1. International Atomic Energy Agency RCA Project (RAS/6/038) on Strengthening Medical Physics through Education and Training: National Project Coordinators Meeting Dhaka, Bangladesh, 26-28 May 2008. Report of Diagnostic guidelines Donald McLean Technical Officer

2. International Atomic Energy Agency What do Medical Physicists Do? Medical physicists are concerned with three areas of activity: clinical service and consultation, research and development, and teaching. On the average their time is distributed equally among these three areas.clinical service and consultationresearch and developmentteaching

3. International Atomic Energy Agency Definition of a Qualified Medical Physicist A Qualified Medical Physicist is an individual who is competent to practice independently one or more of the subfields of medical physics. Therapeutic Radiological Physics Diagnostic Radiological Physics Medical Nuclear Physics Medical Health Physics

4. International Atomic Energy Agency Percentage of medical physicists by specialty and country Country%RT%DR%NM Bangladesh40060 India9811 China9604 Singapore72226 Vietnam88012 Thailand85?15 Sri Lanka10000

5. International Atomic Energy Agency Some UK data Countryyear%RT%DR+NM England20045644 Scotland20087030estimate 1 Scotland20087624estimate 2

6. International Atomic Energy Agency Specialty interest groups in Australia (2005) Radiation oncology – 164; Diagnostic radiology – 130; Nuclear Medicine – 81 However within interest group (includes NZ) – 21 where accredited + 19 potentials; 39 more than interested (training, managerial, PACS, commercial etc.) 71 only interested

7. International Atomic Energy Agency Diagnostic Radiological Physics This particular field pertains to: the diagnostic applications of x rays, gamma rays from sealed sources, ultrasonic radiation, radio frequency radiation and magnetic fields the equipment associated with their production, use, measurement and evaluation the quality of images resulting from their production and use medical health physics associated with this subfield

8. International Atomic Energy Agency What Does the Radiology Physicist Do? (Australia) In part we are training for equipment testing, but more importantly for consultancy roles : Dosimetry, including advice to the patient/medical staff Purchasing advice Optimisation (as opposed to compliance testing) Teaching Problem-solving Service planning Research Regulatory advice Radiation safety including shielding

9. International Atomic Energy Agency Basic Safety Standard and the Medical Physicist

10. International Atomic Energy Agency More on the ‘new’ BSS draft: calibration, dosimetry & QA (e) {II.2} for diagnostic and image-guided interventional uses of radiation, the imaging, calibration, dosimetry and quality assurance (including acceptance and commissioning) requirements of the Standards be fulfilled by, or under the oversight of or with the advice of, a medical physicist with competence in the relevant field, where the degree of involvement of the medical physicist would be determined by the complexity of the particular use of radiation and the ensuing radiation risks.

11. International Atomic Energy Agency Strengthening Medical Physics through Education and Training What is the role in diagnostic physics?

12. International Atomic Energy Agency Clinical Audit A quality assurance tool for improvement and learning. QUATRO missions in radiotherapy: Mongolia, Sri Lanka, Philippines, Indonesia, Malaysia, Vietnam, Thailand, China

13. International Atomic Energy Agency On-site audit procedures Entrance briefing: introduction of auditors to staff, audit objectives, methodology, audit programme Assessment: staff interviews, complete tour of facility, review & evaluation of procedures & documentation, measurements, tests of procedures, observation of practical work Exit briefing: feedback to the department, preliminary recommendations, questions, discussion, response to recommendations

14. International Atomic Energy Agency Auditors will also seek evidence for Patient oriented organization Openness to new technologies Culture of cooperation between staff members QA system in place with the objectives of continuous quality improvement Research integrated into clinical practice

15. International Atomic Energy Agency Audit recommendations Discussed in exit briefing Steps intended by the institution to follow the recommendations Follow-up visit or internal audit, if appropriate

16. International Atomic Energy Agency Diagnostic radiology clinical audit (i) 5.TECHNICAL PROCEDURES 5.1.Principles and criteria for good practice 5.1.1.Quality Assurance Infrastructure 5.1.1.1.PERSONNEL 5.1.1.2.TEST INSTRUMENTATION 5.1.1.3.MANAGEMENT SUPPORT 5.1.1.4.DOCUMENTATION 5.1.2.Radiation protection and general safety 5.1.2.1.RADIATION PROTECTION ORGANISATIONAL STRUCTURE 5.1.2.2.RADIATION LEGAL REQUIREMENTS AND PROTECTION POLICIES 5.1.2.3.RADIATION SHIELDING DESIGN & VERIFICATION 5.1.2.4.OCCUPATIONAL DOSE AND PREGNANCY1.2.4.OCCUPATIONAL DOSE AND PREGNANCY 5.1.2.5.PATIENT DOSE AND INFANCY, CHILDHOOD AND PREGNANCY1.2.5.PATIENT DOSE AND INFANCY, CHILDHOOD AND PREGNANCY

