Doctorate of Medical Physics Handbook in Radiation...

Doctorate of Medical Physics Handbook

in Radiation Oncology Physics

Program Director:

Niko Papanikolaou, Ph.D. Professor and Chief

Phone: 210-450-5664

Fax: 210-450-1076

Email: [email protected]

Associate Program Director:

Sotirios Stathakis, Ph.D. Associate Professor

Phone: 210-450-1010

Fax: 210-450-1076

Email: [email protected]

Last updated on 5 April 2017 by P. Candia

mailto:[email protected]

mailto:[email protected]

UTHSCSA-Division of Medical Physics /93 Resident Handbook

Contents SECTION 1: GENERAL INFORMATION ...................................................................................................................... 5

1.1 INTRODUCTION ................................................................................................................................................... 5

1.1.A: Training Facilities in Collaboration with UTHSCSA ..................................................................................... 5

1.1.B: Licensure/Liability/Risk Management ............................................................................................................ 5

1.1.C: Educational Objectives .................................................................................................................................... 6

1.1.D: Resident Supervision Policy ........................................................................................................................... 6

1.1.E. Reading Requirements ..................................................................................................................................... 6

1.2: GENERAL ORGANIZATION OF THE RESIDENT STAFF ............................................................................... 6

1.3: VACATION AND LEAVE FOR ACADEMIC PURPOSES ................................................................................ 7

1.3.A: Leave Policy.................................................................................................................................................... 7

1.3.B: Scientific Meetings .......................................................................................................................................... 7

1.3.C: Family Leave/Sick Leave ................................................................................................................................ 8

1.3.D: Maternity and Paternity Leave ........................................................................................................................ 8

1.3.E: Workers' Compensation/Holiday ..................................................................................................................... 8

1.4: MOONLIGHTING ................................................................................................................................................. 8

1.5: DRESS CODE..................................................................................................................................................... 8

1.6: SMOKING .............................................................................................................................................................. 9

1.7: EVALUATION AND ADVANCEMENT ............................................................................................................. 9

1.8: RESIDENTS' BENEFITS INFORMATION .......................................................................................................... 9

1.8.A: Parking ............................................................................................................................................................ 9

1.8.B: Uniforms ......................................................................................................................................................... 9

1.8.C: Identification Cards ......................................................................................................................................... 9

1.8.D: Educational Loan Deferment ........................................................................................................................ 10

1.9: RESIDENT GRIEVENCES, DISCIPLINARY POLICY & APPEAL PROCEDURE ........................................ 10

1.9.A: Levels Of Discipline .................................................................................................................................... 10

1.9.B: Formal Grievance Procedure ......................................................................................................................... 11

1.9C: Hearing ........................................................................................................................................................... 11

SECTION 2: EDUCATION ............................................................................................................................................ 12

Requirements for Successful Program Completion ..................................................................................................... 12

Clinical Rotation 1 Schedule and Objectives ................................................................................................................... 15

Objectives Master Checklist ........................................................................................................................................ 15

References .................................................................................................................................................................... 15

Introduction to Radiation Oncology Nursing Worksheet (NEW PATIENT) .......................................................... 16

Introduction to Radiation Oncology Nursing Worksheet (ON-TREATMENT PATIENT) .................................... 17

Introduction to Radiation Oncology Nursing Worksheet (FOLLOW-UP PATIENT) ............................................ 18

Introduction to Radiation Oncology—LINAC Checklist (Form R.1.A) .................................................................. 19


Introduction to Radiation Oncology – CT SIMULATION (Form R.1.B) ............................................................... 20

Introduction to Radiation Oncology—LINAC Engineer Checklist (Form R.1.D) .................................................. 23

Introduction to Radiation Oncology—MU CALCULATIONS Checklist (Form R.1.E) ........................................ 24



References: ................................................................................................................................................................... 25

In vivo/patient specific dosimetry Checklist (Form R.2.A) ..................................................................................... 27

Air Chamber and Electrometer Checklist (Form R.2.B) .......................................................................................... 28

HDR Checklist (Form R.2.C) .................................................................................................................................. 29

On Board MV and kV Imaging Checklist (Form R.2.D) ......................................................................................... 30

IMRT QA Checklist (Form R.2.E) .......................................................................................................................... 32

TREATMENT PLANNING Proficiencies (Form R.2.F) ........................................................................................ 33

CT simulator checklist (Form R.2.G) ...................................................................................................................... 36

Treatment Planning Terms 1 (Form R.2.H) ............................................................................................................. 37

Treatment Planning Terms 2 (Form R.2.I) ............................................................................................................... 38



References: ................................................................................................................................................................... 40

ExacTrac (kV) (Form R.3.A) ................................................................................................................................... 41

Total Skin Electron Treatment (Form R.3.B) .......................................................................................................... 42

Total Body Radiation Therapy (Form R.3.C) .......................................................................................................... 43

Intensity Modulated Radiation Therapy (IMRT) Planning(Form R.3.D) ................................................................ 44

Annual Linac QA (Form R.3.E) ............................................................................................................................... 45

TG-51 Calibration Checklist (Form R.3.F) .............................................................................................................. 46

Informatics (Form R.3.G) ........................................................................................................................................ 47


References: ................................................................................................................................................................... 48

Normal Tissue Tolerance Checklist (Form R.4.A) (cont’from Rotation 2 and 3) ................................................... 49

Low Dose Rate (LDR) Brachytherapy Checklist (Form R.4.C) .............................................................................. 51

Radiation Protection Checklist (Form R.4.D) .......................................................................................................... 52

Patient Safety (Form R.4.E) ..................................................................................................................................... 55



References .................................................................................................................................................................... 56

LINAC Design and Function Checklist (Form R.5.A) ............................................................................................ 57

Treatment plan and patient chart checks (Form R.5.B) ........................................................................................... 58

Brachytherapy Checklist (Form R.5.C) ................................................................................................................... 59

COMS Eye Plaque Applicator Checklist (Form R.5.D) .......................................................................................... 62




References .................................................................................................................................................................... 63

Stereotactic Body Radiation Therapy Checklist (Form R.6.A) ................................................................................ 64

Stereotactic Radiosurgery Checklist (Form R.6.B) .................................................................................................. 65

Stereotactic Radiosurgery Checklist (Form R.6.C) .................................................................................................. 66

Treatment planning system QA (Form R.6.D) ......................................................................................................... 67



References .................................................................................................................................................................... 69

Imaging List (Form R.7.A) ...................................................................................................................................... 70

Linac Selection/Acceptance/Commissioning (Form R.7.B) ................................................................................... 72

CT simulator Selection/Acceptance/Commissioning (Form R.7.C) ........................................................................ 73


2.1 DESCRIPTION OF EDUCATIONAL EXPERIENCE ............................................................................................. 75

2.1.A: Research Experience ......................................................................................................................................... 75

2.1.B: Facilities ............................................................................................................................................................ 75

2.1.C: Work Hours Policy ............................................................................................................................................ 75

2.2: EDUCATIONAL CONFERENCES ......................................................................................................................... 75

2.3: RESIDENT ROOM and LIBRARY ROOM ........................................................................................................... 75

2.4 Radiation Oncology New Employee Orientation Checklist ....................................................................................... 76

2.5: Department Organizational Chart ............................................................................................................................ 77

2.6: Oral Exam Evaluation ............................................................................................................................................... 78

2.7: Evaluation Forms ...................................................................................................................................................... 83

2.7.1: In-service Presentation Evaluation ..................................................................................................................... 83

2.7.2 Course Evaluation Form ..................................................................................................................................... 83

2.7.3: Residency Curriculum Evaluation Form ............................................................................................................ 86

2.7.4 Resident Evaluation Form ................................................................................................................................... 87

2.7.5: Residency Mentor Evaluation Form .................................................................................................................. 88

2.7.6: Medical Conferences Attendance Log ............................................................................................................... 89

2.7.7 Program Evaluation Form ................................................................................................................................... 91

2.7.8 Milestones Agreement Form……………………………………………………………………………………92


SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

Welcome to the Medical Physics Residency Program in the Department of Radiation Oncology at

the University of Texas Health Science Center at San Antonio (UTHSCSA). The faculty and staff

hope that the time you spend with us will be both educational and enjoyable. This handbook serves

as a guide for our medical physics residents and third/fourth year graduate students in the Doctor of

Medical Physics (DMP) program. Hereforth, in this document the word “resident” shall refer to both

Medical Physics Residents and DMP students. In addition to clinical assignments, this handbook

contains general information which pertains to the policies of the department of radiation oncology

at the University of Texas Health Science Center and the Cancer Therapy and Research Center.

Residents are responsible for familiarizing themselves with and adhering to the policies and

guidelines contained in this manual. Ad hoc additions and clarifications may become available via

email from the Program Director and are considered policy.

Mission Statement: The mission of the Department of Radiation Oncology is to conduct high quality

education with state-of-the-art radiotherapy equipment, and cutting-edge basic and clinical research

and to provide excellent quality patient care. Our residency program offers education and training

for medical physicists to become skillful professionals in the practice of clinical radiation physics.

Our Division, the Department of Radiation Oncology and UTHSCSA are committed to serve the

needs of the citizens of Texas, the Nation, and the world through clinical, educational and research

programs of excellence.

1.1.A: Training Facilities in Collaboration with UTHSCSA

The University of Texas Health Science Center at San Antonio (UTHSCSA) is the major source of

health professions education and life science research and a major center for patient care in South

Texas. UTHSCSA has enjoyed innovative partnerships within the community and has excelled at

fostering mutually beneficial, collaborative arrangements with its primary teaching hospitals in San

Antonio - the University Hospital and clinics of the University Health System, the Audie L.

Murphy Division of the South Texas Veterans Health Care System (VA) and Christus Santa Rosa

Hospital and its military partners - Wilford Hall and the Brooke Army Medical Center. The Cancer

Therapy and Research Center (CTRC) is part of the UTHSCSA and is the NCI designated cancer

center of the University.

1.1.B: Licensure/Liability/Risk Management

It is expected that all residents shall obtain a temporary Texas Medical Physics License prior to or

during the first rotation of the Radiation Oncology Physics Residency Training Program. It is the

responsibility of the physics resident to ensure that the license remains current throughout the two

year training program. UTHSCSA practices a no tolerance rule if the license is to lapse during the

training period. This may also affect Visa status.


1.1.C: Educational Objectives

The objective of a medical physics residency training program is to educate and train medical

physicists to a level of competency sufficient for them to become qualified for independent,

professional practice in their subfield of medical physics. To accomplish this goal the appropriate

facilities, staff, patient mix and educational environment must be provided.

The program emphasizes a close personal working relationship between the faculty and the resident

as well as the other specialties in our department. Knowledge, skills and other resident characteristics

are evaluated and informally addressed by faculty on an on-going basis and formally reported through

scheduled evaluations.

Residents are expected to participate in research activities during their training. Special effort is made

to identify and mentor those who have the interest and talent to pursue careers in academic radiation

physics.

1.1.D: Resident Supervision Policy

The educational program is designed to provide close supervision of residents' clinical activities by

designated faculty. The resident is assigned to a designated faculty for a period of three months. At

the end of the assigned period, the resident will be evaluated and will rotate with another faculty until

the completion of the twenty-four month program. Regular communication between residents and

attending faculty is one of the key factors in quality learning. Any clinical issues must be brought to

the attention of the supervising faculty.

1.1.E. Reading Requirements

Reading is an essential part of learning in Radiation Oncology Physics. Self-discipline and good

study habits are required. All residents should set up a study schedule and adhere to it.

1.2: GENERAL ORGANIZATION OF THE RESIDENT STAFF

Annually, a chief resident will be designated by the faculty. The chief resident should guide

the junior resident(s) by serving as a role model and mentor. He/she may delegate

responsibilities to other residents:

CHIEF RESIDENT MAJOR DUTIES:

a. Acts as liaison between faculty/residents

i. holds meetings with residents as necessary

ii. meets regularly with Program Director to discuss areas of concern

b. Coordinates medphys resident coverage for the TBI and TSE program

c. Coordinates the IMRT patient QA validation assignments

d. Attends departmental meetings as the resident representative as directed by the

division chief


e. Helps orient new residents, post-doctoral researchers and medical physics graduate

students

1.3: VACATION AND LEAVE FOR ACADEMIC PURPOSES

The leave policy for the DMP students in the didactic years (years 1 and 2) follows that of the

UTHSCSA academic holiday calendar. However, for the DMP students in clinical rotations

(years 3 and 4) the leave policy follows the clinical coverage guidelines of the department that

the DMP student is assigned. Pursuant to the CAMPEP guidelines for the clinical residency

requirements, the DMP students in clinical rotations will have to provide coverage any time

the clinics are open. A coverage schedule will be posted ahead of time to provide adequate

coverage on those special occasions.

1.3.A: Leave Policy

The general policy in the Department of Radiation Oncology is to grant DMP students 12 days per

year vacation leave and 3 days per year of Personal leave. This includes actual vacation time and

time for attending meetings for scientific purposes. Doctor of Medical Physics students are allowed

three additional days a year if they present an abstract at a meeting. As a general rule, only one week

of vacation is allowed at any given time, exceptions must be discussed with the respective attending

faculty and Program Director well in advance. In general, only one DMP students is allowed to take

vacation at a time unless under special circumstances. First preference is given to those who are

presenting or attending meetings. All other times are on a first- come, first-serve basis. Additionally,

no more than one week of vacation may be taken during any three-month rotation period. Exceptions

must be discussed with the assigned faculty and Program Director well in advance. All vacation and

meeting time must be arranged at least one month in advance. The faculty of that rotation should sign

off on it to indicate their awareness. Actual approval is granted by the Program Director.

Manage your time off well, especially during your final year. All time spent at academic meetings,

job interviews, house hunting, etc. is taken from the overall 3-week yearly allotment of

vacation/meeting time and must be taken in the academic year in which it is accrued; unused time

may not be carried forward into the following year.

Any DMP student who is absent without leave (AWOL) will be subject to disciplinary action which

may include expulsion from the program. Timely communication with the Program Director can

avoid disciplinary actions of this magnitude.

1.3.B: Scientific Meetings

In general, only one DMP student may be on leave at any time. However, under special

circumstances, up to two DMP students may attend meetings with the Program Director’s approval.

For attending any meeting, priority is given first to those as follows: oral presentations, poster

presentations, and senior DMP students who have not attended any and other DMP students.

For DMP students presenting at a meeting, an additional three days of leave is allocated per year

(also no carry-over).


1.3.C: Family Leave/Sick Leave

DMP students are eligible for family leave as outlined in the UTHSCSA family leave policy. Any

requests for family leave must be reviewed by the Program Director and the Administration Office.

The Administration Office will obtain the appropriate information/forms. A DMP student may

request from his/her department family and medical leave for the birth of the DMP student’s own

child, for the placement of an adopted or foster child with the DMP student, for the DMP student’s

own serious health condition, or for the serious health condition of the DMP student’s parent, spouse,

or child. The duration of the family medical leave is governed by UTHSCSA policy.

