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Medical Physics Residency Program

Medical Physics Residency Handbook

David Pearson, Ph.D.
Professor, Medical Physics Residency Director

(updated 01/28/2026)

Sections
 

Longitudinal Learning Objectives

Throughout the 2 years each resident must take part in regular clinical operations beyond the scope of the rotation they are currently involved in. Residents do not need to document each individual case but every effort should be made to ensure that each resident takes part in the full breadth of activities and plan types.

The specific longitudinal activities that each resident should take part in are listed below:

    • Treatment Planning – all cases in the clinic including SRS/SBRT and gated treatments. This includes plan documentation in the medical record system.
    • Patient Specific QA – all IMRT/VMAT plans at UToledo and ProMedica.
    • Simulation & Patient Education – residents will take in turns to attend all simulations and patient consultations on breath hold while based at UToledo.
    • Machine QA – residents will follow the QA schedule which indicates which machines they are responsible for.
    • Chart Checks and EOTs – residents will check the board daily and work on chart checks and end of treatments checks.

Residents Feedback

For each rotation, please complete a residents’ rotation feedback form:

https://webforms.utoledo.edu/form/60224806438

Completing this form does not require a UTAD log-in, allowing you to fill in an anonymous feedback form at the end of each rotation. 

This is an opportunity for you to list any ways we can improve the residents’ education or training environment so please be honest.  The form is the same for each rotation and asks you to tell us about how you think the rotation went and how well you think the rotation prepared you for a job or the ABR. It also asks to tell us if you experienced any unprofessional or concerning behavior during the rotation. Please note that these forms are our formal way of collecting feedback from you.  We also encourage you to bring up issues to any of us as they arise.  Please don’t feel that you have to wait until the end of a rotation as we can address things immediately, if needed.

Rotation Reports

A template is available in the residents’ shared folder and one of these should be completed for each rotation.  It should include a list of what tasks you completed during the rotation that are relevant to the topic.  There is also an Extracurricular Activities section for you to list activities not related to the topic.  This section should include, amongst other things, any conferences you attended, research you worked on and resident’s seminars you presented. In addition, during each rotation you should complete a clinic project and document your work.  Projects may be assigned to you, or they may be your ideas discussed with the rotation director. The project does not need to be related to the topic of the rotation.

Residency Steering Committee

The steering committee for the residency program is tasked with making sure all residents are on track and getting the best possible education.  As part of this role they are also there for you to talk to if you have any concerns.  The committee meets twice a year to review residents’ progress and also discuss any changes that should be made to the education program to improve your education.  These improvements may be based on your rotation feedback reports or your comments to the faculty at periodic meetings that occur between you and the residency leadership.

The steering committee consists of the medical physics faculty of the Dana Cancer Center, a medical physicist from ProMedica and a radiation oncologist. The current committee members are listed below.

Research & Clinical Project Expectations

Projects should be worked on whenever the clinic schedule allows.  At the least, we expect residents to submit abstracts each year to national meetings.  Each resident should have at least one abstract where they are the primary contributor. In addition, residents should assist students or other residents with preparing abstracts.

During each rotation the resident is asked to document a project that they have worked on that may or may not be related to the rotation topic.  Residents may fill this requirement by documenting progress on research. Alternatively, the rotation project could be clinical.  You may discuss a project with your faculty rotation director as they may have a specific assignment in mind. Possible examples of clinical projects include commissioning or acceptance of clinical equipment, teaching and creating a new class presentation for a graduate course, writing a new set of clinical instructions for the wiki or making measurement to verify currently commissioned equipment.

Residents Seminar

Every week, as the clinic schedule allows, each resident will attend resident’s seminar.  One resident will present, on a rotating basis, a topic of their choosing, approved by the program director or associate program director. Topics should be education and medical physics related. These topics may include, but are not restricted to,

  • A review of a new or current AAPM task group report
  • A review of a medical physics practice guideline
  • A review of a scholarly article
  • A presentation of a topic that the resident feels would be beneficial for ABR board preparation

Didactic expectations

All residents should complete and document that they have completed the following didactic courses:

    • Radiation Safety certificate course taught by the radiation safety office.
      • Deadline: this course must be completed no later than the end of the first year. If it was taken as a graduate student then the course certificate must be copied and placed in the resident’s folder for documentation.
    • MPHY 6260/8260 Computers in Radiation Therapy. Residents should audit the class, offered each fall, and discuss with Dr Sperling which classes are required.
      • Deadline: The class must have been taken prior to graduation of the resident but can either be taken in fall or if the class was taken as a graduate student, then this will be accepted.
    • Professionalism and Ethics. Residents should complete all modules of the course offered by the AAPM/RSNA. At the completion of each module the resident should save the completion certificate in their folder for documentation.
      • Deadline: These modules should be completed prior to December of the second year when the rotation Special Topics is due. The modules can be found here:
    • https://education.rsna.org/diweb/catalog/t/10792
      • For each module, please save a copy of your certificate. Since UToledo graduates cover research ethics is covered in the class ‘on being a scientist’ then the modules required for UToledo graduates are:
        • COI
        • relationships with vendors
        • ethics in graduate and resident education
        • Professionalism in everyday practice a physician
        • publication ethics
        • negotiations
        • physician-physician and physician-patient interactions

Residents from other graduate programs should either take all modules or provide certificates to the PD that shows they have already covered research ethics

Due Process

The University of Toledo must provide residents with fair, reasonable, and readily available written institutional policies and procedures for due process for appeal of corrective actions. The policy and procedures minimize conflict of interest by adjudicating parties in addressing:

    1. Corrective actions taken against residents that could result in dismissal, non-renewal of a resident’s agreement, non-promotion of a resident to the next level of training or being placed on probation.
    2. Providing Program Directors with procedures for implementing appropriate processes and guidelines for remediation and corrective actions for residents based on Academic and Non-Academic Deficiencies.

The policy for due process can be found here: https://www.utoledo.edu/policies/academic/gme/pdfs/Policy008.pdf 

Benefits

Salary

Salary for both PGY1 and PGY2 residents will be $55,000 annually.

Vacation

Total of 4 weeks/20 customary working days/160 hours. (Based on a July 1 – June 30 contract) and 10 holidays as observed by the University of Toledo.

Sick Leave

15 days with pay per contract year, July 1-June 30.

Paid Leave

FMLA is available after 1 year of employment. The amount paid for FMLA is dependent on how much sick and vacation time the resident has available.

Exercise Facility

Residents are able to join the Morse Center on Health Science Campus and the Recreation Center on Main Campus for an annual fee through payroll deduction.

Education Assistance and Tuition Waiver

Full time residents are eligible to receive a tuition waiver for payment of up to eight credit hours per semester for University of Toledo tuition and certain fees.  Spouses, domestic partners, and dependent children of residents who have been employed at UT for at least one year will be eligible to receive a tuition waiver for payment of undergraduate tuition and certain fees.  Dependents must be under age 24, unmarried, claimed as IRS dependent on UT employee's taxes and enrolled as a full time University of Toledo student with a minimum of 12 credit hours.  Please see the University's policy on Education Assistance and Tuition waiver for a full description of the program.  In addition, there may be tax implications associated with the tuition waiver and recipients may want to consult with a tax advisor.

Health Care/Dental Insurance

Residents are eligible to participate in comprehensive major medical and dental plans. A partial premium payment is required. Residents may choose between single or family coverage and contributions are payroll deducted. Optical and prescription plans are also available.

Life Insurance

$10,000 Basic Life Insurance, $10,000 Employee Basic Accidental Death and Dismemberment Insurance paid by The University of Toledo. Optional dependent life insurance is available and requires a minimum of monthly contributions.

Disability Insurance

Professional Liability Insurance provided without charge for each resident.

Malpractice/Liability Insurance

Full coverage by UToledo as long as the resident is functioning within the scope of the residency program.

Retirement

Residents may participate in the Ohio Public Employee Retirement System (OPERS) retirement plan or the Alternate Retirement Plan. Employee contributions are "deducted" by the University from the employee's gross pay and paid directly to the retirement systems. The resident annual contribution is 10%, and the university contribution is 13-14%, depending on the type of plan.

Credit Union

The University of Toledo Federal Credit Union offers loans at favorable interest rates and dividends on savings.

Employee Assistance

The University of Toledo Employee Assistance Program provides confidential and professional assistance to employees and dependents. Services include counseling, legal advice, identity theft prevention and recovery, financial education and more.

Career Services for Spouses/Domestic Partners

The UToledo Career Services assists spouses and domestic partners of residents in their job search through: exploring career and local employment opportunities; CV/resume and cover letter review and feedback; and practice mock interviews.

Additional Resources

The department wiki can be used to provide written instructions for a number of tasks.  It can be found using the link below (a request for access will be generated upon the first attempt to connect; once granted, your university Microsoft account email, e.g. john.doe@rockets.utoledo.edu, is required for access).

RadOncMedicalPhysics

Rotation Plans

During the first year, residents will alternate each month between ProMedica and UToledo Dana thus allowing each rotation to be spent half at UToledo Dana and half at ProMedica.