17. International Atomic Energy Agency Diagnostic radiology clinical audit (ii) 5.TECHNICAL PROCEDURES 5.1.Principles and criteria for good practice 5.1.3.Equipment Quality Assurance Processes 5.1.3.1.SELECTION OF EQUIPMENT 5.1.3.2.ACCEPTANCE TESTING OF EQUIPMENT AND THE SETTING OF BASELINE VALUES 5.1.3.3.ROUTINE QUALITY CONTROL TESTING 5.1.3.4.EQUIPMENT REPLACEMENT POLICY 5.1.4.Calibration of instrumentation 5.1.5.Dosimetry 5.1.5.1.DOSIMETRY PRINCIPLES 5.1.5.2.PATIENT DOSE PROTOCOLS 5.1.5.3.PHANTOM DOSE MEASUREMENTS 5.1.5.4.PATIENT DOSE SURVEYS 5.1.6.Optimisation

18. International Atomic Energy Agency Strengthening Medical Physics through Education and Training

19. International Atomic Energy Agency Clinical Training

20. International Atomic Energy Agency Development of clinical training guide for Diagnostic Radiology Physics Schedule First meeting in Manila – Oct 29- Nov 2. Development of competencies Follow up meeting Seoul July 7-11. Development of competencies & assessment Pilot - 2009

21. International Atomic Energy Agency Developing the Training Program Guide Steps Define the roles and responsibilities Define the required “Knowledge and Competencies” to undertake these roles and responsibilities Prepare a competency based clinical training program which meets the required knowledge and competencies

22. International Atomic Energy Agency Suggested Training Overview Suggested Clinical Training Program Overview Resident Clinical Supervisor External Reviewers IAEA External Coordinator Certificate of Completion External Resources e.g.text+ documents AV material etc National Responsible Authority National Steering Committee Relevant Professional Body Resident’s Handbook Clinical Training Guide National coordinator Handbook for Clinical Supervisors Administrator’s Guide Implementation Manual Competency Document Assessments

23. International Atomic Energy Agency Clinical Training Guide - Therapy ModuleTitle% of Entire Program 1“Clinical Introduction”3% to 7% 2“Radiation Safety and Protection”5% to 10% 3“External Beam Dosimetry”5% to 10% 4“External Beam Therapy”15% to 20% 5“External Beam Treatment Planning”15% to 20% 6“Brachytherapy”10% to 15% 7“Professional Studies and QM”7% to 12% 8“Research and Development”10% to 15% Expected time: 2 to 3 years

24. International Atomic Energy Agency Clinical Training Guide - Diagnostic ModuleTitle 1“Clinical Introduction” 2“Technology management” 3“Routine quality control testing of imaging equipment” 4“Dosimetry, instrumentation and calibration” 5“Patient dosimetry and dose audit” 6“Image quality assessment” 7“Professional Studies and QM” 8“Teaching, Research and Development” 9“Optimisation” 10“Imaging support to other specialties” Expected time: 2 to 3 years

25. International Atomic Energy Agency Modules (i) Clinical Awareness / Introduction Basic Anatomy, Physiology & Radiobiology Patient related experience Radiation safety and protection Personnel monitoring ALARA programme incl. staff dose audit Supporting compliance with radiation protection regulatory requirements Provision of advice for radiation incident and accident situations Dose reduction techniques Staff Patient Shielding & Departmental Design Research & Development and Teaching Professionalism, Communication and QM Communication with medical staff and allied health Professional awareness Providing technical consultation Scientific support to other medical specialities Clinical audit

26. International Atomic Energy Agency Modules (ii) Quality control of imaging equipment Introduction Film screen Processing Radiography Fluoro AEC BL CR/DR Mammo MRI US Monitors Technology management (Equipment life cycle) Equipment planning (Identification of imaging requirements, Equipment acquisition Identification of imaging requirements, specification and choice of equipment, pre acquisition evaluation Acceptance testing and commissioning Equipment maintenance oversight* Disposal Dosimetry, Instrumentation and calibration Ionising radiation dosimetry and principles of medicine Non ionizing radiation quantities and principles of measurement Basic instrumentation, measurement and practice Dosimetry system calibration. Patient dosimetry & dose audit. Image quality assessment Optimization

27. International Atomic Energy Agency Availability of qualified and clinically trained educators Availability of qualified and clinically trained educators The educators/ trainers must have medical physics qualification and possess the necessary clinical experience. They must be enthusiastic teachers. In this way they can impart knowledge and to serve as role models for the students. KH Ng

28. International Atomic Energy Agency Utilization of state-of-the arts mode of delivery Adequate educational infrastructure and resources Key textbooks, reference books and journals are essential. Electronic materials – CDs, Online resources online tutorials, computer-aided learning

29. International Atomic Energy Agency Academic education Diagnostic Radiology Handbook underway 24 chapters + 2 appendices Completion in 2009. Nuclear Medicine Handbook scheduled to start in 2008. Support of MSc programmes through TC support in an increasing number of member states

30. International Atomic Energy Agency

32. International Portal : AAPM http://www.aapm.org/international/default.asp Many of the Educational Resources are also available to medical physicists in the Developing Countries. Access requires registration as a Developing Country Educational Associate (DCEA) and obtaining a Developing Country Educational Associate USERNAME and PASSWORD. To become a DCEA submit the online registration form at Developing Country Educational Associate Registration.A list of Developing Countries recognized by the AAPM is posted at AAPM Recognized Developing Countries.Developing Country Educational Associate Registration AAPM Recognized Developing Countries

33. International Atomic Energy Agency Thank you for your attention.