MASTER’SPROGRAMMEINMEDICALPHYSICS

JointlyorganisedbyICTPandTriesteUniversity

(ver10/12/2016)

TheMasterisaddressedtostudentswithaMScinPhysics(orequivalentacademicdegree).

Thecourse,takingintoaccountIAEAandIOMPrecommendations,isorganisedintwoyearsofactivities:

- AfirstyearofacademiccoursesandpracticalexercisesinMedicalPhysics- AsecondyearofsupervisedClinicalTraining

AftertheMaster,therecommendationistofollowother1-2yearsofClinicalTraininginordertoberecognisedasClinicallyQualifiedMedicalPhysicist(CQMP)oradifferentpathaccordingtotherequirementsofthecompetentauthoritiesintheCountry.TheCertification/RegistrationasClinicallyQualifiedMedicalPhysicist(CQMP)hastofollowexistingStateregistrationrules.IAEAandIOMParerecommendingthatthecompetenceshavetobemaintainedwithaCPD(ContinuousProfessionalDevelopment)programme.

MedicalPhysicsMaster-Year1

Theacademiceducationofthefirstyeariscoveringalltherelevantspecialtiesofmedicalphysicstopreparethestudenttoenterinaformalclinicalmedicalphysicsresidency(secondyear).Itwillalsoprovidethestudentwiththebasicknowledgeneededtoembarkonacareerintheregulatory,industry,metrology,researchanddevelopmentorinnovationthroughresearchsectors,forinstance.

Themajoroutcomeoftheacademicprogrammewouldbetoprovidestudentswithathoroughgroundinginthephysiologicalbasis,analyticalmethodsandfundamentalaspectsofmedicalphysicsandinstilanattitudeofintegrity,professionalism,critical-thinkingandscientificrigor.

Teachingisprovidedbothbyfulltimeacademicstaffandbyclinicalmedicalphysicistsandotherhealthcareprofessionals,likeradiobiologists,cliniciansandregulators.

COREMODULESThecoremodulesareprovidedbelow,includinganoutlineoftheircontent:

Code

Nameofcourseorpracticals ECTS*

No.hoursoflectures

orsupervisedexercises

Typeofactivity

Examinationtype

L1 AnatomyandPhysiologyasappliedtoMedicalPhysics

4 32lesson Oral

L2 Radiobiology 1 8 lesson OralL3 RadiationPhysics 4 32 lesson Oral

L4 RadiationDosimetry 4 32 lesson Oral

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L5 MedicalImagingFundamentals 3 24 lesson Oral

L6 PhysicsofImagingDetectors 1 8 lesson Oral

L7 PhysicsofNuclearMedicine 3 24 lesson OralL8 PhysicsofDiagnosticandInterventional

RadiologywithX-ray12 16

lesson Oral

L9 PhysicsofDiagnosticandInterventionalRadiologywithX-ray2

2 16lesson Oral

L10 PhysicsofDiagnosticRadiologywithUSandMR 4 32 lesson Oral

L11 PhysicsofRadiationOncology1 4 32 lesson OralL12 PhysicsofRadiationOncology2 4 32 lesson Oral

L13 RadiationProtection1 2 16 lesson Oral

L14 RadiationProtection2 1 8 lesson OralL15 TechnologyofInformationTechnologyfor

MedicalPhysics2 16

lesson Oral

Guidedexercisesandpracticals(228h):

P1 Athospitalinradiology,nuclearmedicine,radiotherapyandmedicalphysicsdepts 3 36

laboratory written

P2 Radiology 3 36 laboratory writtenP3 Nuclearmedicine 2 24 laboratory written

P4 Radiationoncology 8 96 laboratory written

P5.1 Informationtechnologyandsoftwaretools:exerciseswithImageJ 1 12

laboratory written

P5.2 Statisticsformedicine 1 12 laboratory writtenP6 Montecarlosimulationmethods 1 12 laboratory written

TOTALECTSANDHOURS 60 556 European Credit Transfer and Accumulation System(ECTS) is a standard for comparing the study attainment andperformanceof studentsofhighereducationacross theEuropeanUnionandother collaboratingEuropeancountries. Forsuccessfully completed studies, ECTS credits are awarded. One academic year corresponds to 60ECTS-creditsthat areequivalentto1500–1800hoursofstudyinallcountriesirrespectiveofstandardorqualificationtypeandisusedtofacilitatetransferandprogressionthroughouttheUnion.Typically,aECTSisequivalentto25-30hoursofstudy.