1.3.D: Maternity and Paternity Leave

The DMP student shall be entitled to parental leave without pay for up to twelve (12) weeks after

one year of employment in accordance with the Family and Medical Leave Act. The DMP student

will be responsible for completing the rotation competencies upon return and complete the 24 month

mandatory clinical training.

1.3.E: Workers' Compensation/Holiday

Refer to policies outlined in UTHSCSA operating procedures http://www.uthscsa.edu/hop2000/

and UTHSCSA Calendar http://www.uthscsa.edu/hr/inside/holiday.asp

1.4: MOONLIGHTING

In general, the practice of moonlighting is not allowed, but under certain circumstances a waiver can

be obtained from the Program Director. If a resident is allowed to moonlight, they have to do so on

their personal time. Note: University malpractice insurance will not cover a resident engaged in either

locum tenens or moonlighting activities.

1.5: DRESS CODE

The overall appearance of personnel in the Department of Radiation Oncology must reflect

professional standards and departmental attitude. Professional attire is required at all clinical areas.

All members of the staff must have a clean, professional appearance. Men should wear collared shirts,

tie, slacks and closed toe shoes. Women should wear blouse/skirt or dress (at least knee length) or

Blouse/slacks (ankle length). No sandals, jeans, t- shirts, or shorts are allowed and no open toe shoes

in procedure areas. Halters, leotard tops, T- shirts, tube tops, shorts, sweatshirts, sweat pants, and

excessive ornamental earrings, necklaces and bracelets are not permitted; simple rings, earrings and

necklaces are appropriate. Hair longer than shoulder length must be tied back during direct patient

care. Hats, scarves, large colorful hair ornaments and headbands worn around the forehead are not

allowed. Head coverings for ethnic, or religious reasons are permitted. Should the attending faculty

object to a resident's grooming or clothing, the Program Director will be responsible for counseling

that resident.


1.6: SMOKING

Smoking is prohibited in any area of the Department, CTRC, VA or UTHSCSA.

1.7: EVALUATION AND ADVANCEMENT

Residents in the program will be given graded responsibility under appropriate supervision according

to their level of training, ability and experience. A resident's progress during residency training is

evaluated formally, in writing, by the resident's attending faculty at the end of their respective

rotation. Every effort is made to help residents with any problem during the rotation.

The Program Director will discuss as needed residents' performance and progress with residents

individually. They will be reviewed with the faculty at least annually at a residency review committee

meeting. Yearly advancement within the training program is contingent on evidence of satisfactory

professional growth of the resident, including demonstrated ability to assume graded responsibility.

Increased responsibilities include assignment of additional specific skill tasks over the course of the

residency. The annual reappointment and promotion of a resident is not automatic and requires a

demonstration of competence at each educational level. Failure to advance to the next level may

result in dismissal from this residency program. If it becomes apparent that a resident is having

trouble with a rotation, he/she should make an appointment to discuss the problem with his/her staff

and the Program Director.

Residents will also be asked to evaluate each faculty member confidentially at the end of rotation

and these evaluations will be submitted to the Program Director.

1.8: RESIDENTS' BENEFITS INFORMATION

1.8.A: Parking

Parking is under the auspices of the UTHSCSA police department and the residents can purchase a parking tag. This permit is valid on all UTHSCSA campus locations (with the exception of spaces that are numerically marked as reserved). The program coordinator can assist you in obtaining a parking permit.

1.8.B: Uniforms Hospital white laboratory coats are ordered in advance by one of the department administrative

assistants. The department provides residents with a standard laboratory coat at the start of their

residency.

1.8.C: Identification Cards Residents are required to have UTHSCSA identification cards and wear them at all times when on any UTHSCSA campus sites. The program coordinator will facilitate obtaining the ID cards from the police department.


1.8.D: Educational Loan Deferment For the residents that qualify, loan deferment forms, may be obtained from the department administrator.

1.9: RESIDENT GRIEVENCES, DISCIPLINARY POLICY & APPEAL PROCEDURE

This department adheres to the policy established by the Graduate Medical Education Committee.

Dismissal or non-renewal of appointment could occur because of failure to comply with the resident’s

responsibilities or failure to demonstrate progress in acquiring appropriate medical physics

knowledge or skill as determined by the program's supervising faculty. This appeals mechanism is

open to all residents subject to dismissal or non-renewal. Formal disciplinary action is reportable to

credentialing and licensing agencies.

1.9.A: Levels Of Discipline

If indicated, the initial level of discipline can be probation or dismissal

1. Informal counseling minor

For minor issues, counsel is given, no record is kept (i.e. Dress code adherence).

2. Informal counseling moderate

For issues not considered serious enough for defined, disciplinary action, a memo will

be placed in a file outside of the resident’s record for reference and tracking by the Program

Director (Timeliness of assigned clinical tasks (e.g. IMRT QAs, missing conferences, and

tardiness).

3. Administrative Status Letter

Although not considered formal disciplinary action, the delivery of an administrative

status letter should be seen as a strong warning that the resident is on unsteady ground and

that the next step is formal disciplinary action. A copy of this letter and any documents related

to its resolution are kept in the resident’s file for the duration of the residency. This is the last

step that is considered non-reportable (considered an informal, intradepartmental matter). The

administrative status letter outlines the problem and a plan for remediation and a designated

time frame. For the lack of resolution (such as ongoing clinical problems, repeated tardiness),

the progression would lead to formal probation.

4. Probation.

This is the last opportunity for correction before dismissal. A formal record is kept of

the violation, a plan for remediation with measurement criteria and a time frame. Failure to

meet the goals and requirements within the prescribed time frame is cause for dismissal. This

record is maintained permanently in the residents file.

5. Immediate dismissal

It would be unusual to dismiss a resident without a probationary period except in

instances of flagrant misconduct. Immediate dismissal would be for conduct beyond that

which is not considered professionally acceptable and in any way denigrates or endangers an

individual or the reputation of the Department or Institution. Examples include, and are not

limited to: being under the influence of intoxicants or drugs; disorderly conduct, harassment

of other employees (including sexual harassment), or the use of abusive language on the

premises; violation of medical record privacy; fighting, encouraging a fight, or threatening,

attempting, or causing injury to another person(s) on the premises.


1.9.B: Formal Grievance Procedure

In the event that a resident is to be dismissed or his/her contract is not renewed, he/she may initiate

a formal grievance procedure. The resident shall present the grievance in writing to the Department

Chair within thirty (30) calendar days after the date of notification of termination or non-renewal.

The grievance shall state the facts upon which the grievance is based and requested remedy sought.

The Department Chair shall respond to the grievance with a written answer no later than fifteen (15)

calendar days after he/she receives it. If the resident is not satisfied with the response, he/she may

then submit, within fifteen (15) days of receipt of the Department Chair’s response, a written request

for a hearing.

1.9C: Hearing The hearing procedure will be coordinated by the Department Chair, who will preside at the hearing, but will not be a voting participant. The hearing will be scheduled within thirty (30) days of the resident's request for a hearing. The hearing panel will consist of at least three (3) members of the faculty. The Department Chair will determine the time and site of the hearing in consultation with the resident and program leadership. The resident shall have a right to self-obtained legal counsel at his/her own expense; however, retained counsel may not actively participate or speak before the hearing participants, nor perform cross-examination. The format of the hearing will include a presentation by a departmental representative; an opportunity for a presentation of equal length by the house officer; an opportunity for response by the representative, followed by a response of equal length by the house officer. This will be followed by a period of questioning by the hearing panel. The Department Chair in consultation with the departmental representatives and the resident will determine the duration of the presentations and the potential attendees at the hearing. The resident will have the right to request documents for presentation at the hearing and the participation of witnesses. The Department Chair at his/her discretion will invite the latter, following consultation with the hearing panel. A final decision will be made by a majority vote of the hearing panel and will be communicated to the resident within ten (10) working days after the hearing. This process will represent the final appeal within the Health Science Center.


SECTION 2: EDUCATION

Requirements for Successful Program Completion

The UTHSCSA Medical Physics Residency is a two-year program. To complete the Residency

Program, the resident must:

1. Successfully complete all eight clinical rotations as defined in the “Clinical Rotation Schedule and

Objectives (CRSO)” (see rotations in following section). The rotation schedule has been structured

to include all clinical topics in radiation oncology physics. For each rotation, the resident is assigned

a mentor from the physics staff and performs clinical tasks under the mentor’s direct supervision. A

rotation is considered complete when all rotation assessments have been signed off by the mentor

and resident. Failure to complete a rotation or unsatisfactory progress in a rotation will be reviewed

by the residency committee. The resident will be notified in writing of their probationary status and

will be given a plan for remediation. The resident will have one month to complete the remediation

plan. Failure to complete the remediation plan will be grounds for termination.

2. Successfully complete the didactic courses on Treatment Planning Techniques (RADI 7005 and

RADI 7006) and the AAPM task group review courses (RADI 6031 and RADI 6035). The courses

are offered during the fall and spring semester of each academic year. Passing grade is considered to

be a grade of “B“ or higher. The program director can issue a course waiver upon request by the

resident, provided the resident can prove that they have taken the equivalent course at another

institution. If a resident does not obtain a passing grade for any of the courses, they will be presented

with a plan for remediation.

3. The Medical Physics resident must complete a learning module on ethics and professionalism as

specified in AAPM Report 159. The resident is expected to complete the

ABR/ACR/RSNA/AAPM/ASTRO/ARR/ARS, Online Module on Ethics and Professionalism

anytime during the rotation one of residency program.

(http://www.aapm.org/education/onlinemodules.asp)

4. Secure a passing grade for twenty one (21) monthly written exams on the assigned topics that will

be covered during each rotation (see table 3). Each exam is two hours long, and has up to 50 multiple

choice questions. Passing grade is considered to be a score above 70%. In case of a failing exam

grade, a second exam will be given within 7 days. After a second failed attempt, the resident will be

given a plan for remediation that has to be completed before the next examination.

5. Complete a comprehensive oral examination every 6 months. The topics of all oral examinations

are listed below. See Table 4 for the specific topics of each exam. Oral examinations are considered

complete when the oral evaluation form has been signed by the appropriate faculty mentor and

student. A blank oral evaluation form is included in the Appendix. The resident will be given

feedback on their performance and it is possible that the examining committee will ask the resident

to be prepared to answer question on the same topics (in addition to the new ones) for the next oral

examination. A minimum of two faculty members must be present during the examination or else

the examination will be rescheduled.

6. Attend the new patient QA conference and didactic lectures that are given by the faculty. The

expectation is that the residents will make a best effort to attend 50 of such conferences and will

document in their portofolio log a minimum of 50 attendances for the duration of the residency. The


attendance log will be reviewed at the end of each rotation and a remediation plan will be presented

if the resident has not attended the required number of conferences.

7. Residents are required to teach a minimum of two lectures per year in one of our degree programs

(medical physics program, medical dosimetry program) or the medical residents physics course. An

evaluation will be completed for each lecture.

8. Complete twenty-four months of clinical training at which time a certificate of training will be

awarded to the resident.

9. Milestones Agreement Form 2.7.8

Table 1. Monthly Exam topics

August Written Exam 1 Radiation Safety, Patient CT Simulation

September Written Exam 2 MU Calculations

October Written Exam 3 Periodic Linac QA

November Written Exam 4 Dosimeters, IMRT QA

December Written Exam 5 OBI MV and kV Imaging

January Written Exam 6 CT Sim QA, HDR Daily QA

February Written Exam 7 TSET, TBI

March Written Exam 8 Annual Linac QA, ExacTrac

April Written Exam 9 TG 51

May Written Exam 10 Patient Safety, Tissue Dose Tolerance

June Written Exam 11 LDR planning for Prostate Seed Implants

July Written Exam 12 Radiation Protection

August Written Exam 13 Linac Design

September Written Exam 14 Chart Checks

October Written Exam 15 Brachytherapy

November Written Exam 16 SBRT/SRS delivery and Planning, Narrow Field Dosimetry

December Written Exam 17 Treatment Planning System QA

January Written Exam 18 Imaging in Radiation Therapy

February Written Exam 19 Acceptance and Commissioning of Linac

March Written Exam 20 Acceptance and Commissioning of CT Simulator

May Written Exam 21 Comprehensive


Table 2. Summary of oral and written exams

Rotation Month Oral Exam topics

1

1. Simulation and patient setup

Monitor Unit Calculations

In-vivo and patient specific dosimetry

Dosimeters

AAPM Task Group-51 Calibration

2.

3.

2

4.

5.

6.

3

7. AAPM Task Group 142 QA

kV and MV other position verification technologies and QA

AAPM Task Group 25, Electrons

Treatment Planning

Total Body Irradiation (TBI) and Total Skin Electrons (TSE)

8.

9.

4

10.

11.

12.

5

13. HDR/LDR

LINAC design and function

Shielding Design and Accepted Dose Limits

Normal tissue tolerance and dose response models

Eye plaques

Pregnant patients/Pacemakers/Hip Replacements

14.

15.

6

16.

17.

18.

7

19.

Stereotactic Radiosurgery (AAPM TG 101)

Comprehensive

20.

21.

8

22.

23.

24.

Clinical Rotation 1 Schedule and Objectives

Chief Mentor:______________________ (Year 1, July-Sept)

Objectives Master Checklist

Activity Employee Orientation

Radiation Oncology Orientation

HIPAA Training

Introduction to Radiation Protection.

Introduction to Nursing.

Introduction to Simulation.

Introduction to LINACs.

LINAC QA and warm up.

Monitor Unit Calculations.

Electronic Medical Record orientation.

Regulations, Professionalism and Ethics

References i. AAPM's "The Roles, Responsibilities, and Status of the Clinical Medical Physicist”

ii. AAPM Report No. 38, "Statement on the Role of a Physicist in Radiation Oncology"

iii. AAPM Report No. 79, "Academic Program Requirements for Graduate Degrees in Medical

Physics”

iv. AAPM Report No. 90, "Essentials and Guidelines for Hospital-Based Medical Physics Residency

Training Programs"

v. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21, Issue 4)

(1994) Radiation Therapy Committee Task Group #40

vi. Task Group 142 report: Quality assurance of medical accelerators Medical Physics, Vol 36, Issue 9

vii. AAPM Code of Practice for Radiotherapy Accelerators (Reprinted from Medical Physics, Vol. 21,

Issue 7) (1994) Radiation Therapy Task Group #45

viii. Medical Accelerator Safety Considerations (Reprinted from Medical Physics, Vol. 20, Issue 4)

(1993) Radiation Therapy Committee Task Group #35.

ix. Title 25 Texas Administrative Code, Part 1, Department of State Health Services, Chapter 289:

Radiation Control, Subchapters C-F

x. Texas Department of State Health Services, Texas Health & Safety Code; Subtitle D. Nuclear and

Radioactive Materials; Chapter 401. Radioactive Materials and Other Sources of Radiation.

xi. Requirements of the Texas Board of Licensure for Professional Medical Physicists

xii. Nuclear Regulatory Committee regulations 10 CFR 19, 10 CFR 20, and10 CFR 35.

xiii. NCRP Reports 151, 79, 116, and 147

xiv. NRC Regulatory Guide 8.13, "Instructions Concerning Prenatal Radiation Exposure"

xv. NRC Regulatory Guide 8.39, "Release of Patients Administered Radioactive Material"

xvi. Khan, “The Physics of Radiation Therapy” 4th Edition.

xvii. Verification of monitor unit calculations for non-IMRT clinical radiotherapy: Report of AAPM

Task Group 114 Medical Physics, Vol 38, Issue 1

xviii. ESTRO booklet #3 “Monitor unit calculation for high energy photon beams”, 1997

http://aapm.org/pubs/reports/RPT_114.pdf



Introduction to Radiation Oncology Nursing Worksheet (NEW PATIENT)

Observe and assist in at least three new patient exams from three different services.

