This report details curricular recommendations for graduate degrees in medical physics and serves as an update to Report No. 197. In this section, we review the history of American Association of Physicists in Medicine (AAPM) curricular recommendations, present the aims of this report, and detail how these recommendations should be interpreted.
The first AAPM publication on curricular recommendations for graduate education in medical physics was AAPM Report No. 44, published in 1993, describing the recommendations for the Master of Science Degree in Medical Physics.1 AAPM Report No. 79 was published in 2002 and established a core curriculum for all graduate training in medical physics, as well as more specific education and training associated with the individual subspecialties in medical physics.2 In 2009, Report No. 79 was updated and published as AAPM Report No. 197, and in 2011, AAPM Report No. 197S was published on the essential didactic elements for alternative pathway entrants into the clinical medical physics profession.3,4 Report No. 197S defined the curriculum for a postdoctoral certificate program in medical physics, the first of which was accredited by Commission on Accreditation of Medical Physics Education Programs (CAMPEP) in 2011. The AAPM Working Group on the Revision of Report No. 44 was initially created with the charge of periodically reviewing and updating the recommended curriculum for medical physics graduate education programs. In 2012, the AAPM renamed this as the Working Group on Medical Physics Graduate Education Program Curriculum (WGMPGEPC). The WGMPGEPC was further charged to ensure that the graduate education curriculum reflects current needs of clinical practice and provides a broad foundation upon which to base future innovations. The profession of medical physics has undergone substantial growth and change over the years since the publication of Report No. 197 in 2009, and the WGMPGEPC has updated the curricular recommendations to reflect these changes and prepare the profession for the future.
There exists a common core of similar coursework across all programs accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP), yet each program has the latitude to adapt its curriculum to best leverage the strengths and resources of its faculty and host institution. The number of CAMPEP-accredited graduate programs has more than doubled since the publication of Report No. 197, increasing from 24 in 2009 to over 50 in 2021. A common goal of the AAPM curriculum recommendations is to ensure that the core curriculum meets the current and anticipated future needs of the medical physics profession. The curriculum recommendations in this report support these aims in three ways. They provide guidance to graduate programs in medical physics regarding the topics that should be covered in their curricula. They provide guidance to instructors regarding the breadth of coverage of relevant topics. Finally, they provide a basis for developing standards for graduate medical physics education. The curriculum provides substantial detail within the topics provided for each section. This is primarily to assist graduate programs and course instructors, and it is not our intention to recommend that any accrediting or supervisory body would expect that a program would cover every item explicitly mentioned in the curriculum. A bibliography of suggested resources, categorized by topical area, is included, and entries are duplicated, as appropriate, when relevant to multiple topical areas.
There is a considerable degree of intellectual diversity of students entering graduate programs, including previous degree(s) earned, courses taken, and topics previously learned. The recommendations on graduate medical physics curricula in this report are designed to apply to all students. However, individual programs should determine whether to give credit to incoming students with previous course work that fulfills didactic medical physics training requirements (e.g., previous study of anatomy and physiology).
One major change since the publication of Report No. 197 is the requirement to complete an accredited residency training program to gain knowledge and skills needed to practice independently as a qualified medical physicist and to acquire professional board certification. The residency increases the amount of practical clinical training by at least 2 years, yet there remains a substantial benefit to providing practical learning experiences during graduate education. Benefits of this include baseline learning for all students (including those who pursue nonclinical careers, e.g., in industry and government), reinforcement of didactic learning, enhanced preparedness for clinical research, and preparedness to enter residency training. It is important for programs to design curricula to strike an appropriate balance between theoretical coursework and practical experiences. Graduate programs should provide ample opportunities for practical, hands-on experiential learning in the clinical and laboratory environments. The practical learning experiences appropriate to graduate education are narrower in scope, more selective in topics, and more limited in time when compared with those of a residency program. Although many practical clinical topics are explicitly mentioned in this curriculum, it is left to the individual program to determine the breadth and depth of coverage.
The graduate certificate program remains an important part of the medical physics training infrastructure as the didactic medical physics preparation for alternative pathway entrants into medical physics practice. AAPM Report No. 197S defined the essential elements of this didactic preparation. As Report No. 365 supersedes Report No. 197, it also provides guidance to supersede the supplemental Report No. 197S. The topics defined here as Sections 2.1.1–2.1.10 represent the core elements identified during the development of this report. Topics in Sections 2.1.1–2.1.6 match those identified as essential didactic elements in Report No. 197S; however, their content has been updated. Topics in Sections 2.1.7–2.1.9 (“mathematical and statistical methods”, “computational methods and medical informatics”, and “research methods”) are the ones that may have been covered in the prior training of individuals entering the profession through the alternative pathway. Situations requiring remediation may or may not require the completion of full courses. This leaves topic in Section 2.1.10, “professionalism (leadership, ethics, communication),” as the notable addition to the recommendations of Report No. 197S. Report No. 197S recommended a curriculum, including a minimum of 18 credit hours of didactic coursework. Report No. 365 recommends the minimum curricular recommendations from Report No. 197S plus the delivery of training in professionalism. This may increase the credit hour requirements for programs that deliver this training within a formal didactic course. The AAPM recently commissioned a task group on Alternative Pathway Candidate Education and Training (TG-298) to provide updated recommendations for the alternative pathway.5 Although Report No. 365 aims to provide overarching curricular recommendations for all graduate education programs in medical physics, TG-298 aims to provide recommendations on the education and training of alternative pathway entrants into the medical physics profession. One important recommendation from TG-298 is that programs provide clinical experience and exposure to the application of the didactic material. This recommendation provides support for the emphasis of practical clinical training within graduate education programs. A related recommendation by TG-298 is that online delivery of curricular material should be carefully evaluated to assure that it does not limit the student's exposure to experiential, clinical aspects of medical physics. Lastly, TG-298 recommends that programs include ethics and professionalism as a component of their core curriculum. We have included those components in the recommendations in this report.
The first professional doctorate degree in medical physics (DMP) was created in 2009 and accredited by CAMPEP in 2010. The DMP includes the same core curricular elements as the MS and PhD in medical physics and therefore does not warrant substantial changes in the curricular recommendations for graduate medical physics education. The DMP does provide additional opportunities and incentives for the inclusion of elective coursework that may be valuable for clinical practice, such as business and management coursework. These additional courses and others may also be valuable for students not intending to pursue clinical careers. Finally, DMP curricula must include clinical training of sufficient depth and breadth to prepare the student to become a qualified medical physicist. This training is the purview of other reports such as AAPM Report No. 2496 and Report No. 3737 and is not within the scope of this report.
An aim of the recommendations on graduate curricula presented in this report is to identify the salient topical areas of medical physics graduate education required to prepare trainees for current and future practice in this profession. As such, current technology, techniques, and methodology are often explicitly identified. It is, however, often instructive for trainees to understand historical aspects of medical physics technology and practice in order to understand the evolution of our practice and help guide its future. Such historical context is not always explicitly mentioned within this curriculum. However, it is assumed to be incorporated within medical physics graduate education where useful for the benefit of our trainees.
Similarly, another aim of this report is to prepare students and programs to adapt to future changes in the scope and nature of medical physics applications. This report represents a snapshot of current education and training requirements; however, we must also equip students with the education and skills necessary to contribute to, and be leaders of, future advances in medicine. Future contributions of physicists to medicine are often driven by understanding and training outside of traditional core topics. As such, training in nontraditional areas facilitates potential future contributions to science and medicine in general, and this emphasis has been explicitly incorporated into this curriculum. We should aspire to train our students to be multidisciplinary experts who are leaders in the science of medicine, who ensure the highest quality care and safety, and who initiate and create changes that enhance patient care. Incorporating these aspects and others that will arise in the future requires an increase in the breadth of education and training in medical physics. Programs should minimally strive to provide familiarity in these nontraditional areas, as it would be impossible to provide mastery in them all. Instilling critical thinking and lifelong learning skills will allow medical physicists to continue to enhance their ability to contribute to the science of medicine. Many nontraditional topics as well as applications of didactic material may be provided within seminar and/or practical application courses. Graduate programs are not expected to develop specific expertise in all of these areas, but outside lecturers and material developed by other departments and/or programs may be leveraged to fill these gaps.
The recognition that graduates from medical physics graduate programs may choose to enter nonclinical careers has encouraged the creation and promotion of didactic elements of graduate education aimed at best preparing those who enter nonclinical careers. The AAPM created the Working Group to Promote Non-Clinical Career Paths for Medical Physicists in 2016, and the Working Group for Non-Clinical Professionals in 2018. In order to address the educational needs of some nonclinical careers, in particular industrial career paths, we have included education and training in “Industry and Regulatory” as a component of the curricular recommendations in this report. It should be emphasized, however, that these training elements would also benefit those medical physicists that choose clinical career paths, as many of the challenges (e.g., interaction with industry, good business practices) are areas of essential strength of clinical medical physicists as well.
The provision of training in research is an important element in preparing for the future of our profession. Indeed, the AAPM description of the role of the medical physicist states that “medical physicists play a vital and often leading role on the medical research team.” This includes both basic and clinical research and the problem-solving skills of the medical physicist. As such, we must provide the medical physics student with more than knowledge. We must provide the understanding that allows them to think beyond the present, to do more than just prescriptive problem-solving, and to innovate and solve previously unsolved problems. Additionally, medical physicists have not been sufficiently integrated into clinical trials research in the past, particularly in leadership roles, which has often negatively impacted the quality of clinical research. Specific recommendations for such training are provided in this report that addresses particular areas of research training. In addition, every effort should be made to foster critical thinking skills throughout the education and training of future entrants into our profession, as this is a distinguishing feature of a medical physicist and one that makes us valuable to the medical profession.
Finally, this report is primarily intended to provide recommendations on what to teach rather than how to teach it. The recommended depth of understanding for each topic is not specifically prescribed here, and it is left to the individual program to determine, for each recommended topic, whether mere familiarity is sufficient or whether deep understanding and mastery of a topic is warranted. The application of Bloom's taxonomy or other models to classify educational learning objectives is helpful in determining specific goals for competence.8 We also do not recommend specific courses but rather curricular content presented within topical areas. As there can be significant overlap between topical areas, we have attempted to simplify the report by assigning particular curricular elements to only one topical area and referencing them to that area from others in which they may be relevant. Finally, we make no recommendations on pedagogical aspects of graduate education, including how or when material is provided. Discussion of the merits or application of online coursework, flipped classrooms, or other aspects related to the cognitive science involved in developing and delivering education is not included here.
