Medical physics

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Medical Physics is generally speaking the application of physics concepts, theories and methods to medicine/healthcare.

Medical physics departments are found in hospitals or universities.

In the case of hospital work the term 'Medical Physicist' is the title of a specific healthcare profession with a specific mission statement (see below). Such Medical Physicists are often found in the following healthcare specialties: Diagnostic and Interventional Radiology (also known as Medical Imaging), Nuclear Medicine and Radiation Oncology (also known as Radiotherapy). However, areas of specialty are widely varied in scope and breadth e.g., Clinical Physiology (also known as Physiological Measurement, several countries), Neurophysiology (Finland), Radiation Protection (many countries), and Audiology (Netherlands).

University departments are of two types. The first type are mainly concerned with preparing students for a career as a hospital Medical Physicist and research focuses on improving the practice of the profession. A second type (increasingly called 'Biomedical Physics') has a much wider scope and may include research in any applications of physics to medicine from the study of biomolecular structure to microscopy and nanomedicine.

Contents

Mission Statement of the healthcare profession 'Medical Physicist' [edit]

In the case of hospital Medical Physics departments the mission statement is as follows; it is based on a mission statement found here:[1]

“Medical Physicists will contribute to maintaining and improving the quality, safety and cost-effectiveness of healthcare services through patient-oriented activities requiring expert action, involvement or advice regarding the specification, selection, acceptance testing, commissioning, quality assurance/control and optimised clinical use of medical devices and regarding patient risks and protection from associated physical agents (e.g., x-rays, electromagnetic fields, laser light, radionuclides)including the prevention of unintended or accidental exposures; all activities will be based on current best evidence or own scientific research when the available evidence is not sufficient. The scope includes risks to volunteers in biomedical research, carers and comforters. The scope often includes risks to workers and public particularly when these impact patient risk”

The term ‘Physical Agents’ refers to ionising and non-ionising electromagnetic radiations, static electric and magnetic fields, ultrasound, laser light and any other Physical Agent associated with medical e.g., x-rays in computerised tomography (CT), gamma rays/radionuclides in Nuclear Medicine, magnetic fields and radio-frequencies in Magnetic Resonance Imaging (MRI), ultrasound in Ultrasound Imaging and Doppler measurements etc.

This mission includes the following 11 key activities:

1. Scientific problem solving service: Comprehensive problem solving service involving recognition of less than optimal performance or optimised use of medical devices, identification and elimination of possible causes or misuse, and confirmation that proposed solutions have restored device performance and use to acceptable status. All activities are to be based on current best scientific evidence or own research when the available evidence is not sufficient.

2. Dosimetry measurements: Measurement of doses suffered by patients, volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures (e.g., for legal or employment purposes); selection, calibration and maintenance of dosimetry related instrumentation; independent checking of dose related quantities provided by dose reporting devices (including software devices); measurement of dose related quantities required as inputs to dose reporting or estimating devices (including software). Measurements to be based on current recommended techniques and protocols. Includes dosimetry of all physical agents.

3. Patient safety / risk management (including volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures. Surveillance of medical devices and evaluation of clinical protocols to ensure the ongoing protection of patients, volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures from the deleterious effects of physical agents in accordance with the latest published evidence or own research when the available evidence is not sufficient. Includes the development of risk assessment protocols.

4. Occupational and public safety / risk management (when there is an impact on medical exposure or own safety). Surveillance of medical devices and evaluation of clinical protocols with respect to protection of workers and public when impacting the exposure of patients, volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures or responsibility with respect to own safety. Includes the development of risk assessment protocols in conjunction with other experts involved in occupational / public risks.

5. Clinical medical device management: Specification, selection, acceptance testing, commissioning and quality assurance/ control of medical devices in accordance with the latest published European or International recommendations and the management and supervision of associated programmes. Testing to be based on current recommended techniques and protocols.

6. Clinical involvement: Carrying out, participating in and supervising everyday radiation protection and quality control procedures to ensure ongoing effective and optimised use of medical radiological devices and including patient specific optimization.

7: Development of service quality and cost-effectiveness: Leading the introduction of new medical radiological devices into clinical service, the introduction of new medical physics services and participating in the introduction/development of clinical protocols/techniques whilst giving due attention to economic issues.

