1. EDUCATION AND TRAINING OF MEDICAL PHYSICISTS
James A. Purdy, Ph.D.
Professor and Director
Division of Radiation Physics
Department of Radiation Oncology
Washington University School of Medicine
St. Louis, Missouri, USA
Evolving Strategies in Radiation Oncology
Rome, Italy, June 3-5, 2004

2. EDUCATION AND TRAINING
Education of the clinical radiation oncology physicist can be divided into three stages.
1st Stage: University education in physics, engineering, mathematics, and other relevant topics (B.S.).
2nd Stage: Graduate education leading to M.S. or Ph.D. (Medical physics courses may be introduced into curriculum).
3rd Stage: Physics residency training in a clinical environment.

3. EDUCATION AND TRAINING First Stage
Bachelors degree in physics or equivalent.
Medical physicists should be educated primarily as physicists (or biomedical engineers?) and be qualified and competent to apply the many branches of physics to continually evolving problems and situations which occur in medical environs of hospitals and clinics.

4. EDUCATION AND TRAINING Second Stage
Graduate degree ( Masters or Doctorate ) in physics or medical physics.
Masters program: typically, about 2 calendar years required.
Doctoral program: typically about 4 to 5 years required.
emphasis on developing research capabilities of individual

5. EDUCATION AND TRAINING: Second Stage
Note! If medical physics Masters and Doctorate degree program, it should be subjected to the same scrutiny and approval requirements as all other graduate degree programs of the University.

6. EDUCATION AND TRAINING Third Stage
Formal comprehensive training and experience in areas of clinical dosimetry, treatment planning, treatment aid design and fabrication, brachytherapy, radiation safety, special procedures, machine calibration, and quality assurance.
Length of clinical physics residency training period should be 2 years or longer.

7. EDUCATION AND TRAINING Third Stage
Note! Graduate degree in physics or medical physics is no longer adequate by itself in order to work independently in a clinical situation.
Note! Informal “on-the-job” training working under the tutelage of a more senior medical physicist is no longer adequate.

8. EDUCATION AND TRAINING Accreditation
Accreditation of graduate educational programs in Medical Physics
program conforms with standards that should result in its graduates being qualified for more specialized training or professional practice in clinic medical physics.
Establishes minimum levels of educational and training opportunities that must be offered by program.

9. EDUCATION AND TRAINING: Accreditation
Clinical Physics Residency Programs are based on AAPM Report No. 36

10. EDUCATION AND TRAINING: Accreditation
Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP)
degree programs in medical physics (11)
clinical physics residency programs (6)

11. CAMPEP ACCREDITED DEGREE PROGRAMS
McGill University
University of Alberta - Cross Cancer Institute
University of British Columbia
University of California - Los Angeles
University of Florida
University of Kentucky Medical Center
The University of Texas - Houston Health Science Center (M. D. Anderson Cancer Center)
University of Texas HSC - San Antonio
University of Wisconsin-Madison
Vanderbilt University School of Medicine
Wayne State University

12. CAMPEP ACCREDITED RADIATION ONCOLOGY CLINICAL PHYSICS RESIDENCY PROGRAMS
Washington University/Barnes-Jewish Hospital St. Louis (1997, 2003)
University of Minnesota Medical School (2000)
University of Florida (2000)
McGill University (2000)
Mayo Clinic (2003)
University of Louisville School of Medicine (2003)

13. EDUCATION AND TRAINING: Certification
Certification board performs several functions:
evaluates qualifications of candidates requesting examination in specific medical physics subspecialties.
arranges, controls, and conducts certification examinations.
grants and issues certificates in to applicants who have been found to be qualified by the board.
maintains registry of holders of such certificates.
serves medical and lay public by providing lists of names of certified medical physicists.

14. EDUCATION AND TRAINING: Certification
American Board of Radiology
Radiological Physics
Therapeutic Radiological Physics
Medical Nuclear Physics
Diagnostic Radiological Physics
American Board of Medical Physics
Radiation Oncology Physics
Diagnostic Imaging Physics
Hyperthermia Physics
Medical Health Physics
Magnetic Resonance Imaging

15. EDUCATION AND TRAINING: Licensure
In addition to training program accreditation and individual physicist certification, licensure for clinical medical physicists is recognized as an added means to credential and ensure that the clinical medical physics profession is practiced by competent professionals.
Only three states, Texas, Florida, and New York, have passed legislation requiring licensure of medical physicists, and much work remains.

