the Region Dhaka, Bangladesh 26-28 May 2008 MEDICAL PHYSICS TRAINING IN THE PHILIPPINES LILIAN V. RODRIGUEZ, MSc Dept. of Radiotherapy, Jose R. Reyes Memorial Medical Center

The Philippines Land area : 300,000 km2 Population: 90M

The Philippines 7100 islands 3 major group of islands Language-Filipino 170 dialects

Historical Background 1963 : Philippine General Hospital acquired Cobalt 60 unit Dr. Cook, British medical physicist, trained Luciano Niguidula, on site for 6 months on calibration and radiation treatment planning 1969 : Philippine Atomic Energy Commission (now Philippine Nuclear Research Institute) sent Eulinia M. Valdezco for MSc Medical Physics course in UK 1974 : Radiation Health Service (now Bureau of Health Devices and Technology or BHDT) was established. 1975 : Dr. Celia T. Anatalio , Director, started hiring Physics graduates (Carmen Filamor, Arturo Sy, Agnette Peralta, Romeo Sope) and sending them for on the job training in Australia and New Zealand A.P.Peralta

Historical Background 1978: Philippine government submitted to International Atomic Energy Agency project proposal for technical assistance in “Establishing an MS Medical Physics Course in the Philippines”, a joint project of : Radiation Health Service, National Cancer Control Center, DOH Philippine Atomic Energy Commission, DOST and University of Santo Tomas (UST) Graduate School (total project cost from 1980 to 1992: US$287,598) 1979-1981: Philippine Government sent 5 Filipinos for MSc Medical Physics Courses in UK and US 1981: MS Applied Physics Major in Medical Physics Course established at UST Graduate School – Ms. Agnette Peralta, later on became the Course Coordinator A.P.Peralta

HISTORICAL BACKGROUND (continued) First Batch of Graduates of the IAEA supported MS Applied Physics Major in Medical Physics: Marlon Raul Tecson, Bayani San Juan, Rosita Uy, Aida Lobriquito, Monica Bacaling and Edgar Estoesta Philippine Organization of Medical Physicists (POMP) established and became International Organization for Medical Physics member (IOMP) POMP became member of Asia-Oceania Federation of Organizations of Medical Physics 2001 POMP became member of South East Asian Federation of Organizations of Medical Physics (SEAFOMP) A.P.Peralta

HISTORICAL BACKGROUND (continued) 2002 The Philippines included in new IAEA project “Strengthening Medical Physics through Education and Training” in East Asia and the Pacific 2004 Master in Medical Physics Course (2nd masteral course) established at UST Graduate School 2005 2nd MOA for Medical Physics signed: DOH, DOST, UST and UST Hospital 2007 5th SEACOMP Congress held at UST Graduate School A.P.Peralta

Medical Physics Course Taken from Vision Magazine, 2000 The University of Santo Tomas (1611) Graduate School (1931)

Medical Physics Course IAEA support (1980-1992) Experts (Drs. David Hawkes, Lars Eric Larsson, Bengt Bjarngard, Guy Simmons, Malcolm Cottral, David Goodenough etc.) Books Dosemeters and test tools Phantoms (water phantoms and Rando phantom) 3 PC computers

Course Program Overview The Master of Science in Applied Physics major in Medical Physics (MSc) and Master in Medical Physics (MMP) are two year graduate degree programs The course is intended to meet the need for qualified medical physicists in hospital departments especially in radiotherapy, diagnostic radiology and nuclear medicine; the national regulatory agencies with responsibilities in radiation protection and the research and academic institutions

Admission Requirements BS Physics, Applied Physics, Physics for Teachers BS Engineering or other Sciences with at least 12 units in Physics (up to Modern Physics), 21 units of Mathematics (covering Algebra, Trigonometry, Differential and Integral Calculus, Differential Equations and Vector Analysis) General average of at least 2.0, 85% or B Complete accomplished application and referral forms