Section 2 provides a description for each of the sections within the report, whereas Section 3 provides detailed curricular recommendations where applicable. Sections 2.1 and 3.1 provide recommended core topics, whereas Sections 2.2 and 3.2 provide additional (optional) topics. Sections 2.3–2.7 and 3.3–3.7 represent professional specializations (diagnostic imaging, nuclear medicine, radiation therapy [RT], medical health physics, and industry). These respective sections provide curricular recommendations for students specializing in each of these professional practice areas. These areas are denoted as optional and some programs do not provide an option for specialization.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
TOPICAL DISCUSSION Core topics Radiological physics and dosimetryAn understanding of the structure of matter and the manner in which ionizing radiation interacts with it is critical to the application of radiation to imaging, nuclear medicine (NM), RT, and health physics. This material builds off concepts of modern physics and is recommended within an introductory course to serve as a foundation for many of the other sections contained within this curriculum. The primary learning objectives include an understanding of individual interaction mechanisms, including both the physics involved in describing the probability for each interaction and the way in which energy is dissipated in the interaction. The student should be able to apply these concepts to all particles of interest, including uncharged particles (photons and neutrons) and charged particles (electrons, protons, alpha particles, etc.) with the ability to analyze differences between the mechanisms involved in charged and uncharged particle interactions. The physics and mathematics of radioactive decay should be understood along with all decay mechanisms. A broad understanding of the measurement of radiation, specifically including the measurement of absorbed dose, should be attained, including radiation dosimetry concepts, techniques, and equipment. This should include concepts such as radiation equilibria, cavity theory, microdosimetry, and all quantities and relationships involved. Finally, the student should be familiar with the various types of radiation dosimetry equipment, along with their mechanisms of operation and limitations.
Radiation protection and radiation safetyRadiation protection and safety pervades the various subspecialties of medical physics. Although technologies will change, having a fundamental understanding of how radiation works and how to protect oneself and others are crucial principles to the medical physics profession. A comprehensive study of radiation protection and safety could be structured by providing the answers to these major questions: Why does radiation need to be managed? What can you do to manage radiation exposure? How can you detect radiation? How much exposure can you safely receive? For whom is this important? How can you develop a safety culture? By posing these questions, a broad spectrum of topics can be discussed, including fundamental physics interactions, biological effects of radiation, and basic principles of radiation protection. Special attention is given to protection and safety of the radiation worker, patients, the public, and the environment. It is important to consider the present regulatory environment and the interactions with the recommendations from multiple organizations outside of the AAPM. Complementary tutorial instruction could include a sequence of laboratory experiences focusing upon radiation detection instrumentation, shielding methodology, and clinical applications for radiation protection and safety. The emphasis in this topic is to provide a broad knowledge base of radiation safety and protection supportive of the varied environments of medical physics practice.
Fundamentals of imaging in medicineMedical imaging is a foundational component of medical physics and has been developed and advanced over decades to become a cornerstone of healthcare. Because of the ubiquitous use of imaging, all medical physicists need a working knowledge of key imaging physics concepts. The core competencies presented in this section include concepts of image processing, image display and image quality; image reconstruction from projections; and the key hardware, software, and operational details of each imaging modality. These modalities are projection X-ray imaging (radiography, mammography, and fluoroscopy), volumetric X-ray imaging (computed tomography [CT], cone-beam CT, and tomosynthesis), nuclear imaging (scintigraphy, single-photon emission CT, and positron emission tomography [PET]), ultrasound imaging (echo 2D and 3D imaging, and Doppler imaging), and magnetic resonance imaging (MRI). The details listed for each core competency indicate the minimum depth of coverage. The core competencies presented in this section can be supplemented by application-specific knowledge about targeted use of imaging technologies, whether for imaging or therapeutic applications.
Fundamentals of radiation therapy physicsRT is a foundational component of medical physics, with 2/3 of all cancer patients receiving RT and numerous applications for RT for nonmalignant conditions. Medical physicists in all disciplines should have basic familiarity with the clinical, technological, and radiobiological concepts involved in RT. The significant overlap of imaging and NM with RT and the associated potential for collaborative work across these specialties underscores the need for cross-disciplinary training. The core elements of RT are presented here, including clinical and radiobiological principles, equipment and technology used for RT, specific treatment techniques and principles of radiation protection and quality management. The information presented here should ideally be supplemented by practical exposure to these technologies and techniques in the clinical environment.
RadiobiologyAll subspecialties of medical physics require an understanding of the biological effects of radiation. Specifically, radiobiological principles comprise foundational knowledge in underpinning theories of radiation protection, RT, radiation imaging of humans, and NM. Radiobiology provides the basic connection between microscopic and molecular interactions of radiation with cellular and tissue responses. This material provides a solid biological and physiological background for understanding the effects of radiation on human tissues and cancers and the resulting safety policies and therapy regimens. These topics should be presented in a cohesive and consistent manner, not distributed among subspecialty applications such as RT physics, imaging physics, radiation protection and safety, and NM.
Anatomy and physiologyAnatomy and physiology underpin the entirety of medical physics. Familiarity with normal anatomy is fundamental to radiotherapy treatment planning and medical imaging optimization. Cancer biology must also be understood at a basic level, as it drives many aspects of RT and medical imaging. Key linking concepts can be covered where they exist, such as cardiotoxicity from radiotherapy and the link between normal glucose metabolism and PET imaging. An organ system approach is logical for presenting the content in this section, with particular emphasis on normal imaging appearance, common imaging tasks related to pathology, and disease sites related to radiotherapy.
Mathematical and statistical methodsCompetency in mathematical methods is foundational to the understanding of medical imaging, radiological physics, and dosimetry. Incoming graduate students should have a strong background in mathematics demonstrated by their undergraduate or graduate coursework. Medical physics graduate training should enhance the understanding of mathematical techniques as they relate to medical imaging, computational science, and optimization. Graduate training should also provide a foundation in statistical methods as it relates to experimental design and analysis.
Computational methods and medical informaticsIt is becoming increasingly important that medical physicists possess a working knowledge of computational methods and informatics. Graduate curricula should include the basics of programming and machine learning as they relate to the many potential applications in medical physics. They should also include informatics as it relates to medical image storage and transfer. These skills could be developed through opportunities to practice implementation such as class projects, assignments, and research.
Research methodsStudents should be exposed to and participate in research and be familiar with research methods, ethics, and scientific communication, which includes academic writing, reviewing, and presentation. In addition, protocol and grant writing, clinical translation/implementation, literature search and reading, and laboratory management are important skills with which students should become familiar. As the experience a student gains from their research endeavors will vary depending on individual advisors and projects, programs should consider how to ensure the consistency of development of research skills across all students. The delivery of a seminar series, such as journal clubs or presentations from students, faculty, and invited speakers is one useful mechanism for the development of research skills. Although all formats should expose students to a breadth of current research topics, different formats inevitably emphasize different skills such as literature review, communication and scientific presentation skills, and others. Programs should keep this in mind when designing the seminar format to give students the opportunity to develop all of these skills. Programs that do not require a thesis project or a seminar series should consider how their students will develop the skills traditionally associated with such offerings. Alternatives practiced by some programs include class projects, laboratory sections, “special topics” courses focused on current literature and research, and student attendance at scientific conferences. Finally, exposure to areas such as clinical trials, grant/protocol writing, laboratory management, and clinical translation/implementation may be best acquired via a faculty advisor/mentor and is perhaps more suitable in a PhD program. As the certificate program pathway is open only to individuals holding a PhD degree, it is anticipated that these research requirements would have been fulfilled prior to entry into the certificate program.
Professionalism (leadership, ethics, and communication)The medical physicist will be routinely involved in interactions with professional colleagues, collaborating clinicians, trainees, patients, research subjects, administrators, and/or support staff, to name just a few. In all such interactions, a number of critical skills must be applied. First and foremost, the medical physicist must understand the ethical obligations and responsibilities of this role. As many medical physicists will be involved in leadership and management within the hospital and university setting, as well as serving as the de facto leader of the technical, quality, and safety aspects of a clinical department, the development of leadership skills is very important. These skills allow the medical physicist to have an appropriate and sufficient influence within these areas, for example, to influence the safety culture of a clinical department. Good communication skills are critical for leadership as well as for patient and clinician interactions. Such skills not only enhance leadership capabilities but also efficiency and accuracy in clinical collaboration as well as facilitating the most effective patient care.
Additional topics (optional) Biology/oncology/medicineRadiation biology and anatomy and physiology are essential for medical physics competency. However, additional training in biology subfields can provide further competency both for research and in clinical practice, enhancing the ability of medical physicists to contribute to medical science and practice in general. Some example areas include biochemistry and biomolecules, cardiology, computational biology, epidemiology, genomics, immunology, neurobiology, oncology, pathology, and clinical pharmacology. Although it would be impossible to include all of these topics within a graduate program in medical physics, familiarity with these topics, along with preparation in health science terminology, helps medical physicists better communicate with clinicians and other research scientists and contribute more integrally to clinical and research efforts. This additional training further facilitates the identification and exploration of nontraditional applications of medical physics and thus expands our contribution to medicine.
Advanced physics, engineering, and computer scienceElective coursework provides students with the opportunity to broaden their understanding of related fields or deepen their knowledge of medical physics specialties. Advanced physics disciplines of interest to the medical physicist may include nuclear physics, electricity and magnetism, optics, and solid state physics. Engineering coursework can be found in the biomedical, nuclear, electrical and computer engineering disciplines. Computer science electives should focus on topics to prepare medical physicists to be effective collaborators within the scientific community. Example coursework may cover statistical software packages, team programming practices, including version control and best practices for readability, and artificial intelligence.
Frontiers in medical physics and opportunities outside of medical physicsFrontiers in medical physics represent areas in which physics has begun to contribute to the improvement of medical care and/or has the potential to further improve human health. In RT, examples include FLASH, RT for non-cancer treatments (e.g., cardiac ablation), radiomics, interplay with other therapies (e.g., immunotherapy, photodynamic therapy [PDT]). In imaging, examples include radiomics and theranostics, interferometry imaging, biophotonics, magnetoencephalography, and alternative (monochromatic) X-ray sources. In NM, examples include novel radiotracer development for radiomics and theranostics. Additional opportunities outside medical physics represent areas outside the current landscape of medical physics practice. Areas for potential involvement include surgery (image guidance), pathology (image display, automation), ophthalmology (optical modeling), dentistry (3D modeling), orthopedics (motion analysis), cardiology (electrophysiology), neuroscience, and psychology. There is no expectation that any particular program cover these materials, rather this functions as a survey of potential topics. Incorporation of these topics in a specific program should reflect that program's strengths and research.
Business applications in medical physicsMedical physics as a profession has multiple facets that often interact and overlap with business principles in a wide range of areas. Although it is not necessary to have an intricate knowledge of business aspects, it is important to be able to effectively communicate in these areas. As with all roles, the effectiveness of the function of medical physics is based on sound business decisions being made. A medical physicist may find use for these skills working in a clinic, working for a vendor, or working in a physics consulting company. In addition, any medical physicist functioning in a leadership role will eventually require business skills. A medical physicist's role will ultimately determine the level of knowledge that is required, whether it be large commercial operations or a single consultant. As such, the skills below are a broad cross section of areas that will provide a foundation for this knowledge, and the topics are intended as a baseline dependent on the demands of the individual's situation. Many of these business skills are strongly correlated with, and can be considered simply another facet of, skills outlined in other sections of this curriculum.