Identify the patient’s name, diagnosis, stage of disease, and treatment techniques to be used. Note

the anatomical structures of interest.

New Patient Exam

1. Patient’s initials: _____________________________________

2. Diagnosis: __________________________________________

3. Stage of disease: _____________________________________

4. Describe treatment to date and the proposed treatment technique:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

___________________

Faculty/staff: __________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_________________________________________________________________


Introduction to Radiation Oncology Nursing Worksheet (ON-TREATMENT PATIENT)

Observe and assist in at least three on-treatment patient exams from three different services.

Identify the patient’s name, diagnosis, stage of disease, treatment technique, number of treatments

received, cumulative dose, and reactions noted.

Current Patient Exam

1. Patient’s initials: _____________________________________

2. Diagnosis: __________________________________________

3. Stage of disease: _____________________________________

4. Describe treatment to date and the proposed treatment technique:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_______________________________________________

5. Number of treatments and dose received to date:

_________________________________________________________________________

_________________________________________________________________________

_______________________________________________________

6. Description of reaction (tumor response and/or normal tissue)

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_______________________________


Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_________________________________________________________________


Introduction to Radiation Oncology Nursing Worksheet (FOLLOW-UP PATIENT)

Observe and assist in three follow-up patient exams from three different services. Identify the

patient’s name, diagnosis, stage of disease, treatment technique and current status of patient’s

health.

Follow-up Exam

1. Patient’s initials: __________________________

2. Diagnosis: _______________________________

3. Stage of disease: __________________________

4. Describe treatment technique and area(s) treated:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________

5. Total dose received:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________

6. Discuss the current status of patient’s health and any past and/or present side effects due

to treatment:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_____________________________________


Resident: _____________________________________________ Date

Comments:______________________________________________________________________

______________________________________________________________________


Introduction to Radiation Oncology—LINAC Checklist (Form R.1.A)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of the warm-up of treatment units.

Demonstrate an understanding of pre-treatment chart checks

Demonstrate an understanding of pre-port procedures

Demonstrate an understanding of checking of MLC blocked fields

Demonstrate an understanding of port film acquisition, analysis and

approval

Demonstrate an understanding of the pertinent recommendations for

quality assurance of linear accelerators used in radiation therapy;

Demonstrate an understanding of in-house quality assurance

documentation and procedures;

Perform and be competent in routine (daily/weekly/monthly) quality

assurance tests of external beam treatment units;

Perform and be competent in the analysis of routine quality assurance

tests of external beam treatment units;

Demonstrate an understanding of the basis of accepted tolerances for

routine quality assurance tests performed on treatment units and required

actions should any of the checks fall out of tolerance;

Demonstrate an understanding of the operation of the linac and the

interlock codes;

Perform and be competent in end-to-end checks of patient treatment

plans using phantom images and data;

Demonstrate an understanding of MOSAIQ / 4D Console

Demonstrate an understanding of grouping/auto sequencing of fields and

remote movement of gantry and collimator.

Observe/assist in the treatment of TBI patient (when available)

Observe/assist in the treatment of a Total Skin Electron patient(when

available)

Observe/assist in acquisition of TLD/OSL readings (when available)

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a

Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate

knowledge of the topic


Introduction to Radiation Oncology – CT SIMULATION (Form R.1.B)

Competencies Resident

Initials

Mentor

Initials**

Demonstrate an understanding of morning warm-up and QA of equipment

Demonstrate an understanding of positioning of the patient for simulation

Demonstrate an understanding of placement of BB’s or other radiographic

markers

Demonstrate an understanding of in the selection of an isocenter and the

transfer of the isocenter to the treatment planning system

Demonstrate an understanding of what treatment information needs to be

recorded in the patient’s chart during simulation

Demonstrate an understanding on how CT scans are transferred to the

treatment planning computers

Review the differences of CT simulators versus diagnostic CT scanners

(e.g. lasers, table top and indexing, localization software, bore size);

Demonstrate an understanding of the theory of CT image reconstruction

and operation of a CT simulator;

Demonstrate an understanding of the major subsystems and components

of a CT simulator;

Demonstrate an understanding of the room shielding and other radiation

protection requirements of a CT-simulator.

Understand the reasons for using contrast in imaging

Faculty/staff: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Intro to Radiation Oncology-RADIATION PROTECTION CHECKLIST (Form R.1.C)

Activity Resident

Initials

Mentor

Initials**

Participate in receipt, assay, inventory and disposal of radioactive

material, such as 32P and 131I. The resident shall accompany a radiation

safety technician three mornings during the receipt of radioactive

material by the Radiation Safety Office.

Participate in survey meter calibration

Demonstrate an understanding of the operation/limitations of a hand-held

survey meter

Demonstrate an understanding of DOT regulations for transport and

labeling or radioactive material by attending Radioactive Materials

Certification Course

Demonstrate an understanding of the room preparation for 131I and 32P

patients

Demonstrate an understanding of regulations for labeling rooms

containing radioactive sources: radiation area, high radiation area, very

high radiation area

Demonstrate an understanding of function/limitations of a personnel

monitoring badge

Demonstrate an understanding of concepts of: time, distance and

shielding

Demonstrate an understanding of definitions for: dose equivalent,

effective dose equivalent, deep dose equivalent, committed dose

equivalent, quality factors, organ dose weighting factors, planned special

exposure, declared pregnant worker, occupational dose

Demonstrate an understanding of Nuclear Regulatory Commission

(NRC) and/or state licensing (by-product materials and x-ray producing

devices);

Demonstrate an understanding of the appropriate regulations for radiation

protection and dose limits for radiation workers and members of the

general public;

Explain the ALARA (As low as reasonably achievable) concept;

Discuss the role and significance of the Joint Commission;

Discuss the role and responsibility of a radiation safety committee;

Discuss the role and responsibility of a radiation safety officer;

Discuss the significance of ACR, ASTRO, and AAPM

recommendations;

Demonstrate an understanding of release of patients (with sealed or

unsealed sources).


Activity Resident

Initials

Mentor

Initials**

Demoinstrate and understanding of the following concepts:

Failure mode effects analysis (FMEA) principles/applications

Root cause analysis (RCA) principles/applications

Sealed source storage/safety/protection

Sealed source inventory/check in/out procedures

Sealed source packaging/transportation (e.g. Title 19 CFR)

Calibration of sealed sources

Exposure and contamination surveys

Radiation signage

Definition and reporting requirements for medical events

Radiation safety of personnel during radionuclide therapy

Patient release criteria following radionuclide therapy and radiation

safety for the public

Safety policies/procedures

Compliance audits

Occupational and public dose limits

National and state regulations

Radiation exposure to the public

Site design and shielding (primary and secondary barrier computations)

Neutron shielding

Facility radiation surveys

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

**A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are

scored on a Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have

demonstrated adequate knowledge of the topic


Introduction to Radiation Oncology—LINAC Engineer Checklist (Form R.1.D)

Activity Resident

Initials

Mentor

Initials**

Observe/participate in the daily start-up of each of the treatment

units with a service engineer. Prints detailed operating parameters of

the LINAC and understand the use of this data.

Observe/participate in the daily shut-down of each of the treatment

units with a service engineer. Record machine logs and understand

the use of this data.

Be able to identify and explain the function of linac mechanical

components and geometry

Be able to identify and explain the general clinical fault indicators,

causes and reset levels

Demonstrate understanding of laser alignment geometry and

verification

Demonstrate understanding of tomographic geometry and laser

systems for the CTs.

Observe and assist in a linac MLC motor change.

Observe and participate in a linac MLC PM

Observe and participate in a single modality (low energy) gantry PM

Observe and participate in a multimodality (high energy) collimator

PM

Observe and participate in a linac digital readout calibration

Observe and participate in linac beam tuning

Demonstrate understanding of linac anatomy

Demonstrate understanding of machine ionization systems and self-

calibration

Demonstrate understanding of tolerances and what to do if they are

exceeded.

Observe/understand operation of linac oscilloscope signals

Observe/understand OBI preventive maintenance

Faculty/Staff: __________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Introduction to Radiation Oncology—MU CALCULATIONS Checklist (Form R.1.E)

Competency Resident

Initials

Mentor

Initials**

1) Demonstrate an understanding of the following factors:

a. Percent depth dose (PDD)

b. Tissue-air ratio (TAR)

c. Tissue-maximum ratio (TMR)

d. Tissue-phantom ratio (TPR)

e. Scatter factors (Sc, Sp, Scp)

f. Off-axis factors

g. Inverse square factors

h. Calibration factor (MU reference conditions)

i. Standard wedge factors

j. Virtual and dynamic wedge factors

k. Compensator factors

l. Tray and other insert factors

2) Perform MU calculations for photon and/or electron beams with the

following configurations:

a. SSD setup

b. SAD setup

c. Extended distance setup

d. Off-axis calculation points

e. Rotational beams

Demonstrate an understanding and perform MU calculations using

heterogeneity corrections;

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 1, Oct-Dec)


Activity

Monthly LINAC QA.

IMRT QA.

EPID QA.

QA of the HDR unit.

CT Simulator QA.

LDR brachytherapy.

2D/3D External Beam Planning (RADI7005).

In vivo/patient specific dosimetry and Dosimetry

References: i. Protocol for Clinical Dosimetry of High-Energy Photon and Electron Beams ( Reprinted from

Medical Physics, Vol. 26, Issue 9) (1999) Radiation Therapy Committee Task Group #51

ii. A protocol for the determination of absorbed dose from high energy photon and electron beams.

(Reprinted in Medical Physics, Vol. 10, Issue 6, 1983). Radiation Therapy Committee Task Group #21

iii. ICRU 50, Prescribing, recording, and reporting photon beam therapy.

iv. ICRU 62, Supplement to ICRU 50

v. Pinnacle manuals as needed.

vi. Diode In Vivo Dosimetry for Patients Receiving External Beam Radiation Therapy. AAPM report #87

(2005). Radiation Therapy Committee Task Group #62.

vii. Introduction to Radiological Physics and Radiation Dosimetry. F.H. Attix, 1986. (Good for TLD)

viii. The Essential Physics of Medical Imaging. Second Edition. Bushberg 2002. (Good for film).

ix. Clinical electron beam dosimetry. Med Phys, Vol. 18, Issue 1, (1991). Radiation Therapy Committee

Task Group #25. (good summary of electron detectors)

x. Khan, “The Physics of Radiation Therapy” 4th Edition.

xi. Halvorsen PH. Dosimetric evaluation of a new design MOSFET in vivo dosimeter. Med Phys 32, 110

– 117 (2005).

xii. Dosimetry of Interstitial Brachytherapy Sources. Report of AAPM Radiation Therapy Committee Task

Group 43. Reprinted from Medical Physics, Vol. 22, Issue 2, 1995.

xiii. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose

calculations. Medical Physics, Vol. 21, Issue 3, 2004.

xiv. Permanent Prostate Seed Implant Brachytherapy. Report of AAPM Radiation Therapy Committee Task

Group 64. Reprinted from Medical Physics, Vol. 26, Issue 10.

xv. Report of TG142 (Quality Assurance of Medical Accelerators) Med. Phys. Volume 36, Issue 9, pp.

4197-4212, September 20093

xvi. The Calibration and Use of Plane-Parallel Ionization Chambers for Dosimetry of Electron Beams

(Reprinted from Medical Physics, Vol. 21, Issue 8) TG#39

xvii. Radiochromic Film Dosimetry (Reprinted from Medical Physics, Vol. 25, Issue 11) Radiation Therapy

Committee Task Group #55

xviii. Clinical use of electronic portal imaging (Reprinted from Medical Physics, Vol. 28, Issue 5) Radiation

Therapy Committee Task Group #58

xix. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: A report of the

AAPM TG-179 Medical Physics, Vol 39, Issue 4

xx. The Role of In-Room kV X-Ray Imaging for Patient Setup and Target Localization: Report of AAPM

Task Group 104

xxi. Radiation Therapy Committee Task Group #58, Clinical use of electronic portal imaging (Reprinted

from Medical Physics, Vol. 28, Issue 5)

xxii. Radiotherapy Portal Imaging Quality Radiation Therapy Committee Task Group #28

xxiii. Khan. “treatment Planning in Radiation Oncology.

xxiv. IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from AAPM














Task Group 119 Medical Physics, Vol 36, Issue 11

xxv. Emami, B. et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991

May 15;21(1):109-22.

xxvi. Lyman, JT. Complication probability as assessed from dose-volume histograms. Radiat. Res. 104:S-13 –

S-19; 1985.

xxvii. Kutcher GJ and Burman C. Calculation of complication probability factors for nonuniform normal tissue

irradiation: the effective volume method. Int J Radiat Oncol Biol Phys. 104:1623-1630; 1989.

xxviii. Kutcher G J, Burman C, Brewster L, Goitein M, Mohan R. Histogram reduction method for calculating

complication probabilities for three-dimensional treatment planning evaluations. Int J Radiat Oncol Biol

Phys. 21:137-146; 1991.



In vivo/patient specific dosimetry Checklist (Form R.2.A)

Competency Resident

Initials

Mentor

Initials**

TLD

1) Demonstrate an understanding of the physical mechanisms involved in the process

of radiation detection and readout using thermoluminescent dosimeters, including

Randall-Wilkins theory, intrinsic sensitivity, linearity, energy dependence, chemical

composition, physical forms, and TLD reader design and operation;

2) If possible, perform TLD measurements and readout including calibration using

standard irradiation;

3) Demonstrate understanding of the method and rationale for TLD annealing;

4) Discuss the advantages and disadvantages of TLDs including their limitations of use.

Diodes


of radiation detection and readout using semiconductor dosimeters;

2) If possible, perform diode measurements including investigation of angular and dose

rate dependence, temperature sensitivity, etc.;

3) Discuss the advantages and disadvantages of diodes, including the inherent

limitations of diodes.

Film (silver bromide, radiochromic)


of radiation detection and measurement using film, including measurement of the

optical density and its characteristics as a function of absorbed dose, and dependence

on radiation energy and on film handling and processor conditions;

2) If possible, perform film dosimetry including creation of calibration curve;

3) Discuss the advantages and disadvantages of using film, including the inherent

limitations of film.

MOSFET detectors

1) Demonstrate understanding of the physical mechanisms involved in the process of

radiation detection and readout using Metal Oxide Semiconductor Field Effect

Transistor dosimeters;

2) Discuss the advantages and disadvantages of using MOSFETs, including their

limitations of use.

OSLD


of radiation detection and readout using optically stimulated luminescent dosimeters;

2) Discuss the advantages and disadvantages of using OSLDs, including their

limitations of use.