16. EDUCATION AND TRAINING: Continuing Education
Attendance at seminars, scientific meetings, and advanced training courses is essential to maintaining professional competency.
Provides opportunities for obtaining deeper knowledge in special branches of medical physics.
Necessary due to increased specialization among clinical physicists and continuing technological advances.

17. CLINICAL PHYSICS RESIDENCY PROGRAMS
Object of residency training program is to train physicists in the clinical practice of radiation oncology physics.
To accomplish this goal, the following must be provided:
adequate organization
staff
facilities
patient resources
educational environment

18. CLINICAL PHYSICS RESIDENCY: Program Director
Certified in Radiation Oncology Physics
Full-time staff member, qualified in and practicing radiation oncology physics
Contribute sufficient time to program to insure adequate direction
Responsible for training program:
Instruction/supervision of physics residents
insure adequate facilities, teaching staff, clinical resources and educational resources
selection of physics residents (must insure that the appointed residents meet eligibility requirements).

19. CLINICAL PHYSICS RESIDENCY: Faculty and Staff
Faculty must include at least the following:
2 full-time radiation oncology physicists, both certified by the American Board of Radiology or its equivalent.
1 full-time radiation oncologist certified by the American Board of Radiology or its equivalent.
accessibility to 1 full time radiation biologist .

20. CLINICAL PHYSICS RESIDENCY: Faculty and Staff
Faculty must be qualified in those areas in which they instruct/supervise physics residents.
Must have a real interest in teaching and devote necessary time/effort to residency program.

21. CLINICAL PHYSICS RESIDENCY: Faculty and Staff
Faculty should ALSO be engaged in scholarly activities such as:
participation in national scientific societies
participation in their own continuing education
scientific publications and presentations
active involvement in radiation oncology physics development and research.

22. CLINICAL PHYSICS RESIDENCY: Facilities
Space.
There must be space adequate for the conduct of a good clinical physics practice and training program.
Clinical Resources
Training program must provide sufficient patient volume and variety of cancer patients for adequate resident experience.
Number of patients treated per year at least 500.

23. CLINICAL PHYSICS RESIDENCY: Facilities
Equipment Required:
Two or more multi-modality megavoltage linacs
Desirable, superficial/orthovoltage x-ray units
Dedicated therapy simulatorand CT-simulator
Interstitial & intracavitary brachytherapy equip.
Computerized treatment planning system
Equipment to construct special treatment aids
Physics dosimetry equipment
Availability of electronics and machine shops

24. CLINICAL PHYSICS RESIDENCY: Educational Environment
Environment that encourages exchange of knowledge and experience among physics residents and with clinical residents located in the same institution.
Library Resources
Sufficient variety of journals, reference books, and resource materials pertinent to radiation oncology physics and associated fields in oncology and basic sciences must be immediately accessible for resident study.
Access to a general medical library.

25. CLINICAL PHYSICS RESIDENCY: Educational Environment
Conferences
Conferences and teaching rounds must provide for progressive resident participation.
Adequate frequency of conferences and attendance by physics residents, radiation oncology physicists, radiation oncologists and other staff should be documented.
Adequate conference room and audio-visual facilities must be provided.

26. CLINICAL PHYSICS RESIDENCY: Educational Environment
Conferences
New Patient conferences
Weekly Chart Reviews & Problem Case Conferences
Physics/Dosimetry Conference
Morbidity Conference
Radiation Biology Conference
Journal Review Conference

27. CLINICAL PHYSICS RESIDENCY: Requirements for Completion
Complete a series of clinical rotations (3 months each)over 2 year period.
Pass a set of special training sessions and didactic courses.
Participate in clinical conferences and special lectures.
Prepare handouts and make presentation for 3 assigned topics each year.
Pass Year 1 Oral Exam
Pass Year 2 Oral Exam