Teaching for medical physicistsEffective teaching is an increasingly important skill for all medical physicists. Indeed, medical physicists are often asked to teach within medical physics, RT technology, dosimetry, and residency programs and to provide training in-services for other clinicians. As such, it is valuable for medical physicists to have an understanding of adult learning theory and the different educational pedagogies that may be used. As teachers tend to teach in the manner in which they were taught, the most effective way to teach students about different methodologies along with the potential advantages and disadvantages of different pedagogies is not to lecture about them, but rather to have students experience those pedagogies firsthand in the classroom. Physics Education Research has clearly shown that didactic lecture, while being the most efficient for the lecturer, is likely the least effective method of teaching for the majority of physics students. The more active and hands-on the pedagogy, the more engaging and effective the time spent in class. However, it has also been shown that alternate pedagogies can sometimes take significantly more time to cover the same amount of material as a traditional didactic lecture. This means that there is still value in a well-prepared and well-delivered lecture. The topics listed here provide methods designed to create the most effective learning environment for the student.
Diagnostic imaging specialization (optional)Medical imaging is a foundational component of medical physics. Every medical physicist must master core competencies, including the principles of image formation, imaging hardware and software, and the optimization and constraining of the imaging process. However, those physicists specializing in diagnostic imaging (DI) require additional depth in imaging physics theory and practical applications. The topical outline here replicates and extends the outline provided in fundamentals of imaging. This enhanced knowledge includes the principal concepts for each DI modality: projection X-ray imaging (radiography, mammography, and fluoroscopy), volumetric X-ray imaging (CT, cone-beam CT, and tomosynthesis), ultrasound imaging (echo and transmission 2D, 3D, and Doppler imaging), MRI (MRI methods and spectroscopy), and information technology (picture archive and communication system [PACS], displays, EMR, and safety and quality monitoring). The nuclear imaging specialization (planar, single-photon emission CT, and PET) is described in a separate section, although there is substantial overlap in many topics. The training of a DI physicist must also incorporate experiential knowledge gained through hands-on practical activities, as they pertain to optimal use of imaging technologies in the clinic, including quality assurance (QA), applications, and processes to customize a procedure to the patient. The clinical priority is to enable and ensure optimized, reliable, quantitative, and safe use of the imaging technologies.
Nuclear medicine specialization (optional)The work of NM physicists spans radionuclide production, radiation protection, scanner operation (including calibration, maintenance, and QC), image reconstruction, and image analysis (including tracer kinetic modeling) and creating new hardware and algorithms for NM applications. Although most physicists’ jobs do not entail all of these components, it is important that basic NM physics education be broad because of both the different job opportunities that exist and their fundamental interrelatedness. NM inherently draws on the related contributions of physicists, chemists, pharmacists, physicians, technologists, and others. Some familiarity with the other professionals’ disciplines can be beneficial for the physicist as part of the interdisciplinary team and essential for understanding NM in general. NM physics education should cover the principles, devices, and algorithms used in the field. A broad background provided in medical physics core topics is essential. It is widely regarded that therapeutic applications of NM will continue to increase and that more patient-specific dosimetry, specifically based on imaging/therapeutic compound pairs, will be warranted, providing a good opportunity for broadly trained NM physicists. Much NM physics (especially that related to the imaging devices) is performed by physicists practicing in DI. From an educational perspective, a physicist broadly engaged in NM, whether as a DI physicist or as a dedicated NM physicist (or even as an RT physicist), should have the in-depth NM didactic background recommended in this section.
Radiation therapy specialization (optional)RT is a foundational component of medical physics. As such, medical physicists in all disciplines should have basic familiarity with the clinical, technological, and radiobiological concepts involved in RT. This section provides both the historical background and fundamental bases for the therapeutic use of ionizing radiation, along with a detailed description of the equipment and techniques used in modern RT, including all aspects necessary for clinical practice in radiation oncology. The wide variety of radiation sources, the technology associated with production and delivery of this radiation, and the clinical characteristics and utility of the various modalities used for RT are presented. The information presented here should be supplemented by practical exposure to these technologies and techniques in the clinical environment.
Medical health physics specialization (optional)Health physics is a distinct profession with its own training programs, curricula, and professional society (Health Physics Society). Health physics contains subtopics, however, that are germane to medical physicists. Content from radiation physics, detection, and dosimetry; radiation protection and safety; and radiation biology is especially fundamental to many medical health physics topics. Although that content is fundamental, medical health physics students will need the greater depth covered here.
Industry specialization (optional)Roles in industry and regulatory agencies require a diverse set of skills and knowledge to be able to effectively collaborate with team members with backgrounds that may differ substantially from those in a clinical environment. This sector of potential employment is critical in translating research/academic concepts to a product that can be put into clinical use. Often there is some mystery surrounding roles in this sector due to the variety of opportunities. Additionally, some of the topics suggested may be unfamiliar to candidates who have specialized in science. It is suggested that knowledge levels in these areas are attained to the understanding level of Bloom's taxonomy as an introduction to industry. The proposed topic lists are not exclusive nor comprehensive, and the content within these topics will differ over time as the landscape in this field changes rapidly. In addition, it should be noted that some subject areas are US specific; however, they could be adapted for other countries. It is, however, strongly recommended that any candidate who is considering a role in this sector gain awareness in each of these topics. With that said, it is also important to note that there is extensive detail within each of these topics, some having their own full degree programs associated with them. The goal should always be to have enough peripheral knowledge to conduct daily workplace operations unassisted and understand when it is necessary to reach out to experts in the respective topic.
TOPICAL OUTLINE Core topics Radiological physics and dosimetryReview of atomic and nuclear structure
Atomic structure, electron shells, electron shell filling, electron binding energy, electron excitation, and models of the atom
Nuclear structure, nucleons, nucleon binding energy, nuclear excitation, nuclear stability, and models of the nucleus
Unstable structures, line of nuclear stability, radioactive decay and de-excitation
Classification of radiations
Basic physical quantities and units used in radiation physics
Types and sources of directly and indirectly ionizing radiations
Description of ionizing radiation fields
Quantities and units used for describing radiation fields
Radiant and rest-mass energies
Fluence and fluence rate
Energy fluence and energy fluence rate
Monoenergetic and polyenergetic spectra
Quantities and units used for describing the interaction of ionizing radiation with matter
Interaction cross sections
Microscopic and macroscopic cross sections and their relationships
Kerma, collisional kerma, radiative kerma, and converted energy per unit mass
Absorbed dose
Exposure/air kerma
Relationships between exposure, kerma, and absorbed dose
Equivalent dose, quality factor, and radiation weighting factor
Indirectly ionizing radiations
X-ray transitions, characteristic radiation, ionization versus excitation of atoms
Radiation from accelerated charge, production of bremsstrahlung, and Larmor relationship
X-ray targets, bremsstrahlung yield
Photon beam quality and filtering
Energy deposition in matter by photon beams
Neutron sources and spectra
Neutron beam energy regimes
Interaction of indirectly ionizing radiation beams
Simple exponential attenuation
Half-value layer, 10th-value layer, attenuation coefficients, and interaction cross sections
Narrow versus broad beam attenuation and geometry
Buildup factor
Spectral effects in attenuation, beam hardening, and softening
Reciprocity theorem
Energy transfer coefficient, energy absorption coefficient
Photon interactions with matter
Thomson scattering/Rayleigh scattering
Photoelectric effect
Compton scattering
Pair production and triplet production
Photonuclear reactions
Relative predominance of individual effects as a function of energy and atomic number
Contributions of individual effects to the attenuation coefficient, energy transfer, coefficient, and energy absorption coefficient
Neutron interactions with matter
Neutron interactions, including scatter, absorption kinematics, and cross sections
Shielding consideration for neutrons
Neutron kerma and absorbed dose calculations in different media
Gamma-neutron mixed field dosimetry
Neutron quality factor and radiation weighting factor
Charged-particle interactions with matter
Stopping power (collisional and radiative), scattering power
Stopping power (electronic and nuclear)
Restricted stopping power, linear energy transfer (LET)
Continuous slowing down approximation and straight-ahead approximation
Pathlength, range, projected range, energy, and range straggling
Charged particle transport (water-equivalent thickness)
Energy distribution of charged particles (e.g., electrons and protons)
Calculation of absorbed dose from charged particles
Types of charged particle beams used clinically
Radioactive decay
Total and partial decay constants
Units of activity
Mean- and half-life
Radioactive disintegration processes
Fluorescence yield, Auger effect
Parent–daughter relationships
Transient and secular equilibrium
Harvesting of daughter products
Radioactivation by nuclear interactions
Exposure rate constant and air-kerma rate constant
Charged particle and radiation equilibria
Radiation equilibrium, “buildup”
Charged-particle equilibrium (CPE), transient CPE, and conditions causing CPE failure
Relationships between absorbed dose, kerma, and exposure under CPE
Radiation detection and dosimetry
Principles of radiation detection/radiation detection mechanisms
Types and general characteristics of detectors and dosimeters
ICRU (International Commission on Radiation Units and Measurements) definitions of dosimetry quantities and units
Absolute versus relative dosimetry techniques
Interpretation of dosimeter measurements
Uncertainties and uncertainty budgets
Primary and secondary calibration standards and the chains of calibrations
Cavity theory
Bragg-Gray cavity theory and corollaries
Spencer–Attix and Burlin cavity theories, Fano's theorem
Applications and limitations of cavity theory
Calculation of the mean stopping power using the method of moments of the energy loss distributions
Dose near interfaces
Ionization chambers
Basic characteristics of ionization chambers
Standard free air ionization chamber
Cavity (thimble) ionization chamber
Plane parallel chamber/extrapolation chamber
Ion chamber survey meters
Measurement of chamber current (differential mode) and charge (integral mode) and operation of electrometer
Mean energy required to create an ion pair
Saturation characteristics of ionization chambers: initial and general recombination
Correction factors applied to ionization chamber measurement (e.g., following the nomenclature and terminology of International Atomic Energy Agency [IAEA] TRS 398)
Calibration of radiation beams with ionization chambers
Cavity chamber calibration: air-kerma in air and dose in water
Dosimetry protocols (e.g., AAPM TG-51; IAEA TRS-398)
Phantom materials for photon, proton, electron, and neutron beams
Radiation detectors and measurement techniques (principles of operation, detector geometry and response, calibration, and corrections)
Gas ionization detectors (ionization chamber, proportional counter, and Geiger-Müller [GM] counter)
Scintillators and photosensors
Semiconductors
Film (radiographic film and radiochromic film and their use for relative and absolute dosimetry)
Thermoluminescent dosimeters, including excitation and de-excitation of crystalline solids
Optically stimulated luminescence dosimeters
Calorimeters