3) Demonstrate an understanding of the following components of an in vivo dosimetry

program.

a. Acceptance, commissioning, calibration, and ongoing quality assurance

procedures for in vivo dosimetry systems;

b. Use of in vivo dosimetry systems for patient specific measurement;

c. Limitations of specific in vivo dosimetry systems.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________





Air Chamber and Electrometer Checklist (Form R.2.B)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of absorbed dose calculation and measurement;

Demonstrate an understanding of Bragg-Gray, Spencer-Attix, and Burlin cavity theories;

Demonstrate an understanding of dosimeter design considerations including detection

mechanism, sensitivity, size, shape, thickness of sensitive volume and wall, materials,

energy dependence, detector/phantom media matching, dose and dose rate range, stability

of reading.

Demonstrate an understanding of design considerations for cylindrical ionization

chambers including size, shape, materials, electrical characteristics, etc.;

Demonstrate an understanding of design considerations for parallel-plate ionization

chambers including size, shape, materials, electrical characteristics, use for measuring

dose in the buildup region, etc.;

Demonstrate an understanding of advantages and disadvantages of each ionization

chamber design, including detector limitations;

Demonstrate an understanding of ionization chamber measurement techniques including

electrometer, operational amplifiers, triaxial cable and connections, etc.;

Perform acceptance testing for ionization chamber and electrometer including

measurements of leakage and evaluation of relevance, polarity effects, and stem effects;

Perform ionization chamber measurements using Farmer, parallel-plate, scanning

chambers, and large volume survey ionization chambers;

Demonstrate understanding of ion chamber correction factors including PTP, Ppol, Pelec,

Pion, Pwall, Pgrad, Pfl, and Pcel. Calculate corrected charge reading for ion chamber

measurement using TG-51 formalism;

Demonstrate an understanding of ion chamber calibration process through NIST/ADCL;

Demonstrate an understanding of design and characteristics of monitor chambers.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





HDR Checklist (Form R.2.C)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of HDR morning QA procedures, tests

performed, level of accuracy required

Demonstrate an understanding and performance of comprehensive periodic

QA (daily, monthly, annually) of remote afterloader ;

Discuss and perform periodic treatment planning QA;

Demonstrate an understanding of implant specific QA.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





On Board MV and kV Imaging Checklist (Form R.2.D)

On Board imaging (MV and kV) Resident

Initials

Mentor

Initials**

Discuss the different detector technologies that have been used for on-board

MV and kV imaging;

Discuss the imaging dose associated with on-board MV and kV imaging

technologies;

Discuss the different measures of radiographic image quality.

Demonstrate an understanding of the quality assurance processes and

frequencies for on-board MV and kV imaging, including cone-beam CT (e.g.,

image quality, image integrity, safety and mechanical checks, network

connectivity, imaging dose, and localization software, and isocenter

calibration).

General

Demonstrate an understanding of the basic imaging principles behind CT;

Define the 4 generations of CT imaging systems;

Demonstrate an understanding of the detector technology, e.g., scintillation

detectors, xenon gas chamber;

Demonstrate an understanding of the basic principle of reconstruction algorithms

(i.e. filtered back-projection);

Demonstrate an understanding of image artifacts that may arise in CT images

and be able to identify their causes;

Discuss how to perform density calibration of a CT scanner, and how this

calibration is used for tissue density corrections in treatment planning systems;

Discuss the differences between a free–breathing helical CT and 4D-CT;

Discuss the differences between prospective versus retrospective image

acquisitions, and cine versus helical scanning techniques;

Discuss the imaging dose associated with various CT protocols;

Discuss how 4D data is used for target definition and describe MIPs, averaged,

maximum inhale and exhale scans.

Quality Assurance

Demonstrate an understanding of the quality assurance processes and

frequencies for CT-simulators (e.g., image quality, image integrity, safety and

mechanical checks, network connectivity, imaging dose, localization software,

and CT#).

Image Registration/Fusion

Discuss the motivation as well as the advantages/challenges of image registration

and image fusion;

Define the image features on which registration can be based (i.e. landmarks,

segments, intensities);

Define the different forms of registration (i.e. rigid, affine, deformable), and

discuss their advantages/limitations;

Define similarity metrics used to assess quality of registration (i.e. squared

intensity differences, cross-correlation, mutual information);


Discuss how to commission imaging modalities such as MRI, PET-CT, and

diagnostic CT for the purpose of image registration to a radiation oncology

planning CT;

Discuss issues associated with the transfer of images (i.e. connectivity and image

dataset integrity);

Discuss issues associated with patient positioning (i.e. bore size, couch-top,

lasers, compatibility of immobilization devices, differences in patient

position/organ filling and motion).

Discuss issues associated with image acquisition technique (i.e. length of scan,

slice thickness, FOV, kV and mAs).

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





IMRT QA Checklist (Form R.2.E)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of commonly used QA procedures and

guidelines, delivery and dosimetry equipment, and QA analysis

techniques;

Demonstrate an understanding of verification plans creation within the

treatment planning system along with independent checks with

secondary MU calculation software;

Demonstrate an understanding of IMRT delivery QA measurements

using 2D/3D array, film, and/or ion chamber techniques, including

analysis of these results and determination of passing criteria (including

familiarity with the concept of gamma analysis);

Demonstrate an understanding of acquisition and analysis of MLC QA

measurements designed for accelerators used for IMRT;

Perform review of individual patient-specific QA results with staff

physicists and physicians.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





TREATMENT PLANNING Proficiencies (Form R.2.F)

Competency Resident

Initials

Mentor

Initials**

Register a new patient and import imaging studies,

Be able to export a treatment plan and import to MOSAIQ

Be familiar with IMRT concepts and have a basic idea of IMRT planning.

Review the Pinnacle Physics manual and become familiar with the

commissioning data requirements and beam modeling.

Beam Properties

Demonstrate an understanding of photon and electron percent depth dose in tissue

and other media;

Demonstrate an understanding of electron ranges (Rp, R80, R90, and dmax) for

different energies;

Demonstrate an understanding of proton percent depth dose in tissue and other

media and proton ranges for different energies (e.g. stopping and scattering power

and range);

Demonstrate an understanding of the potential uncertainties in dose deposition in

proton radiotherapy;

Demonstrate an understanding of flatness and symmetry of photon and electron

beams;

Demonstrate an understanding of the differences between an SAD and SSD

treatment.

Compare electron and photon therapy, their advantages and disadvantages;

Discuss the impact of dose and fractionation on normal and tumor tissues;

Demonstrate an understanding of the impact of beam quality (e.g. LET) on the

RBE of different forms of ionizing radiation (e.g. electrons, photons, and

protons);

Discuss the uncertainties related to electron and photon therapy (e.g. physics,

biology, machine, and patient related) and how they may be detected and

mitigated during the planning and delivery process.

Beam Modifiers

Demonstrate an understanding of the effect of beam modifiers (wedges,

compensators, etc.) on the dosimetric characteristics of the incident beam;

Demonstrate an understanding of wedges (wedge angle, hinge angle), and the

different style wedges clinically utilized (physical, universal, dynamic);

Demonstrate an understanding of the design of the different commercially

available MLCs;

Demonstrate an understanding of blocking and shielding for therapy beams;

Demonstrate an understanding for the use of custom bolus;

Demonstrate an understanding of the design and use of tissue compensators;


Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

______________________________________________________________________________*A

sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a

Treatment simulation techniques

Demonstrate an understanding of common patient positioning and immobilization

devices;

Demonstrate an understanding of when and how to use specific treatment devices

for specific treatments;

Discuss how to account for beam attenuation from patient positioning and

immobilization devices in treatment planning.

Tumor localization and normal tissue anatomical contouring:

Perform region of interest contouring on CT data sets;

Perform region of interest contouring on MRI data sets;

Perform region of interest contouring on PET and PET/CT data sets;

Perform region of interest contouring on SPECT and SPECT/CT data sets;

Demonstrate an understanding of target volume determination, including the

design of ICRU target structures (e.g. GTV, CTV, ITV, PTV, and PRV).

Demonstrate an understanding of how 4D data is used for target definition and

relevant radiation treatment prescription parameter such as GTV, PTV, CTV and

ITV;

Demonstrate an understanding of the role of MIP images in the treatment

planning process;

Demonstrate an understanding of the role of DRR images in the treatment

planning process;

Demonstrate an understanding of and perform image registration and fusion of

data sets, including CT/CT, CT/MRI, CT/PET, deformable registration, and

image/dose registration.

Plan evaluation

Define and discuss each of the following treating planning evaluation tools,

including their limitations:

Dose volume histograms (V(dose), D(volume), mean dose) (cumulative and

differential)

Conformity index

Homogeneity index

Biological evaluators (e.g. gEUD, EUD, NTCP, TCP)

Discuss dose tolerances for various normal tissue structures along with relevant

volume effects


CT simulator checklist (Form R.2.G)

Competency Resident

Initials

Mentor

Initials**

Quality assurance

Perform and be competent in routine quality assurance test processes for CT-

simulators and understand their relationship to acceptance testing and

commissioning measurements;

Understand the basis of recommended measurements and their tolerances

specified by the AAPM, ACR and other professional bodies for CT-simulators;

Understand, perform and be competent in determining the geometric accuracy

of laser alignment, couch motion, gantry motion, and CT-simulator images for

both static and moving objects;

Understand, perform and be competent in assessing image quality for CT-

simulators in any mode of operation and image reconstruction. Be able to

discuss the impact of image artifacts and distortion on treatment planning;

Understand the connectivity requirements of a CT-simulator to other computer

systems that form part of a modern radiation therapy treatment process as well

as be familiar with the internet and DICOM RT image data transfer protocols.

CT protocols

Demonstrate an understanding of the following parameters, their typical

values, and how these parameters are combined in CT protocols: slice

thickness, pitch, kV, mAs, FOV, and scan length;

Demonstrate an understanding of how CT protocols consider multi-slice

capabilities, tube heating, and max scan time;

Demonstrate an understanding of the relationship between image quality and

patient dose from examination;

Demonstrate an understanding of the need to define dose optimized imaging

protocols for various body parts and sizes of patient;

Demonstrate an understanding of image artifacts that may arise in CT images.

Be able to identify their causes, and assess or mitigate their impact on radiation

treatment planning;

Understand the different imaging protocols used in tumor motion management

(e.g. voluntary breath hold, active breathing control, shallow breathing by

compression, free–breathing helical CT and 4D-CT);

Understand the different CT image acquisition modes available with a modern

CT-simulator (prospective, retrospective, cine, helical, 4D and image sorting

based on breathing phase and breathing amplitude).

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Treatment Planning Terms 1 (Form R.2.H)

Define the terms below giving examples and mathematical formulas where applicable.

Attach additional sheets as necessary.

1. Air Gap

2. Attenuation

3. Beam Hardening

4. dmax

5. Obliquity Factor

6. Effective Field

7. Equivalent Square; A/P

8. Radiation Dose (Gy)

9. Fluence

10. Hot Spots

11. HVL

12. Isodose Curve

13. Radiographic Magnification Factor

14. Electron Output Factor

15. Maximum/Minimum Target Dose

16. Orthogonal Films

17. PDD or %DD

18. Penumbra

19. Build-up bolus

20. Primary Radiation

21. Scatter Radiation

22. Skin Sparing

23. Bolus

24. SAD Technique

25. SSD Technique

26. PTV/CTV/GTV/ITV/IV/TV/SM/PRV

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Treatment Planning Terms 2 (Form R.2.I)

Define the terms below giving examples and mathematical formulas where applicable.

Attach additional sheets as necessary.

1. Absorbed Dose

2. Activity

3. Attenuation Coefficient

4. Buildup Region

5. Decay Constant

6. Dynamic Wedge

7. Entrance Dose

8. Exit Dose

9. Skin Gap Calculation (Craniospinal treatments)

10. GM Meter

11. Sensitometric Curve

12. Tissue Heterogeneity

13. Independent Jaw

14. ICRU

15. Irregular Field

16. Manchester Method

17. Mass Attenuation Coefficient

18. MLC

19. IMRT

20. 3D conformal

21. Paterson-Parker Method

22. Pig (not the animal)

23. Quimby Method

24. SAR

25. Sc

26. Sp

27. TMR

28. TLD

29. Normal Tissue Tolerance

30. Wedge Angle

31. Hinge Angle

32. DVH

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Transperineal Ultrasound Guided Prostate Brachytherapy Checklist (Form R.2.J)

Volume study Treatment plan Procedure Post plan:

Date:

Date:

Date:

Activity Resident

Initials

Mentor

Initials** Participate in volume study including discussion of stepper function and slice

spacing

Participate in treatment plan including discussion of Rx dose, normal tissue

constraints and peripheral loading

Participate in ordering of seeds including different loading options for seed

applicators (loose seeds, preloaded needles, suture-mounted sources, MICK

cartridges)

Participate in receipt, calibration, leak testing and inventory of radioactive

material including discussion of applicable state regulations

Learn DOT regulations for transport and labeling or radioactive material Participate in preparation of procedure room including discussion of

regulations for signage on rooms containing radioactive sources, radiation area,

high radiation area, very high radiation area

Participate in brachytherapy procedure including discussion of position

verification, seed accountability

Participate in post-insertion cystoscopy including discussion of how to handle

seeds in the bladder or urethra

Participate in patient and room survey pre- and post-procedure including

discussion of lost seeds

Participate in release of patient with radioactive materials Participate in post-procedure treatment planning including discussion of seed

migration and prostate edema

Participate in disposal of radioactive material including discussion of

applicable state regulations

Discuss function/limitations of a personnel monitoring badge including energy

discrimination

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 1, Jan-Mar)


Activity

On Board MV and kV Imaging

ExacTrac design and function.

ExacTrac Daily, Monthly QA

Linac Annual QA

The RPC: The resident knows what the RPC is/does.

TBI and TSE.

IMRT Planning. (RADI 7006)

References: i. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21, Issue 4) (1994) Radiation

Therapy Committee Task Group #40

ii. Report of TG142 (Quality Assurance of Medical Accelerators) Med. Phys. Volume 36, Issue 9, pp. 4197-4212,

September 2009

iii. The Calibration and Use of Plane-Parallel Ionization Chambers for Dosimetry of Electron Beams (Reprinted from

Medical Physics, Vol. 21, Issue 8 (1994) Radiation Therapy Committee Task Group #39; 10 pp.

iv. AAPM protocol for 40-300 kV x-ray beam dosimetry in radiotherapy and radiobiology. Medical Physics, Vol.28,

Issue 6, (2001). Radiation Therapy Committee Task Group #61.

v. A primer on theory and operation of linear accelerators in radiation therapy. 2nd ed., Karzmark and Morton, Medical

Physics Publishing, 1998.

vi. The Physical Aspects of Total and a Half Body Photon Irradiation (1986) Radiation Therapy CommitteeTask Group

#29; 55 pp.

vii. Total Skin Electron Therapy: Technique and Dosimetry. Report of AAPM Radiation Therapy Committee Task

Group 30 (1987)

viii. Clinical use of electronic portal imaging (Reprinted from Medical Physics, Vol. 28, Issue 5) (2001) Radiation

Therapy Committee Task Group #58; 26 pp.

ix. Quality assurance for CT simulators and the CT simulation process. AAPM report #83. (Reprinted in Medical

Physics, Vol. 30, Issue 10, 2003). Radiation Therapy Committee Task Group #66.

x. Khan. “Treatment Planning in Radiation Oncology”

xi. Mellenberg DE, Dahl RA, Blackwell CR. Acceptance testing of an automated scanning water phantom. Med Phys.