First Semester (13 units) Introduction to Life Sciences (MedPhy 603) 3 UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM FIRST YEAR: First Semester (13 units) Introduction to Life Sciences (MedPhy 603) 3 Radiation Physics (MedPhy 602) 3 Physics of Diagnostic Radiology (MedPhy 704) 3 Radiation Protection and Radiobiology I (MedPhy 701) 3 Practicum in Diagnostic Radiology 1

UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM FIRST YEAR: Second Semester (11 units) Radiation Dosimetry (MedPhy 703) 3 Radiation Protection and Radiobiology II (MedPhy 702) 2 Physics of Nuclear Medicine (MedPhy 705) 3 Physics of Ultrasound (MedPhy 707) 2 Practicum in Nuclear Medicine 1

Biostatistics (MedPhy 601) 3 UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM Summer (6 units) Biostatistics (MedPhy 601) 3 St. Thomas on Critical Thinking (GS 500) 3

Second Year: First Semester (8 units) UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MS Applied Physics Major in MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM Second Year: First Semester (8 units) Physics of Radiation Therapy (MedPhy 706) 3 Non-Ionizing Radiation Protection (MedPhy 708) 2 Research Methodology with Instrumentation (GS 501) 3

COMPREHENSIVE EXAMS Second Year: Second Semester (7 units) UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MS Applied Physics Major in MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM COMPREHENSIVE EXAMS Second Year: Second Semester (7 units) Thesis Writing I (Research Proposal ) 1 Thesis Writing II (Research Colloqium) 2 Thesis Writing III (Oral defense) 3 Practicum in Radiotherapy 1 Total No. of Units (45)

Second Year: First Semester (11 units) UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MASTER MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM Second Year: First Semester (11 units) Physics of Radiation Therapy (MedPhy 706) 3 Non-Ionizing Radiation Protection (MedPhy 708) 2 Research Methodology with Instrumentation (GS 501) 3 Special Topics in Medical Physics (MedPhy 709) 3

Second Year: Second Semester (7 units) UNIVERSITY OF SANTO TOMAS GRADUATE SCHOOL MASTER MEDICAL PHYSICS GRADUATE PROGRAM : CURRENT CURRICULUM Second Year: Second Semester (7 units) Practicum in Radiation Therapy 1 Imaging in Medicine 3 Graduate Seminar 3 COMPREHENSIVE EXAMS TOTAL NUMBER of UNITS (48)

Training Courses in Radiotherapy, Diagnostic Radiology and Nuclear Medicine 1992 – One month course in Medical Imaging conducted by Dr. Goodenough (WHO) held at DOH-BHDT, Manila 1996- Regional Training Course on QA in Radiation Therapy Dosimetry, conducted by Dr. Ben Mijnheer, et. al. Danarra Hotel, Q.C. 1997 – Three week course on Advanced Course in Quality Control in Diagnostic conducted by Dr. Joel Gray (WHO) held at DOH-BHDT 1999- Advances in Nuclear Medicine Training Course (IAEA) conducted by Dr. Guy Simmons held at PNRI, Quezon City 2000- IAEA Seminar Workshop on Radiotherapy Safety conducted by Dr. Pedro Ortiz, et. al. held at PNRI, Quezon City B.SanJuan

Training Courses in Radiotherapy, Diagnostic Radiology and Nuclear Medicine 2002 – IAEA/RCA Workshop on Radiation Protection in Nuclear Medicine conducted by Dr. Madan Rehani, et. al. held at PNRI, Quezon City 2003 Quality Assurance and Radiation Protection in Interventional Radiology, CT and Mammography equipment conducted by Dr. John Vetter (WHO) Physics and Quality Assurance of MRI by Dr. John Felmlee (WHO) B.SanJuan

Training Courses in Radiotherapy, Diagnostic Radiology and Nuclear Medicine 2005 Advances in Quality Assurance in Diagnostic Radiology conducted by Dr. John Vetter (WHO) Regional Course & Workshop on Current Practices & Advances in Radiation Therapy Physics, sponsored by AAPM, IOMP and POMP and conducted by Prof. Khan, Drs. Niroomand, Shah et.al), Manila QA/QC of External Beam Teletherapy Machines conducted by POMP held at MROC, Q.C. Meeting-Workshop on Doses in Diagnostic Procedures in Nuclear Medicine conducted by DOH, POMP, PNRI and PSNM, at PHC, Quezon City