Chemical (Fricke) dosimeters
Neutron detectors/gamma–neutron mixed field dosimeters
Miscellaneous detectors, for example, MOSFET (metal oxide semiconductors—field effect transistor), diamond detectors, three-dimensional gels
Microdosimetry
Lineal energy, specific energy
Experimental microdosimetry and microdosimetric spectra
Relationship between LET and relative biological effectiveness (RBE)
Management of radiation risk
Rationale for the management of radiation risk
Examples of management strategies for radiation risk
Examples of past radiation incidents and events
Biological effects of radiation
Observed radiation injury
Non-stochastic and stochastic responses
Biological experimental data base of radiation injury
Biological Effects of Ionizing Radiation Reports
UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) Reports
Fetal dose
Biological effects of nonionizing radiation
Principles of radiation safety and radiation protection practices
As low as reasonably achievable
Time, distance, and shielding
Handling of radioactive sources and materials
Radioactive source management and security
Additional practical applications of radiation safety principles
Protective apparel/PPE
Materials used for protective apparel (lead vs. composite)
Ancillary equipment (e.g., shields, glasses, and gloves)
Effectiveness and implementation of monitoring of personnel
Shielding design principles
Directly and indirectly ionizing radiation
Primary particle shielding
Secondary–tertiary particle shielding
Dependence of shielding design on energy and particle type
Buildup parameterization/Archer equation
Modeling radiation environment
Interlocks and access control
NCRP (National Council on Radiation Protection and Measurements) shielding recommendations and techniques
Shielding for types of facilities
Diagnostic facilities
NM
Linac vaults
Brachytherapy suites
Proton/heavy ion accelerators
Applications of radiation detection for radiation safety
Detection techniques and instrumentation for radiation safety (including well counter, dose calibrator, liquid scintillation counter)
Appropriate selection of radiation detection/measurement technique
Radionuclide identification techniques and equipment
Statistics of radiation detection
Statistical interpretation of instrument response
Stochastic and non-stochastic error analysis
Minimum detectable activity
Propagation of errors
Quantifying radiation
Units, kerma and absorbed dose, and dose equivalent
Operational dosimetry
Recommendations of the national and international organizations
Quality factors
Radiation monitoring of personnel
Detection devices and techniques for personnel monitoring
Integral and active devices
Dynamic range and response sensitivities
Occupational limits for personnel and public
Effective dose-equivalent calculations for personnel using protective apparel (EDE1 and EDE2)
Pregnant workers and fetal dose limits
Internal exposure
National and international organization recommendations
Medical internal radiation dose (MIRD) dosimetry
Monitoring and radiation control (including biological assay and dispersion in a working environment)
Allowed limit of intake and derived air (or water) concentrations
Regulations and Recommendations for Radiation Protection and Safety
Definitions of radiation safety regulations versus recommendations
National and International Recommendations and Regulations (10CFR19-70; 49USDOT300-399, 198; 219SFDA 278; 290SHA; 42USPHS; 40USEPA)
Transportation of radioactive materials (RAMs) (labeling and transportation index)
Environmental dispersion and waste disposal
Regulatory oversight (US Nuclear Regulatory Commission [NRC] vs. Agreement States)
Recommendations from NCRP, International Commission on Radiological Protection, American College of Radiology (ACR), The Joint Commission (TJC), Conference of Radiation Control Program Directors
Radiation physics and detection for imaging
Fundamentals of digital image processing
Linear systems
Discrete signal processing
Pixel-based operations: window, leveling, subtraction, and thresholding
Convolution and spatial domain filtering for smoothing and enhancement
Fourier-space filtering
Magnification, interpolation, deformation, and registration
Segmentation
Analysis (e.g., similarity, cross-correlation, texture, and shape)
Compression; lossy and lossless methods
Image quality
Resolution/unsharpness/blur: point-spread function (PSF), modulation transfer function (MTF), and related metrics
Contrast, including radiographic contrast
Noise, including noise power spectrum (NPS)
Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), detective quantum efficiency (DQE), contrast detail, and other composite metrics
Detectability and task-based observer performance (false/true positive/negative, sensitivity and specificity, predictive value, precision and recall, f-score)
Fundamentals of image reconstruction
Relationship of Radon and Fourier transforms: the central slice theorem
Analytical reconstruction: backprojection; ramp filter, filtered backprojection, noise-reduction filters; inverse Radon transform
Fundamentals of iterative reconstruction: advantages, limitations, and common algorithms
X-ray production
History of X-ray physics
Bremsstrahlung production and characteristic radiation
Hot-cathode X-ray tube design (Coolidge design)
High-voltage generators
Impact of design and operating parameters
Requirements for specific applications (mammography, CT, and fluoroscopy)
X-ray imaging detectors
Historical impact of radiographic film on modern detectors and techniques
Intensifying screens
Storage phosphor plates
X-ray flat-panel detectors
Projection X-ray imaging
Radiography: geometry, hardware, techniques, QA, and safety
Mammography: geometry, hardware, techniques, QA, and safety
Fluoroscopy: geometry, hardware, techniques, QA, and safety
Volumetric X-ray Imaging
CT: geometry, hardware, techniques, artifacts, QA, and safety
Cone-beam CT: geometry, hardware, and artifacts
Tomosynthesis: geometry, hardware, and artifacts
Ultrasound imaging
Ultrasound physics: interactions and propagation
Transducers: physics, materials; design and operation
US systems: ancillary components, operation
Image acquisition
Doppler flow measurement and Doppler imaging
Image quality: resolution (axial, lateral, elevational), artifacts, and noise
Bioeffects
Survey of ultrasound safety, QA, and regulatory requirements
Magnetic resonance imaging
History of magnetic resonance physics
Core topics in physics (magnetism, magnetic moments of nuclei, and induction)
Physics of nuclear magnetic resonance
NMR pulse sequences: hardware, pulse sequences, and weighting
Contrast agents
MR spatial signal localization: gradients, timing diagrams, and k-space filling
Common MR image acquisition modes: timing diagrams and features
Image quality: effects of acquisition parameters
Artifacts and their causes
Introduction to advanced MR techniques: spectroscopy, elastography, functional MR, diffusion-weighted imaging, and angiography
MR bioeffects
Principles of MR safety: personnel and patient safety
Siting and facility safety
QA and regulatory requirements
NM imaging
History: Becquerel, the Curies; de Hevesy; discovery of Tc-99m
Detectors used in NM: scintillators, semiconductors, and gas-filled
Counting (Poisson) statistics
Gamma-ray spectroscopy
Radioactivity
Radionuclide production
Radiopharmaceuticals
Non-imaging detectors in NM: dose calibrator, well counter, and thyroid uptake probe
Gamma cameras and scintigraphy
Single-photon emission computed tomography (SPECT)
PET
Image reconstruction: importance of iterative reconstruction in NM
Radiation protection in imaging and NM
Entrance air kerma, entrance exposure; relationship to dose and dose equivalent
Radiation dose and risk: typical values for imaging procedures (all X-ray and NM modalities)
Dose reduction in imaging: “right-sizing” of techniques
NM-specific radiation protection, QA, and safety, including room and personnel surveys, and shielding design/evaluation
Patient as source; hazards to staff; release criteria
Overview of clinical oncology
Cancer incidence/etiology
Cancer classification/staging
Overview of oncology treatment modalities
History, evolution, radiobiological principles, and practical applications of RT
History and evolution of RT
Radiobiological principles of RT
Common clinical RT applications
Physics and operation of radiation oncology equipment
Linear accelerators
Other external beam RT equipment
Brachytherapy equipment
Technology for imaging in RT
Computerized treatment planning systems
Ancillary RT physics equipment (patient immobilization, dosimetry, and QA equipment)
External beam RT
External beam RT modalities
Target definition, treatment intent, and dose prescription criteria
Prescribing, reporting, and evaluating RT treatment plans
Treatment simulation techniques
Treatment planning techniques
Treatment delivery and verification
Brachytherapy
Radioactive sources
Treatment planning and dose specification
Treatment delivery techniques
Special techniques in radiation oncology
Rationale for special techniques and required physics resources and requirements
Examples of special techniques (e.g., total body irradiation [TBI], total skin electron therapy, intraoperative radiotherapy, stereotactic radiosurgery [SRS], stereotactic body RT, and radionuclide therapy)
Imaging for RT
Imaging for treatment simulation
Multimodality imaging for treatment planning
Imaging for treatment guidance, motion management, and verification
Radiation protection and quality management in radiation oncology
Shielding for simulation and treatment rooms
NRC and state regulations
Radiation protection programs
Radiation injury to DNA
Radiation chemistry of water
Structure of DNA and types of radiation-induced lesions
Double-strand breaks
Radiation dosimetry, microdosimetry, and ionization density and their relationship to DNA damage
Repair of DNA damage
Single-strand repair pathways
Repair of double-strand breaks
Radiation-induced chromosome damage and repair
Chromosome biology and aberrations
Linear-quadratic model
Survival curve theory
Cellular sensitivity
Mechanisms of cell killing
Target theory
Survival curve models (single-hit multi-target, linear quadratic)
Concepts of cell death
Reproductive cell death
Programmed cell death
Cellular recovery processes
Types of radiation damage
Potentially lethal and sublethal damage
Fractionation effect
Dose rate effects
Cell cycle
Cell kinetics and cycle phases
Radiosensitivity and cell cycle position
Radiation effects on cell cycle
Modifiers of radiation response: sensitizers and protectors
Oxygen effect and other radiosensitizers
Radioprotection
RBE, oxygen enhancement ratio (OER), and LET
LET
RBE
OER
Cell kinetics
Cell cycle and quantitation of its constituent parts
Growth fraction and cell loss from tumors
Autoradiography and flow cytometry
Growth kinetics of human tumors
Radiation injury to tissues
Tissue and organ anatomy
Biologic endpoints, expression, and measurement of damage
Temporal aspects of radiation effects—acute and late effects
Acute and late responding normal tissues
Pathogenesis of acute and late effects
Different kinds of late responses
Residual damage/radiation syndromes
Histopathology
General morphology of radiation injury
Morphology of cell death
Morphologic changes in irradiated tumors
Tumor radiobiology
Basic tumor structure and physiology
Importance of hypoxic cells in tumors and importance of reoxygenation
Time, dose, and fractionation
The 4 R's of radiobiology
Volume effects
The basis of fractionation
Dose–response relationships for early and late responding normal tissues
Hyperfractionation and accelerated treatments
Hypofractionation and high doses per fraction
α/β Model
Tumor control probability (TCP) versus normal tissue complication probability
Equivalent dose in 2-Gy fractions, biologically effective dose
Radiation genetics: radiation effects on fertility and mutagenesis
Target cells for infertility
Doses to result in temporary and permanent sterility
“Reverse-fractionation effect”
Mechanisms of mutation induction
Relative risk versus absolute risk
Time course and latency period/risks of cancer induction in different organs and tissues
Exposures, fertility, risks, and management strategies from preconception to birth
Molecular mechanisms
Molecular cloning techniques
Gene analyses
Oncogenes and tumor suppressor genes
Drug radiation interactions
Chemotherapy
Immunotherapy
Language of anatomy
Planes
Projections
Imaging conventions
Landmarks
Homeostasis
Tissues, body membranes, and the skin
Epithelial tissue
Connective tissue
Tissue repair
Body membranes
Skin (cancer and radiation effects on the skin and hair)
Basic cytopathology
Musculoskeletal system
Anatomy and physiology of muscle tissue
Anatomy and physiology of bone tissue
Major bones and muscles (landmarks and features, imaging landmarks)
Joints
Imaging appearance—normal and common pathology
Endocrine system
Endocrine signaling (steroid hormones, peptide hormones, and second messengers)
Hypothalmic-pituitary axis
Thyroid and its hormones
Parathyroids and their hormones
Thymus and immune system development
Pancreas and its hormones
Adrenal glands and their hormones
Ovaries and their hormones
Testes and their hormones
Imaging appearance—normal and common pathology
Nervous system
Nerves and microanatomy
Central nervous system (lobar and ventricular anatomy of the brain, functional areas of the brain (sensory and motor homunculus, thalamus, hippocampus, Wernicke's area, Broca's area, sensory cortices, chiasm, and pituitary), anatomy of the spinal cord and spinal nerves)