Year One

1. Dosimetric Systems - July + Aug - DP
2. Linac Commissioning - Sept + Oct - NS
4. TG51 + MU calcs - Nov + Dec - KG
6. TPS theory - Jan + Feb - NS
5. TPS QA - Mar + Apr - NS
3. Brachy - May + Jun - AH

Year Two

8. Simulation - July + Aug - KG
9. SRS/SBRT - Sept + Oct - DP
7. IMRT - Nov + Dec - NS
10. Special Topics - Jan + Feb - NS
11. IGRT - Mar + Apr - DP
12. Shielding - May + Jun - KG

Legend:

  • AH = Andrea Herric, MSBS, DABR
  • DP = David Pearson, Ph.D., DABR
  • KG = Nicholas Sperling, Ph.D., DABR
  • NS = Nicholas Sperling, Ph.D., DABR

 

Rotation Plan for 1) Dosimetric Systems and Safety

  1. Skills
    1. Linac Operation
      1. Treatment Mode for Varian Digital Linacs with Aria/Varian Treatment Software
      2. Service Mode on Varian Digital Linacs
    2. Use of an Ionization Chamber and Electrometer to Read Dose
    3. Introduction to Daily QA
      1. Observe daily QA being performed
      2. Each resident will perform daily QA independently
    4. Safety in Radiation Therapy
      1. Failure Mode Analysis (FMEA)
      2. Root Cause Analysis (RCA)
  2. Knowledge Base
    1. Design and Basic Operation of Dose Measurement Devices
      1. Ion Chambers
      2.  Film
      3. Metal Oxide Semiconductor Field Effect Transistor (MOSFET)
      4.  Diodes
      5. Thermoluminesence Dosimeters (TLD)
      6. Optically Stimulated Luminescent Dosimeters (OSLD)
    2. Radiation Safety Principles
      1. Safety Around Radiation Sources
      2. Radiation Packaging and Signage
      3. National and State Rules and Regulations
    3. Design and Basic Operation of Electrometers
    4.  Phantoms
      1.  Slabs
      2.  Anthropomorphic
      3. Water Tanks
  3. Clinical Processes
    1. Commissioning of Dose Measurement Systems
      1. Ion Chambers / Electrometers
      2.  Film
      3. OSLDs
    2. Commissioning of 3D Water Tank
    3. Ion chamber Dosimetry System Effects
      1.  Leakage
      2. Stem Effect
      3. Signal-to-noise for different chamber volumes
      4. Variation with bias level and polarity at different dose rates
      5. Variation with changes in water temperature
    4. Perform dose profile measurements with each detector and compare results
    5. Manual Film Densitometry
      1. Preparation and use of GAF Chromic film for dosimetry
      2. Use of the film scanner to read film. RIT software use for film dosimetry
    6. Incorporating Safe Practices into the Clinic
      1. Time Out procedures
      2. Radiation Safety in Practice
      3. Review of ASTRO’s  ‘Safety is No Accident’ and the implementation of accident recording in radiation therapy

Learning Objectives

  • Describe the basic principle of treatment mode, QA mode and service mode on a Varian digital linac.
  • Describe the difference between QM, QA and QC, as discussed in TG-100. Describe FMEA and RCA. Calculate the RPN.
  • Describe the different types of water phantom used in the clinic.
  • Describe the different sizes of ion chambers used in the clinic and describe their limitations with respect to field size.
  • Describe the basic concepts of safety in a radiation therpay clinic.
  • Describe how in-vivo dosimetry systems can be used in the clinic, and how they work.

Learning opportunities 

Observe physicist measurements performed with ion chamber and phantom:  monthly calibration, electron cutout measurements, IMRT QA.  Observe dose verification on patient using OSLD dosimeters. 

Reading List

  1. The Physics of Radiation Therapy, Khan, Chs.6 and 8.
  2. Task Group 142 report: Quality assurance of medical accelerators, Eric Klein et al. Med Phys. 36 (9), September 2009, p4197-4212.
  3. Task Group 62 - Diode in Vivo Dosimetry for Patients Receiving External Beam Radiation Therapy (2005) Radiation Therapy Committee Task Group #62; 84pp.
  4. Acceptance testing of an automated scanning water phantom
    David E. Mellenberg, Robert A. Dahl, and C. Robert Blackwell
    Phys. 17, 311 (1990)  
  5. Radiochromic Film Dosimetry (Reprinted from Medical Physics, Vol. 25, Issue 11) (1998) Radiation Therapy Committee Task Group #55; 23 pp.
  6. Safety is no Accident
  7. Task Group 100 - AcceptanceTesting and QualityAssurance Procedures for Magnetic Resonance Imaging Facilities
  8. Task Group 235 - Radiochromic Film Dosimetry: An update to TG-55 (2020)

Assessment

The resident will present a report that describes each of these systems, how they operate, and results from their commissioning process.  The report must give an overview of all the processes, describing the individual steps conceptually.   Finally, the resident will take an oral exam.  An understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated.

 

Rotation Plan for 2) Linear Accelerator Acceptance Testing/ Commissioning/ Annual QA

Note:   This rotation has three major components.  The student is expected to devote sufficient time and effort to each area to attain a comprehensive understanding of each area as well as the over-arching synthesis of all three.

    1. Linear Accelerator Acceptance/Testing
      1. Fundamental concepts of linear accelerators, beam production and control.
      2. Medical linear accelerator safety features.
      3. The acceptance testing process
    2. Radiotherapy Beam Data Collection for Commissioning
      1. Data definitions.
      2. Measurement (acquisition) techniques and underlying principles.
    3. Medical Radiotherapy Equipment QA
      1. Linac QA
      2. Other treatment machine QA
  2. Prerequisite Skills
    1. Radiation Safety –X-ray machine operation
    2. Fundamentals of Radiation Detection/Measurement
      1. Use of ionization chambers, diodes
      2. Use of electrometer
    3. Introduction to Monitor Unit calculation parameters
    4. Use of radiographic films/film scanning
  3. Knowledge Base
    1. Linear Accelerator Fundamentals Relevant to Commissioning
      1. Linac components
      2. How a linac works
    2. Medical Linear Accelerator Specifications
      1. Non-beam specifications
      2. Beam specifications
    3. Acceptance Tests
      1. Safety-related tests (Radiation survey)
      2. Acceptance vs Commissioning Data Collection
      3. Non-beam tests
      4. Beam modifier and Accessory testing
    4. Commissioning Data Acquisition Tasks
      1. Data acquisition using scanning water phantom.
        1. Types and significance of scans
        2. Scans with different detectors
        3. Scans with different beam modifiers
      2. Point data acquisition
      3. Film/planar data acquisition
      4. Understanding of measurement selection
    5. Analysis of Measurements and Preparation for Commissioning
      1. Preparation for MU Calc data
      2. Preparation for TPS beam commissioning
    6. Annual QA
      1. Conceptual understanding of objectives with respect to commissioning
      2. Relevant measurement selection, performance and documentation of same
  4. Clinical Processes
    1. On-going QA:  Use of constancy values and standards
    2. Non-routine QA and Commissioning
      1. Post repair QA not requiring recommissioning
      2. Post-repair QA requiring recommissioning

Learning Objectives:

  • Describe the compoents of the accelerator, including functions and features.
  • Describe machine acceptance tolerances, where they may be found, and how they would be measured
  • Determine data necessary to clinically commission one photon and one electron beam. Collect that data, and format it for commissioning
  • Determine the data necessary to perform MU Calculations for one photon and one electron beam. Collect the data and in a later rotation confirm that MU calculations agree with measurements for a range of depths, field sizes and beam modifiers. 
  • Participate in the Annual QA on a linear accelerator

Assessment:

The resident will provide a written report of the principles and process of Linear Acceptance Testing, Commissioning Measurements, and Annual QA with an overview and detailed descriptions of the relevant underlying principles for each major step.  The report should also contain data acquired through measurements or experiments as well as analysis thereof.  Finally, an understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated in an oral exam setting.

Reading List:

  1. Horton, J.L., “Handbook of Radiation Therapy Physics”, Prentice-Hall (1987). Chapters 5,6,7.
  2. Task Group 142 report: Quality assurance of medical accelerators, Eric Klein et al. Med Phys. 36 (9), September 2009, p4197-4212.
  3. Starkschall G., Steadham R., et al, “Beam-commissioning methodology for a three-dimensional convolution/superposition photon dose algorithm,” Journal of Applied Clinical Medical Physics, 1:1 p 8 – 27, (2000).
  4. AAPM Report #62 TG-53 Report “Quality Assurance for Clinical Radiotherapy Treatment Planning”  
  5. AAPM Report #56 TG-35 Report “Medical Accelerator Safety Considerations”
  6. AAPM Report #7 TG-18 Report on Neutron dosimetry.
  7. AAPM Report #13 TG-26 and TG-22 Report “Physical Aspects of Quality Assurance in Radiation Therapy”.
  8. AAPM Report #19 TG-27 Report “Neutron Measurements Around High Energy X-ray Radiotherapy Machines”.
  9. “Medical Linear Accelerator Fundamental Principles”, Waldron T., Internal Handout/lecture materials.
  10. AAPM MPPG 8b

 

Rotation Plan 4a) (This rotation is taught simultaneously with 4b) MU Calculations)

  1. Skills
    1. Operation of ionization chamber
    2. Operation of electrometer
    3. Operation of linear accelerator
    4. Adjusting linear accelerator output
    5. Spreadsheet development and verification
  2. Knowledge Base
    1. TG-51 protocol
    2. Electrometer/Chamber/water tank setup
    3. Chamber/electrometer ADCL calibration
    4. Reference point determination
    5. Calibration point determination
    6. Electrical and mechanical safety
    7. Linac operation
  3. Clinical Process
    1. Set up water tank
    2. Position chamber at calibration point
    3. Connect electrometer
    4. Measure ionization
    5. Convert to dose
    6. Convert to dose/MU at reference point
    7. Demonstrate ability to change accelerator output *
    8. Document results
    9. Develop TG-51 reference data for future use

Learning opportunities

    1. Perform TG-51 calibration for all energies on one accelerator with at least one photon energy > 10 MV. Print report summary and present results to physicist for review.

Reading list

  1. AAPM Task Group 51 Protocol and addendum
  2. Hendee's Radiation Therapy Physics
  3. The Physics of Radiation Therapy, Khan, Ch. 8
  4. TG-71 MU Calculation Formulism

Learning Objectives

  • The resident should be able to complete, unaided, TG-51 on the linear accelerator on which they were trained. As an exam, the resident will be asked to perform TG-51 in the presence of a faculty instructor and answer questions.
  • The resident should be able explain the correction factors in TG-51
  • They should be able to explain the rationale of TG-51

Assessment

The resident will present a report of his/her TG-51 results for the calibrated accelerator.  The report will include a summary of the processes describing the individual steps that were taken to perform the calibration. The resident will take an oral exam at the conclusion of the rotation. The resident should be able to demonstrate knowledge of the calibration process and other relevant information obtained from the reading lists.