L1.AnatomyandPhysiologyasappliedtoMedicalPhysics

o AnatomicalNomenclature§ Originofanatomicalnames§ Prefixesandsuffixes§ Anatomicalpositionandbodyplaneterminology

o Structure,Physiology,Pathology,andRadiographicappearance(x-ray,CT,MRIandnuclearmedicineimaging)of:

§ BonesandBoneMarrow§ BrainandCNS§ Thorax§ Abdomen

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§ Pelvis§ Respiratory,Digestive,Urinary,Reproductive,Circulatory,Lymphatic,

EndocrineSystems

L2.Radiobiologyo ClassificationofRadiationinradiobiologyo Cell-Cycleandcelldeatho Effectofcellularradiation,oxygeneffecto Typeofradiationdamageo Cellsurvivalcurveo Dose-responsecurveo Earlyandlateeffectsofradiationo Modelling,LinearQuadraticModel,α/βRatioo Fractionation,EQD2Gyo DoseRateEffecto TumourControlProbability(TCP),NormalTissueComplicationProbability(NTCP),

EquivalentUniformDose(EUD)o ToleranceDosesandVolumes,QuantitativeAnalysisofNormalTissueEffectsinthe

Clinic(QUANTEC)[10]o Normalandtumourcelltherapeuticratioo Radio-sensitizers,Protectors

L3.RadiationPhysics

o Briefreviewofquantummechanicsandmodernphysicso X-raysradiology-introductiono Passageoftheradiationthoughmatter;microscopictreatment

§ coherentandincoherentscatteringonatoms§ photoelectriceffect§ characteristicx-rays

o Passageofx-raysthroughmatter:macroscopictreatment§ Filtering§ X-raysinstrumentation§ Contrastandscatteredradiation

o X-raysdetectors§ Imageintensifiers§ Imagescreens§ Digitaldetectors:computedradiography;thef-centers,directradiography,

indirectconversionmethods,directconversionmethods§ Otherdigital detectors

L4.RadiationDosimetry

o QuantitiesandUnits

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o Stochastic,non-stochasticquantitieso Fluence,Exposure,KERMA,Absorbeddoseo Radiation,chargedparticleequilibriumo NeutronInteractionso Multiplescatteringtheorieso StoppingPower

§ Restricted,Unrestricted§ LinearEnergyTransfer(LET)

o TransportEquation§ ChargedParticleslowingdown § ContinuousSlowingDownApproximation(CSDA)

o Fanotheoremo CavityTheory

§ Large,smallcavityo RadiationDosimetersandinstrumentationo RadiationStandardso CalibrationChaino AbsolutedosimetryprotocolsandIAEAcodesofpractice

L5.MedicalImagingFundamentals

o MathematicalMethodso TomographicReconstructionTechniqueso LinearSystemso Acquisition,formation,processinganddisplayofmedicalimageso Perceptiono EvaluationofImageQuality

L6.PhysicsofImagingDetectors

o Basics:IntroductiontoPoissonstatisticso Physicsofgenericphotondetectors

§ Quantumefficiency• Directconversiondetectors

o Chargegenerationandchargecollection• Indirectconversiondetectors

o Scintillators§ Integratingdetectors§ Countingdetectors§ Spectroscopicdetectors

o Sampling§ Space§ Time

o Noiseconsiderations

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§ Signaltonoiseratioo Photontransfercurveo Conceptofspatialfrequencydependingdetectivequantumefficiency

§ Integratingdetectors§ Countingdetectors

L7.PhysicsofNuclearMedicine

o Shortelementsofnucleardecayso Radioisotopeimaginggeneralitieso Imagesfromradioisotopeso Radioisotopesproduction

§ Batemanequationso Radionuclidesadministrationo Themostfrequentyusedradioisotopeso ImagingInstrumentation

§ Planar,Whole-body§ SPECT§ PET§ HybridImaging

o Medicalapplicationsofspectandpeto ImageQualityandnoiseo Non-imagingInstrumentation

§ Dosecalibrators,Wellcounters§ Probes

o InternalDosimetryo QuantitativeImagingo RadionuclideTherapyo Acceptancetestingandcommissioningo QualitymanagementofNuclearMedicine