Peripheral nervous system (cranial nerves, dermatomes, and reflex arcs)
Human visual system (perception, integration time, contrast sensitivity, imaging implications for perception of medical images)
Functional classification
Imaging appearance: normal and common pathology on CT, MRI, and functional magnetic resonance imaging (fMRI)
Cardiovascular system
Blood and microanatomy (hematopoiesis and formed element lineages, vascular anatomy)
The heart (chambers, valves and their function, intrinsic conduction system, great vessels and their connection to the systemic circulation, coronary arteries, and coronary angiography)
Major vessels and circulations (aorta and its branches, cerebral circulation, portal vein and abdominopelvic drainage, major venous structures of abdomen/pelvis)
Physiology (vital signs, autoregulation)
Pulmonary system
Conducting zone (pharynx, larynx, trachea, and main bronchi)
Respiratory zone (lobar bronchi through respiratory bronchioles, blood–air interface, pulmonary ventilation, physics and physiology of gas exchange)
Thorax (external landmarks and links to bony and muscular anatomy, lung anatomy, normal, and common pathology on X-ray and CT imaging)
Relationship with the cardiovascular system (pulmonary arteries and veins, physics and physiology of gas exchange in body tissues, blood pH, and the bicarbonate buffer system)
Lymphatic system
Lymph nodes, lymphatic vessels, and cisterna chyli
Lymphatic ducts and relationship with cardiovascular system
Regions of lymphatic drainage and relationship to cancer spread
GI system
Alimentary canal (oral cavity, teeth, salivary glands/parotid glands, salivary amylase, pharynx, esophagus, tunics of the alimentary canal, stomach, small intestine, and large intestine)
Peritoneum and mesenteric attachments
Accessory organs (liver, gallbladder, pancreas, and biliary system)
Digestion and its regulation (hormones, enzymes, and nervous system)
Imaging appearance: normal and common pathology
Urinary system
Kidneys (anatomy from nephron to renal tubule, glomerular filtration, tubular reabsorption, and secretion)
Physiology (electrolyte and blood volume regulation, renin-angiotensin system, blood pH regulation, and the bicarbonate buffer system)
Collecting system (renal pelvis, ureters, urinary bladder, and urethra)
Imaging appearance: normal and common pathology
Reproductive system
Meiosis
Male (testes, duct system, prostate, external genitalia [penile bulb], and spermatogenesis)
Female (ovaries, uterus, external genitalia, ovarian cycle, uterine cycle, and mammary glands/breasts)
Conception and fetal development
Mathematical methods
Math background
Fermi-type estimation problems (e.g., how to estimate input data if it is not readily available and recognition of the uncertainties caused by these estimations)
The complex plane, odd/even functions
Algorithm complexity and basic linear algebra subroutines (BLAS)
Entropy and information gain
Introduction to linear systems
Fourier's theorem: Fourier series and the continuous Fourier transform
Properties of the Fourier transform
Gaussian, sinc, rect, sinusoid, and comb functions and essential Fourier transform pairs
Dirac delta function/the impulse symbol
Linear time-invariant systems
Complex transfer function
Convolution principle
The edge response function
Auto and cross-correlation
Linear independence and vector spaces
Discrete signal processing
Sampling theorem and Nyquist frequency
Discrete Fourier transform (DFT)
Fast Fourier transform
Apodizing and aliasing
Approximate restoration from sampling (pixels)
Mathematics of noise
Effect of noise on decision criteria
SNR
DQE and noise-equivalent quanta
Principles of noise averaging, covariance concept
Autocovariance and power spectrum concepts
Filtering: inverse, Metz, Weiner, matched, and Wiener–Hellström filters
Mathematics of optimization
Cost functions
Unconstrained and constrained optimization
Convex optimization: simulated annealing and gradient approaches
Statistical methods
Descriptive statistics
Scales of measurement of observations: nominal, ordinal, interval, ratio
Univariate and multivariate observations
Distributions of observations (e.g., normal, binomial, lognormal, Poisson, and Gaussian)
Population parameters versus sample statistics
Distribution of statistics, random sampling
Graphical methods (e.g., box plots, probability plots, Loess plots, and time series)
Quality control statistics, univariate and multivariate control charts
Moments: expectation, mean, and variance
Probability
Classical
Bayesian
Random number generators, probability density, and distribution functions
Inferential statistics
Target population, sampled population, samples, and tolerance intervals
Distributions of sampling statistics: (e.g., chi-squared, student's t, F)
Hypothesis testing, point and interval estimation, and resampling methods
Significance tests, level of significance as “associated probability”
Test of hypothesis (Neyman–Pearson) versus probability of hypothesis (Bayes)
Confidence intervals (Neyman–Pearson) versus credible intervals (Bayes)
Null and alternative hypotheses, multiple comparison problems (Neyman–Pearson), probability of hypothesis, likelihood ratios, Bayes’ factor (Bayes)
Type I and Type II errors, power of a statistical test
Sample size, power analysis
Propagation of error and the covariance matrix
Fourier relationships: characteristic function and the central limit theorem
Regression models
Linear regression models
Simple and multiple regression models
Logistic regression models
Log-linear and Poisson models
Nonlinear models (nonlinear in parameters)
“Goodness-of-fit” measures (correlation coefficient)
Interpolation and extrapolation of models
Regularization: lasso and Tikhanov
Multivariate analysis
Cluster analysis
Discriminant analysis
Factor analysis
Principal component analysis
Categorical data analysis
Odds ratio and relative risk, attributable risk
Logit and log-linear models
Receiver operating characteristic (ROC) analysis
Sensitivity, specificity, and predictive value
Design of clinical studies
Reliability and validity of a study, including internal and external validity
Random selection (population inference), random allocation (causal inference)
Design and analysis of randomized controlled studies, including strengths and weaknesses
Design and analysis of case-control and cohort studies, including strengths and weaknesses
Data mining studies, including strengths (high external validity) and weaknesses (low internal validity)
Experimental design for multiple treatment groups consisting of different individuals
Experimental design for multiple treatments in the same individual
Computational methods
Basic computer skills
Spreadsheet software, word processor, presentation software, and PDF editor
Search engine syntax, journals (e.g., Pubmed, Google Scholar)
Image viewing and processing software
Computer science
Data structure, memory, and ports
Bits, bytes, single and double precision
Debugging
High-level language and editor (e.g., Python, Javascript, C/C++)
Programming Skills
Syntax
Data types (floating point variables, integers, strings, and arrays)
Declaration of variables
Logic, Boolean operators, switches, and conditional statements
Iterative programming
Methods, functions, programs, executables, compilation, and input/output
Machine learning
Supervised learning (classification and regression)
Unsupervised learning (principal component analysis and clustering)
Reinforcement learning
Particle transport
Linear Boltzman equation
Applications of Monte Carlo technique
Dose calculation algorithms: convolution and superposition
Medical informatics
Networking
Types of networks, data rate, and bandwidth
Network infrastructure
Wide area network, local area network
Communication protocols: TCP/IP and OSI Models
Cloud storage
Communication standards
Digital imaging and communications in medicine (DICOM)
Health Level Seven
Integrating the health-care enterprise
DICOM and DICOM-RT
Service object pairs, association negotiation
Information model elements (image, series, study, patient, instances, unique identifiers)
DICOM tags and modules
DICOM anonymization
Databases
Tables and fields
Database schema
Data dictionary
Queries and SEQUEL language
Client server database model
Backup
Picture Archive and Communication System (PACS)
Image storage
Image transfer—teleradiology
Image display—human visual system, ACR Technical Standard for Electronic Practice of Medical Imaging
Literature search and reading
Research methods and documentation
Academic writing, reviewing, and presentation
Clinical trials
Protocol and grant writing
Clinical translation and implementation
Laboratory management
Leadership
Personal and interpersonal
Emotional self-awareness
Adaptability, initiative, and empathy
Organizational awareness and service orientation
Influence, conflict management, teamwork, and collaboration
Professional and developmental
Delegation and time management skills
Leadership communication skills
Professional vitality
New ventures leadership
Medical physics value and advocacy
Executive and administrative
Operations and finance
Information and human resources
Strategic planning
External affairs (external environment that affects the profession (e.g., regulatory and economic environment))
Ethics and professionalism
Ethical principles and values
Medical ethics
Ethical definitions and historical context
Ethics in the era of modern science
Nuremberg Code, Declaration of Helsinki, Belmont Report
Ethics in practice
Professional conduct
Clinical ethics
Research ethics
Education ethics
Business and government ethics
Public and professional responsibility, competence, and continuing education
Ethical encounters or dilemmas
Information privacy
Health Insurance Portability and Accountability Act (HIPAA)
Data security
Professionalism in practice
Roles and responsibilities of the medical physicist
Medical physics and related professional organizations, certification, and licensure
Interactions with other professionals
Responsible and ethical behavior
Diversity, equity, and inclusion
Communication
Scientific communication
Scientific writing
Scientific presentation
Public education
Clinical and professional communication
Written correspondence and reports, business proposals
Communication with other health-care professionals
Communication with health-care administrators
Patient-centered communication
Establishing clinical relationships (physics-patient consultation)
Verbal and nonverbal communication, active listening
Empathy, emotional status, and psychological considerations
Patient advocacy and communicating with families
Literacy, language, and cultural barriers
Radiation Therapy
Radiomics, theranostics; connection to genomics and other -omics
Immunotherapy + RT
RT for non-cancer treatments (e.g., cardiac ablation)
FLASH
Cerenkov imaging (applications for RT, proton and heavy ion therapy)
Chemotherapy + RT
PDT + RT
High-intensity focused ultrasound + RT
Tumor-treating fields
Diagnostic Imaging
Alternative X-ray sources (synchrotron; inverse-Compton scatter/laser-particle accelerators)
Radiomics, theranostics; connection to genomics and other -omics
CAD and AI/machine learning (beyond the basics)
X-ray interferometry
Nanomedicine (contrast agents)
Photon counting X-ray detectors
Biophotonics
Magnetoencephalography
Nuclear Med
Theranostics
Nanomedicine (radiotracers for imaging and/or therapy)
Radiotracer development/radiochemistry
Medical health physics
Personalized dose calculations
Opportunities in other medical specialties
Surgery: image-guided surgery, surgical planning based on imaging, augmented reality, and virtual tools
Pathology: automated analysis, pathology image display and archiving
Ophthalmology: laser surgery, optical modeling, and corrective optics
Dentistry: mechanical modeling, 3D planning, and 3D optical reconstruction
Orthopedics: mechanical modeling, motion analysis, and hardware design
Cardiology: electrophysiology, mechanical modeling, and flow modeling
Neuroscience, psychology, and psychiatry (e.g., incorporation of imaging in diagnosis and monitoring)
Clinical
Medical physics–specific charges
Clinical roles and operation (from a business perspective)
Systems-based practice
Licensing (differences between states)
Purchase agreements (e.g., service and support contracts)
Financial principles
Billing and revenue (professional and technical codes)
Equipment purchasing (selection, revenue generation, and budget management)
Fiscal statements
Financial/market strategy
Accounting principles
Accounting standards
Business models, pro-forma
Business aspects of grant management
Regulatory compliance and policy in medical physics
Legal principles (contracts and agreements, tort law, liability, and introduction to civil procedure)
Best teaching practices
Traditional pedagogies
Assessment and evaluation
Teaching critical thinking
Clinical teaching and mentoring
Online teaching and learning
Blended learning
Open textbooks and online resources
Cognitive science
Adult learning theory
Bloom's taxonomy
Metacognition
Active Learning
Peer instruction
Just in time teaching
The flipped classroom
Project-based learning
Radiation physics and detection for imaging
Core topics from radiological physics and dosimetry (Section 3.1.1)
Photon interactions relevant to imaging
Radiation detectors used in imaging
Foundations of imaging science
Deterministic and stochastic description of imaging systems, objects, and images
Core topic of linear systems in mathematical and statistical methods (Section 3.1.7.)