* Under no circumstances should any dosimetric parameters be altered on any radiation producing equipment without direct supervision by a staff physicist.

 

Rotation Plan 4b) for MU calculations (This rotation is taught simultaneously with 4b) MU Calculations)

This rotation is taught simultaneously with 4a) TG51

  1. Skills
    1. Read Dosimetry Tables for photons and electrons
    2. Use of an ionization chamber and electrometer to read dose
    3. Use of a water tank for profile and depth dose measurements
    4. Operate the Record & Verify system
    5. Operate the Linac
    6. Use and understand second check software (RadCalc)
    7. Determine the needed beam data for an MU calculation
  2. Knowledge Base
    1. TMR, PDD, scatter factors, OAR, WF, TF, VWOAR, etc.
    2. Clarkson Integration, Day’s method, etc.
    3. Calculation Point’s Eye View and multiple source models
    4. Surface Irregularities
    5. Tissue inhomogeneities
    6. Electrons: VSID, obliquity, field size limits (range)
  3. Clinical Processes
    1. MU calculations for simple field configurations
      1. Whole Brain
      2. Crainio-spinal axis
      3. Heterotopic bone
    2. MU calc check for simple plans (e.g. 4 field box)
    3. MU calc check for multiple field-in-field (Forward IMRT) plans
    4. MU calcs for breast (account for flash, off-axis calc points, irregular contour)
    5. MU calcs for electrons, various SSDs, calc points, bolus

Learning Objectives

  • The resident should be able to

Learning opportunities 

            Example patient calculations will be provided.  Calculation variables will be available in the clinical dosimetry book or from sample dosimetry book. Examples will include MU calculations, field gap calculation and divergence and magnification calculations. A large number of test questions, ranging from simple to complex, will be used to allow the resident to practice.

Reading List - shown above in 4a

Recommended

The Physics of Radiation Therapy, Khan, all of Chs.9, 10, 11, 12, and 14.

Suggested

Radiation Therapy Physics, Hendee, Ibbott and Hendee, Chs. 7 and 8.

Blackburn’s Introduction to Clinical Radiation Therapy Physics (edited by S. Shahabi), focus on chapters 1 to 12 and 15.

Monitor Unit Calculations for External Photon & Electron Beams

Assessment

The resident will be given a written exam to access their ability to complete these calculations independently.

 

Rotation Plan for 6) Treatment Planning Theory and Practice

  • Skills
    1. Patient dosimetry system operation
      1. Treatment planning systems used clinically at our sites
      2. Patient database and medical record systems
      3. Contouring and fusion systems
  • Knowledge Base
    1. Determination of data required for TPS Modeling
    2. 3D Photon Beam Dose Algorithms
      1. Pencil Beam
      2. Convolution Method
      3. Polyenergetic Spectra
      4. Inhomogeneity Corrections
      5. Collapsed Cone Convolution
      6. Linear Boltzman Transport Solver
      7. Clinical Photon Monte Carlo
      8. Output Factors
      9. Monitor Units
    3. Electron Beam Dose Algorithms
      1. Hogstrom / Shiu Pencil Beam model
      2. Clinical Electron Monte Carlo
    4. Non-dosimetric Calculations within Treatment Planning Systems
      1. CT dataset resolution
      2. CT number to electron density
      3. Contouring thresholds / expansion / contraction
      4. Transformations / Projections in Beams-eye-view
      5. Digitally Reconstructed Radiographs
    5. Dose Evaluation Tools
      1. Dose grid resolution
      2. Isodose lines
      3. Tolerance of Normal Tissues
      4. Dose-Volume Histograms
      5. TCP/NTCP
    6. Operation of Planning System
      1. Treatment Planning Protocols
      2. Dose Evaluation Tools
      3. Data transfer and medical record system
      4. Plan documentation (printing plans)
      5. Independent MU calculations
      6. Treatment Planning Quality Assurance (Patient Specific QA)
      7. Record and Verify system data import/approval
  • Clinical Processes
    1. Observe Treatment Planning
      1. Brain, Head and Neck, Lung & Esophagus, Breast, Abdominal & Rectum, Pelvis & Bladder, and Prostate.
    2. Determine the treatment planning protocol for each anatomical site observed.
      1. Prescription summary (total, fractionation, max/min)
      2. Typical imaging techniques
      3. fields, beam energy, blocking,
      4. Regions of interest and their associated doses
    3. Create Treatment Plans
      1. Brain, Head and Neck, Lung, Breast, Rectum, and Prostate.
      2. IMRT and VMAT; appropriate use and practice
      3. 3D conformal arcs for SRS and SBRT cases
    4. Complete 3D planning competencies (Appendix A)

Learning Objectives

  • Create clinically acceptable treatment plans on all practice plans in competencies.
  • Describe common treatment planning dose calculation algorithms and their appropriate uses, including common errors.
  • Select reasonable planning techniques for common treatment sites.
  • Explain appropriateness of the common types of dose evaluation tools, and be able to demonstrate use of each.
  • Perform complete end-to-end planning process including TPS import and QA delivery for clinical patients.

Learning opportunities 

Observe clinical physicist in performing the treatment planning process, and understand the functionality of the planning system. Hands-on time with the planning system to learn functionality of all options. A number of practice plans will be performed and the resident will document each case. Plans will be reviewed and the record signed to document progress. Perform the treatment planning process and understand the functionality of the planning system. Quality assurance of every aspect of the plan, from plan evaluation through verification within the record and verify system.

Reading List

  1. Treatment planning system Beam Modeling User Manual
  2. A convolution method of calculating dose for 15-MV x rays, TR Mackie, JW Scrimger, JJ Battista, Medical Physics, Vol 12, Issue 2 (1985).
  3. Investigation of the convolution method for polyenergetic spectra, N Papanikolaou, T Rockwell Mackie, C Meger-Wells, M Gehring, P Reckwerdt, Medical Physics, Vol. 20, Issue 5 (1993).
  4. Separation of Photon Beam Output Factor into its Phantom and Machine Components using the Convolution/Superposition Method, N. Papanikolaou, T. Rockwell Mackie, B.R. Thomadsen, D.M.D. Frye, B. Paliwal and C.M. Sanders, University of Wisconsin Medical School, Madison WI.
  5. Monitor Unit Calculations for Convolution and Monte Carlo Dose Planning Systems, R. Mackie, N. Papanikolaou, B. Thomadsen, P. Reckwerdt, T. Holmes, C. Sanders. 1994 AAPM, Anaheim CA.
  6. Tolerance of normal tissue to therapeutic irradiation, B Emami, J Lyman, A Brown, L Cola, M Goitein, JE Munzenrider, B Shank, LJ Solin, M Wesson, Int J Radiation Onc Bio Phys, Vol. 21, Issue 1 (1991).
  7. Dose-volume histograms, RE Drzymala, R Mohan, L Brewster, J Chu, M Goitein, W Harms, M Urie, Int J Radiation Onc Bio Phys, Vol. 21, Issue 1 (1991).
  8. Collapsed cone convolution of radiant energy for photon dose calculation in heterogeneous media, A Ahnesjo, Medical Physics, Vol. 16, Issue 4 (1989).
  9. Electron beam dose calculations, K Hogstrom, M Mills, P Almond, Phys. Med. Biol., Vol. 26, Issue 3 (1981).
  10. On methods of inhomogeneity corrections for photon transport, J Wong, J Purdy, Medical Physics, Vol. 17, Issue 5 (1990).
  11. TPS Beam Modeling User Manual and training presentations
  12. Aria documentation
  13. Tolerance of Normal Tissue to Therapeutic Irradiation, Enami et al.

Assessment

Each resident will maintain a list of plan types that they have completed and this list must be reviewed at the end of this rotation.  Finally, the resident will take an oral exam.  An understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated.

 

Rotation Plan for 5) Treatment Planning System Commissioning/Acceptance; Annual/Periodic QA Testing

  1. Skills acquired cover two principal aspects:
    1. Radiotherapy Beam Data Collection for Commissioning of a Clinical Treatment Planning System (TPS)
      1. Data definitions
      2. Measurement (acquisition) techniques and underlying principles
      3. Data processing and preparation for importing into a Clinical TPS
    2. Radiotherapy Beam Data Modeling for a Clinical TPS
      1. Photon Beam modeling
      2. Electron Beam modeling
  2. Prerequisite Skills
    1. Radiation Safety –X-ray machine operation
    2. Fundamentals of Radiation Detection/Measurement
      1. Use of ionization chambers, diodes, film-based dosimetry.
      2. Use of electrometer
      3. Introduction to Monitor Unit calculation parameters
  3. Knowledge Base 
    1. Linear Accelerator Fundamentals Relevant to TPS Commissioning
      1. Basic beam optics
      2. Beam flattening
      3. Significance of beam control parameters
      4.  Collimation
        1. Rectangular Jaws
        2.  MLC
        3. Electron Collimation
    2. Medical Linear Accelerator Specifications
      1. Non-beam specifications
      2. Beam specifications
    3. Commissioning Data Acquisition Tasks
      1. Data acquisition using scanning water phantom
        1. Types and significance of scans
        2. Scans with different detectors
        3. Scans with different beam modifiers
      2. Point data acquisition
      3. iii. Film/planar data acquisition
      4. Understanding of measurement selection
        1. Analysis of Measurements and Preparation for TPS Commissioning
          1. Preparation for MU Calc data
          2. Preparation for TPS beam commissioning
        2. Beam modeling/data table entry in planning system
          1. Conceptual understanding of commissioning a TPS
          2. Relevant measurement selection, performance and documentation of same
  4. Clinical Processes
    1. Periodic QA: Use of constancy values and standards.
    2. MU Calcs: Where do those numbers come from, anyway?
    3. Non-routine QA and Commissioning
      1. Post-repair QA not requiring re-commissioning
      2. Post-repair QA requiring re-commissioning

Learning Objectives (including mini-projects):

  • Determine data necessary to commission one photon and one electron beam in a clinically used treatment planning system. Collect that data, and format it for commissioning. 
  • Determine the data necessary to perform MU Calculations for one photon and one electron beam. Collect the data and in a later rotation confirm that MU calculations agree with measurements for a range of depths, field sizes and beam modifiers. 
  • Mini-project: create and commission a beam model in RayStation TPS for one photon beam (e.g., Edge 6FFF beam).
  • Mini-project: create and commission a beam model in RayStation TPS for one electron beam (e.g., TrueBeam 6MeV beam)
  • Participate in TPS dosimetry verification testing (e.g., TG-23 test package)

Assessment:

The resident will provide a written report of principles and process of TPS testing, commissioning measurements with an overview and detailed descriptions of the relevant underlying principles for each major step.  The report should also contain data acquired through measurements or experiment as well as analysis thereof.  The report should reference the relevant TG reports pertinent to planning system QA and commissioning. Finally, an understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated in an oral exam setting.