L8-L9.PhysicsofDiagnosticandInterventionalRadiologywithX-Ray

o OverviewofImagingModalities(ionizingandnon-ionizing)o XrayImaging

§ Generationofx-rays,x-rayspectra§ Detectors§ ImageParameters§ Imagequality,Noise,contrast,resolution§ Radiographic,Mammography,Fluoroscopic,§ CT,DECT,Tomosynthesis§ InterventionalRadiology§ Dualenergyimagingandabsorptiometry§ Patientdoseandsystemoptimization

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o DualandMulti-modalityImagingo QualityManagementofDiagnosticandInterventionalRadiology

L10.PhysicsofDiagnosticRadiologywithUSandMR

o UltrasoundImaging§ Acousticpropertiesofbiologicaltissues§ Wave,motionandpropagation,acousticpower§ ModesofScanning§ Transducers§ Doppler§ Safety

o MagneticResonanceImaging(MRI)§ PhysicsofMagneticResonance§ MRImageformation§ MRInstrumentation§ MRImethods§ MRcontrastandimagequality§ Clinicalapplicationsandartefacts§ Safety

L11-L12.PhysicsofRadiationOncology

o Overviewofclinicalradiotherapyo Radiationtherapyequipment(accelerators,cobalt60,cyclotrons,kVgenerators)o Basicphotonradiationtherapy(dosimetricfunctions,etc.)o Basictreatmentplanningo Simulation,virtualsimulation,DRR’s,imageregistrationo Patientsetup,includingpositioningandimmobilizationo ICRUReports50,62and83o Basicelectronradiationtherapy,ICRUReport71o Kilovoltageradiotherapyo Dosecalculationalgorithmsandheterogeneitycorrectionso Brachytherapy,ICRUReport38,AAPMTG43formalism

§ HDR/LDR,Equipment,TreatmentPlanningo InversePlanning,optimization,IMRTo Smallfielddosimetry(fundamentalaspects,protocols)o Small-fieldradiotherapyequipmentandtechniques(StereotacticRadiotherapyand

Radiosurgery,StereotacticBodyRadiotherapy,IntensityModulatedRadiotherapy,TomotherapyTM,CyberknifeTM,GammaknifeTM,etc.)

o Imageguidanceandverificationinradiotherapy(ConebeamCT,ultrasound,Portalimaging,in-vivodosimetry,imageregistration)

o Radiationtherapyinformationsystemso Acceptancetestingandcommissioning

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o QualitymanagementofradiotherapyL13-L14.RadiationProtection

o SourcesofRadiationo Activity,half-life,exponentialattenuation,half-valuelayer(HVL),inversesquarelaw,

tenth-valuelayer(TVL)o BiologicalEffectsofRadiationo RadiationQualityfactor,Equivalentdose,Effectivedoseo Legalframeworkforradiationprotection(BSS)o Aslowasreasonablyachievable(ALARA)concepto Occupational,publicexposureandannuallimitso Radiationprotectiondetectors(Ionizationchambers,Geiger-Mueller,Proportional

counters,Scintillators,ThermoluninescentDosimeters(TLDs),neutrondetectors)o Personalandenvironmentaldosimetryo Shieldingcalculationo Radioactivetransportandwastemanagemento Emergencyprocedureso Radiationprotectionprogrammedesign,implementationandmanagementinthe

medicalsectorL15.TechnologyofInformationTechnologyforMedicalPhysics

o Internationalstandards§ IEC,DICOM,IHE

o HIS/RIS/PACSo RadiotherapyR&Vsystemso Navigationsystemso Registration,segmentation

Seminarscoveringfollowingtopics:

• ICTPandICTP/IAEAtrainingcourses• ProfessionalandScientificDevelopment

o Ethics,professionalism• PresentationSkills

o ScientificCommunicationo TechniquesofInstruction

PRACTICALSESSIONSP1.Practicalsessionswithahospitalfacilities3hourssessionstobeheldattheTriesteHospitalfacilities.

