Study-Unit Description

Study-Unit Description


CODE MPH5017

 
TITLE Medical Physics and Radiation Protection in Nuclear Medicine and Radioisotope Cyclotron Facilities (Major)

 
UM LEVEL 05 - Postgraduate Modular Diploma or Degree Course

 
MQF LEVEL 7

 
ECTS CREDITS 10

 
DEPARTMENT Medical Physics

 
DESCRIPTION This study-unit focuses on preparing candidates to fulfill their role as CLINICAL MEDICAL PHYSICISTS, potential MEDICAL PHYSICS EXPERTS, RADIATION PROTECTION EXPERTS and RADIATION PROTECTION OFFICERS in Nuclear Medicine and radioisotope cyclotron facilities. The unit follows the recommendations regarding core and specialist Nuclear Medicine and radioisotope cyclotron facility expertise to be found in the EC documents 'European Guidelines on the Medical Physics Expert' and 'Requirements and methodology for recognition of Radiation Protection Experts'. The study-unit includes all common nuclear medicine DIAGNOSTIC modalities including SCINTIGRAPHY, SPECT, PET, PET/CT, PET/MRI and THERAPEUTIC methods.

Study-unit Aims:

The aims of this study-unit are:
1. To prepare candidates to fulfill their role as CLINICAL MEDICAL PHYSICISTS, potential MEDICAL PHYSICS EXPERTS, RADIATION PROTECTION EXPERTS and RADIATION PROTECTION OFFICERS in Nuclear Medicine and Radioisotope Cyclotron facilities.
2. To prepare candidates to contribute to maintaining and improving the quality, safety and cost-effectiveness of healthcare services through patient-oriented activities requiring expert action, involvement or advice regarding the specification, selection, acceptance testing, commissioning, quality assurance/control and optimized clinical use of Nuclear Medicine imaging devices and therapeutic methods, patient risks from radionuclide use including protection from such radiations, installation design and surveillance, and the prevention of unintended or accidental exposures. The study unit includes all common nuclear medicine DIAGNOSTIC modalities including SCINTIGRAPHY, SPECT, PET, PET/CT, PET/MRI and THERAPEUTIC methods.
3. To prepare candidates to be able to play a leading part in radioisotope cyclotron facilities.

Learning Outcomes:

1. Knowledge & Understanding
By the end of the study-unit the student will be able to:

1. Explain in detail statutory and institutional requirements for Medical Physics Services and the roles of the Medical Physicist, MPE, RPE and RPO in the establishment and management of systems for effective clinical use of medical devices and radiation protection of patient/staff/public in Nuclear Medicine and radioisotope cyclotron facilities;
2. Interpret qualitatively and quantitatively anatomical and functional 2D/3D images from the various imaging modalities and recognise specific anatomical, functional and pathological features to a level necessary to be able to contribute effectively to the work of the Nuclear Medicine team;
3. Describe the perspective of the patient and other healthcare professionals in the Nuclear Medicine team;
4. Explain in detail and quantitatively the design and functioning of medical devices used in Nuclear Medicine and the design variables which impact device performance indicators and clinical effectiveness;
5. Explain in detail and quantitatively methods for quality assurance of medical devices in Nuclear Medicine, including acceptance testing and commissioning;
6. Explain quantitatively and in detail dose-bioeffect relationships relevant to Nuclear Medicine;
7. Describe in detail and quantitatively the process and practical implementation of patient/occupational/public risk assessments, dose optimization (including foetal risk) and limitation in Nuclear Medicine;
8. Discuss in detail ethical issues related to the protection of patients, carers and comforters and volunteers from ionising radiation in Nuclear Medicine research;
9. Apply European laws, regulations, recommendations, acceptance criteria and standards (including IEC standards where relevant) related to device performance and patient/occupational/ public protection in Nuclear Medicine;
10. Describe present and envisaged future developments of medical devices and protection from associated ionising radiations in Nuclear Medicine;
11. Explain pedagogical methods used for the training of other healthcare professionals in patient and personal protection in Nuclear Medicine;
12. For each Nuclear Medicine imaging modality (gamma camera, SPECT, PET, hybrid systems):
    a. list and explain target image quality outcomes relevant to diagnostic effectiveness,
    b. explain in detail image quality assessment criteria and the relationship with device performance indicators,
    c. predict the effect on image quality, diagnostic accuracy, patient and occupational risk when changing scanning and image reconstruction parameters and radiopharmaceutical,
    d. explain in detail the structure of acquisition protocols, pre-processing of image data, mathematics of image reconstruction methods and post-processing of images. Describe the influence of the reconstruction method and processing parameters used in PET/SPECT (e.g. cut-off frequency, number of iterations, number of subsets, post-filtering type and parameters) on activity measurements,
    e. apply quantitative image processing techniques to increase the diagnostic value of images,
    f. explain the strengths and limitations of the imaging modality and impact on diagnostic efficacy,
    g. define patient/occupational protection related indicators/quantities suitable for ensuring adherence to safety limits and reference levels including methods for measurement or calculation,
    h. explain the physical principles underpinning the methods for the prevention of contamination, protective barriers, accessories and personal protective equipment with regard to occupational/public safety including shielding calculations (including PET systems and cyclotrons),
    i. identify possible causes of device malfunctioning, below target imaging quality and suggest appropriate action in simple situations;
13. Describe and explain in detail the structure of a radiopharmacy with particular reference to radiation protection and quality control of radiopharmaceuticals;
14. Explain in detail the structure, functioning and use of devices required within the context of patient dosimetry e.g., well counters, dose calibrators;
15. Explain the MIRD scheme and the fundamental characteristics and limitations of the formalism, and how this governs its usage;
16. Explain the fundamental limitations of dosimetry at the organ level, for instance in deriving tumour dosimetry, taking into account activity and density heterogeneities;
17. Describe how Dose-Volume-Histograms or isodose curves are calculated and what results should be provided;
18. Describe how diagnostic and therapeutic exposures are managed in the context of Nuclear Medicine, including optimization of dose through prescription of recommended administered activities and protocols;
19. Describe the process and practical implementation of radiation risk assessments in the context of Nuclear Medicine arising from both external and internal sources of exposure;
20. Describe the key considerations when designing a new facility to optimise radiation safety of workers and the public including radionuclide therapy facilities, radiopharmaceutical production and radioisotope cyclotron facilities;
21. Describe the requirements for regulatory compliance with respect to the management and use of sealed and unsealed radiation sources including security considerations, requirements for storage, shielding, record-keeping, disposal, transportation and audit;
22. Explain the nature and sources of internal and external radiation exposure and the relevant dose limits in Nuclear Medicine for the worker, including extremity doses and dose limits for pregnant and lactating workers, and young workers, and the public, and dose constraints for comforters and carers.