Reading List:

  1. Starkschall G., Steadham R., et al, “Beam-commissioning methodology for a three-dimensional convolution/superposition photon dose algorithm,” Journal of Applied Clinical Medical Physics, 1:1 p. 8 – 27, (2000). http://onlinelibrary.wiley.com/doi/10.1120/jacmp.v1i1.2651/epdf
  2. AAPM Report #62 TG-53 Report “Quality Assurance for Clinical Radiotherapy Treatment Planning”  http://www.aapm.org/pubs/reports/rpt_62.pdf
  3. APPM Report # 55, ‘‘Radiation Treatment Planning Dosimetry Verification, Radiation Therapy Committee Task Group #23,’’ edited by D. Miller (American Institute of Physics, College Park, MD, 1995)
  4. TRS #430, “Commissioning and quality assurance of computerized planning systems for radiation treatment of cancer”, IAEA 2004
  5. IAEA-TECDOC-1540 “Specification and Acceptance Testing of Radiotherapy Treatment Planning Systems”, IAEA 2007.
  6. IAEA-TECDOC-1583 “Commissioning of Radiotherapy Treatment Planning Systems: Testing for Typical External Beam Treatment Techniques”, IAEA 2008.
  7. IAEA Safety Series Report No 17
  8. AAPM MPPG 5b - Commissioning of Radiotherapy Treatment Planning Systems
  9. TRS430 - Commissioning and quality assurance of computerized planning system
  10. Beam Commissioning Data Specification; RayPhysics Manual, RayStation 8 (or current version), RaySearch Laboratories, 2017.
  11. Pinnacle Physics Reference Guide Pinnacle 9.2 (or current version), Philips Medical Systems 2010
  12. See “…\Educational materials\Residency Rotations\Residents – TPS commissioning” on the Z drive for additional reading materials

 

Rotation Plan for 3) Brachytherapy

Note that this rotation requires the completion of specific projects.  These projects will be discussed at the introduction at the beginning of the rotation.

  1. Skills
    1. Brachytherapy Safety
      1. Safe source handling
      2.  Time/distance/shielding
      3. Signage and packaging
      4. Quality management program (QMP)
    2. Brachytherapy Dosimetry
      1. Exposure Rate Constant Formalism
      2. Air Kerma Strength Formalism
    3. Brachytherapy Treatment Planning
      1. Dose prescription – Written directive
      2. Dose objectives – DVH parameters
  2. Knowledge Base
    1. Radioactive Decay
      1.  Alpha
      2.  Beta
        1.  Electron capture
        2. Internal conversion
      3. Gamma
    2. Radioactive Sources Commonly Used in Radiotherapy
      1. Radium
        1. Decay
        2. Source construction
        3. Source specification
        4. Exposure rate constant
        5. Applications
        6. Physical characteristics
      2.  Cesium-137
      3.  Cobalt-60
      4.  Iridium-192
      5.  Gold-198
      6.  Iodine-125
      7. Palladium-103
    3. Calibration of Brachytherapy Sources
      1. Specification of source strength
        1. Activity
        2. Exposure rate at distance
        3. Equivalent mass of radium
        4. Apparent activity
        5. Air kerma strength
      2. Exposure rate calibration
        1. Open-air measurements
        2. Well-type ion chambers
    4. Calculation of dose distributions
      1. Exposure rate
        1. Sievert Integral
        2. Effects of inverse square law
      2. Absorbed dose in tissue. 
      3. Modular dose calculation model: TG-43 and TG-43 U1
      4. Isodose curves
    5. Prostate Seed Implants
      1. Volume Study
        1.  Ultrasound imaging
        2. Volume estimate
        3. Contouring – volume for planning
      2. Treatment planning
        1.  Dose-volume constrained
        2. Nomogram based
      3. Seed ordering
      4. Source strength assay
      5. Implant QA checklist
      6. Implant Procedure
        1.  Seed sterilization
        2. Needle placement
        3. Seed placement
        4. Cystoscopy (seed recovery from bladder)
        5. Recovery/disposal of waste seeds
      7. Post Implant Dosimetry
        1. CT-based planning/assessment
        2. Dose-volume parameters
    6. High Dose Rate Brachytherapy
      1. Source Exchange/Calibration check
      2. Daily (day of treatment) QA
      3. Applicator/catheter placement
      4. Imaging for treatment planning
        1. Orthogonal images
        2. Reconstruction geometry
        3. CT-based planning
      5. Dose prescription/fractionation/rational
      6. Treatment planning
        1.  Written Directive
        2. Dose planning objectives
        3. Critical structure doses
        4. Treatment planning procedures
        5. Treatment plan QA
      7. Treatment delivery
        1. Pre-treatment survey
        2. Attach catheters/applicator
        3. Authorized User/Medical Physicist requirements
        4. Treatment progress assessment
        5. Post-treatment survey
        6. Recovery/remove catheters/applicator
      8. Emergency procedures
        1. Annual HDR safety training
        2. Manual source retract
        3. Stuck source
        4. Patient safety
  3. Clinical Processes
    1. Source Calibration check
      1. HDR
      2. LDR seed
    2. Low Dose Rate Cesium Implant (from literature)
      1. Dosimetry planning
      2. Hand calculation (time)
    3. Implant Dosimetry Hand Calculation (from literature)
      1. Paterson-Parker tables
      2. Quimby System
      3. Memorial System
      4. Paris System
    4. Prostate Implant procedure
      1. Volume study
      2. Treatment planning
      3. Source strength assay
      4. Implant procedure
      5. Seed recovery
      6. Post Implant Dosimetry
    5. High Dose Rate Procedures
      1. Vaginal Cylinder
      2. Ring and Tandem (compare with Tandem and Ovoid)
        1. Ring and Tandem Applicators, construction and limitations
        2. CT-based planning
        3. Bladder rectal dose points
        4. Prescription dose (Point A)
        5. Dose optimization points
        6. Treatment plan assessment
        7. Treatment plan QA
        8. Treatment Delivery
        9. Patient recovery
      3. Interstitial Implant
        1. CT-based planning
        2. Dose-Volume assessment
        3. Manual plan/dose manipulation
      4.  Endobronchial
        1. Pre-planned treatment template
        2. Endoscopic-guided catheter placement
        3. Pre-treatment verification imaging
      5. MammoSite (partial breast irradiation)
        1. Prescription dose/fractionation/rationale
        2. CT-based planning/assessment
        3. Point dose prescription/dwell time calculation
        4. Pre-treatment verification imaging (Ultrasound and CT)

Learning Objectives/Competencies:

This rotation requires reading an extensive amount of background material.

Resident will be evaluated on the following procedures:

HDR

  • Ability to perform the HDR morning warmup accurately without assistance.
  • Ability to evaluate an HDR brachytherapy plan.
  • Knowledge and ability to run a basic HDR plan for a ring and tandem and vaginal cylinder.
  • Ability to perform a quarterly/annual HDR calibration procedure.
  • Adherence to radiation safety standards.

I-125

  • Understanding of the entire prostate seed implant procedure from beginning to end, including pre-implant, seed assay, implant, and post implant procedures.

I-131

  • Understanding of the entire I-131 procedure and documentation.

Laws and regulations

  • Understanding of the laws surrounding high and low dose brachytherapy in Ohio including:
  • Definition and reporting requirements for medical events
  • ODH Compliance audits
  • Exposure and contamination surveys

Reading List:

  1. Radiation Therapy Physics, Hendee, Ibbott and Hendee, Chapter 1. Chapters 12 & 13, Chapter 15.
  2. The Physics of Radiation Therapy, Khan, Chapters 1 & 2, Chapter 15, Chapter 17.
  3. The Physics of Radiology (4th), Johns and Cunningham, Chapter 13.
  4. Brachytherapy Physics, 2nd Ed (2005 AAPM Summer School Proceedings), Thomadsen, Rivard, Butler (Eds), Chapters 1, 2, 3, 4, 5 (Overview & Fundamentals), Chapters 12, 13 (Localization), Chapters 14, 15, 16 (Dosimetry).
  5. TG-56 - Code of Practice for Brachytherapy Physics (Reprinted from Medical Physics, Vol. 24, Issue 10) (1997) Radiation Therapy Committee Task Group #56; 42 pp. 
  6. ICRU Report No. 38 - Dose and volume specification for reporting intracavitary therapy in gynecology, 1985.
  7. Radiation Therapy Physics 3rd Ed, Hendee, Ibbott and Hendee, Chapter 13..
  8. The Physics of Radiation Therapy, Khan, Chapter 22 (HDR), Chapter 23 (Prostate Implants) and Chapter 24 (Intravascular Brachytherapy).
  9. TG-43 U - A revised AAPM protocol for brachytherapy dose calculations. Medical Physics, Vol. 31, Issue 3 (2004); Radiation Therapy Committee Task Group #43;
  10. TG-59 - High Dose-Rate Brachytherapy Treatment Delivery (Reprinted from Medical Physics, Vol. 25, Issue 4) (1998) 
  11. TG-64 - Permanent Prostate Seed Implant Brachytherapy (Reprinted from Medical Physics, Vol. 26, Issue 10) (1999)  
  12. TG-186 - Model Based dose calculation medthods in brachytherpay, beyond TG-43

In addition, various other research articles of interest selected in consultation with the mentoring physicist should be read in preparation for presentation at the monthly journal club.