8: Expert consultancy: Provision of expert advice to outside clients (e.g., clinics with no in-house medical physics expertise).

9. Education of healthcare professionals (including medical physics trainees: Contributing to quality healthcare professional education through knowledge transfer activities concerning the technical-scientific knowledge, skills and competences supporting the clinically effective, safe, evidence-based and economical use of medical radiological devices. Participation in the education of medical physics students and organisation of medical physics residency programmes.

10. Health technology assessment (HTA): Taking responsibility for the physics component of health technology assessments related to medical radiological devices and /or the medical uses of radioactive substances/sources.

11: Innovation: Developing new or modifying existing devices (including software) and protocols for the solution of hitherto unresolved clinical problems.

University Biomedical Physics Departments [edit]

In the case of Research-based University departments the mission is wider and to emphasize this fact we often speak of Biomedical Physics (in some countries 'Medical Biophysics'): Biomedical physics is the use of physics concepts, theories and methods for the greater understanding and development of both clinical practice and experimental medicine. This is a wider definition than hospital Medical Physics and would include physics based aspects of life science research which would have a future impact on clinical practice (e.g., various forms of microscopy, nanodevices, spectrometry, biomolecular structure, cell biology physics). Many biomedical physics departments today are of necessity multi-disciplinary and may include not only physicists but also engineers, mathematicians and sometimes chemists and physicians.[2]

Areas of specialty [edit]

Diagnostic and Interventional Radiology [edit]

Para-sagittal MRI of the head in a patient with benign familial macrocephaly.

Radiation Oncology [edit]

Nuclear Medicine [edit]

This is a branch of medicine that uses radiation to provide information about the functioning of a person's specific organs or to treat disease. In most cases, the information is used by physicians to make a quick, accurate diagnosis of the patient's illness. The thyroid, bones, heart, liver and many other organs can be easily imaged, and disorders in their function revealed. In some cases radiation can be used to treat diseased organs, or tumours. Five Nobel Laureates have been intimately involved with the use of radioactive tracers in medicine.

Over 10,000 hospitals worldwide use radioisotopes in medicine, and about 90% of the procedures are for diagnosis. The most common radioisotope used in diagnosis is technetium-99, with some 30 million procedures per year, accounting for 80% of all nuclear medicine procedures worldwide.

In developed countries (26% of world population) the frequency of diagnostic nuclear medicine is 1.9% per year, and the frequency of therapy with radioisotopes is about one tenth of this. In the USA there are some 18 million nuclear medicine procedures per year among 311 million people, and in Europe about 10 million among 500 million people. In Australia there are about 560,000 per year among 21 million people, 470,000 of these using reactor isotopes. The use of radiopharmaceuticals in diagnosis is growing at over 10% per year.

Nuclear medicine was developed in the 1950s by physicians with an endocrine emphasis, initially using iodine-131 to diagnose and then treat thyroid disease. In recent years specialists have also come from radiology, as dual CT/PET procedures have become established.

Computed X-ray tomography (CT) scans and nuclear medicine contribute 36% of the total radiation exposure and 75% of the medical exposure to the US population, according to a US National Council on Radiation Protection & Measurements report in 2009. The report showed that Americans’ average total yearly radiation exposure had increased from 3.6 millisievert to 6.2 mSv per year since the early 1980s, due to medical-related procedures. (Industrial radiation exposure, including that from nuclear power plants, is less than 0.1% of overall public radiation exposure.)

Physiological Measurement [edit]

ECG trace

Used to monitor and measure various physiological parameters. Many physiological measurement techniques are non-invasive and can be used in conjunction with, or as an alternative to, other invasive methods.

Radiation Protection [edit]

Education and training [edit]

In Europe [edit]

The presence of Medical Physicists at Expert level ('Medical Physics Experts') in healthcare in Europe is required by EC Directive 97/43/Euratom. At the moment the European Federation of Organizations for Medical Physics is defining a detailed inventory of learning outcomes for Medical Physics Experts in terms of Knowledge Skills and Competences. In Europe education consists of a first degree in Physics or equivalent, a Masters in Medical Physics and a training Residency. For the latest on the EC funded 'Guidelines on the Medical Physics Expert' project go to the EFOMP website (www.efom.org)>

In North America [edit]

In North America,[3] medical physics training is offered at the bachelor's, master's, doctorate, post-doctorate and/or residency levels. Several universities offer these degrees in Canada and the United States.