28. WUBJH PHYSICS RESIDENCY PROGRAM
Washington University/Barnes-Jewish Hospital (WUBJH) Radiation Oncology Center formalized their previous "post-doctoral" training approach and established Radiation Oncology Physics Residency Program in 1992.
Became first physics residency program to be accredited by CAMPEP in Oct

29. WUBJH PHYSICS RESIDENCY PROGRAM: Clinical Rotations
Provides for physics resident’s participation in clinical and technical subjects pertinent to radiation oncology physics including:
Megavoltage photon and electron beam therapy
Superficial x-ray therapy
Simulation/CT-simulation
2D and 3D computerized dose planning
Treatment aids
Calibration and periodic QA of therapy equipment
Brachytherapy Interstitial and intracavitary Radiopharmaceutical therapy
Radiation safety procedures
Special procedures (IMRT, radiosurgery, TBI, etc)

30. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
July Orientation/Team 1 Treatment Planning
August “
September “
October Team 2 Treatment Planning
November “
December “
January Special Procedures incl. IMRT Planning
February “
March “
April Brachytherapy
May “
June Chart Checking (plan, calculations)

31. WUBJH PHYSICS RESIDENCY PROGRAM: Year 02 Clinical Rotations
July External Beam/Radiosurgery
August “
September “
October External Beam & IMRT
November “
December “
January External Beam & Brachytherapy
February “
March “
April External Beam
May “
June “

32. WUBJH PHYSICS RESIDENCY PROGRAM: Training Sessions & Didactic Courses
Orientation Course (first 2 weeks of year 01)
Radiation Safety Exam (within 30 days beginning year 01)
Physics Didactic Course (Sep-Mar. year 01)
Cancer Biology Didactic Course (Mar-June year 01 or year 02)
Clinical Oncology Conference ( 1 hr lecture every Friday for 2 years)

33. WUBJH PHYSICS RESIDENCY PROGRAM: Conferences
Patient Management Conference
(3 times a week for 2 years)
Current Case QA Review Conference
(once a week 3-4:30 PM for 2 years)
Morbidity Conference
(once a month 12:00 - 1:00 pm, 2 years
Current Topic Conference
(once a month 4:30- 5:40 pm for 2 years)
Research Seminar
(once a month 5:00 - 6:00 pm, 2 years)

34. WUBJH PHYSICS RESIDENCY PROGRAM: Conferences
Treatment Planning/QA Conference
(once a month for 2 years)
Physics Resident Seminars
(once a month Sep.-June for 2 years)
Treatment Machine Operation Labs
(1st year)
Simulation Labs
Annual Radiation Safety Review
(one lecture a year)
Annual Fire, Chemical, Biohazards Review
(once a year)

35. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
WUBJH operates one of the most comprehensive external beam services in the country (Over 2000 patients treated annually:
traditional 2D photon and electron beam approaches
advanced 3D conformal radiation therapy approaches
inverse planning and IMRT.
stereotactic radiosurgery
total body photon irradiation

36. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
Each physics resident spends a 9 month rotation in Treatment Planning working mainly with medical dosimetrists.
Rotation is focused on learning:
basic treatment planning and dosimetry skills
developing familiarity with all clinical procedures performed.

37. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
Emphasize developing communication skills with all personnel involved with radiation therapy treatment procedures

38. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
Participates in simulation procedures.

39. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
Treatment aid (beam shielding blocks, compensating filter, immobilization/repositioning devices, etc) design and fabrication, and treatment machine quality assurance tests are acquired.

40. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
Patient Treatment Plan Data Acquisition
Monitor Unit Calculations
Point Dose Calculations

41. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Clinical Rotations
Dosimetry Instrumentation and Measurements
Daily, Weekly, Monthly, Yearly QA checks

42. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Conferences & Seminars
Attends and participates in patient conferences.
Assigned to deliver 3 seminars per year on various subjects that range from a detailed review of AAPM Task Group's 21, 25, 35, 40 and 45 Reports to site specific treatment planning reviews.

43. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Didactic Lectures
Expected to master Resident's Physics course, which is a formal lecture series with assignments and examinations.
Course utilizes the textbook by Faiz Khan, Radiation Therapy Physics, 3rd Ed, published by Williams and Wilkins plus handouts from the lecturers.
Core readings are assigned to the trainees.