Assessment:

Residents will be asked to complete a series of short projects to expand their knowledge on regulations and procedures related to HDR and LDR brachytherapy procedures. The reports for these projects will be due 2 weeks following the completion of the rotation. If residents are required to come back to observe more procedures, the report for that section only will be due 2 weeks following their last day or clinical brachytherapy work.

There will be an oral exam at the conclusion of the residency (during the final week). The oral exam will focus on practical knowledge gained throughout the rotation, but may also include items from the listed reading material.

 

Rotation Plan for 8) Radiotherapy Simulation

 During this rotation the medical physics resident will gain an understanding of the Radiotherapy Simulation process, ranging from conventional simulation using planar images and fluoroscopy, through CT based virtual simulation, to 4DCT and the utility of multimodality imaging. While participating in this rotation, the resident will attend simulations for external beam radiation therapy, observe patient setup, use of the moving laser system, and the CT image acquisition process. Also, the resident will follow the process of setup geometry specification, immobilization, marking, tattoos, acquiring CT, including technique, and transfer to planning system. The resident is expected to understand the virtual simulation process and perform a virtual simulation procedure on a phantom, from start to finish with portal image/CBCT verification. Finally, the resident will observe the use of combined imaging modalities in the simulation process (such as PET/CT for metastatic disease, and MRI/CT for SRS treatments) and follow a patient through the Optical Image guided setup simulation process (optional). The resident compiles a written report detailing the learning opportunities that were experienced during the rotation. The rotation concludes with an oral exam given by the physics staff.

  1. Prerequisite Skills
    1. Radiation Safety – CT machine operation
    2. Human Anatomy – common bony landmarks
    3. Fundamental Physics of Radiographic Imaging
      1. Radiation Interactions with Matter
        1. Photoelectric Effect, Compton, Pair Production
        2. Attenuation and Scatter
      2. Basic Imaging Parameters
        1.  Contrast
        2. Detective Quantum Efficiency
        3. Signal to Noise RatioMTF
    4. Introductory Imaging Technologies
      1. Imaging Detector Concepts
        1.  Films
        2.  Fluoroscopy
        3. Computed Radiography
        4. Ion Chamber Arrays
        5. Diode Arrays (a-Si)
        6. Other planar x-ray imagers
        7. X-ray CT
        8. PET
        9. MRI
        10. Ultrasound
  2. Knowledge Base
    1. Principle understanding of simulation process.
    2. Fundamental Principles of Simulation Equipment
      1. Discuss "Conventional Simulator" –Plane Films and Fluoroscopy
      2. CT Simulation
      3. Immobilization and Localization, Gating, Surface contour acquisition for motion management
      4. Other simulation technologies: PET/CT, MR, US
      5. Image co-registration ("fusion") and the role of multimodality imagery in simulation; temporally-registered imagery (4D, Max/Mean/Min IP).
    3. Medical Physicist Role in Simulation and Equipment Management
      1. Conventional Simulation
        1. Process emphasizing physicist role (i.e. historical breast)
        2. QA of Simulator
        3. QA of imaging chain
        4. QA of X-ray generator
      2. CT Simulation
        1. CT numbers, electron density, and relationship to Radiation Oncology treatment planning; heterogeneity correction tables
        2. Diagnostic CT v. Simulator
        3. TG-66 protocol and CTSim QA
          1. Mechanicals, lasers
          2.  Imaging
          3. ACR phantom
      3. PET/CT
        1. Radiation isotope safety, QA – overview
        2. Issues in utilizing PET images in simulation
      4. MRI
        1. Application as image set for fusion
        2. Potential as primary simulation modality
        3. QA for RTMRI
      5. Use of "other" modes in RT Simulation (such as Ultrasound, setup "aids").
  3. Clinical Processes
    1. Conventional Simulation and Planning from Plane Films (literature review)
    2. CT Simulation
    3. ICRU target definitions of GTV, CTV, ITV and PTV
    4. VSIM as an alternative to CT Sim
    5. Simulations ancillary devices: LAP laser system, gating training
    6. Prepare for targeting processes: 4DCT handling, PET/CT and MRI/CT fusions

Learning Opportunities:

Attend a CT simulation for EBRT. Observe patient setup, use of scout image, CT capture, storage and transmission to other clinical systems.

Follow a patient through the CT (PET/CT) simulation process.  Emphasis should be on geometric aspects of the process (setup geometry specification, immobilization, marking, tattoos, CT including x-ray technique, and transfer to planning system).

Observe the use of combined imaging modalities (perform fusions as appropriate) in the simulation process (such as PET/CT or MRI/CT).

Follow a patient through the setup simulation process, attending the initial treatment.

Perform QA on all relevant systems, i.e., CT simulator, LAP lasers.

Observe PET morning warm-up QA

Learning Objectives:

  1. Describe the process and equipement relavent to CT simulation and PET imaging.
  2. Describe ICRU definition of GTV, ITV, PTV, CTV
  3. Apply the methods of TG-66 to the CT-Simulation QAs including annual meaurements of CTDI.
  4. Describe the difference between detectors used in CT vs PET
  5. Describe the difference in resolution between body site protocols.

Assessment:

The resident will present a report that describes the simulation process and equipment in Radiation Therapy. This report should include descriptions of the relevant underlying principles of the systems used, and an overview of all the processes, describing the individual steps conceptually. The report should also contain descriptions of any experiments or measurements performed and analyses of same. Finally, the resident will take an oral exam. An understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated.

Resident should come up with their own schedule for the rotation, which has to include regular participation in simulations taking place in the department, monthly and annual QA’s.

Complete the following Mini-projects (to be submitted with the rotation report):

  1. Design shielding for our PET/CT simulator room (use TG-108)
  2. Outline a QA procedure for one of the CT simulator tests NOT discussed in TG-66 (use the following link for reference: https://www.aapm.org/org/structure/default.asp?committee_code=TG66U1 )
  3. Define BED and EQD2 and provide an example of BED/EQD2 calculation for a re-irradiation case with the objective of making a recommendation to physician/planner (deformable fusion, use Quantec for OAR’s dose limits vs Timmerman’s, define regions of allowable EQD2, possibly with dose adjustment for the number of months since irradiation)

Reading List:

  1. “Quality assurance for computed-tomography simulators and the computed-tomography simulation process: Report of the AAPM Radiation Therapy Committee Task Group No. 66,”  Med Phys 30 (10), 2003,   2762.
  2. S. Curry, J.E. Dowdey, R.E. Murry, Christensen’s Physics of Diagnostic Radiology, 4th edition, 1990, Chapters 14, 15, 19, 22, 24.
  3. T. Bushberg, “The Essential Physics of Medical Imaging”, 3rd edition, 2011, Chapters 4, 6, 7, 10, 12, 14.
  4. Perry Sprawl’ On-line lectures:

http://www.sprawls.org/ppmi2/IMGCHAR/

http://www.sprawls.org/resources/CTIMG/module.htm

  1. Johns & Cunningham, “The Physics of Radiology,” Chapter 16.
  2. Mutic, J. A. Purdy et al., “The Simulation Process in the Determination and Definition of the Treatment Volume and Treatment Planning”, Chapter 7 of Technical Basis of Radiation Therapy: Practical Clinical Applications, Eds.: James Purdy, Carlos Pérez et al., 4th edition, 2006.
  3. “The phantom portion of the American College of Radiology (ACR) Computed Tomography (CT) accreditation program: Practical tips, artifact examples, and pitfalls to avoid”, Med Phys 31(9), 2004 p. 2423.
  4. F. Fowler, 21 years of Biologically Effective Dose, Br. J. Radiol. 83(991), 2010, p.554–568.
  5. See “…\Educational materials\Residency Rotations\Residents - Radiotherapy Simulations” on the Z drive for additional reading materials
  6. TG-109 PET and CT/PET Sheilding Requirements
  7. TG-66 Quality assurance for computed-tomography simulators and the computed-tomography-simulation process (2003)
  8. TG-174 Utilization of FDG in Radiation Therapy

 

Rotation Plan for 9) Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy

  1. Prerequisite Skills
    1. SRS/SBRT Principles
      1. Dose fall-off
      2. Radiobiology
    2. Operation of Linac in SRS mode
    3. MU calculation (TPR, PSF, CF, ISF) for conventional treatments
    4. Use of ion chamber/electrometer/diodes/MOSFETs
    5. Film dosimetry
    6. Imaging systems for pretreatment positioning
    7. Imaging systems for during-treatment positioning
  2. Knowledge Base
    1. Small field dosimetry
    2. Film measurements for small fields
    3. SRS Beam modeling (treatment planning systems)
    4.  Localization
    5. Patient immobilization
      1.   Frame
      2. Frameless
    6. Treatment Planning (treatment planning systems)
      1. Reference frame coordinate systemImage fusion
      2. Target localization
      3. Isocenter selection
      4. Dose verification
    7.  Delivery
      1.  Gantry/collimator/6D or 3D couch alignment
      2. Floor stand isocenter location for frame systems
    8. Verification (QA) of delivery process
  3. Clinical Process
    1. Geometrical Alignment
      1.  Position floor stand (for stand systems)
      2. Verify alignment using CT
      3. Verify target localization accuracy using absolute phantomPatient
      4.  Immobilization
        1.  Frame placement (practice on melon in lab)
        2. Frameless
    2. Beam data acquisition           
      1.  Measure small field profiles
      2. Measure small field output factors
    3. Planning system commissioning
      1.  Enter beam data into planning system
      2. Verify planning system beam data
      3. Verify localization for frame treatments
      4. Verify localization or frameless treatments
    4.  Treatment planning
      1.  Perform image fusion
      2. Create single isocenter plan
        1.  Identify arc/couch limitations
        2. Establish arc/couch angle presets
      3.  Create multiple isocenter plan
        1. Explain isodose line normalization
        2. Explain isodose line prescription
    5. Plan Transfer to Record System/Linac
      1.  Transfer data to Aria
      2. Perform independent MU calculations
    6.  Delivery
      1.  Identify patient safety precautions
      2. Perform pre-treatment QA
      3. Participate/observe frameless delivery
      4. Participate/observe frame delivery
      5. Operate linac (simulated treatment)
    7. Workflow and Plan Quality
      1. Generate SRS/SBRT workflow diagram
      2. Calculate plan quality metrics such as the gradient index and conformity index and compared to published quality metrics and department standards.