1990; 17(2):311-4.

xii. Emami, B. et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991 May

15;21(1):109-22.

xiii. Lyman, JT. Complication probability as assessed from dose-volume histograms. Radiat. Res. 104:S-13 – S-19; 1985.

xiv. Kutcher GJ and Burman C. Calculation of complication probability factors for nonuniform normal tissue irradiation:

the effective volume method. Int J Radiat Oncol Biol Phys. 104:1623-1630; 1989.

xv. Kutcher G J, Burman C, Brewster L, Goitein M, Mohan R. Histogram reduction method for calculating complication

probabilities for three-dimensional treatment planning evaluations. Int J Radiat Oncol Biol Phys. 21:137-146; 1991.

xvi. Varian manuals for OBI and conebeam CT

xvii. Jaffray DA, Drake DG, et. al. A radiographic and tomographic imaging system integrated into a medical linear

accelerator for localization of bone and soft-tissue targets. Int J Radiat Oncol Biol Phys. 45:7731337-789; 1999.

xviii. Jaffray DA, Siewerdsen JH, Wong JW, and Martinez AA. Flat-panel cone-beam computed tomography for image-

guided radiation therapy. Int J Radiat Oncol Biol Phys. 53:1337-1349; 2002.

xix. Groh BA, Siewerdsen JH, et. al. A performance comparison of flat-panel imager based MV and kV cone-beam CT.

Med Phys 29, 967-975 (2002).

xx. Balter JM, Wright JN, et. al. Accuracy of a wireless localization system for radiotherapy. Int J Radiat Oncol Biol

Phys. 61:933-937; 2005.


ExacTrac (kV) (Form R.3.A)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of the function of the ExacTrac System

Demonstrate an understanding of how are images acquired

Demonstrate an understanding of the image reconstruction

Demonstrate an understanding of ExacTrac QA (Daily, Monthly,

Annual)

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Total Skin Electron Treatment (Form R.3.B)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of Simulation Measurements / technique

determination

Demonstrate an understanding of Hand calculations for treatment

Demonstrate an understanding of Chart preparation and diagrams

Demonstrate an understanding of Calibration of TSE setting in LINAC

Discuss the rationale of TSET treatments (e.g. malignant and benign

conditions treated with TSET);

Demonstrate an understanding of TSET delivery techniques, issues

related to the clinical commissioning and maintenance of a TSET

program;

Discuss and demonstrate an understanding of the significance of beam

modifiers commonly used during TSET treatments (shields, beam

spoilers);

Participate in all aspects of a TSET treatment (simulation, planning, plan

verification, treatment, treatment verification, and in vivo

measurements). (Recommended but not required)

Demonstrate an understanding of TSE Program

a) Field size determination

b) Field flatness determination, gantry angle matching

c) Relative output determination at the patient plane

d) Dose variation around the periphery of patient/phantom

e) Absolute determination of dose per monitor unit at

patient plane

f) Boost field dose determination

g) Shielding considerations for eyes, nails, top of feet

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Total Body Radiation Therapy (Form R.3.C)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of Simulation Measurements / technique

determination

Demonstrate an understanding of Hand calculations for treatment

Demonstrate an understanding of Chart preparation and diagrams

Demonstrate an understanding of Calibration of TBI beam

Demonstrate an understanding of TBI prescription and delivery

techniques, issues related to the clinical commissioning and maintenance

of a TBI program;

Discuss and demonstrate an understanding of the significance of beam

modifiers commonly used during TBI treatments (lung/kidney blocks,

beam spoilers);

Participate in all aspects of a TBI treatment (simulation, planning, plan

verification, treatment, treatment verification, and in vivo

measurements). (Recommended but not required)

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Intensity Modulated Radiation Therapy (IMRT) Planning(Form R.3.D)

Competency Resident

Initials

Mentor

Initials**

Inverse planning

a) Demonstrate an understanding of the use of objective functions for

IMRT optimization;

b) Demonstrate an understanding of the optimization processes involved in

inverse planning;

c) Perform inverse planning optimization for a variety of treatment sites in

sufficient number to become proficient in the optimization process;

d) Demonstrate an understanding of commonly used planning procedures

and guidelines, and optimization and dose calculation algorithms.

IMRT delivery

a) Demonstrate an understanding of various IMRT delivery techniques (e.g.

compensators, static field IMRT, and rotational delivery techniques),

including their relative advantages and disadvantages;

b) Discuss the differences between DMLC and SMLC leaf sequencing

algorithms in terms of delivery parameters and dose distributions;

c) Participate in IMRT delivery for patients with a variety of treatment sites

and demonstrate an understanding of the techniques and requirements

for patient setup, immobilization, and localization.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Annual Linac QA (Form R.3.E)

Competency Resident

Initials

Mentor

Initials**

Perform and be competent in the mechanical, safety, and radiation tests

required during accelerator acceptance and commissioning;

Demonstrate an understanding of the process for defining the treatment

beam isocenter of a gantry based particle accelerator and its relation to the

gantry’s mechanical isocenter and any on-board imaging isocenters;

Discuss how to perform treatment unit head radiation leakage and

shielding adequacy tests;

Independently setup and perform water tank scans for photon and electron

beam measurements that calibrate and characterize those external beams

to facilitate computerized treatment planning and hand calculations of

radiation dose to a point;

Analyze water tank scans and demonstrate an understanding of the results

from these scans, including typically accepted tolerances for each test

performed;

Demonstrate an understanding of acceptance, commissioning and on-

going annual QA requirements for radiation treatment planning system

modules dealing with external beam treatments.

Demonstrate an understanding and use of the instrumentation (i.e. theory

of operation, limitations) and protocols that may be employed in the

process of calibration of radiation treatment beams of energy in the

megavoltage and kilovoltage range;

Demonstrate an understanding of how and why phantoms are utilized for

physical measurements;

Demonstrate an understanding of the correction factors utilized for photon

and electron calibration measurements;

Perform and be competent in the calibration of megavoltage and

kilovoltage external beams of photons and electrons using a recognized

national or international protocol

Perform and be competent in photon calibration hand calculations;

Perform and be competent in electron particle calibration hand

calculations.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





TG-51 Calibration Checklist (Form R.3.F)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of TG 51 protocol

Calibrate photon and electron beams using TG 51

Discuss and/or demonstrate the following:

a) energy range covered by TG-51

b) standard calibration equation: define each term for photons and

electrons

c) measurement corrections: define Pion, Pelec, Ppol, CTP

d) calibration conditions: field size, SSD, depth of reference

dosimetry

e) specification of beam energy

f) point of measurement: define for cylindrical and parallel chambers

g) How is %DD10x determined for low and high energy photons?

h) How is R50 determined for low and high energy electrons?

i) How do you determine kQ, kecal, k’R50?

j) What is beam quality Qecal?

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Informatics (Form R.3.G)

Topics Resident

Initials

Mentor

Initials**

Beam data acquisition/management

Beam modeling

Treatment planning algorithms

Validation of imported images

PACS systems and their integration

HL7

DICOM standards

DICOM in radiation therapy (DICOM-RT)

Information acquisition from PACS/images o Quality/maintenance of

imaging workstations

Evaluation of viewing conditions

Image registration, fusion, segmentation, processing

Quantitative analysis

Record and verify systems

Treatment record design/maintenance

IHE – Radiation Oncology (IHE-RO)

Network integration/management, and roles of physics and information

technology staff

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 1, Apr-Jun)


Activity

LDR planning.

Eye plaque process

Patient Safety

Learn shielding techniques for CT, kV imaging, LINAC and isotopes.

References: i. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21, Issue 4) (1994) Radiation

Therapy Committee Task Group #40. 37 pp.

ii. AAPM Code of Practice for Radiotherapy Accelerators (Reprinted from Medical Physics, Vol. 21, Issue 7) (1994)

Radiation Therapy Committee Task Group #45. Report #47.

iii. High dose rate brachytherapy treatment delivery. Med Phys, Vol. 25, Issue 4 (1998). Radiation therapy committee

task group #59. Report #61.

iv. Dosimetry of 125I and 103Pd COMS eye plaques for intraocular tumors: Report of Task Group 129 by the AAPM

and ABS Medical Physics, Volume 39, Issue 10

v. Niemierko A. Reporting and analyzing dose distributions: A concept of equivalent uniform dose. Med Phys. 24,

103-110 (1997).

vi. Wu Q, Mohan R, Niemierko A, and Schmidt-Ullrich R. Optimization of intensity modulated radiotherapy plans

based on the equivalent uniform dose. Int J Radiat Oncol Biol Phys. 52:224-235; 2002

vii. Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group: Third-party brachytherapy

source calibrations and physicist responsibilities Medical Physics, Vol 35, Issue 9

viii. Hall, Eric J. Radiobiology for the radiologist.

ix. UTHSCSA tissue tolerance planning guidelines for SBRT

x. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N. Int J Radiat Oncol Biol Phys. 2000 May

1;47(2):291-8. PMID: 10802351 [PubMed - indexed for MEDLINE]

xi. RTOG 90-05: the real conclusion. Buatti JM, Friedman WA, Meeks SL, Bova FJ. Int J Radiat Oncol Biol Phys.

2000 May 1;47(2):269-71.

xii. A dosimetric uncertainty analysis for photon-emitting brachytherapy sources: Report of AAPM Task Group No. 138

and GEC-ESTRO Medical Physics, Vol 38, Issue 2

xiii. QUANTEC data for radiation does tolerances

xiv. Neutron Measurements Around High Energy X-Ray Radiotherapy Machines (1986) Radiation Therapy Committee

Task Group #27; 34 pp.

xv. NCRP 49: Structural Shielding Design and Evaluation for Medical Use of X-rays and Gamma Rays of Energies up

to 10 MeV

xvi. NCRP 51: Radiation Protection Design Guidelines for 0.10 MeV Particle Accelerator Facilities

xvii. NCRP 79: Neutron Contamination from Medical Electron Accelerators

xviii. NCRP 102: Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment

Design, Performance and Use (Supersedes NCRP Report No. 33)

xix. NCRP 147: Structural Shielding Design for Medical X-Ray Imaging Facilities

xx. NCRP 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy

Facilities

xxi. Shielding Techniques for Radiation Oncology Facilities. Patton H. McGinley.

xxii. Fetal Dose from Radiotherapy with Photon Beams (Reprinted from Medical Physics, Vol. 22, Issue 1) (1995)

Radiation Therapy Committee Task Group #36.

xxiii. NRC Regualtory Guide 8.13, "Instructions Concerning Prenatal Radiation Exposure"

xxiv. Management of Radiation Oncology Patients with Implanted Cardiac Pacemakers(Reprinted from Medical Physics,

Vol. 21, Issue 1) (1994) Task Group #34; 6 pp. Also be aware of ERRATUM published by Stovall, et al., Med Phys

22(8), August 1995.

xxv. Dosimetric considerations for patients with hip prostheses undergoing pelvic irradiation. Med Phys Volume 30, Issue

6, (2003). Radiation therapy task group committee #63.








Normal Tissue Tolerance Checklist (Form R.4.A) (cont’from Rotation 2 and 3)

Topic Resident

Initials

Mentor

Initials**

Retina, optic nerves, chiasm and lens: fractionated and single dose

Brain: fractionated

Brainstem: single dose

Spinal cord: fractionated and single dose

Parotid: fractionated

Lung: fractionated

Kidney: fractionated

Small bowel: fractionated

Large bowel: fractionated

Heart: fractionated

Liver: fractionated

Bladder: fractionated

Rectum: fractionated, prostate implant

Urethra: prostate implant

Femoral Head: fractionated

Skin: fractionated

Lyman-Kutcher model for calculation of NTCP

Definition and understanding of gEUD

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





PINNACLE Treatment Planning Cases Checklist (Form R.4.B) (cont’from Rotation 2 and 3)

Topic Resident

Initials

Mentor

Initials**

Irregular Fields

Lung 3D

Pelvis 3D

Pancreas 3D

Brain 3D

Larynx 3D

GYN 3D

Abdomen (seminoma)

Prostate 3D

Breast 3D

Lung IMRT

Pelvis IMRT

Pancreas IMRT

Brain IMRT

Larynx IMRT

GYN IMRT

Prostate IMRT

Breast IMRT

Electron fields

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Low Dose Rate (LDR) Brachytherapy Checklist (Form R.4.C)

Competency Resident

Initials

Mentor

Initials**

Discuss the program requirements for control of radioactive material,

isotope room layout, logout-login procedures for Cs-137, Ir-192, I-131

Demonstrate an understanding of TG-43 formalism and update

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________


Pass/Fail scale and the resident will have the opportunity to repeat any competency until they have demonstrated adequate knowledge

of the topic


Radiation Protection Checklist (Form R.4.D)

Competency Resident

Initials

Mentor

Initials**

Megavoltage photons (linear accelerators and/or cobalt-60 units) and

electrons, kilovoltage, superficial x-rays, and/or protons

Demonstrate an understanding of the Nuclear Regulatory Commission (NRC)

and/or state licensing (by-product materials and x-ray producing devices);

Explain the principles behind a radiation protection program, including the

rationale for the dose limits for radiation workers and members of the general

public;

Demonstrate an understanding of NRC and/or state, local, and institutional

regulatory requirements;


Demonstrate an understanding of site planning and how to supervise

construction (key elements to monitor);

Demonstrate an understanding of structural shielding designs for a radiotherapy

department (e.g. NCRP 151) and discuss the key parameters necessary to

perform a shielding calculation;

Perform shielding calculations for an accelerator vault. Calculations should

include primary and secondary barrier transmission calculations;

Discuss the shielding requirements for the maze and door of a high energy

room;

Perform radiation survey of a facility including low energy (4–6 MV) and high

energy (15–25 MV) units;

Discuss advantages and disadvantages of various materials that may be used for

shielding;

Discuss how special procedures such as TBI and SBRT may impact shielding

parameters.

IMRT

Demonstrate understanding of effects of IMRT delivery on leakage radiation

and its potential effects on patients and personnel exposure;

Demonstrate understanding of the effects of different IMRT delivery techniques

on the amount of leakage radiation produced;

Demonstrate understanding of effects of IMRT delivery on vault shielding

requirements.

Conventional Simulator (Radiographic/Fluoroscopic)

Demonstrate an understanding of state licensing (x-ray producing devices);



public;

Discuss the key parameters necessary to perform a shielding calculation;

Demonstrate an understanding of structural shielding designs for a conventional

simulator and perform a shielding calculation (walls, ceilings, floor, and control

area);

Demonstrate an understanding of film processing and darkroom design.

