05 May 2005

Expert Steering Group Meeting, Mumbai 04 – 06 May 2005

Minutes of IAEA/RCA RAS/6/038 Expert Steering Group Meeting on

“Strengthening of Medical Physics Trough Education and Training”Citizens Hotel, Juhu,

Mumbai, India, May 4 – 6, 2005

The Opening Ceremony started with welcoming remarks by Dr. B.S. Rao, Head, RP & AD, BARC, NC, followed by remarks and introduction to the RCA program by Dr. K Raghuraman, India RCA National representative. Dr. J. Drew, LCC and Dr. F Pernicka, IAEA Technical Officer gave their remarks and thanks to the organisers. The welcoming address was given by Dr. H.S. Kushwaha, Director of Health Safety and Environmental Group of BARC, who then officially inaugurated the meeting.

04 May 2005Session 1

The participants were formally introduced (Appendix 1) and the session started with the elections of:

Convenor : Dr. John Drew (Australia) Rapporteurs : Dr. Fuad Ismail (Malaysia)

The proposed agenda (Appendix 2) was adopted by the group.

Project Overview

Dr. J Drew introduced the background of the project. Issues needed to be addressed for the region include :

1. Shortage in the number of MP2. Defining the role and responsibilities of the MP3. Education and training

Academic training Clinical training

4. Professional standards

Slow progress of the project was partly due to the earlier scope and objectives being too wide covering all 3 aspects of medical physics namely imaging, radiation therapy and nuclear medicine. Therefore the focus of the project has been changed to radiation oncology medical physics with view to expand to the other 2 aspects when the initial phase of project is successful.

The revised objectives of the project are :1. Develop a definition and requirements for a qualified radiation oncology medical

physicist suitable for the Region2. Review and develop guidelines for a clinical training program for radiation

oncology medical physicists3. Assist and advise the program co-ordinator in the management of the project and

determining priorities

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4. Oversee progress of the project5. Liaise with the IAEA and the country co-ordinators within RCA to facilitate

progress of the project

Dr. T Kron introduced the concept of the ESG and discussed the “Terms of Reference” for the ESG. (Appendix 3). He elaborated on the role and position of the ESG within the working frame of the IAEA / RCA projects which would be mainly advisory and to provide a framework for the project. Communications from the ESG would be through the “Convenor”. Any proposals/recommendation from the ESG would be forwarded to the National Project Coordinators for endorsement and action.

Dr. F. Pernicka gave a summary of IAEA projects around the world pertaining to MP. The ARCAL region has just started on an MP project similar to the RCA project. He also gave a short briefing on the rules and regulations for RCA and IAEA projects.

Session 2

Definition of Radiation Oncology Medical Physicist (ROMP)

J. Drew and T. Kron gave an overview on the definitions of MP from several societies and associations with special reference to IAEA Techdoc 1040 and Basic Safety Standard (BSS) 115. Issues discussed include terminology, academic qualification, training, remuneration, certification and licensing. The agreed definition of a ROMP is in Appendix 4.

Training and Certification of ROMP

For certification of ROMP, adequate clinical training is a basic requirement and a minimum of 3 years of supervised clinical training was felt necessary. The full training requirement of a ROMP is given in Appendix 4. The definite roles and responsibilities of an MP is well defined in the IPEM document “Guidelines for the Provision of a Physics Service to Radiotherapy” which could be adopted for use in the region. The IAEA would communicate with IPEM for permission to use the relevant sections of the said document.

05 May 2005

Session 3

Resources

Some of the available resources for medical physics include web-based resource, textbooks, IAEA technical documents and international course are as listed in Appendix 5. Availability of some resources is limited by memberships, course fees and textbooks/document costs.

Dr. Ismail gave an overview on the development and progress of the RAS 6033 “ASO– Distance Learning Project”. The project has undergone successful piloting in 7 countries and a final CD version is targeted for completion in 2006. The CD has also been approved for pilot use and evaluation in Australia for the radiation oncology medical physics course.

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Training and education of ROMP

Prof. Inamura gave a presentation on “The needs and opportunities for medical physicists in the Region”. He emphasised on the various issues raised in the previous AFOMP meetings and results of a recent survey conducted by AFOMP on the needs and requirements for medical physicists in the various countries in the region. Close collaboration and formal relationship with AFOMP would be desirable for continuity of the RAS 6038 project.

Dr. Rao gave a presentation on the course for medical physicist conducted by the BARC. The program includes extensive lectures as well as practical projects over a 1 year period. The Australian medical physics program was given by Dr. Drew. Training requirements for the Australian program was compared to and is similar with international practices.

