Medical Physicist Courses in India

1 Minimum qualification for Medical Physicist/RSO

The minimum qualifications stipulated for Medical Physicist/Radiation Physicist/Radiological Physicist and RSO (Radiological Safety Officer) in AERB safety code on Radiation Therapy Sources, Equipment and Installations, AERB/RF-SC/MED-1 (rev.1), 2011 are as follows:

1.1 Medical Physicists

(i) A post graduate degree in Physics from a recognized university; (ii) A Post M.Sc. diploma in radiological/medical physics from a recognized university; & (iii) An internship of minimum 12 months in a recognized well-equipped radiation therapy department. OR (i) A basic degree in science from a recognized university, with Physics as one of the main subjects; (ii) A post graduate degree in radiological/medical physics from a recognized university; & (iii) An internship of minimum 12 months in a recognized well-equipped radiation therapy department.

1.2 Radiological Safety Officer (RSO)

(i) Minimum qualifications required for a Medical Physicist/Radiation Physicist/ Radiological Physicist as mentioned above; & (ii) An approval from the competent authority to function as Radiological Safety Officer.

1.3 List of Medical Physics Courses

List of the institutions whose Medical Physics course is in accordance with AERB requirements as on 31st May, 2014 is enclosed as Annexure-1: List of Medical Physics Course

1.4 Important Note for Medical Physics Courses

Only those candidates who successfully complete the Medical Physics course from the institutions listed in annexure-1 and undergo one year internship in a well equipped radiotherapy centre are eligible to work as Medical Physicist in the country. They are also eligible to appear for Radiological Safety Officer (RSO) examination conducted by Radiological Physics & Advisiory Division (RP&AD), Bhabha Atomic Research Centre, Mumbai on succesful completion of which they become eligible to work as RSO in Medical Institutions and can function as RSO with prior approval from AERB.

It is advised that candidates must verify the status of the Medical Physics course with the course conducting institutions and enroll themselves only in those institutions whose course is in line with AERB requirements. Candidates completing the course from any other institutions will not be considered eligible to work as Medical Physicist and RSO in radiotherapy facilities in the country.

Institutions already conducting Medical Physicist course and have not approached AERB so far, shall communicate in order to get their course assessed by AERB.

2 Guidelines for Medical Physics Internship Programme

2.1 General Information

As per revised AERB safety code on Radiation Therapy Sources, Equipment and Installations, 2011 [Code No. AERB/ RF-MED/SC-1(Rev. 1)], minimum 12 months internship in a recognised well-equipped radiation therapy department has been specified as a mandatory requirement for a qualified Medical Physicist and Radiological Safety Officer. To fullfill this requirement, all the Medical Physicists passing out from different academic courses in the country should work as an intern/ resident Medical Physicist under the supervision of a qualified and sufficiently experienced Medical Physicist at a recognised well-equipped radiotherapy centres in the country, as described below, for a duration not less than 12 months.

2.2 Well equipped radiotherapy centre

A radiotherapy centre which is having at least following facilities is considered as well equipped radiotherapy centre for internship program:

2.3 Radiotherapy Equipments

One Linear Accelerator (with photon and electron beams)

One HDR Brachytherapy Unit

One Simulator/ CT-Simulator

One Treatment Planning System

Adequate dosimetry and monitoring instruments

2.4 Manpower

— At least one Medical Physicist with minimum 5 years of experience

2.5 Eligibility for Internship Supervisor

The internship supervisor must have more than 3 years of working experience in a Radiotherapy Department.

2.6 Medical Physicist Interns Ratio

One intern per Medical Physicist having more than 3 years of working experience

2.7 Evaluation and certification procedure

The competency of conducting a clinical task by the intern should be evaluated at regular intervals by the internship supervisor. While doing this evaluation the internship supervisor should ensure that the intern is capable of conducting the desired task unsupervised. It is also important that the intern should prepare a comprehensive report of the work done during the 12 months period of the internship. The report so prepared should jointly be authenticated by the internship supervisor and the Head of Radiation Oncology Department of the institute. Page 4 of 8 June 30, 2014

2.8 Certificate format

The internship completion certificate should be issued on the letterhead of the institution in the following format:

Ref. No. and date of issuing the certificate This is to certify that Dr./Mr/Ms .............................................. of ......................................... University/ Institution has underwent the medical physics internship at the department of radiotherapy under the supervision of .................................................................. (name of the internship supervisor) from (date) ...................... to (date) ...................... It is also certified that the candidate has obtained the full competency in the following components

Radiotherapy equipment (treatment and imaging) and QA

Beam calibration and dosimetry

External beam treatment planning

Brachytherapy dosimetry and treatment planning

In-vivo dosimetry and patient dose verification

Radiation Protection and Safety

and has acquired sufficient knowledge in

Clinical Orientation

Professional skill development and career planning

(Signature with date) (Signature with date) (Signature with date) (Name) (Name) (Name) Head of the Institution Chief Medical Physicist Internship Supervisor Office Seal Office Seal Office Seal

2.9 Syllabus for Internship

2.9.1 Part – I: Core Components

CC1. Radiotherapy Equipment (treatment and imaging) and QA

Specifications, operation and use of telecobalt unit and its accessories such as wedges, breast cone, trays (if available), medical LINAC and its accessories (MLC, EPID, Electron applicators, etc), radiotherapy simulator and its accessories; remote after-loading brachytherapy equipment and its accessories (connectors, guide tubes, applicators, needles, etc), and radiotherapy treatment planning system (RTPS), Familiarization with networking and Record and Verify systems (if available). Page 5 of 8 June 30, 2014

Purchase document preparation, tendering and selection of equipments; Acceptance testing, commissioning measurements and Quality assurance (QA) of radiotherapy treatment and imaging equipments, maintenance of QA records.

