Residency Program Outline

 

The resident rotations and the curriculum will be developed and coordinated by the CAMPEP-approved medical physics educational committee (MPEG), which will also be responsible for judging the competence of the resident in each area. The competency will be judged on the basis of CAMPEP program guidelines as well as interviews with the primary physicist in each area, interviews with the resident and performance on standardized and customized examinations. Didactic courses (to be described below) will be supplemented with suggested reading in areas related to each rotation. The curriculum for the physics resident, which conforms to the CAMPEP guidelines that is partially listed as follows:

Year I

 

  1. General radiotherapy physics - theory:

  • Interactions of radiation with matter
  • Treatment machines - principles of operation and beam properties
  • Measurement of exposure and dose
  • Calibration of photon and electron beams
  • Treatment planning theory
  • Dose distributions
  • Radiation protection and shielding
  • Radiological imaging theory
  • Intensity modulation method
  • Treatment equipment - practical:

    • Calibration techniques in electron and photon beams
    • Instrumentation for calibration
    • Quality Assurance checks - daily, weekly, monthly, annual
    • Accelerator commissioning and acceptance procedures
    • Operation of automated water phantom
    • Film scanning techniques
    • TLD reading and quality assurance
    • Electron and Photon beam properties
    • Simulator quality assurance and operation
    • General accelerator operation and maintenance considerations
  • Clinical support: 

    • Hand calculation of monitor units
    • Patient immobilizing devices
    • Custom blocking (photon and electron)
    • Tissue compensators
    • Asymmetric collimation
    • Multi-leaf collimator design
    • Off-axis dose calculations
    • In-vivo dosimetry
    • Patient positioning
    • Verification of position for treatment
    • Portal image generation and evaluation
    • Disease-specific treatment considerations
    • Selection of treatment machine
    • Treatment technique selection
    • Simulation technique
  • Treatment planning:

    • Planning from patient contours
    • CT-based treatment planning using coplanar beams only
    • Fully 3-dimensional CT-based treatment planning
    • Production and use of treatment aids (DRR's, Beam's eye view plots)reatment plan optimization techniques
    • Radiographic anatomy
    • Correlation of magnetic resonance images with CT images
    • Dose algorithms
    • Quality Assurance considerations treatment planning 
  • Brachytherapy: 

    • Radionuclides
    • Calibration of sources
    • Leak checking
    • General radiation protection
    • Survey instruments
    • Clinical applications
    • Treatment planning for remote afterloader applications
    • Source spacing
    • Source position verification
    • Planning and preparation of source distributions
    • Remote afterloader programming and q/a procedures
    • Inventory and reporting requirements 
    • Treatment planning and source preparation for interstitialimplants of brain tumors, ocular melanoma and prostate tumors with I-125

     

    Year II

     

    1. Supervised clinical dosimetry

      Dosimetry checks of the machine.

    2. Special techniques with designed physics faculty

      The resident will learn the physics of special procedures including: superficial x-ray treatment for skin lesions, IORT (intra-operative radiation therapy with electrons). The clinical applications of these techniques as well as the special dosimetric considerations will be covered.

    3. Stereotactic radiosurgery

      The resident will learn the clinical indications for single fraction radiosurgery, the techniques for diagnostic localization of targets using combinations of MRI, CT and angiographic projections (for both tumors and arterial-venous malformations), for treatment planning, documentation and implementation of treatments using the Gamma Knife. The installation of the Cyberknife will permit the resident to learn methods of stereotactic radiosurgery and radiotherapy using the linac.

    4. Intensity modulated radiotherapy

      The resident will learn the principles of inverse treatment planning, the advantages and disadvantages of different methods of IMRT beam delivery, will assist with preparation and interpretation of treatment plans for verification dosimetry and for patients with tumors in a variety of locations. Stop-and-shoot as well as Peacock MIMiC and dynamic MLC beam delivery methods will be investigated.

    5. Clinical physics research in radiotherapy

      The resident will have the opportunity to participate in the clinical implementation of new techniques in radiotherapy such as: computerized image comparison for evaluation of patient position using portal images, the use of multiple multileaf collimator patterns to produce 3-dimensionally conformal dose distributions, and the design of new treatment techniques such as intensity modulation which can improve the ratio of tumor dose to normal tissue dose. In addition, the resident will learn about the use of other modalities such as neutrons, protons and heavy ions through assigned readings and discussions. The resident will also participate in the planning and treatment of ocular melanoma patients with protons at the U.C. Davis cyclotron. This module will provide the background for clinical physics research in radiotherapy.

    6. Clinical and experimental hyperthermia

      The resident will participate in a comprehensive hyperthermia program involving both research and development "state of the art" hyperthermia technologies, as well as ongoing clinical treatments with a wide assortment of modern equipment. The residents will assist in clinical hyperthermia treatments and learn required quality assurance procedures for ultrasound and microwave devices. In addition, the resident will learn about techniques for temperature monitoring, treatment planning, and radiobiological considerations of heat and radiation.

    7. Radiobiology

      Through lectures and reading assignments, the resident will learn the basics of radiobiology. This will include cellular response to deposited energy, mammalian cell radiosensitivity, modifiers to cellular radiosensitivity, repair mechanisms, dose-rate effects, solid tumor systems, linear energy transfer, relative biological effectiveness, cell and tissue kinetics, dependence of biological response on time, dose, fractionation and volume of tissue irradiated, response of tissues to heat (hyperthermia), acute and late effects after irradiation, and tissue-specific descriptions of radiation effects.

    8. Clinical topics

      Through lectures and reading assignments plus discussions with physicians, the resident will learn the basics of clinical presentations of malignancies, sites of anatomical spread, modes of metastases, extent of disease, potential complications of disease and of treatment, indications for radiation therapy and for combined surgery and/or chemotherapy, as well as basic radiographic anatomy. In addition to daily clinical conferences and lectures, the resident will be expected to attend a special set of clinical lectures by the medical faculty offered during July or August.