Learning Opportunities:

  • Perform QA using a stereotactic/cube phantom for treatment isocenter vs imaging isocenter verification.
  • Perform QA using a phantom and micro-ion chamber.
  • Measure SRS cone concentricity with film.
  • Verify physics data in planning system.
  • Establish mechanism for independent MU calculations.
  • Create and execute a single isocenter plan on a phantom. Measure the dose delivered to the phantom and compare it to the planned dose.
  • Follow a frame patient through all steps of process (frame placement, imaging, planning and delivery.) See item C. above.
  • Follow a frameless patient through all steps of process (bite plate generation, imaging, planning and delivery.) See item C. above.
  • Using workflow diagram, identify critical failure points and make recommendations on how to minimize or eliminate critical failures.
  • Calculate plan quality metrics such as the gradient index and conformity index and compared to published quality metrics and department standards

Reading List:

  1. Report No. 101 - Stereotactic body radiation therapy: The report of AAPM Task Group 101 (2010)
  2. The Physics of Radiation Therapy, 3rd, Khan, Ch.21 (or equivalent later edition)
  3. Retrospective dosimetric analysis of brain lesions planned in Pinnacle 9.8 via a HDMLC linac
  4. IAEA 483 on small field dosimetry
  5. Alfonso, P. Andreo, R. Capote, M. S. Huq, W. Kilby, P. Kjäll, T. R.Mackie, H. Palmans, K. Rosser, J. Seuntjens, W. Ullrich, and S. Vatnitsky,“A new formalism for reference dosimetry of small and nonstandard fields,”Med. Phys.35(11), 5179–(2008)
  6. Francescon, S. Beddar, N. Satariano, and I. J. Das, “Variation of small-field dosimetric parameters percentage depth dose, tissue-maximum ratio, and off-axis ratio,”Med. Phys.41(10), 101708 (14pp.)(2014)
  7. TG-42 Stereotactic Radiosurgery

Assessment:

The resident will acquire output factors for 2 small collimator fields. Upon successful demonstration of the acquired data, the staff physicist will give the resident data for all other collimator sizes. The resident will assemble a data book of the SRS planning data. He/she will format the measurement data appropriate to enter into the planning system and to use for independent calculations.

The resident will perform end-to-end QA on the stereotactic system, from imaging and localization to IGRT and delivery, giving quantitative analysis of the geometrical errors at each step of the process.

The resident will be expected to observe as many actual SRS treatments as possible during their rotation.

The resident will take an oral exam at the conclusion of the rotation. The resident should be able to demonstrate knowledge of these processes and other relevant information obtained from the reading lists.

 

Rotation Plan for 7) IMRT

  1. Skills
    1. Treatment planning
      1. Theory of IMRT optimization
      2. Types of optimization (traditional vs Direct Machine Parameter Optimization (DMPO), Multi Criteria Optimization (MCO))
      3. Specify Dose-Volume constraints
      4. Review of constraints from common sources such as Emami, Timmerman, NCCI, Quantec, and RTOG protocols
    2.  QA
      1. Planar diode arrays
      2. Planar ion chamber arrays
      3. Cylindrical diode arrays
      4. EPID based
      5. QA of IMRT, VMAT, IMAT plans
    3. Use of an Ionization Chamber and Electrometer to read Dose
    4. Operate the Record & Verify system
    5. Operation of the Linac
    6. CT scanning a phantom and importing it into the planning system
    7. Positioning a phantom – determining shifts from fiducials to isocenter
  2. Knowledge Base
    1. Optimization – an introduction
    2. Critical organ doses, parallel vs serial organs, typical dose-volume constraints
    3. Dose calculation algorithms specific to IMRT
    4. Film as a dose measuring device
    5. Small field dosimetry – measurement and modeling in the planning system
    6. Imaging for IMRT – CT basics
  3. Clinical Processes
    1. IMRT planning
    2. IMRT chart check (ARIA)
    3. IMRT QA
      1. Patient specific
      2. Delivery system specific
    4. IMRT boosts (simultaneously integrated vs consecutive)
    5. IMRT delivery
  4. Learning Objectives
    1. Complete IMRT treatment plans for clinical use.
    2. Describe appropriate planning objectives and clinical goals.
    3. Describe different algorithms used in optimization and the benefits of each type.
    4. Perform patient specific QA on clinical treatment plans.
    5. Evaluate and perform calibration of patient specific QA equipment.

Learning opportunities 

Residents will use practice patients to hone their planning skills. Following this, residents will work on patient plans, while being supervised by their physics mentor.  The resident compiles a written report detailing the learning opportunities that were experienced during each rotation section. The rotation concludes with an oral exam given by the physics staff.

Review the list of IMRT planning competencies. Each resident will be responsible for ensuring that all non-SRS/SBRT plan competencies should be completed and signed by a mentor by the end of the rotation.

Reading List

 

  1. Radiation Therapy Physics, Hendee, Ibbott and Hendee, Ch. 11, focus on pp 270 to 277, Ch. 15, focus on pp. 394-397
  2. The Physics of Radiation Therapy, 3rd, Khan, Chs.19 and 20, Ch 8 (focus on pp 151-153) and ch 14 (pp 304-305).
  3. Treatment Planning in Radiation Oncology, Khan and Potish, editors, Chs. 8 (focus on pp172-176), 9, 12,
  4. TG-218 Tolerance limits and methodologies for IMRT measurement-based verification
    QA
  5. TG-307 Use of EPIDs for Patient-Specific IMRT and VMAT QA
  6. http://www.sprawls.org/resources/CTIMG/module.htm-This is a nice intro to CT image acquisition. Needed to understand the data acquisition requirements for IMRT.

Assessment

The resident will present a report that includes printouts of the relevant steps for the phantom plan:  The IMRT QA report (SNC Patient), the ion chamber measurement spreadsheet, and the relevant pages from the treatment plan (dose distributions in various planes, constraints used in the optimization, plan parameters for the beams).  In addition to this, the resident will create a dose calibration and array calibration for a diode based IMRT QA system such as the MapCheck or ArcCheck.  The report must also give an overview of all the processes, describing the individual steps conceptually (i.e. not the details of which buttons to push but rather an overview that indicates how one might go about the same steps on a different planning system or with a different tool set).  Finally, the resident will take an oral exam.  An understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated.

 

Rotation Plan for 10) Special Topics and Procedures in Radiation Therapy

  1. Prerequisite Skills
    1. Radiation Safety –Treatment machine operation
    2. Human Anatomy –common bony landmarks
    3. Introduction to custom shielding used in Radiation Therapy.
    4. Introduction to electron beam dosimetry.
  2. Knowledge Base
    1. Dosimetry of electron beams
    2. Clinical Basis for Total Body Irradiation (TBI), Total Skin Electron Therapy (TSET) and Intraoperative Radiation Therapy (IORT).
    3. Proton therapy; clinical applications, delivery methods and QA
    4. Dosimetry issues in TBI, TSET and IORT
      1. Field uniformity
      2. Beam energy/penetration
      3. Field Shaping
        1. Collimation and patient alignment (IORT).
        2. Collimation and energy adjustment (TSET).
        3. Collimation and beam profile (TBI)
    5. Superficial Therapy
    6. Other specialized treatments such as Proton therapy, MR guided RT, Tomotherapy, Cyberknife and Gammaknife will be covered in a didactic series.

Ethics and Professionalism – each resident should complete the online course modules for Professionalism and Ethics offered by the RSNA and the AAPM found here: https://education.rsna.org/diweb/catalog/t/10792

Refer to the rotation ‘Special Topics’ for instructions to residents on which modules must be covered. For each module, please save a copy of your certificate.

 

Professionalism and Ethics

How covered

Comments

Professionalism

RSNA/AAPM Course and Seminar

All aspects of professionalism are covered in a 1-hour seminar. The seminar on ethics and professionalism is given on the first seminar day of each fall semester to all graduates and residents

o   Definition of a profession and professionalism

 

 

o   Elements of a profession

 

 

o   Definition of a professional

 

 

o   Elements of professionalism

 

 

o   How is professionalism judged?