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Session1 Session2 Session3 Session4 Session5 Session6

InterventionalandDiagnosticRadiology

InterventionalandDiagnosticRadiology

InterventionalandDiagnosticRadiology

InterventionalandDiagnosticRadiology

NuclearMedicine NuclearMedicine

Conventionalradiography Mammography

InterventionalRadiology

ComputedTomography

Non-imagingInstrumentationQC

ImagingInstrumentation

(SPECT)QC

Session7 Session8 Session9 Session10 Session11 Session12

RadiationDosimetryRadiationProtection RadiationOncology RadiationOncology RadiationOncology RadiationOncology

RadiochromicFilmDosimetry

RadiationSurveyofaclinicalinstallation

WaterTankScanningofPhotons

clinicalbeams

WaterTankScanningof

Electronsclinicalbeams

QConLinac QConMLC

P2.Radiology• Generalradiology:QA,patientdosimetry(softwaretools)• Interventionalradiology:

o EquipmentQAo Procedureoptimisation:DRLs,equipmentset-up,protocoloptimisationo Preventionofskinburns:skindosimetry,triggerlevel,protocoloptimisation,clinical

follow-upofhighdosepatients• IntroductionanduseofIDLtoolsforimageanalysis

P3.NuclearMedicine

• Imagequalityassessment• QCofnuclmedicineinstrumentation• Patientinternaldosimetry(useofsoftwaretools)

P4.RadiationOncology

• CommissioningandbasicQCo Linac(AAPMTG106and142)o Simulators(AAPMRPT83)o Epido kVImager,R&V

• MUcalculation(ESTRO)• QAofaTPS(AAPMTG43)• Externalbeamphotontherapyplanning(ICRU50&62)• Electronbeamelectrontherapyplanning(ICRU71)• 3DCRTplanning

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• IMRT/VMAT:Planning(ICRU83)andQA(includedAAPMTG142)• Simulation,virtualsimulation,DRR’s,imageregistration,patientsetup,includingpositioning

andimmobilization• Imageguidanceandverificationinradiotherapy:conebeamCT,ultrasound,portalimaging,

(AAPMTG179and95)• Multimodality:imageregistration,motionmanagement• BrachytherapyplanningandQA

P5.1Informationtechnologyandsoftwaretoolsformedicalphysics

• ProgrammingwithImageJ:quantitativeimagequalityassessmentP5.2StatisticsforMedicine:Statisticsasausefulandnecessarytoolforthehealthprofessions.

• Descriptivestatistics:o Charts/tables,box-plot,measuresofcentral tendency,measuresofdispersionand

their'critical'use.ExamplesandexerciseswithRinthefieldofbio-medical.o Elementsofprobabilitytheory:definitionsandproblems,theconditionalprobability.o DiagnostictestsandROCcurve:ExamplesandexerciseswithRo PopulationsofGaussiandataandtheirproperties.

• Elementsofstatisticalinference:o Pointestimates,estimatesofintervals,the'confidenceintervals'.Estimationofthe

meanofapopulationofGaussiandata.ExamplesandexerciseswithR;o Statisticaltests:thechi-squaretest,Fisher'sexacttest,thettestStudent,Mann-

WhitneytestandtheWilcoxontest.ExamplesandexerciseswithRo Riskmeasures:relativerisk(RR)andoddsratio(OR)o Linearregression:ExamplesandexerciseswithR

• CriticalreadingofascientificarticleP6.MonteCarlosimulationmethodsformedicalphysics

• GeneralIntroductiontoMonteCarlomethods• UseofMonteCarlomethodsinMedicalPhysics• BasicofMonteCarlosimulationwithintheGeant4framework• PracticalsessionofGeant4simulation• BasicinformationaboutotherMCtools

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MedicalPhysicsMaster-Year2

Year2isdevotedtoasupervisedfulltimeclinicaltrainingtobeperformedinoneaccreditatedhospitals.Thestudentshould\practicescoveringmainlyaspecificareaofmedicalphysics(medicalphysicsfordiagnosticimagingormedicalphysicsforradiationtherapy.Activitiestoperform,assessmentoftheskillsandcompetencesacquiredineachfieldareadaptedfromtheIAEAandAFRAclinicaltrainingofmedicalphysicistsguidelines.

Activitytype ECTS* MinimumNo.Ofhours

Clinicaltraininginahospitalofthenetwork 55 1200Finalthesis 5 125

TOTALECTSANDHOURS 60 1325Theassignmenttohospitalswillbenotleesthan45weeks(about1700hours)thatincludestheworkforthedevelopmentofthethesiswork.

ClinicaltrainingcontentandassessmentagreementTwoprogrammesareidentified:

• thefirstforthetraininginradiotherapy,• thesecondfordiagnosticradiologyandnuclearmedicine.

ThecontentanddurationoftheclinicaltrainingwillbetailoredtothebackgroundandknowledgeoftheResidenttakingintoaccountthefollowingtables.AnindividualPortfoliowillbedevelopedbytheClinicalMedicalPhysicistSupervisortailoredtotheResidentbackgroundandknowledgebeforethebeginningoftheclinicaltraining.