2. Skills
By the end of the study-unit the student will be able to:
(demonstration and/or detailed description/discussion)

1. Operate at a basic level selected medical devices used in Nuclear Medicine as appropriate to the role of a medical physicist and adjust equipment settings (e.g., choice of energy windows, collimators, scan duration, counting statistics) for optimum activity results;
2. Use selected methods for quality assurance/control of medical devices in diagnostic Nuclear Medicine, and prepare a plan for acceptance testing and commissioning;
3. Use Information and Communication Technologies (ICT) standards and infrastructures applied in Nuclear Medicine;
4. Apply quantitatively and in a detailed manner the concepts of justification, optimization and dose limitation with respect to patient / occupational-public protection from external radiation and internal contamination in Nuclear Medicine;
5. Use selected quantitative methods of patient and personal dosimetry and workplace / individual / environmental monitoring in Nuclear Medicine and for the establishment of recommended activities and dose constraints;
6. Optimize quantitatively patient /occupational physical agent protection in high risk practices in Nuclear Medicine;
7. Design arrangements for prevention of accidents and incidents, preparedness and response in emergency exposure situations and disposal of any sources/waste in Nuclear Medicine;
8. Prepare technical specifications for medical device procurement and new installation design in Nuclear Medicine;
9. Survey at a basic level Nuclear Medicine installations with regard to patient/occupational/public protection including the prevention of contamination, categorization of areas, classification of workers and any protective apparel and barriers;
10. For each imaging modality (gamma camera, SPECT, PET, hybrid systems):
    a. apply quantitative image processing techniques to increase the diagnostic value of images,
    b. identify possible causes of device malfunctioning, below target imaging quality and suggest appropriate action in simple situations,
    c. design methods for the prevention of contamination, protective barriers, accessories and personal protective equipment with regard to occupational/public safety including shielding calculations,
    d. Extract parametrical information;
11. Design optimal dosimetry protocols and calculation procedures for molecular radiotherapies;
12. Perform dosimetric calculations using the MIRD formalism;
13. Determine whole body, organ and effective doses using tools such as OLINDA.

Main Text/s and any supplementary readings:

MAIN TEXTS:

- Cherry S. R., Sorensen J. A. & Phelps M. E. Physics in Nuclear Medicine. Saunders.
- Hamilton D. I., Riley P. J. Diagnostic Nuclear Medicine: A Physics Perspective. Springer.
- Sharp P. F., Gemmell H. G., Murray A. D. Practical Nuclear Medicine. Springer.
- Hoskin P. J. Radiotherapy in practice - Radioisotope therapy. OUP.
- Martin C. J. and Sutton D.G. Practical Radiation Protection in Healthcare. OUP.
- Emerald-Emit project: http://emerald2.eu/cd/Emerald2/
- IAEA. Clinical Training of Medical Physicists Specializing in Nuclear Medicine.
- EC Directives regarding protection from ionizing radiation.
- Relevant EFOMP, IAEA, AAPM, IPEM, ICRU, ICRP, EC, UNSCEAR Documentation.
- Research articles from the literature.

SUPPLEMENTARY TEXTS:

- Knoll G. F. Radiation Detection and Measurement. Wiley.
- Del Guerra A. Ionizing Radiation Detectors for Medical Imaging. World Scientific.

 
STUDY-UNIT TYPE Lecture and Independent Study

 
METHOD OF ASSESSMENT
Assessment Component/s Assessment Due Sept. Asst Session Weighting
Open Book Examination (3 Hours) SEM2 Yes 100%

 
LECTURER/S Mario Marengo
Sam Agius
Carmel J. Caruana

 

 
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The availability of optional units may be subject to timetabling constraints.
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It should be noted that all the information in the description above applies to study-units available during the academic year 2024/5. It may be subject to change in subsequent years.

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