The EMERALDTM program was discussed and may be adequate for an MSc program but would be inadequate for the proposed ROMP program. The proposed framework for the ROMP program by ACPSEM entitled “Competency Based Clinical Training Program For Training Radiation Oncology Medical Physicists” was deemed suitable and suggested to be adopted with suitable modifications for this RCA program pending on agreement by ACPSEM. However this framework is incomplete and would still need extensive development and validation. This program includes a checklist of core competencies for trainees upon completion of the program.

The core competencies and weighting identified for a ROMP are :

Heading Weighting1. Imaging 22. Anatomy & physiology 13. Radiobiology 24. Equipment specification, commissioning and QA 65. Dosimetry 66. Radiation protection 27. Treatment planning 58. Brachytherapy 39. Management & communications 110. Research & teaching 611. Professional awareness 112. Clinical studies / exposure 1

Total 36

Each training module would be divided into sub-modules. An example of a training module and checklist of core competencies is given in Appendix 5 & 6.

Additional material was felt necessary for the project. Although an internet based program resource has certain advantages, a CD-based program similar to ASO was deemed more suitable and easier to achieve in the immediate future. However this may be limited by funding and pilot use of selected modules of the ASO CD under the RAS6038 will be explored.

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06 May 2005

Project implementation

For the implementation of the project, the scheme of the official document with “Project LCC” and “Assistant LCC” would be in-charge of the project. The Project LCC would be responsible for the project as a whole including initiating actions, communications, convening of meetings, making recommendations (including budget) and delegation of responsibilities as appropriate, within the rules of RCA. The meeting report would be circulated to the NC for comments and suggestions.

The revisions to the Project Proposal (Dated : 10th Feb 2005) were discussed in detail and modified including new time-lines for the project. Non-core activities were generally excluded from the original proposal. A pilot project on the clinical training for ROMP will be undertaken will existing (modified) material from ACPSEM at selected centres. An overview of timelines for the various project activities is shown in Appendix 8.

The concept paper for the next phase of RAS 6038 in 2007 - 2010 was reviewed. Proposal for integration of medical physics program in radiology and nuclear medicine into the RAS 6038 would need to be detailed and budgeted for by end 2005.

The next ESG meeting is planned for February 2006.

The participants thanked the host, Bhabha Atomic Research Centre for the excellent organisation and hospitality throughout the meeting.

ACTION LIST

1. All: Study IPEM document of MP roles and responsibilities. Provide comments about suitability for adoption and suggestions for modification

2. All: Footnotes for definition of a MPS3. Maintain communication with AFOMP - Develop MOU for a formal relationship between

RAS6038 and AFOMP4. Explore possibility of test run of existing module(s) of Applied Sciences of Oncology CD with

medical physicists in the region5. Prepare executive summary for roles and responsibilities of ROMP for administrators6. Consider textbooks and related resources (not equipment) to be supplied to pilot institutions

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APPENDIX Title Page

1 List Of Participants 6

2 Agenda 8

3 RAS6038 Expert Steering Group Terms Of Reference 9

4 Definition and roles / responsibilities of ROMP 10

5 Resources for RAS 6038 11-12

6 Example of modules / sub-modules 13-14

7 Example of assessment of core competencies 15

8 Projected Timeline for RAS 6038 16

9 Abbreviations 17

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APPENDIX 1 : LIST OF PARTICIPANTS

COUNTRY NAME DESIGNATION

1. Australia Mr. John Drew Medical physicist(Project LCC)

2. Australia Mr. Tomas Kron Medical physicist

3. IAEA Mr. Frank Pernicka IAEA Technical Officer

4. India Mr. BS Rao Medical physicist

5. India Mr. DD Deshpande Medical physicist

6. India Mr. SD Sharma Medical physicist (Observer)

7. Japan Mr. Kiyonari Inamura Medical physicist (Assistant LCC)

8. Japan Mr. Nobuyuki Kanematsu Medical Physicist (Observer)

9. Malaysia Mr. Fuad Ismail Clinical Oncologist

10. Thailand Ms Anchali Krisanachinda Medical physicist

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APPENDIX 2

AGENDA Expert Steering Group Meeting, Mumbai 04 – 06 May 2005

TIME WEDNESDAY 4TH May THURSDAY 5th May FRIDAY 6TH May

0900 Introduction of participants and background brief

Election of Chairman and Rapporteur

SESSION – 3

Needs and opportunities within the region

Kiyonari Inamura

SESSION – 5Discussion of role and mandate of the program co-ordinator

1000 Introduction and welcome by local host

Nomination and discussion of program co-ordinator

1030 BREAK BREAK BREAK

1100 SESSION -1

Background briefing

John Drew

Tomas Kron

Frank Pernicka

SESSION –3

Guidelines for training program Review materials provided Duration

Contents/competencies

Break-up into ‘modules’