Linear and nonlinear systems: discrete versus continuous
Stochastic models of objects and images
Transport theory and diffraction theory for imaging
Mathematical description of noise in imaging systems (Poisson statistics, shot noise, and speckle)
Core topics in computational methods and medical informatics (Section 3.1.8)
Digital representation of images
Human visual system and perception
Display of images
Display hardware
Grayscale rendition, ambient illumination, maximum, and minimum luminance
Spatial rendition
Color rendition
Digital image processing
Core topics from mathematical and statistical methods (Section 3.1.7)
Discrete signal processing
Pixel-based operations
Windowing and leveling; thresholding and binarization; and image subtraction
Histogram equalization
Convolution and spatial domain filtering
Smoothing/averaging, median filtering, unsharp masking
Fourier-space filtering
Low-pass, band-pass, and high-pass
Coordinate and affine transformations
Magnification and interpolation
Image deformation
Image registration: mutual information, mean square distance, normalized cross-correlation
Deformable image registration: B-spline, intensity-based
Image agreement metrics: Dice similarity coefficient and Hausdorff distance
Image fusion and display
Segmentation
Analysis
Similarity, cross-correction
Texture, shape
Neural networks and machine learning; computer-aided diagnosis
Compression, lossy and lossless methods
Imaging informatics
Core topic of medical imaging informatics from computational methods and medical informatics (Section 3.1.8)
Standardization of digital file formats; DICOM and other standards encountered in imaging
PACS, radiology information systems, and electronic medical records; related health-care information systems
Protection of information, HIPAA
Anonymization for research
Image quality
Resolution/unsharpness/blur, PSF, line-spread function (LSF), edge-spread function (ESF), MTF
Spatial domain metrics: PSF, LSF, and ESF
Fourier domain metrics: MTF
Contrast
Noise (statistical, structured); NPS
Composite metrics
SNR, CNR, and contrast detail
DQE
Perceptual metrics
Detectability
Task-based observer performance (false/true positive/negative; sensitivity, specificity, accuracy; positive predictive value, precision and recall, f-score)
Ideal and other numerical observers
ROC analysis, applications, and extensions
Image reconstruction
Inverse problems
Projection geometry in 2D
The Radon transform and the sinogram
Parallel-beam and fan-beam geometry
Relationship of Radon and Fourier transforms: the central slice theorem
Image reconstruction based on interpolation and inverse Fourier transform
Analytical reconstruction
Backprojection
Ramp filter and filtered backprojection
Noise-reduction filters
Inverse Radon transform
Extension of projection geometry and reconstruction to 3D and 4D
Central plane theorem and fully 3D reconstruction algorithms
Cone-beam geometry and reconstruction algorithm
Gating and binning of 4D data
Iterative reconstruction
Advantages and limitations compared to analytical methods
Forward (physics) model
Cost functions
Classes of iterative algorithms
Common algorithms and applications
Image registration in sinogram space
X-ray production
History: Roentgen's discovery of X-rays; evolution from cathode-ray tube (Coolidge)
Core topics from radiological physics and dosimetry (Section 3.1.1)
Characteristic radiation
Bremsstrahlung production
Generic hot-cathode X-ray tube design (Coolidge design)
Filament, target, and focal spot
Anode materials; beveled and rotating anodes
Ancillary components for filtration and collimation, cooling, shielding
Cold-cathode X-ray tube design
High-voltage generators
Transformers and rectification
Three-phase, multiphase, and ripple
Impact of design and operating parameters
Filament current and tube current
Accelerating voltage
Exposure time
Characteristic and bremsstrahlung emission spectra
Heating and cooling
Heel effect
Requirements for specific applications (mammography, CT, and fluoroscopy)
X-ray detectors
Radiographic film and radiochromic film
Composition of emulsion
Development
Characteristic (H&D) curve, speed, and latitude
Intensifying screens
Composition
Influence on blur, efficiency, and patient dose
Storage phosphor plates
Composition
Computed radiography readout process
X-ray flat-panel detectors
Indirect versus direct conversion
CCD and CMOS technologies
Scintillators
Gas-filled detectors for CT
Projection X-ray Imaging
Radiography
Projection geometry
Techniques (acquisition parameters and protocols)
Magnification; source-to-image distance, source-to-object distance
Anti-scatter grids and other scatter-reduction techniques (air gap, slot scan)
Collimators, automatic exposure control, and ancillary devices
Impact of techniques on image quality, artifacts; appropriate technique choices
Impact of techniques on dose (dose vs. kV, mA s, magnification); appropriate technique choices
Contrast agents, temporal subtraction imaging
Dual-energy imaging, tissue/energy-selective imaging, photon counting
Portable radiography
Mammography
MQSA and related regulatory requirements
Mammography-specific concerns: resolution and contrast versus dose; screening mammography versus diagnostic mammography
Mammography-specific choices: X-ray source and filtration; geometry and collimation; generator
Mammography-specific detector requirements
Techniques: compression, scatter reduction, magnification; automatic exposure control
Image quality, artifacts and dose
Digital mammography
Breast tomosynthesis
Computer-aided diagnosis in mammography
Fluoroscopy
Fluoroscopy-specific concerns: resolution and contrast versus dose
Fluoroscopy source requirements (vs. radiography)
Image intensifier (II) design and operation; II-specific image quality issues
Flat panel detectors as alternative to an image intensifier
Modes of operation; control curves; added filtration
Contrast agents and subtraction imaging techniques: temporal and, dual energy
Image quality, artifacts, and dose, including to personnel
Interventional radiology: angiography, cardiac catheter lab, and intraoperative
Volumetric X-ray imaging
Computed tomography
History: Hounsfield, Cormack
CT geometries (rotating vs. stationary components; fan-beam vs. parallel; multidetector and cone beam)
Filtration/compensation, collimation, and scatter reduction
CT detectors (gas and solid-state designs)
Techniques (kV, mA, rotation speed, slice thickness, pitch) and acquisition modes (sequential, helical, and scout/scanned projections)
Contrast agents
Impact of techniques on image quality, artifacts; appropriate technique choices
Impact of techniques on dose; CT dosimetry (computed tomography dose index [CTDI], dose length product [DLP], effective dose); appropriate technique choices, dose versus risk
Specific applications (cardiac, lung, including gating/4D; dual-energy; perfusion)
Utilization with functional modalities (PET, SPECT)
Cone-beam CT
Acquisition geometry (differences vs. CT)
Image reconstruction (differences vs. CT)
Image quality, artifacts, noise, and dose
Applications (onboard imaging for RT; dedicated imaging for cardiac, intraoperative, dental, musculoskeletal/extremities)
Tomosynthesis
Acquisition geometry; evolution from classical tomography
Image reconstruction
Image quality versus CT and radiography
Patient dose versus CT and radiography
Applications to breast, lung, and other organs
Dual-energy X-ray absorptiometry
Bone mineral density image derivation
Projection geometry
Techniques (acquisition parameters and protocols)
Other applications (body composition, vertebral fracture, and abdominal aortic calcification)
Ultrasound imaging
Ultrasound physics (speed, impedance; reflection/refraction/scattering/attenuation) and propagation (intensity/pressure vs. distance/laterally; near-field, far-field)
Transducers (physics, materials; design and operation)
US systems (ancillary components) and operation (focusing and steering; gain and attenuation compensation)
Contrast agents
Echo 2D imaging
Acquisition methods
Image display
Real-time imaging and image quality
Image quality: resolution (axial, lateral, elevational), artifacts, noise
Harmonic imaging
Acquisition methods
Image display and image quality
Elastography
Acquisition: static compression, transient elastography, and acoustic radiation force impulse methods
Analysis: characteristics of tissue stiffness and correlation with disease processes
3D imaging
Acquisition methods
Image display and image quality
Doppler flow measurement; Doppler imaging
Hardware and operation; data analysis
Operating modes (continuous, pulsed; duplex; color flow)
Data quality and artifacts
Transmission ultrasound imaging
Acquisition methods; image processing
Image quality
Bioeffects and safety
Bioeffects; relationship to US power
Non-imaging (therapeutic) applications of US
Ablation, lithotripsy, and heat (warming) therapy
Magnetic resonance imaging
History (e.g., Bloch, Purcell, Lauterbur)
Underlying physics (magnetism, magnetic moments of nuclei, and induction)
Physics of nuclear magnetic resonance (precession and resonance, energy absorption/emission, excitation, relaxation, and dephasing)
Precession and resonance; Larmor frequency; effect of B-field strength
Energy absorption/emission
Excitation
Relaxation (T1, T2) and dephasing (T2*)
Nuclear magnetic resonance (NMR) pulse sequences
Hardware (coils and magnets)
Excitation pulses and gradients
Timing diagrams
Rephasing and echoes
Weighting
Specific pulse sequences (spin echo, inversion, and gradient echo)
Contrast agents
MR spatial signal localization
Gradient coils (hardware; types: slice, frequency, phase; rephasing)
Timing diagrams
k-Space: relation to spatial domain via Fourier transform
k-Space filling strategies
MR image acquisition modes (for each: timing diagram, acquisition time vs. time to echo, time to repetition, other parameters)
2D spin echo
Inversion recovery
2D multiplanar
Fast spin-echo
Gradient echo
Echo planar
Parallel imaging
3D FT
Image quality (including effects of acquisition parameters)
Artifacts (e.g., instrumentation, motion, susceptibility, and molecular environment)
Special techniques
Spectroscopy
Angiography
Elastography (liver, brain)
Perfusion and fMRI
Diffusion weighted imaging
Chemical exchange saturation transfer and magnetization transfer
Quantum coherence
MR bioeffects
Principles of MR safety (including aspects of personnel and patient safety)
Siting and facility/QA and regulatory requirements
Quality management in DI
Regulations and recommendations
Process mapping
Failure modes and effects analysis
Fault tree analysis
Establishing a quality management program
Radiation protection in imaging
Core topics from radiological physics and dosimetry (Section 3.1.1) and radiation protection and safety (Section 3.1.2)
Entrance air kerma, entrance exposure; relationship to dose and dose equivalent
Radiation dose and risk
Typical whole-body dose values for imaging procedures