 

 

o   Do’s and don’ts of professionalism

 

 

o   Physician’s charter and applicability to physicists

 

 

Leadership

 

 

o   Vision and charisma

Group discussion

 

o   Qualities of leaders

Group discussion

 

o   Rules of leadership

Group discussion

 

o   Causes of leadership failure

Group discussion

 

Ethics

RSNA/AAPM Course and Seminar

All aspects of professionalism are covered in a 1-hour seminar. The seminar on ethics and professionalism is given on the first seminar day of each fall semester to all graduates and residents

o   Ethics of a profession

 

 

o   Ethics of an individual

 

 

o   Interactions with colleagues and co-workers

 

 

o   Interactions with patients and the  public

 

 

o   Confidentiality

 

 

o   Peer review

 

 

o   Negotiation skills

 

 

o   Relationships with employers

 

 

o   Conflicts of interest

 

 

o   Ethics in research

 

 

o   Use of animals in research

 

 

o   Use of humans in research

 

 

o   Relationships with vendors

 

 

o   Publication ethics

 

 

o   Ethics in graduate and resident education

 

 

o   Selected case studies

 

 
  1. Clinical Processes
    1. Clinical indications and conditions treated
    2. Simulation and Field shaping
    3. MU calculations
    4. In-vivo dose measurement
    5. Custom compensators
  2. Commissioning of a TBI Program
    1. General electron beam commissioning
    2. Specifics related to TSET commissioning.

Learning Opportunities:

  • Decribe the clinical indications for the use of MR-guided RT, and the safety considerations on MR use, including MR zones
  • Describe the benefits of proton therapy, Bragg peak and SOBP, RBE, the types of proton accelerators including mechanisms to paint the target with dose
  • Describe clinical indications for TBI and techniques to produce a uniform dose
  • Describe clinical indications for TSET 
  • Describe the clinical indications for kV energy treatment machines
  • Describe clinical indications for IORT 

Assessment:

The resident will provide a written report of principles and process of Total Skin Electron Therapy, Total Body Irradiation, Intraoperative Radiotherapy, Superficial therapy and proton therapy, with an overview and detailed descriptions of the relevant underlying principles for each major step.  If the resident observed these procedures through our collaboprations then document that in the report. Some emphasis should also be placed on practical issues in establishing TSET, TBI and IORT programs.  The report should also contain data acquired through measurements or experiment as well as analysis thereof.  Finally, the resident will take an oral exam.  An understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated.

This rotation will also serve as a foundation in ethics and professionalism in the field of medical physics.

Reading List:

  1. Perez & Brady, “Principles and Practice of Radiation Oncology”, Lippincott, 2nd ed, 1992, Chapters 10 and 22.
  2. Khan, F.M., “The Physics of Radiation Therapy”, Williams & Wilkins (3rd or equivalent later edition), Chapter 14.
  3. TG 25 - Clinical Electron-Beam Dosimetry, Reprinted from Medical Physics (Vol. 18, Issue 1) (1991) Radiation Therapy Committee Task Group #25; 40 pp.
  4. Commissioning of a mobile electron accelerator for intraoperative radiotherapy
    Michael D. Mills, Liliosa C. Fajardo, David L. Wilson, Jodi L. Daves, and William J. Spanos
    Appl. Clin. Med. Phys. 2, 121 (2001)
  5. A study of the effect of cone shielding in intraoperative radiotherapy
    Nikos Papanikolaou and Bhudatt Paliwal
    Phys. 22, 571 (1995)
  6. Khan, F.M., “The Physics of Radiation Therapy”, Williams & Wilkins (3rd or equivalent later edition), Chapter 14, particularly section 14.8.
  7. TG 30 - Total Skin Electron Therapy: Technique and Dosimetry(1987)
  8. Multiple scattering theory for total skin electron beam design John A. Antolak and Kenneth R. Hogstrom
    Phys. 25, 851 (1998)  
  9. Spatial distribution of bremsstrahlung in a dual electron beam used in total skin electron treatments: Errors due to ionization chamber cable irradiation
    Indra J. Das, John F. Copeland, and Harry S. Bushe, Phys. 21, 1733 (1994)
  10. Dosimetric study of total skin irradiation with a scanning beam electron accelerator
    Subhash C. Sharma and David L. Wilson, Phys. 14, 355 (1987)  
  11. Physical aspects of a rotational total skin electron irradiation, B. Podgorsak, C. Pla, M. Pla, P. Y. Lefebvre, and R. Heese Med. Phys. 10, 159 (1983)
  12. Van Dyk et al, AAPM Report 17 /TG-29 “Physical Aspects of Total and Half Body Irradiation”
  13. Zierhut, Dietmar et al, “Cataract incidence after total-body irradation”, IJBORP 45(1) p. 131, 2000.
  14. Thomas, Oliver et al, “Long-term complications of total body irradiation in adults”, IJBORP 49 (1) p.125, 2001.
  15. Faraci, Maura, et al, “Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant”, IJORBP 63(5) p. 1568, 2005.
  16. T R Mackie et al. “Tomotherapy: A new concept for the delivery of dynamic conformal radiotherapy.”
  17. S F Alhujaili et al. Quality assurance of Cyberknife robotic stereotactic radiosurgery using an angularly independent silicon detector. JACMP 20. 2019.
  18. Andrew Wu et al. “Physics of gamma knife approach on convergent beams in stereotactic radiosurgery”. International Journal of Radiation Oncology, Biology, Physics Vol 18, Issue 4, April 1990, Pages 941-949
  1. MPPG 18.a -  Superficial radiation therapy using low-energy kilovoltage x-rays (in press - see wiki)
  2. TG-351 on MR linac clinical reference dosimetry
  3. ACR manual on MR Safety 2024
  4. TG 72 - Intraoperative radiation therapy using mobile electron linear accelerators

A hand-out for proton therapy is included until a proton MPPG becomes available.

A literature review for the most recent articles is strongly suggested for this topic.

 

Rotation Plan for Rotation in 11a) Imaging for Planning and Treatment Verification

  1. Skills
    1. Fundamental Understanding of Basic Radiotherapy Process
      1. Simulation imaging
      2. Treatment planning
      3. Treatment delivery/verification
    2. Basic Understanding of Radiological Imaging Modalities
      1. X-ray film/fluoroscopy
      2. X-ray CT
      3. MRI
      4. PET (PET/CT)
    3. Basic Imaging Science
      1. Contrast Resolution
      2. Signal to Noise
      3. Image Quality
        1. Point/Line spread function
        2. Modulation transfer function
      4. Digital imaging
        1. Quantum mottle
        2. Noise frequency/spectrum
        3. Detective Quantum Efficiency
  2. Knowledge Base
    1. Radiotherapy Simulation
      1. CT simulation/virtual simulation
      2. DRR generation
        1. Set-up verification
        2. Portal image verification
      3. X-ray simulator
        1. Set-up verification
        2. Portal image verification
    2. Verification Imaging in Radiotherapy
      1. Kilovoltage x-ray images
        1. Simulator set-up images
        2. Simulator portal images
        3. Beams eye view DRR from CT
        4. Set-up/Portal verification
      2. Megavoltage x-ray images
        1. X-ray film/cassette
        2. Comparison to hardcopy DRR
        3. Electronic portal images
      3. kV conebeam CT
        1. 3-d localization
        2. Adaptive targeting
    3. Electronic Portal Imaging Devices
      1. Fluoroscopic screen/camera based systems
        1. Principles of operation
        2. Disadvantages/Limitations
        3. Clinical prevalence
      2. EPID Flat Panel (a-Si) based systems
        1. Principles of operation
        2. Advantages/Limitations
        3. iii.  Clinical prevalence
      3. kV ‘port films’
        1. Principles of operation
        2. Advantages/Limitations
        3. iii.  Clinical prevalence
  3. Clinical Processes
    1. CT simulation
      1. Patient set-up
      2. Iscocenter localization
    2. Digital Reconstructed Radiograph
      1.  Generation
      2. Clinical use
    3. Electronic Portal Imaging Devices
      1. Principles of operation
      2. Daily/monthly quality assurance testing
      3. Set-up/portal image verification
      4.   Megavoltage cone-beam computed tomography

Learning Opportunities:

  • Clinical Use of Images
  • Portal Imaging Detector Systems
  • Image Quality
  • Commissioning and QA

Learning Objectives - see below (IGRT)

 

The resident will develop knowledge of portal imaging systems used during the simulation/planning process and during treatment verification.  The application of different electronic portal imaging systems will be studied by comparison of systems from Varian and Siemens.  The resident will perform the necessary processes for commissioning the EPID systems, as well as identify and perform continuing quality assurance.  During the rotation the resident will perform monthly and annual quality assurance on different portal imaging systems.

Reading List:

  1. Radiation Therapy Physics 3rd Ed, Hendee, Ibbott and Hendee, Chapter 9.
  2. The Physics of Radiation Therapy, 3rd Ed (or equivalent later edition), Khan, Chapter 12, Section 12.7 (Patient Positioning),
  3. Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180. Med. Phys. 45 (5), May 2018
  4. Marks JE, et al. “Localization error in the radiotherapy of Hodgkin’s disease and malignant lymphoma with extended mantle fields,” Cancer (NY) 34, 83-90 (9174).
  5. Rabinowitz J, et al. “Accuracy of radiation field alignment in clinical practice,” J. Radiat Oncol., Biol., Phys. 11, 1857-67 (1985).
  6. Nixon E. “Hydrogenated Amorphous Silicon Active Matrix Flat Panel Imagers (a-Si:H AMFPI) Electronic Portal Imaging Devices.  Graduate Research Paper.  University of Iowa. 
  7. Pang G and Rowlands J A Electronic portal imaging with an avalanche-multiplication-based video camera Phys. 27 676–84. 2000.
  8. Rajapakshe R, Luchka, and Shalev S, “A quality control test for electronic portal imaging devices,”  Phys.  23,  137-1244  !996).
  9. Gilhuijs KG, et al. “Optimization of automatic portal image analysis.” Phys.  22, 1089-1099 (1995).
  10. Fristch DS, et al. “Core based portal image registration for automatic radiotherapy treatment verification.”  J. Radiat. Oncol., Biol., Phys.  33, 1287-300  (1995).
  11. Herman MG, “Clinical use of on-line portal imaging for daily patient treatment verification,”  J. Radiat. Oncol., Biol., Phys.   28 (4) 1017-1023 (1994).
  12. Herman MG, et al. “Effects of respiration on target and critical structure positions during treatment assessed with movie-loop electronic portal imaging,” J. Radiat. Oncol., Biol., Phys.   39, 163 (1997).
  13. Mubata CD, et al., “Portal imaging protocol for radical dose-escalation radiotherapy treatment of prostate cancer,”  J. Radiat. Oncol., Biol., Phys.  40, 221-231 (1998).
  14. Lebesques JV, et al., “Clinical evaluation of setup verification and correction protocols:  Results of multicenter Studies fo the Dutch cooperative EPID Group,”  The Fifth International EPID Workshop, Phoenix AZ,  p. 20.
  15. Kirby MC, et al. “The use of an electronic portal imaging device for exit dosimetry and quality control measurements.” Int. J. Radiat. Oncol., Biol., Phys 31, 593-603 (1995).
  16. Hansen VN, “The application of transit dosimetry to precision radiotherapy,”  Med Phys. 23, 713-721 (1996).