CC2. Beam Calibration and Dosimetry

Dosimeters, phantoms and protocols (e.g. IAEA TRS 398/TG-51) for reference dosimetry; output measurements in reference conditions of telecobalt gamma ray beams, high energy x-ray and electron beams from medical LINACs; Familiarization with radiation field analyser (RFA); Measurements of relative dosimetry parameters and factors such as PDD,TPR, TMR, Scatter factors, Wedge factor, Tray transmission factor, electron applicator output factor; Measurement of beam profiles and evaluation of flatness, symmetry and beam penumbra. Uncertainty analysis and testing the authenticity of measured data; Verification of measured data by alternate techniques such as film dosimetry; Quality assurance and up-keeping of dosimetry systems.

CC3. External Beam Treatment Planning

Customization and creation of beam library in the RTPS; Capabilities and limitations of the RTPS, Forward and inverse planning - algorithms; Definition and localization of PTV, CTV, ITV, Organ at risks (OARs), Time and monitor unit calculations for simple treatments, time dose fractionation and gap correction; Steps of treatment planning and treatment planning procedures – patient data acquisition, contouring, immobilization, mould preparation; optimization and evaluation – DVH/ TCP/ NTCP; Planning of common treatment cases; Execution of treatment plans and supervision. Practice with conventional planning, 3D CRT, SRS/SRT, IMRT/IGRT; Acceptance testing and quality assurance of RTPS.

CC4. Brachytherapy Dosimetry and Treatment Planning

Dosimeters for source strength measurements, source strength measurement methods and protocols; dosimetry formalisms, measurement of dosimetry parameters, Definition of reference points of dose calculation, applicator placements, image acquisition, planning procedures, optimization, evaluation; Brachytherapy treatment protocols and recommendations; Practice of planning with clinical cases of intracavitary, intraluminal and interstitial brachytherapy. Execution and supervision of brachytherapy treatments.

CC5. In-Vivo Dosimetry and Patient Dose Verification

Objectives of patient in-vivo dosimetry and dose verification; Understanding the use of different dosimeters in such measurements e.g. ionization chambers, TLD, diodes, MOSFET, films; Selection criteria for the dosimeter; In-vivo dosimetry measurements in gamma rays, x-rays and electron beams; Familiarization with national/ international protocols/ procedures of in-vivo dosimetry and patient dose verification.

CC6. Radiation Protection and Safety

Familiarization with regulatory requirements - safety codes and guides; Responsibilities and duties of a Medical Physicist and radiological safety officer (RSO) in radiotherapy; Working out room layout and shielding calculations for external beam, brachytherapy and simulator (Physical/CT) installations; Submission of safety status report to AERB – ASR, Unusual occurrences, source loss etc. Maintenance of records – QA, calibration certificates of equipments, source inventory, personnel dose records, protection survey Page 6 of 8 June 30, 2014

Radiation safety requirements for radiotherapy equipments; Radiation protection survey of equipment and installations; Analysis of survey data and assessing the safety status of equipment and installations; Familiarization with national regulation pertaining to procurement, use and decommissioning of radiotherapy equipment and sources; Safety of radioactive sources; Experience in handling emergency situations. Safety requirements for occupational, medical and public exposures; Understanding the methods for minimizing the dose to critical sites of the patients. Orientation for RSO certification examination.

2.9.2 Part – II: Auxiliary Components

AC1. Clinical Orientation

Surface and cross sectional anatomy with reference to radiotherapy, identify key anatomical features on x-ray/ CT images, role of radiotherapy in cancer treatment, benign and malignant tumours, primary and secondary tumours, metastasis and routes of metastases, tumour stage and grading, common cancer sites, identification of abnormal size of organs due to primary tumours and metastases on radiological images, identification of organs at risk surrounding the tumours, palliative and curative therapy, time dose fractionation, accuracy requirement in radiotherapy, tissue tolerances, therapeutic gain, clinical targets, anatomical and physiological changes due to radiotherapy treatment, Patient related clinical experiences. Familiarisation with different professionals/ departments involved directly or indirectly with radiation treatment of cancer.

AC2. Professional Skill Development and Career Planning

Ethics in medical use of ionizing radiation; Development of research and teaching skills; Planning research and development on a given topic related to development of dosimetry methods, development of dosimeters, development of QA tools and methods, development of treatment devices and accessories, etc. Training to work as effective educator and mentor in radiation oncology physics.

2.10 Important Note for internship

1. The institutions fulfilling the above mentioned guidelines for Medical Physics Internship Programme and desirous of conducting the internship programme are allowed to take Medical physics interns and no separate permission is required from AERB for carrying out the internship programme. However, the institution providing internship are advised to ensure that the candidates have undergone their Medical Physics Course from an institution who’s Course has been assessed by AERB (Ref: Annexure-1).

2. The co-ordinator the medical physics course conducting institution/candidates are advised to ensure that the institution where the internship is sought by them is meeting the guidelines for Medical Physics Internship Programme laid down by AERB.