CT Simulator

Demonstrate an understanding of state licensing (x-ray producing devices);




public;


Discuss the significance of an isodose distribution plot for the CT simulator;

Demonstrate an understanding of structural shielding designs for a CT

simulator and perform a shielding calculation (walls, ceilings, floor, and control

area);

Demonstrate an understanding of film processing and darkroom design.

Brachytherapy

Demonstrate an understanding of shielding calculations for primary and

secondary barriers (i.e. NCRP 151);


Discuss and/or perform a shielding calculation for a brachytherapy vault;

Discuss and/or perform a radiation survey for a brachytherapy vault;

Discuss requirements for personal radiation safety badges;

Discuss labeling, shipping, and receiving requirements for radioactive material;

Discuss management of isotope inventory;

Discuss patient-release criteria for radioactive patients (i.e. patients with

temporary or permanent implants and radiopharmaceuticals);

Discuss how to handle changes in medical status for radioactive patients (i.e.

medical emergency or death, NCRP 155);

Explain the key concepts of Title 10 of the Code of Federal Regulations parts

19, 20, and 35;

Demonstrate how to safely operate a remote afterloader unit, including

emergency procedures.

Regulations/recommendations/licensing

Demonstrate an understanding of Nuclear Regulatory Commission (NRC)

and/or state licensing (by-product materials and x-ray producing devices);

Demonstrate an understanding of the appropriate regulations for radiation

protection and dose limits for radiation workers and members of the general

public;

Demonstrate an understanding of NRC and/or state, local, and institutional

regulatory requirements;


Discuss the role and significance of the Joint Commission;

Discuss the role and responsibility of a radiation safety committee;

Discuss the role and responsibility of a radiation safety officer;

Discuss the significance of ACR, ASTRO, and AAPM recommendations;

Demonstrate an understanding of release of patients (with sealed or unsealed

sources).

Survey meters (ionization chamber, Geiger Müller (GM), scintillation)

Discuss the operation and appropriateness of different survey instruments (i.e.

Geiger-Muller counter, ionization survey meters, and scintillation counter);

Performs battery and constancy checks. Understands the allowable deviation

from baseline reading;

Understands how a survey meter is calibrated, who may calibrate a meter (i.e.

ionization versus GM) and the required frequency of calibration;

Personnel monitoring


Demonstrates an understanding of the physical mechanisms involved in the

process of radiation detection and readout of personnel monitors (film, TLD,

and OSLD).

Understands the rationale for occupational dose limits and the federal/state

limits;

Understands the definition of a “declared pregnant woman”;

Understands the federal/state personnel monitoring requirement;

Understands the rationale for ALARA investigation levels;

Understands the role and responsibility of physics in developing a radiation

safety culture;

Understands the requirements for providing personnel monitoring reports to

staff;

Reviews and discusses the results of personnel monitoring reports.

Guidelines and instructions for personnel

Understands the roles and responsibilities of a radiation worker (i.e. NRC Form

3).

Understands the requirements and frequency of radiation safety refreshers for

staff;

Understands the personnel radiation safety hazards specific to the uses of

radiation in a therapeutic setting (e.g. linear accelerator, brachytherapy,

radioisotope handling);

Demonstrates the ability to tailor a radiation safety training program for the

intended audience (e.g. physicists, therapists, dosimetrists, nurses, physicians,

physician residents, students, and maintenance staff).

Hazards of low levels of radiation

Understands the linear no-threshold (LNT) hypothesis, its origins and

limitations;

Understands the collective dose theory as it applies to large populations;

Understands the potential biological effects associated with prolonged exposure

to low levels of radiation;

Knows the major natural sources of background radiation;

Knows the major man-made sources of background radiation.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Patient Safety (Form R.4.E)

Competency Resident

Initials

Mentor

Initials**

General

Understand the principles behind the development of a general patient and staff

safety management program within the hospital;

Discuss the physicist’s role in developing and overseeing an overall quality

assurance program both for equipment and for procedures, including a discussion of

allocation and management of resources necessary to carry out these tasks,

incorporation of tools and techniques, and inclusion of various groups within the

structure of the radiation oncology department;

Discuss the principles and rationale of the Joint Commission Universal Protocol and

discuss the use of pre-procedure verification and time-outs for the prevention of

treatment errors;

Discuss the implementation of a continuous quality improvement (CQI) program,

including the use of both internal review and external audits/peer review for the

assurance of high quality care;

Discuss the concept of a Failure Mode and Effect Analysis (FMEA), how to design

and implement an FMEA, and how to use the results for error prevention

minimization of risks to patients and staff;

Discuss charting systems for prescription, delivery, and recording of treatment

information, standardization of such systems, and the use of such systems within a

record and verify / electronic medical record system;

Discuss mechanisms for independent checking of treatment information.

Equipment

Discuss the implementation of an effective set of equipment operating procedures

including preventative maintenance and repair, maintenance and repair records,

emergency procedures, and systematic inspection of interlock systems;

Discuss the development of a program to prevent mechanical injury by the machine

or accessory equipment, including the need for visual and audio contact with the

patient while under treatment;

Understand potential patient safety hazards related to the use of blocks, block trays,

wedges, and other ancillary treatment devices and accessories and mechanisms to

minimize these risks;

Understand potential patient safety hazards related to patient support and

immobilization systems and mechanisms to minimize these risks;

Understand the potential patient safety hazards with respect to potential gantry–

patient collision and mechanisms to minimize this risk.

Other Patient/Staff Safety Issues

Understand potential electrical hazards to patients and staff;

Understand potential hazards of strong magnetic fields to patients and staff;

Understand the mechanisms of ozone production and potential hazards to patients

and staff;

Understand potential hazards to patients and staff from the use of cerrobend.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 2, July-Sept)


Activity

Treatment plan checks.

Brachytherapy

Eye Plaque

Weekly Chart Checks.

LINAC Design.

Assume primary oversight of all QA, operations and service activities on Novalis. The resident

shall not make any adjustments to their LINAC without faculty supervision.

References i. Quality Assurance for Clinical Radiotherapy Treatment Planning (Reprinted from Medical Physics, Vol. 25,

Issue 10) (1998) Radiation Therapy Committee Task Group #53; 57 pp.

ii. Bortfeld T et al, X-ray field compensation with multileaf collimators. Int J Radiat Oncol Biol Phys. 28(3):723-

30, 1994.

iii. Bortfeld T et al, Realization and verification of three-dimensional conformal radiotherapy with modulated

fields. Int J Radiat Oncol Biol Phys. 30(4):899-908, 1994.

iv. Ezzell G et. al., Guidance document on delivery, treatment planning, and clinical implementation of IMRT:

Report of the IMRT subcommittee of the AAPM radiation therapy committee, Med. Phys. 30(8):2089-2115,

2003.

v. S Webb, Intensity Modulated Radiotherapy, Institute of Physics Publishing, 2001.

vi. Intensity Modulated Radiation Therapy, A Clinical Perspective, Mundt AJ and Roeske JC Eds. BD Decker Inc,

2005.

vii. Intensity Modulated Radiation Therapy Collaborative Working Group, Intensity- Modulates Radiotherapy:

Current Status and Issues of Interest, Int. J. Radiation Oncology Biol. Phys., 51(4): 880–914, 2001.

viii. Philips Pinnacle3 P3IMRT Instructions for Use.

ix. High dose rate brachytherapy treatment delivery. Med Phys, Vol. 25, Issue 4 (1998). Radiation therapy

committee task group #59. Report #61.

x. A primer on theory and operation of linear accelerators in radiation therapy. 2nd ed., Karzmark and Morton,

Medical Physics Publishing, 1998.


LINAC Design and Function Checklist (Form R.5.A)

Competency Resident

Initials

Mentor

Initials**

LINAC Design: discuss schematic of major components

Klystrons and Magnetrons

Circulator

Waveguide

Modulator

Accelerator structure: Standing wave, traveling wave

Buncher and side couple cavities

Bending magnet

Treatment head: primary collimator, monitor chamber, flattening filter,

jaws, MLCs, electron foils, x-ray target

Electron gun

Mechanism for energy change: photons and electrons

Mechanism for dose rate change

Mechanism for change between photon and electron mode

Can you identify a picture of all components above

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Treatment plan and patient chart checks (Form R.5.B)

Competency Resident

Initials

Mentor

Initials**

Perform treatment plan verification including:

Review of patient history (including prior radiotherapy and potential overlap

with current treatment), disease, course of treatment, and dose prescription;

Review of appropriateness of treatment plan and dose distribution to achieve

goals of treatment course;

Review of simulation (e.g. patient positioning and immobilization), planning,

imaging, and treatment field parameters;

Review of monitor unit or time calculations;

Review of images to be used for patient positioning and/or monitoring;

Review of transfer of plan parameters and images to record and verify system

and any other patient monitoring systems.

Perform ongoing review of treatment records (chart checks) including

verification of delivered treatments;

Perform ongoing review of patient imaging and/or tracking using:

a) Film

b) Electronic portal imaging device (EPID)

c) Real time planar imaging

d) Cone beam CT (CBCT)

e) Ultrasound (US)

f) External fiducial and/or surface tracking

g) Internal radiofrequency beacon tracking

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Brachytherapy Checklist (Form R.5.C)

Competency Resident

Initials

Mentor

Initials**

SOURCES

Sealed Radionuclide Sources

Demonstrate an understanding of how commonly used sources are

generated;

Discuss the decay, decay energies (mean energy), and half-life of

commonly used sources;

Discuss the form and construction of sealed sources;

Discuss and define the different units of source strength that have been

used, past and present;

Perform a decay calculation, total dose delivered for temporary and

permanent implants;

Discuss personal protection techniques (time, distance, and shielding) and

safe handling of sealed sources;

Discuss the appropriate methods of storage of radioactive material

(security and accountability);

Perform routine receipt procedure and check-out and check-in temporary

and permanent sources into inventory;

Perform a source room survey and quarterly inventory;

Discuss and/or perform leak checks on sealed sources;

Demonstrate an understanding of and gain hands-on experience of

radioactive material packaging and transportation (Title 49 of the Code of

Federal Regulations);

Demonstrate an understanding of the equipment used to calibrate sealed

sources;

Discuss the process by which sealed sources are calibrated;

Discuss the process by which measurement equipment (i.e. electrometers,

well ionization chambers) is calibrated;

Explain the theory of operation of a well ionization chamber;

Discuss and/or perform an assay for sealed sources;

Demonstrate an understanding of licensing issues and requirements (i.e.

NUREG 1556);

Discuss the operation and appropriateness of different survey instruments

(i.e. Geiger-Muller counter, ionization survey meters, and scintillation

counter);

Demonstrate an understanding of the regulatory requirements for sealed

sources (i.e. state regulations or 10 CFR 35).

Unsealed radionuclide sources

Demonstrate an understanding of how commonly used

radiopharmaceuticals (i.e. I-131, P-32, Sm-153, Sr-89) are generated;

Demonstrate an understanding of the decay, decay energies (mean energy),

and half- life of commonly used radiopharmaceuticals;

Discuss personal protection techniques (time, distance, and shielding) and

safe handling of unsealed sources;

Discuss the process by which unsealed sources are calibrated;

Discuss the process by which measurement equipment (i.e. dose

calibrator) is calibrated;


Discuss and if possible, perform an assay for unsealed sources;

Demonstrate an understanding of licensing issues and requirements (i.e.

NUREG 1556);

Discuss the operation and appropriateness of different survey instruments

(i.e. Geiger-Muller counter, ionization chamber, and scintillation counter);

Demonstrate an understanding of the regulatory requirements for unsealed

sources (i.e. state regulations or 10 CFR 35);

CLINICAL APPLICATIONS

Discuss the various brachytherapy sources that have been used, past and

present, clinically. Discuss the rationale for source selection.

Discuss the how a brachytherapy program is developed.

Discuss in detail the use and operation of different brachytherapy

modalities, including their advantages and disadvantages.

Low dose-rate (LDR)

High dose-rate (HDR)

Pulsed dose-rate (PDR) (optional)

Electronic

Discuss and perform source strength (Air Kerma Rate, Sk) verification and

comparison between measured and vendor’s specification;

Discuss radiation protection for radiation workers and visitors;

Demonstrate an understanding of commissioning and acceptance of

Remote After Loaders (RAL);

Demonstrate an understanding of GYN and GU anatomy;

Demonstrate an understanding of the treatment of cervical and endometrial

cancer with LDR, HDR, and PDR (recommended);

Demonstrate an understanding of prostate cancer and the treatment with

HDR and LDR;

Treatment planning

Perform brachytherapy treatment plans for a cylindrical applicator;

Perform brachytherapy treatment plans for a cervical applicator (e.g.

tandem and ovoids, tandem and ring);

Discuss the differences between point and volume based treatment

planning (ICRU 38 and the GEC ESTRO recommendations);

Perform interstitial brachytherapy treatment plans (e.g. prostate,

gynecologic, sarcoma);

Perform a brachytherapy treatment plan for an eye plaque (Recommended

but not required);

Perform a brachytherapy treatment plan for microsphere therapy

(Recommended but not required).

Demonstrate an understanding of applicator acceptance, commissioning,

and performance of periodic quality assurance;

Demonstrate an understanding and performance of daily QA;

Describe emergency training requirements (10CFR35);

Demonstrate an understanding of Quality Management Program (QMP) as

required by the federal/state for auditing;

Discuss the criteria and subsequent handling of recordable and reportable

events.


IMAGING

Demonstrate an understanding of the mathematics of localization of target

volume and catheter reconstruction by orthogonal films (2D);

Demonstrate an understanding of CT/MRI/US/PET based localization of

Region of Interests (ROIs) and catheter reconstruction.

TREATMENT PLANNING

Demonstrate an understanding of source strength of radioactive sources;

Discuss dose rates and dose calculation formalisms (HEBD, LEBD);

Demonstrate an understanding of the performance of computerized

planning of various imaging modalities of LDR and HDR;

Discuss in details the advantages and disadvantages of dose optimizations;

Discuss and perform secondary calculations as a QA check for

computerized planning.

Demonstrate an understanding testing of new sealed sources

Discuss the calibration check of new sealed sources

Discuss the calibration check of well chambers

Discuss the elongation factor determination for well chambers (LDR

Ir-192)

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





COMS Eye Plaque Applicator Checklist (Form R.5.D)

Competency Resident

Initials

Mentor

Initials**

Demonstrate an understanding of seed strength determination

Process for ordering seeds

Demonstrate re-planning using actual seed strength

Source logging and calibration

Perform Implant preparation including gathering of required

equipment

Demonstrate an understanding of eye plaque sterilization procedure

Participate in all OR activities for an eye plaque

Perform the Recovery room Radiation Protection survey and

documentation

Discuss the home radiation precautions or hospital room precautions

Participate in OR applicator removal procedures

Perform Post implant Radiation protection survey of OR

Discuss End of implant duties, source inventory, seed removal from

plaque

Demonstrate an understanding of proper disposal of seeds

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 2, Oct-Dec)


Activity

Stereotactic Treatment Planning Concepts

Stereotactic Quality Assurance

Daily

Monthly

Annual

Participate in all aspects of SBRT treatment

Treatment planning QA.