Radiotherapy

Module Duration(weeks) Range

(weeks)

Clinicalenvironmentinradiotherapy Entireprogramme46weeks

Externalbeamradiotherapy(EBRT)referencedosimetry 4 2-6

EBRTrelativedosimetry 7 4-10

Imagingequipment 3 2-4

EBRT 17 14-20

Brachytherapy 2.5 1-4

Radiationprotectionandsafety 3 2-4

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Equipmentspecificationandacquisition 1.5 1-2

Qualitymanagement 8 6-10

Professionalethics Entireprogramme46weeks

Totalweeks 46

Diagnosticandinterventionalradiology&nuclearmedicine

Module Duration(weeks) Priorities

Clinicalawareness Entireprogramme23wks

Radiationprotectionandsafety 3

Dosimetryinstrumentationandcalibration 1

Performancetestingofimagingequipment 13 1

Patientdoseaudit 2 4

Technologymanagementofimagingequipment 1 2

Optimisationofclinicalprocedure 3 3

Professionalethics Entireprogramme23wks

Totalweeks 23

(Thetrainingcanbeexpandedupto36wksincludingangiographyunitsandMRIimagingandsafety.Theremaining10weekswillbedevotedtoperformancetestingmodulesofnuclearmedicineequipment)–Priorities:1basic–4highestcompetences

Module Duration(weeks) Priorities

Clinicalawareness Entireprogramme23wks

Radiationprotectionandsafety 4 4*

TechnologymanagementinNM 2

Radioactivitymeasurementandinternaldosimetry 3

PerformancetestingofNNMequipment 7 1

Preparationandqualitycontrolofradiopharmaceuticals 1

Radionuclidetherapyusingunsealedsources 2 3

Optimisationinclinicalapplication 4 2

Professionalethics Entireprogramme23wks

Totalweeks 23

(Thetrainingcanbeexpandedupto36wksincludingalsoPET/CT.Theremaining10weekswillbedevotedtoperformancetestingmodulesofdiagnosticradiologyequipment)–Priorities:1basic–4highestcompetences

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(*)designoftheNMDpt

Fordiagnosticandinterventionalradiology&nuclearmedicineitisstatedthatthe2sub-programmescanshareequallythetimeor,inthecaseofspecificresidenttrainingneeds,asub-programmecanbeenlargedmaintainingsomemodulesofthesecondprogrammethathastobeincludedfollowingtheindicatedpriorities(priority1indicatethemandatorymodule)

Thestudents,attheendofthefirstyearoftheCoursewillbeassignedtoahospitaloftheNetworkofaccreditedhospitals.

HeadoftheMedicalPhysicsDepartmentsandHospitalsoftheNetworkofHospitalsfortheClinicalTraining

HeadMPDpt Hospitalname Town

StefaniaMaggi Az.OspedalieroUniversitariaOspedaliRiuniti Ancona

ElviraCapra CentrodiRiferimentoOncologico Aviano

AndreoliStefano Az.OspedalieraPapaGiovanniXXIII Bergamo

AlessandroTurra Az.OspedalieroUniversitaria“ArcispedaleSant’Anna” Ferrara

BusoniSimone Az.OspedalieraCareggi Firenze

AlbertoTorresin OspedaleNiguardaCa'Granda Milano

GabrieleGuidi Az.Ospedaliero-Universitaria di Modena Modena

AndreaCrespi Az.OspedalieraS.Gerardo Monza

MarcoBrambilla Az.OspedalieroUniversitariaOsp.MaggioredellaCarità Novara

MartaPaiusco IstitutoOncologicoVeneto Padova

AntonioTraino Az.OspedalieroUniversitariaPisana Pisa

LidiaStrigari Ist.NazionaleTumoriReginaElena Roma

RobertoRopolo A.O.U.CittadellaSaluteedellaScienza Torino

AldoValentini OspedaleS.Chiara Trento

MarioDeDenaro Az.OspedlaieroUniversitariaOspedaliRiuniti Trieste

MariaRosaMalisan Az.OspedalieroUniversitariaS.MariadellaMisericordia Udine

CarloCavedon Az.OspedalieroUniversitariaIntegrata Verona

PaoloFrancescon ULSS6Vicenza,OspedaleSanBortolo Vicenza

HrvojeHrsak UniversityHospitalCentreZagreb(KBC) Zagreb

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