SESSION-5Review revision to RAS6038 for 2005/06

Timeline for the project – milestones

1300 LUNCH LUNCH LUNCH

1400 SESSION – 2

Definition and requirements for a ROMP suitable for the Region

SESSION – 4

Cont. from session 3

SESSION – 6Review project concept proposal for 2007/10

1530 BREAK BREAK BREAK

1545 SESSION – 2 (cont) SESSION – 4 (Cont.) SESSION – 6 Final discussion, date for next meeting and farewell

1700 End End End

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APPENDIX 3

RAS6038Expert Steering Group

TERMS OF REFERENCE

Membership: Three representatives of the radiation oncology medical physics profession from

within the region – one of them will be elected convenor One representative from radiology medical physics One representative from nuclear medicine medical physics One representative from academia One radiation oncologist (‘customer’ representative)

Objectives:1. Develop a definition and requirements for a qualified radiation oncology medical

physicist suitable for the Region2. Review and develop guidelines for a clinical training program for radiation

oncology medical physicists3. Assist and advise the program co-ordinator in the management of the project and

determining priorities4. Oversee progress of the project5. Liaise with the IAEA and the country co-ordinators within RCA to facilitate

progress of the project

Meeting frequency Once per year in person Regular electronic communication

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APPENDIX 4

DEFINITIONS :

Medical Physics is the application of physics’ concepts in the prevention, diagnostics and therapy of human disease.

A medical physics specialist (MPS) is an individual has sufficient knowledge, training and experience to accept full responsibility and is competent to practice independently in one of the medical physics specialties.

The particular specialty of Radiation Oncology Medical Physics (ROMP) pertains to:1. The therapeutic applications of ionising radiation2. The equipment associated with their production, use, measurement and evaluation3. The quality and handling of images resulting from their production and use4. Radiation protection associated with this specialty

A MPS is required to be certified by an appropriate professional body.

Suggested framework for certification of Radiation Oncology Medical Physics Specialists

Degree majoring in physics or equivalent1

Postgraduate degree in medical physics OR postgraduate degree in science/engineering and participation in a medical physics course of at least 6 month duration

Three years of clinical training as a medical physics resident2

Passing an appropriate assessment

1 Equivalence requires a minimum of … maths, … 2 If this training does not exist a time frame shall be identified in which the training program can be established

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APPENDIX 5 : Resources for ROMP Course

A International Organisations1. IAEA:

Radiation Protection Training courses Applied Science of Oncology BSS 115, particularly appendix II Medical Physics Handbook TecDocs (1040) Technical reports Safety Reports

2. Other international organisations IEC ICRU ICRP UICC IEEE

B Professional organisations:1. AAPM (potential problem with local contents)

Task group reports Teaching materials

2. ESTRO Training courses + course books Booklets

3. Other organisations IPEM ACPSEM Japan EFOMP India

C Existing courses:1. BARC (lecture notes 25; handout for experiments 25)2. Australian Universities:

RMIT QUT Wollongong Sydney Uni

3. Thailand (textbook and ICTP, based)

D Textbooks: Attix FH. Introduction to radiological physics and radiation dosimetry.

John Wiley & sons. NY

Barrett A, Dobbs J and Ash D Practical Radiotherapy Planning 3rd

Edition

Bentell GG

Cember H. Introduction to health physics. New York: McGraw-Hill; 2nd

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edition 1983

Christensen, Radiology

Hall E Radiobiology for Radiologists 5th Edition

Johns H E; Cunningham J R. The physics of radiology. Springfield: CC Thomas; 1983.

Karzmark, C, Nunan C and Tanabe E. Medical electron accelerators. McGraw Hill, New York, 1993.

Khan F. The physics of radiation therapy. 4th edition. Baltimore: Williams & Wilkins; 2004.

McGinley P. Shielding of Radiotherapy Facilities. Medical Physics Publishing: Madison

Metcalfe P.; Kron T.; Hoban P. The physics of radiotherapy X-rays from linear accelerators. Madison: Medical Physics Publishing; 1997.

Metcalfe P, Kron T and Hoban P. The Q book - Problems and solutions to "Physics of radiotherapy X-rays." Medical Physics Publishing, Wisconsin 1998, ISBN 0-944838-86-3

Walter and Miller. Short Textbook of Radiotherapy

Perez C and Brady L. Principles and practice of radiation oncology. Lippincott-Raven: Philadelphia; 1998

Pierquin P and Marinello. A practical manual of brachytherapy. Medical Physics Publishing: Madison. 1997.