References i. Quality Assurance for Clinical Radiotherapy Treatment Planning (Reprinted from Medical Physics, Vol.

25, Issue 10) (1998) Radiation Therapy Committee Task Group #53; 57 pp

ii. Stereotactic body radiation therapy: The report of AAPM Task Group 101 (2010) Treatment Delivery

Subcommittee Task Group #101 Med. Phys. 37 (8)

iii. Stereotactic Radiosurgery. http://aapm.org/pubs/reports/RPT_54.pdf

iv. Novalis, and Eclipse manuals as needed.



Stereotactic Body Radiation Therapy Checklist (Form R.6.A)

Competency Resident

Initials

Mentor

Initials**

Participate in shaping of Body Frame immobilization device

Demonstrate an understanding of various mechanisms monitoring

respiratory motion

Demonstrate an understanding of various mechanisms for respiratory

motion mitigation

Participate in 4D CT image acquisition

Perform retrospective binning of 4D CT data

Generate MIP images and transfer to treatment planning computer

Participate in SBRT treatment planning

Demonstrate an understanding of mechanisms of SBRT localization at the

linac

Participate in cone-beam CT patient setup

Participate in SBRT patient treatments

Discuss the rationale for SBRT treatments, what are the common treatment

sites, and typical dose and fractionation schemes;

Discuss immobilization and localization systems for SBRT treatments;

Discuss use of simulation imaging for SBRT target definition, including

multi-modality imaging and 4D imaging for cases requiring motion

management;

Discuss treatment planning objectives for SBRT treatments, including

OAR dose limits, dose heterogeneity, dose gradient and fall-off, and beam

geometry;

Discuss treatment verification and delivery for SBRT treatments, and use

of in-room imaging.

Discuss TPS validation tests including tissue inhomogeneity corrections

and small-field dosimetry measurements.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Stereotactic Radiosurgery Checklist (Form R.6.B)

Competency Resident

Initials

Mentor

Initials**

Participate in shaping of SRS mask

Discuss fluoro-guided motion assessment

Participate in CT image acquisition

Import of imaging sets to Treatment planning system

Perform fusion of image sets

Participate in SRS treatment planning

Understand mechanisms of SRS localization at the linac

Participate in ExacTrac patient setup

Participate in SRS patient treatments

Discuss rationale of SRS treatments, examples of malignant and non-

malignant lesions treated with SRS, and typical dose and fractionation

schemes for linac-based and Co-60 SRS techniques;

Describe, in general, the components of commissioning for an SRS

system (accurate localization, mechanical precision, accurate and optimal

dose distribution, and patient safety);

Discuss the stereotactic localization of a target (i.e. from angiography

versus CT and MRI) and how the accuracy of this localization is

measured;

Describe the alignment of coordinate systems (i.e. target frame of

reference to linac frame of reference) and how the mechanical precision of

this alignment is measured;

Describe issues associated with dosimetry measurements for an SRS

system (i.e. choice of dosimeter, phantom geometry, etc.);

Describe the components of pre-treatment QA for an SRS system,

including linac-based and Co-60 SRS techniques.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Stereotactic Radiosurgery Checklist (Form R.6.C)

Topic Resident

Initials

Mentor

Initials**

Simple spherical targets (cones)

Non-spherical targets (microMLC)

Multiple targets

Arteriovenous Malformations (AVM)

Trigeminal Neuralgia

Image fusion

Monitor Unit Calculations

Physics

Scatter Factor Measurements (cone and mlc)

TMR measurements

OAR measurements

Isocentric accuracy (Winston-Lutz)

Targeting accuracy (image guidance)

Daily QA

Monthly QA

Annual QA

Imaging

CT scanner accuracy

MR scanner accuracy

Angiographic localizer accuracy

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________





Treatment planning system QA (Form R.6.D)

Competency Resident

Initials

Mentor

Initials**

Data acquisition

Explain the connection between linac commissioning and the data required

for operation of a treatment planning system;

For a particular treatment planning system, describe the required linac data

needed for:

i. Photon beams

ii. Electron beams

iii. IMRT and VMAT

Acceptance testing

Describe what tests of the treatment planning system need to be performed

before patient specific planning can commence for:

iv. Photon beams

v. Electron beams

vi. Brachytherapy sources

Quality assurance

Describe the accuracy of the above tests that need to be performed

Describe accuracy checks for input devices:

vii. Digitizers

viii. Film scanners

ix. Imported images from CT scanners, MRI scanners, etc., and PACs

systems

Describe accuracy checks for output devices:

x. Printers

xi. Record and verify systems

xii. DICOM output

Computer algorithms (models)

Describe how the computer algorithm calculates dose for at least one major

treatment-planning system for:

xiii. Photon beams

xiv. Electron beams

xv. Brachytherapy calculations

xvi. Proton beams (optional)

Describe the advantages and disadvantages of the various treatment-

planning calculation algorithms;

Describe how the computer algorithm determines the number of monitor

units per beam or segment (for step-and-shoot IMRT).

Plan Normalization

Describe the numerous normalization capabilities available on a treatment

planning system;

Describe how different normalization schemes affect final isodose curve

representation;

Describe how the computer plan normalization relates to the calculation of

monitor units for patient treatments.

Inhomogeneity (heterogeneity) corrections


Describe the type of data that needs to be taken on a CT scanner in

preparation for treatment-planning using inhomogeneous material;

Describe how this CT data is converted into inhomogeneity data usable in a

treatment planning system;

Describe how computerized treatments planning system takes

inhomogeneities into account;

Describe where the computer algorithm calculates dose with acceptable

accuracy and in what regions the calculational accuracy is suspect;

Describe how you would check the accuracy of the inhomogeneity

corrections performed by a treatment planning system.

Beam modeling

Completely model at least one photon beam energy for a treatment planning

system;

Completely model at least one electron beam energy for a treatment

planning system;

Completely model at least one proton beam energy for a treatment planning

system (optional);

Test the accuracy of your modeling for the beams and be able to describe

the criteria for acceptability of the modeling.

Imaging tests

Describe to tests that you would perform to ensure that the imported image

data is correct;

Demonstrate that you can import images from CT, MR, and PET or

PET/CT scanners;

Demonstrate the you can accurately fuse the above imaging sets with the

primary treatment planning image set;

Describe the different image fusion algorithms available on a treatment-

planning system and which method is most accurate for which fusions (i.e.

CT-CT, CT-MR, CT-PET) and why.

Secondary monitor unit check computer programs

Describe what input data needs to be acquired;

Describe the checks of that input data that need to be performed to ensure

that the monitor unit check program is working correctly

Describe how imported data from treatment-planning systems is handled in

a monitor unit check program;

Describe how the monitor unit check program calculates the number of

monitor units for off central-axis normalization points;

Describe how the monitor units check program calculates monitor units for

treatments involving inhomogeneous material.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 2, Jan-Mar)


Activity

Dosimetry Rotation (6-8weeks)

Imaging

Acceptance and Commissioning of Major equipment

References

i. The Essential Physics of Medical Imaging. Second Edition. Bushberg 2002.

ii. Comprehensive QA for Radiation Oncology (Reprinted from Medical Physics, Vol. 21,

Issue 4). Radiation Therapy Committee Task Group #40

http://www.aapm.org/pubs/reports/RPT_46.PDF

http://www.aapm.org/pubs/reports/RPT_46.PDF


Imaging List (Form R.7.A)

Competency Resident

Initials

Mentor

Initials**

Magnetic Resonance Imaging (MRI)

General

Demonstrate an understanding of the basic imaging principles behind MRI;

Discuss the advantages and limitations of MRI versus CT for treatment planning;

Demonstrate an understanding of the role of MRI for radiation therapy applications,

providing examples.

Quality Assurance

Demonstrate an understanding of the quality assurance processes and frequencies for

MR-simulators, e.g., image quality, image integrity, safety and mechanical checks,

and network connectivity.

Ultrasound (US)

General

Demonstrate an understanding of the basic imaging principle behind US imaging;

Demonstrate an understanding of the role of US for external beam and

brachytherapy treatments using trans-rectal versus trans-abdominal probes,

providing examples.

Quality Assurance

Discuss methods for QA of US imaging probes prior to clinical use, i.e., prostate

implants, prostate external beam therapy.

Positron Emission Tomography (PET)

General

Demonstrate an understanding of the basic imaging principles behind PET;

Discuss the advantages and limitations of PET versus CT for treatment planning;

Demonstrate an understanding of the role of PET for radiation therapy applications,

providing examples.

Quality Assurance


PET-CT simulators (e.g., image quality, image integrity, safety and mechanical

checks, and network connectivity).

SPECT

General

Demonstrate an understanding of the basic imaging principles behind SPECT;

Discuss the advantages and limitations of SPECT versus CT for treatment planning;

Demonstrate an understanding of the role of SPECT for external beam and

radiopharmaceutical therapy applications, providing examples.

Quality Assurance


SPECT-CT simulators (e.g., image quality, image integrity, safety and mechanical

checks, and network connectivity).

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________




Linac Selection/Acceptance/Commissioning (Form R.7.B)

Competency Resident

Initials

Mentor

Initials**

Selection

Demonstrate an understanding of the theory of operation of megavoltage

electron and proton accelerators currently used in radiation oncology treatment

and their limitations (e.g. linac, synchrotrons, cyclotrons);

Demonstrate an understanding of the theory of operation of kilovoltage x-ray

treatment units currently used in radiation oncology treatment;

Demonstrate an understanding of the major subsystems and use of cobalt units;

Demonstrate an understanding of the major subsystems and components of

megavoltage accelerators;

Review the steps required to select a new electron linear accelerator (linac) for

use in radiation oncology - performance specification and feature comparison;

Review and demonstrate an understanding of the development process for a

Request For Proposal (RFP) aimed at vendors of a linac or other major radiation

treatment unit;

Review and discuss mechanical/architectural considerations when installing a

new particle accelerator in both a new vault and an existing vault (including

discussion on HVAC openings, cabling for communication and dosimetry

systems, electric ports, plumbing and skyshine);

Acceptance/commissioning

Perform and be competent in the mechanical, safety, and radiation tests required

during accelerator acceptance and commissioning;

Demonstrate an understanding of the process for defining the treatment beam

isocenter of a gantry based particle accelerator and its relation to the gantry’s

mechanical isocenter and any on-board imaging isocenters;

Discuss how to perform treatment unit head radiation leakage and shielding

adequacy tests;

Independently setup and perform water tank scans for photon and electron beam

measurements that calibrate and characterize those external beams to facilitate

computerized treatment planning and hand calculations of radiation dose to a

point;

Analyze water tank scans and demonstrate an understanding of the results from

these scans, including typically accepted tolerances for each test performed;

Demonstrate an understanding of acceptance, commissioning and on-going

annual QA requirements for radiation treatment planning system modules

dealing with external beam treatments.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________ **A sign-off for any of the competencies is equivalent to a passing grade for that competency. The competencies are scored on a




CT simulator Selection/Acceptance/Commissioning (Form R.7.C)

Competency Resident

Initials

Mentor

Initials**

Selection

Review the steps required to select a new CT simulator - performance

specification and feature comparison;

Review and demonstrate an understanding of the process to develop a Request

For Proposal (RFP) for a CT simulator;

Review and understand the mechanical/architectural considerations when

installing a new CT simulator in both a new room and an existing room.

Acceptance testing

Demonstrate an understanding of the mechanical tests performed during a CT

simulator acceptance procedure;

Demonstrate an understanding of the tests of image quality and characteristics

for a CT image and digitally reconstructed radiograph for a CT simulator;

Demonstrate an understanding of the measurement of dose and CTDIs from a

CT simulator for different body sites;

Demonstrate an understanding of the measurement of CT number versus

density calibration with kVp and its use in treatment planning systems;

Demonstrate an understanding of the alignment of internal and external laser

systems for a CT simulator;

Demonstrate an understanding of network connectivity tests between other

systems used in the radiation oncology process (e.g. treatment planning

systems, treatment verification systems, and PACS);

Demonstrate an understanding of the validation tests for transfer of CT imaged

objects to treatment planning systems.

Dose calculations

Understand the physical basis of the use of CT-simulator images in treatment

planning as the current standard for dose calculations and the calibration of

these images for use in computing radiation dose deposition in different tissues.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________






Chief Mentor: (Year 2, Apr-Jun)

Note: the comprehensive oral exam should be completed in the first month to allow time for

catch up in areas of weakness.

The resident shall:

1. Complete a final oral exam. The final oral exam will be comprehensive and structured

similar to an ABR oral exam.

2. Complete any unfinished topics/check sheets. All objectives need to be completed to

receive a certificate of completion for this residency.

3. Contribute to clinical service as guided by the Program Director. A resident should be

capable of performing all the tasks of a clinical medical physicist with little supervision by

the end of rotation #8.

Faculty: ______________________________________________ Date

Resident: _____________________________________________ Date

Comments:______________________________________________________________________

_________________________________________________________________


2.1 DESCRIPTION OF EDUCATIONAL EXPERIENCE

2.1.A: Research Experience

Residents are encouraged to participate in clinical research. There are several areas of research in

which the medical physics group is engaged, including: image guided delivery techniques, IMRT

optimization, radio-biological optimization and scoring, novel QA techniques, Monte Carlo

simulation.

2.1.B: Facilities

The residents have access to a several laboratories including: (1) a dosimetry instrumentation lab in

the physics research area; (2) a brachytherapy lab in the Brachytherapy Suite; and (3) other research

labs and offices in the Clinical Science Research Building. In all, the availability of dosimetry and

clinical treatment areas and equipment is more than adequate to serve the needs of the residency

training program. Procedures are in place that (1) allow the resident reasonable access time to clinical

equipment, (2) provide residents sufficient training and technical support to ensure safe and proper

use of equipment, and (3) to ensure equipment is left in the proper state for clinical use.

Treatment planning and external beam delivery equipment utilized in the training program include

4 Varian LINACs, 1 Novalis Tx unit, 2 GE 4D CT-simulators (16-slice and 4-slice large bore

scanners), 15 PINNACLE TP workstations, 1 Varian Eclipse workstation, iPlan workstation.

Specialized equipment includes DMLC-IMRT delivery, linac-based stereotactic radio-

surgery/therapy and image guidance via on-board x-ray imaging and portal imaging. We also

maintain a comprehensive in vivo dosimetry program with OSLD and TLD.

2.1.C: Work Hours Policy

All residents are expected to be in the clinic promptly by 8:00 AM which is when most morning

conferences begin. Often, special tumor conferences, didactic lectures, or other educational and

clinical activities may require that the residents come at work earlier or stay later than normal work

hours, which are from 8:00 AM to 6:00 PM except for the resident(s), who are assigned to the patient

QAs and machine QAs services that are performed afterhours. Medical physics duties often require

the faculty and the residents to work on evenings and on weekends

2.2: EDUCATIONAL CONFERENCES Educational conferences include the New Patient conference (twice a week), numerous tumor boards and the medical physics QA and clinical meetings. Tumor Board Schedules and New Patient Conference times will be distributed by the program coordinator. Residents are expected to make every effort to attend such conferences. 2.3: RESIDENT ROOM and LIBRARY ROOM Neatness, courtesy and order are essential in keeping the resident’s room a pleasant workplace. The library contains some past journals and texts. Current journals are available online to all the residents. The departmental library should be considered a quiet area for reading and study. Again, keep this room neat and place journals back neatly where they belong. Material cannot be removed from the library room.