44. WUBJH PHYSICS RESIDENCY PROGRAM: Brachytherapy Rotations
WUBJH has an active clinical brachytherapy service, encompassing intracavitary brachytherapy, temporary interstitial implants, permanent interstitial implants, and therapeutic radiopharmaceutical administrations.
Manual afterloading, remote-afterloaded low dose-rate and high dose-rate treatments.
Over 350 brachytherapy and radiopharmaceutical procedures are executed annually.

45. WUBJH PHYSICS RESIDENCY PROGRAM: Brachytherapy Rotations
Each physics resident rotates through the Brachytherapy Physics Service twice during their two year program.
First year: 3 month rotation which is focused on learning basic skills, background reading and procedure familiarity.
Second year: 2 month rotation which emphasizes a more independent performance as a brachytherapy physicist.

46. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Brachytherapy Rotation
Basic skills and concepts are emphasized.
Trainee assigned to work with the Brachytherapy Technologists during GYN implant days for 4-6 weeks.
Trainee learns to prepare applicators, assist physicians in the OR, perform daily QA on afterloading equipment, perform surveys, fill out required forms and records, and handle and prepare sources.

47. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Brachytherapy Rotation
About 50% of first rotation is spent working alongside an experienced staff clinical physicist learning to perform basic treatment planning, chart checking and QA tasks.
Computer treatment planning skills are acquired during previous Dosimetry Rotation.
On completion, trainee is expected to function as on-call physicist to handle after-hours emergencies with backup from faculty physicist.

48. WUBJH PHYSICS RESIDENCY PROGRAM: Year 02 Brachytherapy Rotation
Resident expected to function independently as a clinical physicist (within certain limits).
Trainee can be authorized to independently:
review treatment plans/manual calculations
order radioactive material
check in and calibrate radioactive sources/materials
cover Brachytherapy Physics Service for short periods.
More extensive clinical projects expected (e.g. developing written procedures for new treatment, commissioning new devices and instruments, or performing brachytherapy dose measurements.

49. WUBJH PHYSICS RESIDENCY PROGRAM: Year 01 Methods of Evaluation
Informal evaluation on monthly/continuing basis including completion/ understanding of assigned reading and exercises.
Evaluating staff include faculty physicists, dosimetrists, and attending radiation oncologists
Pass Radiation Safety Exam during first month
Treatment planning and dose calculation skills are monitored through review of completed tasks.
Communication skills are evaluated by informal discussion with dosimetry and physician staff.
Pass written and oral exam at end of year

50. WUBJH PHYSICS RESIDENCY PROGRAM: Year 02 Methods of Evaluation
Evaluated on month-by-month basis.
Must be able to perform treatment plan checking and chart checking without direct supervision.
Expected to perform physics tasks independently.
Must be able to carry out an independent annual review and calibration of a dual energy linac.
Must be capable of conducting her/himself with confidence in the clinic (input of physicians and dosimetrists is pertinent in this determination).
Pass 2nd year oral exam. (Questions encompass entire two year training).

51. WUBJH PHYSICS RESIDENCY PROGRAM: Developmental Projects
Physics resident is expected to participate in clinical implementation projects.
Examples are acceptance testing and commissioning multi-leaf collimator system, enhanced dynamic wedge, and IMRT systems.
Physics resident is encouraged to perform an independent clinical physics project suitable for submission as an abstract for AAPM annual meeting.

52. WUBJH PHYSICS RESIDENCY PROGRAM: Developmental Projects
Any special developmental projects or assignments outside the norm of clinical physics support must be approved in advance by the Program Director with the understanding that all such projects must be clinically oriented and will benefit the trainee's clinical experience.

53. SUMMARY Training program accreditation Physics residency program
Board certification
Licensure

54. CONCLUSION
As the various medicines in which physicists participate clinically continue to become more complex, pathway for clinical physics profession should become more formalized.
graduation from an accredited medical physics degree program
followed by clinical physics training in an accredited physics residency program
subsequent board certification.

55. Thank you for your attention.