Training Courses in Radiotherapy, Diagnostic Radiology and Nuclear Medicine 2006 National Training Course in Radiation Protection for Interventional Cardiology conducted by Dr. Louie Wagner (IAEA) Current Standards and Future Trends in Radiation Oncology sponsored by PROS, ASTRO and IAEA conducted by Dr. Palta, et.al., Manila Hotel National Training Workshop on Radiotherapy Dosimetry TRS 398 conducted by POMP and National SSDLs held at JRRMMC and Medical City, MM. Radiation Protection in Lasers, UV, Infrared light applications conducted by Dr. David Causer held at BHDT

Current Status 1990- present Programs Medical Physics is a self- supporting program Programs MSc Applied Physics Major in Medical Physics (with Thesis) 20 graduates Master Medical Physics (Non-Thesis) 15 graduates

Filipino Medical Physicists Work Medical Institutions Regulatory Bodies Academe/Others MSc MMP At least 24 units taken 4 8 27 9  9 2  3  10 Total 39 Total 22 Total 15 * 7 MSc Medical Physics graduates of the Program are now working as Medical Physicists in USA, Australia, S.Arabia A.P. Peralta

FACILITIES and EQUIPMENT 24 Radiotherapy facilities* 7 government owned 4 in MM 3 in the provinces 17 private owned 10 in MM 7 in the Provinces * Additional private facility soon to operate

External Beam Teletherapy Equipment 9 Cobalt 60 machines 20 linear accelerators* 15 dual mode 5 single mode 1 Gammaknife *additional 1 operational soon

Brachytherapy Facilities 10 HDR remote afterloader machines 6 Manual afterloading system 2 Permanent seed implant LDR HDR PSI 5 1 8 1 1

FACILITIES and EQUIPMENT 153 Mammography 4 government owned 149 private owned 120 CT Scan Machines 14 government 106 privately owned 18 MRI 2 Government 16 Private 19 Gamma Cameras 8 government owned 11 privately owned PET/CT and Cyclotron 1 privately owned

Bureau of Health Devices and Technology, Department of Health Regulates linear accelerators, simulators, x-ray machines, CT scanners, etc. Issues Administrative Orders (AO) Requires full time Medical Physicists with experience for facilities with linear accelerator

Philippine Nuclear Research Institute, Department of Science and Technology Regulates Cobalt-60 machines, brachytherapy facilities, etc. Issues Code of PNRI Regulations (CPR) Requires part time Medical Physicists with experience for Cobalt 60 machines and brachytherapy facilities

Problems/issues regarding Medical Physics Education Problem/Issue In the beginning, too few students Solutions Career talks given to graduating Physics students DOH awarded scholarship to employees to pursue Medical Physics (now also DOST) Regulations required Medical Physicists, hospitals sponsored their employees to enroll in the program

Problems/issues regarding Medical Physics Education Problem/Issue Employed Medical Physics students have difficulty finishing their degree because of work load responsibilities Solutions Master in Medical Physics a non-thesis course was offered in 2004

Problems/issues regarding Medical Physics Education Problem/Issue Expensive books Limited facilities for practicum (most facilities are in private hospitals where access is restricted) Limited opportunities to attend international conferences, training Brain drain

Future Plans Participate in the RCA/IAEA Clinical Radiation Oncology Medical Physics Residency Program Establish a certification scheme for Filipino Medical Physicists

Thank YOU for listening!

Acknowledgement Miss Agnette P. Peralta, Director, BHDT, Department of Health Mr. Bayani San Juan, Chief, Medical Physics Division, BHDT, Mrs. Eulinia M. Valdezco, Chief, Nuclear Regulations, Licensing and Safeguards Division, Philippine Nuclear Research Institute, Department of Science and Technology