As of October 2010, twenty-seven universities in North America have medical physics graduate programs that are accredited by The Commission on Accreditation of Medical Physics Education Programs (CAMPEP).[4] The same organization has accredited forty-three medical physics clinical residency programs.[4]

Professional certification is obtained from the American Board of Radiology, the American Board of Medical Physics, the American Board of Science in Nuclear Medicine, and the Canadian College of Physicists in Medicine. As of 2012, enrollment in a CAMPEP-accredited residency or graduate program is required to start the ABR certification process. Starting in 2014, completion of a CAMPEP-accredited residency will be required to advance to part 2 of the ABR certification process.[5]

In the United Kingdom [edit]

The person concerned must first gain a first or upper second-class honours degree in a physical or engineering science subject before they can start the Part I medical physics training within the National Health Service.[6][7]

Trainees can complete Part I training in fifteen months provided they hold an MSc from an IPEM accredited center in the United Kingdom or the Republic of Ireland (National University of Ireland, Galway). For these candidates, the Part I training consists of pure clinical experience. Trainees applying for Part I trainee holding only a degree in an engineering or physical science subject must undertake a combined study and clinical training programme. This programme consists of two years of clinical placement, during which the trainee will study for an MSc in Medical Physics which is approved by the Institute of Physics and Engineering in Medicine (IPEM). The MSc will be either at University College London, Swansea, Sheffield, Surrey, Birmingham, Leeds, Manchester, Aberdeen, Glasgow, King's or Queen Mary's. Open University also offers a Master of Science in Medical Physics, but the prospective student should first check that this degree will satisfy the accreditation requirements or that it is accepted before embarking on it. Successful completion of the Part I training programme leads to an IPEM Diploma. The trainee can then apply for a Part II position, which consists of the IPEM's Part II training which takes a further two years and leads to Corporate Membership of the IPEM, and registration as a Clinical Scientist (if successful).

Note that some training centres offer a contract for the full four (three) years of the scheme, while some offer only part I training, with a requirement to reapply for part II.

As of October 2011, the scheme will be changing again as part of Modernising Scientific Careers.

Legislative and advisory bodies [edit]

See also [edit]

References [edit]

  1. ^ Guibelalde E., Christofides S., Caruana C. J., Evans S. van der Putten W. (2012). Guidelines on the Medical Physics Expert' a project funded by the European Commission
  2. ^ Caruana C.J., Wasilewska-Radwanska M., Aurengo A., Dendy P.P., Karenauskaite V., Malisan M.R., Meijer J.H., Mornstein V., Rokita E., Vano E., Wucherer M. (2008). The role of the biomedical physicist in the education of the healthcare professions: an EFOMP project. Physica Medica - European J of Medical Physics, 25, 133-40.
  3. ^ How does someone become a Medical Physicist?. AAPM. Retrieved on 2011-06-25.
  4. ^ a b CAMPEP Accredited Graduate Programs in Medical Physics. Campep.org (2011-06-01). Retrieved on 2011-06-25.
  5. ^ IC RP CAMPEP addendum. Theabr.org. Retrieved on 2011-06-25.
  6. ^ Medical physicist. NHS Careers. Retrieved on 2011-06-25.
  7. ^ Training as a clinical scientist and the scientist training programme (STP). NHS Careers. Retrieved on 2011-06-25.

Further reading [edit]

  • Amador Kane, Suzanne (2009). Introduction to Physics in Modern Medicine, Second Edition. CRC Press. ISBN 978-1-58488-943-4. 
  • Khan, Faiz (2003). The Physics of Radiation Therapy. Lippincott Williams & Wilkin. ISBN 978-0-7817-3065-5. 
  • Attix, Frank (1986). Introduction to Radiological Physics and Radiation Dosimetry. Wiley-VCH. ISBN 978-0-471-01146-0. 

External links [edit]

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