Limiting tissues/organs for imaging of different anatomical regions
Potential for dose to uterus and fetus from imaging procedures
Stochastic and deterministic effects expected from imaging procedures
Optimization of dose in imaging
“Right-sizing” techniques
Image gently, image wisely
Radiation protection of personnel
Personnel-protective equipment, including dosimeters
Utilization of time, distance and shielding for protection
Shielding design: NCRP 147 and TG 108
Practical/laboratory training in DI
For each modality:
Scanner operation (including imaging of phantoms and image analysis to learn about acquisition parameters vs. image quality/artifacts)
QA (procedures, QA phantoms, data processing/analysis)
Radiation protection (shielding calculations and assessment; personnel and area monitoring)
Safety (interlocks, signage)
Dose measurement:
Projection X-ray imaging: measurement of entrance air kerma; influence of acquisition parameters; dose area product (kerma area product) and peak skin dose considerations; relevant TGs
CT: measurement of CTDI, DLP; influence of acquisition parameters; size-specific dose estimate; relevant TGs
Observation/shadowing
Reading room observation and interaction
Technologist observation and interaction
Basic physics
Basic atomic and nuclear physics
Modes of radioactive decay
Radioactive decay rates, including transient and secular equilibrium
Passage of radiation through matter
Radiation detection
Scintillation
Photomultiplier tube and solid-state light detection
Ionization-based detection—gas and solid state
Instrumentation for radiation detection
Signal propagation
Counting statistics
Propagation of error
Clinical applications of NM
Radiotracer methods and the breadth of applications
Required scanning modes: dynamic, static, whole-body, gated
Radionuclide production
Cyclotron and targetry principles
Reactor-based production
Generators (Mo99/Tc99, Ge68/Ga68, Sr82/Rb82)
Radionuclide QC
Radiotracer production
Principles of radiochemistry
Radiopharmacy
Radiopharmaceutical QC
Radioactivity measurement devices—principles and applications
Dose calibrator (activimeter)
Well counter
Thyroid uptake probe
Liquid scintillation counter
Conventional gamma camera
Design and components
Energy and position measurement
Collimators
Principles
Sensitivity versus resolution
Photon energy—septal penetration
Geometry—parallel hole, fan-beam, cone-beam, and pinhole
Corrections—linearity, energy, and uniformity
Attenuation and scatter effects
Measures of intrinsic and extrinsic performance
Image reconstruction
The detection model
Analytic methods, including filtered backprojection
Iterative methods, including maximum likelihood expectation maximization and ordered subsets expectation maximization
Noise characteristics
Sampling considerations
Incorporating physical effects (e.g., attenuation, spatial resolution) into the reconstruction model
Other means of correcting degrading effects
Methods of noise control—low-pass filtering, limiting iterations, and regularization
Evaluating reconstructed image quality
SPECT
Acquiring SPECT projections with a gamma camera
Performance requirements—center of rotation and uniformity
SPECT attenuation and scatter correction methods
SPECT/CT
CT-based attenuation correction, SPECT, and CT fields-of-view registration
PET
Positron imaging physics
Coincidence detection
Basic detector geometry
Sensitivity and corrections (normalization, timing, energy, and position maps)
Scattered and random events, random estimates
Noise-equivalent counts and statistical quality of data
Time-of-flight PET—principles, benefits
Attenuation—qualitative and quantitative effects
Attenuation correction
Detector design
Scintillators
Silicon photomultiplier detectors
Blocks versus one-to-one coupling
Dead time
Resolution, energy, and timing resolution
Factors limiting intrinsic resolution
PET/CT
CT-based attenuation correction
Model-based scatter correction
PET and CT fields-of-view registration
Other imaging systems
PET/MR
Whole-body PET/CT systems
Novel SPECT designs
Dedicated cardiac SPECT systems
Dedicated breast systems (PET and single-photon)
Unique challenges with corrections and QC
Computer principles in NM
Data storage formats
Digital image representation
Basic image manipulation and processing
Image display—intensity settings and color scales
Quantitative imaging techniques
Concepts
Planar image quantitation—methods and fundamental limitations
Radionuclide quantitation in SPECT and PET
Requirements for accurate quantitation
Standardized uptake value and related parameters
Region-of-interest analysis techniques
Time–activity curve analysis techniques
Tracer kinetics
Basic concepts of radiotracers and tracer kinetics
Tracer kinetic modeling
Radiation dosimetry for NM
Patient considerations
Staff considerations
General public considerations
MIRD method
Image-based dosimetry
Therapeutic NM
Therapeutic radionuclides
Alpha versus beta versus gamma dosimetry
Currently used therapeutics
Radiation protection in radionuclide therapy
Patient-specific dose determinations/dosimetry-based treatment planning
Theranostic—imaging/therapy pairs
Imaging therapeutic radionuclides
Radiation protection for NM
Core topics from radiation protection and radiation safety (Section 3.1.2)
NM shielding
Multiple sources
Fraction emitted from patient
Decay factor during uptake and imaging
Broad beam fitting parameters and transmission
CT component for shielding
NM-specific radiation protection and safety, including room and personnel surveys, shielding design/evaluation, protection devices (syringe shields, L-blocks)
Patient as source, hazards to staff, release criteria/regulations and calculations
Quality management in NM
Dose Calibrator QC tests: accuracy, linearity, geometry, constancy, and special cases (e.g., pure beta emitters, therapy radionuclides for which there is not a factory setting, PET radionuclides for quantitative accuracy)
Well counter/thyroid uptake counter QC tests: chi-squared, constancy, efficiency, and uptake accuracy
Planar gamma camera QC: extrinsic and intrinsic uniformity, resolution and linearity, energy resolution, count rate performance, multiple-window spatial registration, sensitivity, and NaI(Tl) crystal hydration
SPECT QC: high contrast resolution, cold sphere contrast, uniformity, and center of rotation
PET QC: well counter calibration, sensitivity, count rate performance, resolution, quantitative accuracy, hot and cold sphere (or cylinder) high contrast detectability, and uniformity
CT QC: image registration, Hounsfield unit accuracy, uniformity, low- and high-contrast resolution, and dosimetry
RAMs program review/audit
Department of Transportation (DOT) training and placarding
Incoming and outgoing packages
Area radiation surveys
Area wipe-testing
Waste storage and disposal
Patient dosing records
Radionuclide therapy record keeping
Process mapping
Failure modes and effects analysis
Fault tree analysis
Establishing a quality management program
Practical/laboratory training in NM
Reading room observation and interaction
Technologist observation and interaction
Radionuclide handling and hot lab skills
Radioactive spill management
Phantom preparation
Scanner operation—scanning and image processing
Radionuclide generator observation
NM therapy observation
Clinical radiation oncology
Cancer etiology, classification, and staging
Cancer statistics (incidence, survival and hazard functions, proportional hazards model, and Kaplan–Meier analysis)
Overview of oncology treatment modalities
Core topics from radiobiology (Section 3.1.5) and anatomy and physiology (Section 3.1.6)
Radiobiological basis of RT
Workflow of clinical oncology and radiation oncology
Physics and operation of radiation oncology equipment
Linear accelerators (theory, components, commissioning, and QA, safety)
Other external beam RT equipment (isotope units, cyclic accelerators, and accelerators for particle beam therapy)
Brachytherapy equipment (afterloaders, applicators, electronic brachytherapy units, commissioning, QA, and safety)
Imaging equipment in RT (CT, MRI, PET, and onboard imaging)
Computerized treatment planning systems (commissioning, QA, and maintenance)
Ancillary physics equipment (patient immobilization, dosimetry, QA equipment)
External beam RT
External beam RT modalities (properties/characteristics of photon, electron, and heavy charged particle beams)
Beam output calibration
Target definition, treatment intent, and dose prescription criteria
Treatment simulation techniques
Patient data acquisition: non-imaging to imaging-based
Immobilization devices and techniques
Motion management techniques
Prescribing, reporting, and evaluating RT treatment plans
Prescription and reporting nomenclature
Margins, uncertainties, and accounting for patient motion
Treatment plan evaluation and metrics
Treatment planning techniques
Dose specification and normalization
Isodose distribution for static fields in reference conditions
Corrections for dose calculations in a patient
Beam orientation and modification (collimation, multi-leaf collimator, wedges, applicators, and bolus)
Manual and computerized dose calculation algorithms
Forward and inverse planning/treatment plan optimization, and plan robustness
Radiobiological considerations in treatment planning and plan optimization
Photon-beam treatment planning
Energy and field size selection
Modulated delivery techniques
Electron-beam treatment planning
Energy and field size selection
External shielding, internal shielding, and backscatter dosimetry
Particle-beam treatment planning
Particle type, energy, and field size selection
Delivery and optimization techniques
Field matching and patch fields, range uncertainties, and plan robustness
Estimation of RBE and positional variations
QA and safety
Initial chart check and continuous review
Patient-specific QA
Treatment delivery and verification
Setup and immobilization
Image guidance
Adaptive radiation therapy (ART)
In vivo dosimetry
Brachytherapy
Radioactive sources
Types of sources
Source strength specification
Calibration equipment
Treatment planning and dose specification
Radiobiological considerations in brachytherapy
Implant technique
Source loading techniques
Dose calculation techniques
Prescribing, reporting, and evaluating brachytherapy treatments
Disease site–specific planning techniques
Imaging guidance systems
Treatment delivery techniques
Permanent implant brachytherapy
Afterloader-based brachytherapy
Unsealed radionuclide therapy
Intraoperative brachytherapy
Electronic brachytherapy
QA and safety
Routine QA
Brachytherapy room and hot lab shielding
Receiving and shipping of RAMs
Regulatory compliance for RAMs
Special techniques in RT
Rationale for development of special techniques, required physical, and staffing resources
TBI
Total skin electron irradiation
Intraoperative RT
SRS
Stereotactic body radiation therapy, stereotactic ablative radiotherapy