Assessment:

The resident will prepare a written report summarizing their experiences and present this information to the physics faculty during an oral exam.


Rotation Plan for 11b) Image Guided Radiation Therapy (IGRT)

  1. Skills
    1. TPS system operation
    2. Linear Accelerator operation
    3. Varian planar x-ray and CBCT operation
    4. Philips Gemini Big Bore 4D PET/CT operation
  2. Knowledge Base
    1. Prospective and Retrospective CT principles
    2. Gated treatment delivery principles
    3. Treatment planning process for IGRT
    4. Data export/import into each system
  3. Clinical Processes
    1. Perform Quality Assurance on each of the IGRT components
      1. VisionRT infrared optical guidance system
      2. 4D image acquisition
      3. Gated delivery
      4. Megavoltage cone-beam
    2. Export IGRT Treatment Plans for
      1. Brain, Head and Neck, Lung, and Prostate.
    3. Perform image registration and fusion for multimodality imaging utilized in treatment planning
      1. CBCT with CT
      2. PET with CT
      3. MRI with CT

Learning opportunities 

Observe and participate in the IGRT treatment planning and delivery process and understand the functionality of the systems utilized. Quality assurance of every aspect of each IGRT system studied, from image acquisition through verification and treatment delivery.

Reading List

  1. Quality Assurance for Clinical Radiotherapy Treatment Planning (Reprinted from Medical Physics, Vol. 25, Issue 10) (1998)
  2. Radiation Therapy Committee Task Group #53; 57 pp.
  3. Z-Med SonArray and Radiocam user manual
  4. Sanford L. Meeks, Wolfgang A. Tomé, Lionel G. Bouchet, et al. Patient Positioning Using Optical And Ultrasound Techniques. AAPM Summer School 2003
  5. Jean Pouliot, Ph.D., Ali Bani-Hashemi, Ph.D., Josephine Chen, Ph.D., et al. Low-Dose Megavoltage Cone-Beam CT For Radiation Therapy. J. Radiation Oncology Biol. Phys., Vol. 61, No. 2, pp. 552–560, 2005
  6. Nicole M Wink, Michael F McNitt-Gray and Timothy D Solberg. Optimization of multi-slice helical respiration-correlated CT: the effects of table speed and rotation time.  Med. Biol. 50 (2005) 5717–5729
  7. Allen Li,a_ Christopher Stepaniak, and Elizabeth Gore, Technical and dosimetric aspects of respiratory gating using a pressure-sensor motion monitoring system, Med. Phys. 33 (1):145-54, 2006
  8. Vincent Gregoire, Jean-François Daisne and Xavier Geets, Comparison of CT- and FDG-PET-defined GT: In regard to Paulino et al. (Int J Radiat Oncol Biol Phys 2005;61:1385-1392), International Journal of Radiation Oncology*Biology*Physics, Volume 63, Issue 1, , 1 September 2005, Pages 308-309.;
  9. Arnold C. Paulino and Mary Koshy, In Response to Dr. Gregoire et al., International Journal of Radiation Oncology*Biology*Physics, Volume 63, Issue 1, 1 September 2005, Page 309.
  10. Clifton Ling, John Humm, Steven Larson, Howard Amols, Zvi Fuks, Steven Leibel and Jason A. Koutcher. Towards multidimensional radiotherapy (MD-CRT): biological imaging and biological conformality.  International Journal of Radiation Oncology*Biology*Physics, Volume 47, Issue 3, Pages 547-857 (1 June 2000)

Learning Objectives for rotation 11

  • Describe estimates of imaging doses from the various types of imaging used in radition therpy
  • Describe the technical aspects like detector & source design, and physics interactions
  • Describe the clinical indication for imaging in the clinic
  • Describe the QA process of QA for the CT simaultor and on-board imaging systems
  • Describe the technical differences between imaging small and large objects using the flat-panel of a CBCT
  • Describe the differnt mechanisms that can be used to gate a treatment delivery to breathing

 

Assessment

The resident will present a report giving an overview of all the processes, describing the individual steps conceptually, and results from their experimental studies and quality assurance verification measurements in IGRT.  Current capabilities and remaining challenges of the use of multimodality imaging in radiation therapy treatment planning should be discussed.  Finally, the resident will take an oral exam.  An understanding of the principles behind the processes as well as comprehension of other relevant information from the reading lists must be demonstrated.

 

Rotation Plan for 12) Room Design, Radiation Protection and Radiation Safety

  1. Skills
    1. Interpretation of architectural drawings
    2. Survey meter operation
    3. Use of spreadsheet for data analysis
    4. Linac/HDR operation
  2.  Knowledge Base
    1. Understand radiation safety principles
    2. Understand dose limits/regulatory requirements
    3. Understand barrier material composition and preferences
    4. Understand process of neutron production
    5. Barrier HVL/TVL values
    6. Methodology of barrier thickness computation
    7. Understand differences between head leakage, scatter and primary radiation
  3. Clinical Process
    1. Apply radiation safety principles to situations found in a radiation oncology clinic
      1. Time/Distance/Shielding
      2. Brachytherapy safety and source accountability
      3. Operational safety practices for linac, CT, PET, HDR, and MR
      4. Patient safety
    2. Identify allowable radiation limits for occupationally exposed individuals
    3. Identify allowable radiation limits for members of the general public
    4. Identify/define controlled areas vs. non controlled areas
    5. Identify sources of radiation exposure found in typical radiation therapy facility
    6. Compute workloads
      1. Accelerator
      2. HDR
      3. LDR
      4. CT scanner
    7. Determine use factors for various radiation sources
    8. Determine occupancy factors for regions adjacent to sources of radiation
    9. Calculate barrier thickness
    10. Measure actual exposure outside treatment vault/HDR unit.
  4.  Learning opportunities
    1. The resident will demonstrate to the mentor that he/she has developed a solid grasp of radiation safety practices that need to be implemented in a typical radiation oncology facility.
    2. Compute barrier thicknesses for a typical linear accelerator room layout.
    3. Compute barrier thicknesses for a typical HDR suite
    4. Measure exposure at door and in rooms adjacent to linear accelerator
    5. HDR room survey
    6. Neutron survey
    7. Film Badge area monitoring 

Reading list

  1. NCRP Report 49
  2. NCRP Report 151
  3. The Physics of Radiation Therapy, 3rd ed (or equivalent), Khan, Ch. 16
  4. Ohio Department of Health regulations
  5. Shielding Techniques, 2nd ed McGinley
  6. AAPM task group 32 – Fetal Dose
  7. AAPM online refresher courses

 Assessment

The resident will compile a report describing the individual steps that were taken to perform the shielding analysis. A second report should be written of the shielding requirements for the linear accelerator vault and HDR suite assigned in the learning opportunities. This report should be written as if the intended recipient was the architect in charge of designing the facility. A third report will be created estimating the yearly dose that one would expect in selected areas based on actual measurements.  Residents will aslo take the certification class offered by the radiation safety office and present the certificate to the rotation mentor.

While the bulk of this rotation involves a shielding design project, the resident's overall understanding of radiation safety will be evaluated during this rotation. Radiation safety training is a continuous process throughout the 2-year rotation. Specific safety topics should have been addressed in previous rotations. The mentor will use this rotation to evaluate the resident on their understanding of safety issues by asking pertinent questions that the resident should be able to answer.  Should the resident fail to answer any questions to the mentor's satisfaction he/she will be asked to write a report covering the specific safety issues that need further study.

The resident will take an oral exam at the conclusion of the rotation. The resident should be able to demonstrate knowledge of these processes and other relevant information obtained from the reading lists.

 

Appendix A: Practice Treatment Plan List

Plan Name/site

Brain

SRS Brain Regular

 

SRS Brain 1 Met Advanced

 

SRS Brain Multimet Single Iso

 

Whole Brain

 

Head and Neck

Bilateral Neck

 

 

 

Lung Mediastinum

Esophagus

 

Lung SBRT

Mediastinum Large 1

Mediastinum Large 2

Mediastinum Large Challenge

 

 

Breast

Breast 4fld challenge

 

Breast 4fld scv1

 

Breast Challenge

 

Breast DIBH Boost

Breast DIBH

Breast VMAT Challenge

Breast VMAT Simple

Simple Breast

Simple Breast Boost

 

Abdomen

Liver SBRT

Pancreas SBRT

 

 

Pelvis

Pelvis 3D

 

Pelvis 3D Large

Prostate

 

Prostate Bed

ProstateBedandLNs

 

 

Spine

3d conformal spine

Spine SBRT

 

Appendage

APPA femur

 

 

Femur 3d

Femur 3d2

Oblique Arm

 

Last Updated: 2/13/26