2.4 Radiation Oncology New Employee Orientation Checklist

Name:

Start Date:

1. Radiation Safety Officer and employee Health

( ) Film badge and explanation

( ) Personal Protective Equipment

( ) Hepatitis B Vaccine

( ) TB testing

( ) Incident Reporting

( ) Schedule of new employee orientation

2. Tour of Facility (any staff member)

3. Review of Responsibilities with Medical Physics Director

( ) Received and reviewed Resident Handbook

( ) Who to notify for sickness or tardiness

( ) Lab coat REQUIRED - No blue jeans, shorts or cut-offs, the gentleman of

the Department will wear ties.

( ) Foot wear - (no open toe shoes or sandals)

( ) Introductions to Medical Staff- Organizational chart

( ) CPR Certification – optional

( ) Reporting structure, job description and work hours/schedules

4. Administrative Assistant

( ) Parking and ID (with police)

( ) Pager

( ) Office and PC usage

( ) Keys

( ) Supplies

( ) Picture for Directory and email distribution

( ) Computer access – UTHSCSA and CTRC

I certify that I have review the above items with my supervisor or designated person(s) and I

understand each of the items designated by a () mark.

Signature of Resident Date:

SUPERVISOR OR DESIGNATED PERSON(S)

I certify that the above resident has been instructed in each of the previously listed items.

Signature Date:


2.5: Department Organizational Chart


2.6: Oral Exam Evaluation

This evaluation document should be updated by the resident’s mentor and shared with the resident.

A completed copy must be submitted to the Program Director.

Oral Exam I

Date: ___________________________

Evaluators: _________________________________ Resident: __________________

Topics:

Topic Score

Simulation and patient setup

Monitor Unit Calculation

In-vivo and patient specific dosimetry

Dosimeters

AAPM Task Group-51 Calibration Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail

Scores less than 3 will require remediation to be outlined in comments section below

Overall Score: _________________

Comments:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Program Director: ____________________________ Resident: ____________________


Oral Exam II

Date: ___________________________


Topic Score

AAPM Task Group 142 QA

kV and MV verification technologies/QA

AAPM Task Group 25, Electrons

Treatment Planning

TBI & Total Skin Electrons Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail


Overall Score: _________________

Comments:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________



Oral Exam III

Date: ___________________________


Topic Score

LDR

Linac design and function

Shielding design and dose limits

Normal Tissue Tol. & Response Models

Pregnant patients/Pacemakers/ Hip Repl Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail


Overall Score: _________________

Comments:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________



Oral Exam IV

Date: ___________________________


Topic Score

AAPM Task Group 101 (SBRT/SRS)

HDR

Eye Plaque

Comprehensive Scoring: 1-Excellent, 2-Good, 3-Satisfactory, 4-Needs improvement, 5-Fail


Overall Score: _________________

Comments:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________



Written Exams Log Sheet

Month Exam Topic Score

August 1 Radiation Safety, Patient CT Simulation

September 2 MU Calculations

October 3 Periodic Linac QA

November 4 Dosimeters, IMRT QA

December 5 OBI MV and kV Imaging

January 6 CT Sim QA, HDR Daily QA

February 7 TSET, TBI

March 8 Annual Linac QA, ExacTrac

April 9 TG 51

May 10 Patient Safety, Tissue Dose Tolerance

June 11 LDR planning for Prostate Seed Implants

July 12 Radiation Protection

August 13 Linac Design

September 14 Chart Checks

October 15 Brachytherapy

November 16 SBRT/SRS delivery and Planning, Narrow Field

Dosimetry

December 17 Treatment Planning System QA

January 18 Imaging in Radiation Therapy

February 19 Acceptance and Commissioning of Linac

March 20 Acceptance and Commissioning of CT Simulator

May 21 Comprehensive


2.7: Evaluation Forms

2.7.1: In-service Presentation Evaluation

Presenter: _____________________________ Evaluator: ______________________________

Category 1 2 3 4 Score

Organization

Cannot understand because of no sequence of information

Difficulty following presentation because

presenter jumps around

Information presented in

logical sequence

Information presented in

logical, interesting sequence

Subject Knowledge

No grasp of presentation information,

cannot answer questions

Uncomfortable with information and only

providing vague answer responses

Presenter at ease with expected answers to all questions, but

fails to elaborate

Full knowledge by answering

questions and elaborating

Graphics Use of superfluous

graphics or no graphics

Occasional use of graphics that rarely supports text and

presentation

Graphics related to text and

presentation

Graphics explain and reinforce

screen text and presentation

Mechanics

Presentation has four or more

spelling/ grammatical errors

Presentation has three spelling/

grammatical errors

Presentation has two spelling/ grammatical

errors

Presentation has no spelling/

grammatical errors

Eye Contact Presenter reads all of report with no

eye contact

Presenter occasionally uses eye

contact, but most reads

Presenter maintains eye

contact most of the time but

frequently returns to notes

Presenter maintains eye contact with

audience, seldom returning to notes

Elocution

Presenter mumbles, incorrectly

pronounces terms, and speaks too

quietly

Presenter’s voice is low, incorrectly

pronounces terms, difficulty hearing

Presenter’s voice is clear, most

words pronounced

correctly.

Presenter’s voice is clear and correct,

precise pronunciation of

terms for all audience can hear

TOTAL SCORE (Best 24 points)

Comments:

______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Staff Sig._______________Date___________Resident Sig._______________Date___________

2.7.2 Course Evaluation Form


Instructor: _____________________________ Course: ______________________________

1. Course Evaluation:

Excellent Good Fair Poor Very Poor

1. The course as a whole was: 1 2 3 4 5

2. The course content was: 1 2 3 4 5

3. Course organization was: 1 2 3 4 5

4. Quality of questions or problems raised

by the instructor was: 1 2 3 4 5

5. Answers to student questions were: 1 2 3 4 5

6. Availability of extra help when needed was: 1 2 3 4 5

7. Amount you learned in the course was: 1 2 3 4 5

8. Relevance and usefulness of course content

were: 1 2 3 4 5

9. Evaluative and grading techniques were: 1 2 3 4 5

10. Clarity of student responsibilities and

requirements were: 1 2 3 4 5

2. Instructor Evaluation:

Excellent Good Fair Poor Very Poor

1. Instructor’s contribution to the course was: 1 2 3 4 5

2. Instructor effectiveness in teaching the

subject matter was: 1 2 3 4 5

3. Explanations by instructor were: 1 2 3 4 5

4. Instructor use of examples and illustration was: 1 2 3 4 5

5. Instructor spoke clearly: 1 2 3 4 5

6. Instructor’s enthusiasm was: 1 2 3 4 5

7. Instructor’s interest in whether students

learned was: 1 2 3 4 5

3. How did you feel overall about the course? Please comment on any aspects you felt may need improvement or

could be better taught.

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________


4. Additional comments or specific changes you would like to see made to improve the instructor and/or the

course:

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________


2.7.3: Residency Curriculum Evaluation Form

This evaluation document must be completed by the resident once per year. Please submit to the

Program Director.

Date:_____________

Please answer the following questions:

1. Do you feel the objectives and assessments of the residency curriculum are clear? If no,

please elaborate.

2. Do you feel that the residency curriculum has excluded important clinical topics? If Yes,

please elaborate.

3. Do you feel that the residency curriculum is efficient? If no, please elaborate

4. Do you have suggestions to improve the residency curriculum? If yes, please elaborate.

Comments_____________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


2.7.4 Resident Evaluation Form

Resident: _______________________ Date: __________________

Evaluated Rotation: _________________________________________

Faculty Reviewer: ________________________________________________________

Rotation Assessment

Yes No

Has the resident comp

Was the resident sufficiently engaged in this rotation?

Oral Assessment

Comments:

________________________________________________________________________

________________________________________________________________________

Signed,

____________________________________ ______________________________

Faculty Name Signature

____________________________________ ______________________________

Faculty Name Signature

I have read the above evaluation outlined by the faculty members involved in my end of rotation evaluation.

I believe the evaluation is an accurate representation of my oral review.

I believe the evaluation is an inaccurate representation of my oral review.

Comments:

______________________________________________________________________________________

______________________________________________________________________________________

Print Name:____________________________________________________________________________

Signature:____________________________________________ Date:____________________________

High Pass Pass Conditional Pass Fail


2.7.5: Residency Mentor Evaluation Form

Complete one for each rotation (eight in total)

Rotation: _____________________________________________

Mentor(s): _____________________________________________

Dates: _____________________________________________

Sufficient time was allotted to this rotation: □ Yes □ No

Very

Poor Fair Good Good Excellent

1 2 3 4 5

The rotation achieved the outlined objectives:

The faculty mentor(s) actively and effectively participated in the rotation training:

The faculty mentor(s) invited questions and discussion:

The faculty mentor(s) treated me professionally:

The faculty mentor(s) teaches effectively:

Comments:______________________________________________________________________________________

_____________________________________________________________________________ ______________

What are the strengths of this rotation (including faculty)?

_______________________________________________________________________________________________

___________________________________________________________________________________________

What are the weaknesses of this rotation (including faculty)?

_______________________________________________________________________________________________

___________________________________________________________________________________________

General comments:

_______________________________________________________________________________________________

___________________________________________________________________________________________


2.7.6: Medical Conferences Attendance Log

UTHSCSA Medical Physics Residency

Medical Conferences Attendance Log

Resident: _________________________________________

# Date Conference Topic

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25


26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50


2.7.7 Program Evaluation Form Work Experience Importance for Leaving

(Only for residents who leave before they

graduate the residency.)

1. Work Place Evaluation Not at all Somewhat Very

Satisfied Satisfied Satisfied Not at all Somewhat Very

Important Important Important

a. Orientation/Training 1 2 3 4 5 1 2 3 4 5

b. Professional Development 1 2 3 4 5 1 2 3 4 5

c. Teamwork 1 2 3 4 5 1 2 3 4 5

d. Relations with colleagues 1 2 3 4 5 1 2 3 4 5

e. Relations with supervisor 1 2 3 4 5 1 2 3 4 5

f. Relations with Medical staff 1 2 3 4 5 1 2 3 4 5

g. Adequate job autonomy 1 2 3 4 5 1 2 3 4 5

h. Work place stress 1 2 3 4 5 1 2 3 4 5

i. Challenges at work

1 2 3 4 5 1 2 3 4 5

j. Opportunity for career growth 1 2 3 4 5 1 2 3 4 5

k. Utilization of my skills and/or

experience

1 2 3 4 5 1 2 3 4 5

l. Barriers in the work place 1 2 3 4 5 1 2 3 4 5

Program Director /Co-Director Rotation Mentors

2. Director’s/Mentor’s Support Not at all Somewhat Very

Satisfied Satisfied Satisfied Not at all Somewhat Very

Satisfied Satisfied Satisfied

a. Supported my professional growth 1 2 3 4 5 1 2 3 4 5

b. Was open to ideas and concerns 1 2 3 4 5 1 2 3 4 5

c. Had the ability to give

feedback in a constructive and

caring manner

1 2 3 4 5 1 2 3 4 5

d. Kept me informed about issues

important to my job

1 2 3 4 5 1 2 3 4 5

e. Gave me ideas on how to do a better

job

1 2 3 4 5 1 2 3 4 5

f. Listened to my concerns

and took action to improve things

1 2 3 4 5 1 2 3 4 5

g. Was accessible if needed 1 2 3 4 5 1 2 3 4 5

h. Overall, I was satisfied 1 2 3 4 5 1 2 3 4 5

3. Would you recommend the University of Texas Health Science Center Radiation Oncology Physics Residency

program?

___ Yes ___ No

4. As you think about your work environment, what has contributed the most to your satisfaction?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

5. If you could change one thing about your work environment, what would it be?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

-THANK YOU FOR COMPLETING THIS SURVEY-


2.7.8 Milestones Agreement Form

Milestones Agreement Form

Doctor of Medical Physics

This form is provided for the purpose of informing students about the academic milestones that they will

be expected to reach in order to earn their Doctor of Medical Physics (DMP) degree as well as when they

are expected to complete these milestones. Students are expected to reach each milestone within the

specified time period in order to make satisfactory progress through the program. Students who are not

making satisfactory progress may lose funding (if applicable), be placed on academic probation, or be

dismissed from the program.

Academic Advising

Upon entering the Doctor of Medical Physics (Therapy and Diagnostic Track), all students will be assigned

an advisor. The advisor will be a full member of the program department. After notification of their

advisor, the student is asked to schedule an initial meeting with them. At least once a year but preferably

twice a year the student is asked to meet and discuss their progress with their advisor. Each student has

the option at any time of changing faculty advisor simply by requesting the action by submitting the

Change of Faculty Advisor form to the Committee on Graduate Studies (COGS) for approval.

Academic advising includes the following elements that are designed to ensure that students remain in

good academic standing and make satisfactory progress through the program. Advisors are responsible for

the following:

• Ensuring that annual reviews between student and advisor. The results of this review will be

included in the program’s annual doctoral progress report.

• Providing suggestions on course selection. (Program may require course selection to be

entered by student.)

• Reviewing the student’s progress to determine if the student is meeting the expectations of

the program and reaching milestones according to the timeline provided on this form; working

with the DMP Committee on Graduate Studies (COGS) and student to determine if

modifications are necessary.

• Clarifying the timetable for completing any remaining course requirements, examinations, and

other requirements.

• Providing the student with experiences and information that will optimize the student’s career

opportunities and success.


Requirements for all DMP Students

Milestone

Target Date

Review of student’s progress with advisor using Annual Student Review Form

followed by COGS approval

At the end of each Semester,

Annually on February

Successful completion of oral and/or written qualifying exam Year 1, May

Coursework successfully completed Year 2 June

Successful Completion of Clinical Rotation 1 Year 3 December

Successful Completion of Clinical Rotation 2 Year 3 June

Successful Completion of Clinical Rotation 3 Year 4 December

Successful Completion of Clinical Rotation 4 Year 4 June

Complete and submit SED to the Graduate Dean’s Office

Submit exit survey to Dr. Blake in Graduate Dean’s Office Year 4 June

Degree Completion Checklist for Students

• Maintain active student status by registering for courses every fall and spring semesters

• Complete Milestones Agreement Form with your advisor no later than the last class day of the Fall semester

• Complete all required organized coursework

• Schedule and successfully complete required qualifying exams

• Successfully complete all clinical rotations in years 3 and 4

• Submit required documentation to the Graduate School for completion and graduation I have read this form and have had the opportunity to discuss the information contained in it with my advisor. I understand the academic milestones that I am expected to reach in order to successfully complete the Doctor of Medical Physics program, as well as the expected timeline for completing these milestones. Student’s Signature Date Advisor’s Signature Date

Doctorate of Medical Physics Handbook in Radiation...

Documents

Transcript of Doctorate of Medical Physics Handbook in Radiation...