Hyper- and hypofractionation
ART
Electron arc therapy
Hyperthermia
Imaging for RT
Core topics from fundamentals of imaging in medicine (Section 3.1.3)
Treatment simulation processes (including CT simulation, MR simulation, 4DCT)
Multimodality imaging for treatment planning
Image registration and deformable image registration
Imaging for treatment guidance and verification
Imaging for motion management (including surface imaging techniques)
Imaging for ART
Imaging for treatment response
Radiation protection in RT
Core topics from radiation protection and radiation safety (Section 3.1.2)
Operational safety guidelines
Radiation protection programs
Structural shielding
Quality management in RT
Regulations and recommendations
Process mapping
Failure modes and effects analysis
Fault tree analysis
Establishing a quality management program
Practical/laboratory training in RT
Overview of clinical radiation oncology QA/QI/peer review
Measurement of absorbed dose
QA (procedures, machine-specific, and patient-specific)
Treatment planning (hardware, software, objectives, and techniques)
Brachytherapy (planning, delivery, and QA)
Radiation protection (shielding, personnel monitoring, and measurement techniques)
Biological effects of radiation
Core topics from radiobiology (Section 3.1.5) and radiation protection and radiation safety (Section 3.1.2)
Patient dose assessment and dose reconstruction (examples): for example, fluoroscopic skin dose, fetal dose, and RAM administrations
Patient dose tracking (examples): regulatory and accreditation requirements, significant radiation dose level, and diagnostic reference levels
Advanced radiation detection
Core topics from radiological physics and dosimetry (Section 3.1.1) and radiation protection and radiation safety (Section 3.1.2)
Laboratory instrumentation: well counters, high purity germanium, liquid scintillation counting
Advanced internal dosimetry
Inhalation, ingestion, and injection models
Modeling organ clearance, effective half-time, and curve fitting
MIRD formalism, applications in radionuclide therapy
Phantoms: mathematical models and physical phantoms
Staff monitoring: committed effective dose equivalent, bioassays, air limits, derived air concentrations
Advanced external dosimetry
Point, line, and volume gamma sources
Mathematical modeling of external dose distributions
Advanced radiation protection
Core topics from radiation protection and radiation safety (Section 3.1.2)
Principles—controlled versus uncontrolled areas, occupancy factors, and distances
Shielding evaluation techniques
Radiation safety with unsealed therapeutic RAM use
Regulatory oversight
Limited/broad scope materials licensing
X-ray regulatory oversight (10 CFR (Code of Federal Regulations (United States)), US Food and Drug Administration [FDA], and state authority)
Patient release criteria and calculation techniques
Security requirements for sources
Radiation safety officer, authorized user, authorized medical physicist, and authorized nuclear pharmacist requirements
Medical event investigation/reporting
Root cause analysis
Six sigma training
Voluntary regulatory oversight (e.g., ACR, TJC)
Non-RAM hazardous materials
Environmental monitoring and waste release
Release of radionuclides to the environment (air and sewer), air sampling
Dosimetric consequences of environmental release
Environmental Protection Agency (EPA) and NRC air and water dispersion models
High level, transuranic, and low level waste disposal, nuclear fuel cycle
USNRC/USDOE/USEPA repository (NRC/Department of Energy/EPA)
Low-level compacts
Future impacts
Nonionizing radiation
Core topics from fundamentals of imaging in medicine (Section 3.1.3)
UV devices
Lasers: applications, laser safety officer, ANSI guidance
Radiofrequency and microwave radiation
Emergency Response
History of major accidents
Integration into broader emergency response community
Communication and mitigation
Reporting requirements
Nonclinical medical health physics
Radionuclides in research (human and animal)
X-ray units in research (human and animal)
Industrial applications: irradiators, particle accelerators, and others
Quality management in medical health physics
Core topics from radiation protection and safety (Section 3.1.2)
Lead apron integrity assessment and tracking
RAMs program review (incoming and outgoing material, patient dosing records, and waste)
Unsealed RAM therapies
Communication of risk to patients and staff
Radiation safety in-service training
Process mapping
Failure modes and effects analysis
Fault tree analysis
Establishing a quality management program
Practical/laboratory training in medical health physics
Safe radionuclide handling techniques, hot lab safety, personnel decontamination, and spill decontamination
Counting device characteristics: background rate, minimum detectable activity, energy resolution, efficiency, Chi-squared, and dead time
Multichannel analyzer/gamma spectroscopy: photopeak, Compton edge, escape peaks, and backscatter
Gas chamber detector experiments, voltage curves
Area surveys, wipes, and sealed source/contamination wipe testing
Well counter QA testing
Dose calibrator QA testing
Lead apron evaluation
Evaluation of room shielding
Contamination surveys
Decommissioning and other decontamination techniques
Product creation
Market research and strategy
Strategic marketing (e.g., vision, mission, purpose, strategy, objective)
Global RT and radiology demands
Industry trends/direction
Product creation process
Product creation process types
Phases of product creation process types
Key influences on production creation process
Project management tools (e.g., project management methodologies, and software)
Risk assessment
Risk assessment methodology in product design, manufacture, and deployment
Industry risk assessment focus areas
Regulatory implications on risk assessment
Design and manufacture
Hardware manufacturing methodology
Software development methodology
QA methods and systems
Manufacturing processes and systems
Regulatory and legal
Regulatory
Federal and state regulations on radiation-producing devices and nuclear byproducts
Regulatory requirements and public safety
Regulatory requirements on X-ray imaging and mammography systems
Storage, handling, and transport of nuclear byproducts
FDA clearance, approval, and medical device classes
510(k) premarket notification and substantial equivalence
Compliance controls
Compliance
Compliance, especially regarding patient and staff safety
AdvaMed and US Manufacturer Code of Ethics
Role of National Institute of Standards and Technology as a regulator of industry standards to medical physics
Role of regulating bodies (e.g., NRC, FDA, and IAEA)
Role of accreditation commissions (TJC, CAMPEP)
Role of professional societies (AAPM, American Society for Radiation Oncology, Radiological Society of North America [RSNA], and Society of NM and Molecular Imaging)
NEMA and MITA standards
Common medical regulations (HIPAA, 10 CFR, 21 CFR)
Purpose and ubiquity of the DICOM standard
Data privacy and data protection
State-specific data protection rules
Clinical QA and quality control
Legal considerations
Medical care corruption and anti-corruption legislation
Foreign Corrupt Practices Act
Anti-Kickback Statute
Sunshine Act
Whistleblower protections and ombudsmen
501(c)(3) institution benefits and legal significance
Policy in medical physics
Policy and government
Definitions of policy, politics, policy analysis, advocacy, and activism
Types of policy (public, social, health, institutional, and organizational)
Spheres of political action in medical physics (government, workplace, professional societies, and community)
Structure, processes, and power of all three branches of the US government
Enactment of laws (bills and resolutions, authorizing vs. appropriating legislation)
Litigation and liability in the context of medical physics
Role of state governments in certification of medical physicists
International health-care strategy (e.g., role of IAEA, World Health Organization)
Policy for science
Allocation of funding by Congress to relevant government entities (e.g., NIH, NSF, DOD, DOE)
Allocation of funding by government departments to specific research projects
Finance and Insurance
Structures of health-care systems, their expenditures, and health outcomes (Extrapreneurial (US), Mandated Insurance (AUS, CAN), National Health Service (UK))
Sources of funding for the US health-care system (e.g., Federal: Medicare, VA; State: Medicaid; Private: Employer-based insurances)
Health-care procedure coding, coverage, and payment
Further applications in medical physics
Current regulatory affairs landscape surrounding medical physics in the United States (e.g., professional licensure, use of medical devices and equipment)
Influence of professional societies on policy changes (e.g., AAPM committees, ACR, and federal/state advocacy)
Certification (ABR, American Board of Medical Physics, American College of Medical Physics, Canadian College of Physicists in Medicine, and quality management program or qualified medical physicist) policy and its effect on the field of medical physics
Other health policies pertaining to medical physicists, radiation oncology, or radiology (e.g., weighing in on national guidelines)
Note: Some titles listed here are out of print but have been retained in this list due to their important historical role in medical physics education. Every effort has been made to list additional alternatives to these texts and instructors are encouraged to assure that students have access to all texts recommended by the instructor for a given course.
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- National Council on Radiation Protection and Measurements. NCRP Report No. 184 – Medical Radiation Exposure of Patients in the United States. National Council on Radiation Protection and Measurements; 2019.
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Details
1 Department of Oncology, Detroit, Michigan, USA
2 Colorado Associates in Medical Physics, Colorado Springs, Colorado, USA
3 Department of Radiation Oncology, The Ohio State University, Columbus, Ohio, USA
4 Department of Radiation Physics, Houston, Texas, USA
5 Department of Medical Physics, Madison, Wisconsin, USA
6 Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
7 Department of Physics and Astronomy, Baton Rouge, Louisiana, USA
8 Germantown Academy, Fort Washington, Pennsylvania, USA
9 Mary Bird Perkins Cancer Center, Louisiana State University, Baton Rouge, Louisiana, USA
10 Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
11 William Beaumont Hospital, Dearborn, Michigan, USA
12 Barrow Neurological Institute, Phoenix, Arizona, USA
13 Department of Oncology, Wayne State University, Detroit, Michigan, USA
14 Elekta, Inc., Crawley, UK
15 Department of Radiation Oncology, MD Anderson Cancer Center at Cooper/Cooper Medical School at Rowan University, Camden, New Jersey, USA