| CODE | MPH5022 | ||||||||
| TITLE | Medical Physics and Radiation Protection in Radiation Oncology (Major) | ||||||||
| UM LEVEL | 05 - Postgraduate Modular Diploma or Degree Course | ||||||||
| MQF LEVEL | 7 | ||||||||
| ECTS CREDITS | 10 | ||||||||
| DEPARTMENT | Medical Physics | ||||||||
| DESCRIPTION | The study-unit follows the recommended content regarding core and specialist Medical Physics and Radiation Protection in Radiation Oncology expertise to be found in the EU documents 'European Guidelines on the Medical Physics Expert' and 'Requirements and methodology for recognition of Radiation Protection Experts'. The content includes the physics and technology of all therapeutic modalities including photon (IMRT, VMAT, radiosurgery) and electron beam therapies and brachytherapy. In addition to radiotherapy dosimetry, quality control and treatment planning it includes the fundamentals of the latest technological techniques such as radiosurgery and proton therapy. This study-unit focuses on preparing candidates to fulfil their role as clinical Medical Physicists, potential Medical Physics Experts, Radiation Protection Experts and Radiation Protection Officers in RADIATION ONCOLOGY in accordance with EU directive 2013/59/Euratom. Study-unit Aims: - To prepare candidates to fulfill their role as clinical medical physicists, potential medical physics experts, radiation protection experts and radiation protection officers in Radiation Oncology; - 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 ionising radiation based RADIATION ONCOLOGY devices and regarding patient risks from ionising radiations including protection from such radiations, installation design and surveillance, and the prevention of unintended or accidental exposures. The therapeutic modalities include Photon and Electron Beam Therapies, Brachytherapy and Proton Therapy; and - To discuss the use of such modalities in the ambit of EU directive 2013/59/EURATOM. Learning Outcomes: 1. Knowledge & Understanding: By the end of the study-unit the student will be able to: - 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 Radiation Oncology; - Interpret qualitatively and quantitatively anatomical and functional 2D/3D images from the various imaging modalities and recognise specific anatomical, functional and pathological features (including image artifacts) to a level necessary to be able to contribute effectively to the work of the Radiation Oncology team; - Describe the perspectives of the patient and other healthcare professionals in the Radiation Oncology team; - Explain in detail the design and functioning of medical devices used in Radiation Oncology and the design variables which impact device performance indicators and clinical effectiveness and including: a. external beam devices: kV therapy devices, medical linacs and other systems for MV X-ray / electron beams (tomotherapy devices, robotic linacs, mobile linacs, intra-operative radiation oncology devices, cyberknife, flash therapy), gamma knife, proton therapy cyclotrons and brachytherapy afterloading systems, b. imaging devices: e.g., EPID, kV-MV CBCT, in-room CT, in-room MRI, c treatment planning system software, d. dose verification devices; - Explain in detail and quantitatively methods for quality assurance/control of medical devices in Radiation Oncology, including methods for acceptance testing and commissioning; - Explain in detail and quantitatively dose-bioeffect relationships relevant to Radiation Oncology; - Describe quantitatively and in detail the process and practical implementation of patient/occupational/public risk assessments, dose optimization and limitation in Radiation Oncology; - Discuss ethical issues related to the protection of patients and volunteers in Radiation Oncology research; - Apply European laws, regulations, recommendations, acceptance criteria and standards (including IEC standards where relevant) related to device performance and patient/occupational/ public protection in Radiation Oncology; - Describe present and envisaged future developments of medical devices and protection from associated ionising radiations in Radiation Oncology; - Explain pedagogical methods used for the training of other healthcare professionals in patient and personal protection in Radiation Oncology; - Explain in detail and quantitatively: a. the physical principles, capabilities and limitations of the different external beam irradiation techniques: 3D conformal, rotational techniques (conformal arcs, conformal dynamic arcs), non-coplanar techniques, IMRT and VMAT, b. the principles of external beam and brachytherapy treatment planning systems and dose calculation and optimization algorithms, c. the use of conventional techniques to optimize dose distributions, d. recommended European / international absorbed dose measurement protocols based on absorbed dose in water/solid phantoms for photon and electron beams (including brief description/discussion of proton and heavier ion beams), e. the various approaches to in-vivo dosimetry for Radiation Oncology beams and discuss choice of appropriate sensors, f. the calibration chain for dosimetry sensors used in Radiation Oncology, g. theoretical and practical aspects of reference dosimetry for high-energy photons, electrons and brachytherapy sources, h. recommended methods for reference air kerma (RAK) determination for brachytherapy sources, i. The calculation of systematic errors, random errors and planning target volumes, j. Understand different contoured anatomical volumes as well as tackle problems that may arise from artifacts. 