Steel GG Clinical Radiobiology

Sprawls P

UICC

VanDyk, J. Modern Technology of Radiation Oncology (Ed.: J Van Dyk) Medical Physics Publishing, Wisconsin 1999, ISBN 0-944838-38-3

Webb

Williams J; Thwaites D. Radiotherapy Physics. Oxford: Oxford University Press; 1993.

Relevant PhD thesesE Electronic and Remote Teaching materials

Europe:EMERALDEMIT (electronic)

Remote teachingM. Woo (Toronto Sunybrook

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APPENDIX 6 : Example of modules and sub-modules

Module 5 : Dosimetry

5.1 Ion chambers5.2 Solid state dosimetry (TLD, Diodes, MOSFETS)5.3 Film dosimetry and others5.4 Teletherapy calibration5.5 In vivo dosimetry5.6 Brachytherapy dosimetry

Sub Module 5.1Title Calibration of radiotherapy equipment

Aim Calibration of teletherapy equipment under reference conditions traceable to secondary standard.

Pre-RequisiteCompetencies

1. Understanding of calibration machine properties.2. Understanding of radiation interaction with matter3. etc

Resources Ion chamber, ElectrometerManufacturer technical documents.Calibration certificate etc

Objective Absolute dose measurement of teletherapy equipment under reference conditionCalibration of teletherapy equipment

i. Linear acceleratorsii. Cobalt teletherapyiii. Orthovoltageiv. Superficial x-rays

etcDuration of training

2 months

Suggested Method Of Training

Read and understand the IAEA TRS398 absolute dosimetry protocol

Compare TRS 277 with TRS 398 Review TRS398 against other international protocols Explain the difference in air kerma and dose to water calibration

protocols Perform constancy output checks etc. etc

Supervision Requirements

Supervised as required during measurements.

Mandatory Reports

Reports on: An absolute dose calibration of an orthovoltage x-ray beam An absolute dose calibration of a megavoltage x-ray beam An absolute dose calibration of a megavoltage electron beam

Assessment Demonstrate an ability to setup and carry out the required

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Criteria dosimetric procedures Quality and completeness of the reports, including the description

and presentation of the experimental setup, results and conclusions from the results.

Applicable use of references etc. etc

Reading resources

The IPEMB Code of Practice for the determination of absorbed dose for x-rays below 300 kV generating potential, Phys. Med. Biol. 41: 2605-2625, 1996

IAEA TECDOC-1040, Quality Assurance in Radiotherapy, Vienna, 1997

IAEA TECDOC-1274, Calibration of Photon and Beta Ray sources Used in Brachytherapy, Vienna, 1997

etc. etc

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Appendix 7 : Example of assessment of core competencies

Radiation DosimetryBasic Clinical Training

Competencies

Competency Supervised Unsupervised

Understand the characteristics of the radiation produced by therapy devices and sourcesKnow and explain methods of determining beam quality for megavoltage x-ray beams Know and explain use of HVL in kilovoltage x-ray beam dosimetry Measure the HVL of the kilovoltage x-ray beams

Understand the principles of operation of dosimeters used in radiotherapy and the appropriate usage for absolute and relative dosimetry.

Understand the use of different detectors for absolute dosimetry measurements (x-rays) Understand the use of different detectors for relative dosimetry measurements (x-rays) Setup the water tank to be ready for x-ray beam scans Setup the water tank to be ready for electron beam scans

Understand and follow established protocols for the correct testing and use of dosimeters in a radiotherapy department.

Review the quality assurance program of the radiation dosimeters Review and perform the strontium90 QA tests of the ionisation chambers Measure the stem effect and leakage for an ionisation chamber

Under supervision, follow an established dosimetry programme for megavoltage photon and electron beams and kilovoltage x-ray beams and brachytherapy isotopes such that accurate absorbed dose determinations will be obtained.

Read the IAEA TRS398 absolute dosimetry protocol Know the principles of the TRS398 protocol Perform chamber calibration Nd transfer for megavoltage x-ray beam

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APPENDIX 8 :

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APPENDIX 9 : ABBREVIATIONS

AAPM : American Association for Physics in MedicineACPSEM

:Australasian College of Physical Scientists and Engineers in Medicine

AFOMP : Asian Federation of Organizations for Medical PhysicsASO : Applied Sciences in OncologyASTRO : American Society of Therapeutic Radiation OncologyBARC : Bhaba Atomic Research CentreIAEA : International Atomic Energy AgencyESG : Expert Steering GroupESTRO : European Society for Treatment and Research in OncologyIPEM : Institute of Physics and Engineering in MedicineLCC : Lead Country CoordinatorMP : Medical PhysicsNC : National Project CoordinatorPCM : Project Coordinators MeetingQA : Quality AssuranceRCA : Regional Cooperative AgreementROMP : Radiation Oncology Medical Physicist

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05 May 2005

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