2. Skills By the end of the study-unit the student will be able to: (demonstration and/or detailed description/discussion) - Operate at a basic level selected medical devices used in Radiation Oncology as appropriate to the role of a medical physicist; - Use selected methods for quality assurance/control of medical devices in Radiation Oncology (including TPS and manual/remote after-loading systems) and prepare a plan for acceptance testing and commissioning (including acquiring beam data for commissioning the TPS); - Use Information and Communication Technologies (ICT) standards and infrastructures applied in Radiation Oncology; - Apply quantitatively and in a detailed manner the concepts of justification, optimization and dose limitation with respect to patient / occupational-public protection in Radiation Oncology; - Use selected quantitative methods of patient and personal dosimetry and workplace / individual / environmental monitoring in Radiation Oncology and for the establishment of dose delivery prescriptions and dose constraints; - Optimize quantitatively patient /occupational protection in high risk practices in Radiation Oncology; - Design arrangements for prevention of accidents and incidents, preparedness and response in emergency exposure situations and disposal of any sources/waste in Radiation Oncology; - Prepare basic technical specifications for medical device procurement and new installation design in Radiation Oncology; - Survey at a basic level Radiation Oncology installations with regard to patient/occupational/public protection including the categorization of areas, classification of workers and any protective apparel and barriers; - Use a TPS for patient specific treatment plan generation and optimization and conventional techniques for creating optimized patient specific dose distributions including 3D conformal plans, IMRT plans and VMAT plans including use of adequate bolus for patient treatment and how this impacts dose in patient; - Operate selected radiation measurement devices/detectors and interpret the results; - Select the most appropriate detector for measuring absolute and relative dose distributions in different irradiation conditions for photon and for electron beams; - Use the local recommended Code of Practice for the determination of absorbed dose to water from external radiotherapy photon beams; - Perform selected dose measurements to support radiation treatment; - Perform at a basic level brachytherapy source calibration; - Perform constancy checks on ionization chambers and calibrate diode dosimeters; - Perform at a basic level in-vivo dosimetry with appropriately chosen protocols and sensors including verification of the delivered dose at single points or planes (e.g., transit dosimetry using portal imaging); - Apply International, European and National regulations for the transport, handling, storage and use of radioactive sources in Radiation Oncology; - Produce a basic plan for the design of new treatment, simulator and, sealed / unsealed source storage rooms with respect to occupational/public protection; - Use at a basic level selected immobilization (including stereotactic) devices for the immobilization of patients including standard patient set-up techniques; - Use at a basic level selected conventional and CT/CBCT simulators for patient specific planning and plan verification; - Perform different types of study-set fusions of multi-modality imaging data for target volume delineation and planning; - Perform plan optimization and evaluation using uniformity criteria, constraints, DVHs and biological parameters (TCP, NTCP); - Use classical dose distribution calculation systems for LDR (e.g., Paris and Manchester systems) and extension to HDR, PDR; - Participate at a basic level in the verification of the different steps of treatment: patient positioning, target localisation, and dosimetric verification of the irradiation plan; and - Perform independent monitor unit calculation for dosimetric verification of treatment plans. Main Text/s and any supplementary readings: Main Text: - Podgorsak E. B. (ed.). Radiation oncology physics: a handbook for teachers and students. IAEA. (freely available from the IAEA website) - P. N. McDermott and C. G.Orton. The Physics & Technology of Radiation Therapy. Medical Physics Publishing - Hoskin P. Radiotherapy in Practice - External Beam Therapy. Oxford University Press - Hoskin P. and Coyle C. Radiotherapy in Practice – Brachytherapy. Oxford University Press - Hoskin P. and Goh V. Radiotherapy in Practice - Imaging. Oxford University Press - Martin C. J. and Sutton D. G. Practical Radiation Protection in Healthcare. Oxford University Press - Clinical Training of Medical Physicists Specializing in Radiation Oncology. IAEA - S. Tabakov, F. Milano, P. Sprawls (Eds). Encyclopaedia of Medical Physics. CRC Press - Relevant EU, ESTRO, EFOMP, IAEA, AAPM, IPEM, ICRU, ICRP, UNSCEAR documentation. Medical Physics project: http://emerald2.eu/cd/Emerald2/ Supplementary Reading: - Webb S. The physics of 3-dimensional radiation therapy. IoP Publishing - Khan F. M. Treatment Planning in Radiation Oncology. Lippincott, Williams & Wilkins - Baltas D., Sakelliou L. and Zamboglou N. The Physics of High Dose Rate Brachytherapy. CRC Press - P. Dvorak. Clinical Radiotherapy Physics with MATLAB: A Problem-Solving Approach. CRC Press. |
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| STUDY-UNIT TYPE | Lecture and Independent Study | ||||||||
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| LECTURER/S | Miguel Micallef Paul Bezzina Carmel J. Caruana (Co-ord.) Jessica Farrugia Martin Pirotta Chantelle Said Dwayne Vella |
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The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints. Units not attracting a sufficient number of registrations may be withdrawn without notice. 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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