Rotations in the Clinical Medical Physics Residency Program at University Hospitals Cleveland Medical Center, in collaboration with Case Western Reserve University, include the following:
- Dosimetric Systems Rotation (core)
Two-week orientation of the new resident is followed by the Dosimetric Systems rotation, which is the first in the series of the 15 rotations. During this rotation, the medical physics resident develops a basic understanding of the design, characteristics and clinical limitations of several radiation measurement systems: ionization chambers, radiographic and radiochromic film, diodes, thermoluminescent dosimeters, diode arrays and ion chamber arrays. The resident also develops an understanding of the design and utility of multiple phantom systems, with the most complex system (3D water tank) being operated by the resident during linear accelerator (LINAC) annual QA and calibrations.
- Treatment Planning Rotation I (core)
This rotation is the resident’s introduction into treatment planning, which includes observing the medical dosimetrists during the treatment planning process of multiple anatomical sites – brain, head and neck, lung and esophagus, breast, abdomen and rectum, pelvis and bladder, skin, sarcoma, whole central nervous system (CNS) and prostate – and develops a treatment plan for each site observed. Additionally, the resident will develop an understanding of the different 3-D photon beam dose algorithms, electron beam dose algorithms, non-dosimetric calculations performed by the planning system (e.g., DRRs, contouring tools, etc.) and dose evaluation tools.
- Treatment Planning Rotation II (core)
This rotation is focused on intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). The medical physics resident will be introduced to optimization, critical organ doses, parallel vs. serial organs, typical dose-volume constraints and dose calculation algorithms specific to IMRT/ VMAT, film as a dose measuring device, small field dosimetry and the basics of imaging for IMRT/ VMAT. Residents will follow a patient from the computed tomography (CT) scan process all the way through the initial treatment delivery. This will require shadowing the CT therapists, the dosimetrist, the medical physicist and the LINAC therapists. There are a fair number of IMRT/ VMAT patients (H&N, Lung, GI and GU) in our department, and there will be no lack of opportunities.
- Linear Accelerator (LINAC) Acceptance, Commissioning and Annual QA Rotation (core)
During this rotation, the medical physics resident performs the tasks necessary to accept and commission a LINAC, including the annual QA of the system. The resident will develop an understanding of linear accelerator fundamentals relevant to commissioning, beam optics, flattening and control parameters, collimation, beam specs and non-beam specs and more. Residents will also determine the data necessary to commission 1 photon and 1 electron beam in the Pinnacle treatment planning system, collect that data and format it for commissioning and determine the data necessary to perform MU calculations for 1 photon and 1 electron beam. Finally, an Annual Quality Assurance procedure (including TG-51 calibration) will be performed for one of the systems during this rotation.
- TPS Modeling, Acceptance and Commissioning Rotation (core)
The TPS modeling rotation provides the medical physics resident the opportunity to accept and commission a three-dimensional treatment planning system. During the rotation, the resident will determine all input data needed to characterize the CT scanner, linear accelerator, photon beam energy and electron beam energy. The resident will utilize data acquired during the previous rotations to commission the system for photon and electron beam energy and compare the results with measurements. The resident compiles the clinical module, detailing the learning opportunities that were experienced during the rotation.
- Imaging for Simulation, Planning, Treatment Verification rotation - IGRT (core)
During this rotation, the medical physics resident will gain an understanding of the Radiotherapy Simulation process, ranging from CT-based virtual simulation to 4DCT and the utility of multimodality imaging. Also, the resident will follow a patient through the CT (PET/CT) simulation process, with an emphasis on geometric aspects of the process (setup geometry specification, immobilization, marking, tattoos, CT including X-ray technique and transfer to planning system). The resident is expected to understand the virtual simulation process and perform a virtual simulation procedure on a phantom – from start to finish with portal film verification. Finally, the resident will observe the use of combined imaging modalities in the simulation process (such as MRI and CT for SRS) and follow a patient through the image-guided setup simulation process.
- Professionalism and Ethics Rotation (core)
In this rotation, the resident will learn about his/her legal, professional and ethical commitments as a medical physicist. The NRC and the state regulations governing the practice of radiation therapy will be reviewed. The resident will participate in hospital inspections conducted by state or other agencies providing oversight of the radiation therapy program. The resident will gain an understanding of the cooperative trials process and entities involved: NRG Oncology, Imaging and Radiation Oncology Core (IROC), and the hospital’s Institutional Review Board (IRB). The resident will also learn about the ethical and professional aspects of medical physics and also the role of leadership in the profession.
- Brachytherapy Rotation (core)
The rotation is structured to provide the medical physics resident with knowledge of brachytherapy basics and brachytherapy applications. The resident should develop a knowledge base, including radioactive decay, characteristics of radioactive sources, source calibration, calculation of dose distributions, different systems of implant dosimetry and implantation techniques. Basic definitions in dose specification will be covered, along with an overview of remote after loading systems and various applicators. The resident will observe the medical physicist during brachytherapy procedures, perform source calibration checks and perform computerized and hand calculated dosimetry to include fundamental calculation techniques. The resident should develop the imaging and treatment planning of brachytherapy, along with patient-specific and system quality assurance.
- Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) Rotation (core)
The SRS-SBRT rotation is designed to give the medical physics resident experience with an intracranial and extracranial hypofractionated radiation therapy with Gamma Knife and/or CyberKnife/ Linac. The resident first reviews the key principles of SRS and SBRT, then actively participates in both the treatment process and the quality assurance process. The treatment process involves image acquisition, treatment planning and treatment delivery. The resident will participate alongside a staff physicist in clinical SRS and SBRT treatments during this rotation.
- Room Design, Radiation Protection and Radiation Safety Rotation (core)
The shielding and design rotation is structured to give the medical physics resident experience in designing facilities appropriate for radiation oncology equipment. The resident is asked to design the shielding for different types of rooms typically found in a radiation oncology department, including a high energy linear accelerator vault and an HDR vault. The resident consults with the physics mentor during the rotation to discuss the specifics of the design process.
- Physicist of the Day (POD) Rotation (core)
This rotation will provide the resident with the fundamental knowledge and practical training for proficiency with day-to-day clinical operations as the floor physicist. Resident performs all clinical tasks under the supervision of a senior staff physicist, i.e. the mentor. The resident is expected to become experienced with all the details about the clinical tasks that need to be performed in the clinical workflow and the responsibilities of the physicist on clinical duty.
- Proton Therapy Rotation (core)
In this rotation, the resident will be given an overview of the proton therapy physics and treatment techniques. The resident will learn through observation and direct participation in the clinical physics activities. The resident will participate in technical aspects of patient care under the supervision of staff proton physicists. These activities include quality assurance (daily, monthly, annual and patient-specific), patient treatment simulation, treatment planning, review of patient positioning and immobilization.
- Special Procedures Rotation (elective I): Total Body Irradiation (TBI), Total Skin Electron Irradiation (TSEI), and Intraoperative Irradiation (IORT)
This rotation prepares the medical physics resident to develop and commission a total body irradiation program. The resident will develop knowledge of the clinical basis for TBI, equipment, dosimetry issues in TBI, field uniformity, beam energy/penetration, blocking, beam data for TBI and hand calculations. During the rotation, the resident will observe/attend a TBI simulation, fabricate the blocks under supervision, verify the block attenuation on the machine, attend/observe in-vivo dose-measurements for TBI, perform hand calcs and compare to diode results. Additionally, the resident gains an understanding of total skin electron and intraoperative irradiation.
- Dedicated Research Rotation (elective II)
Residents may opt for dedicated research time, provided they are in a good position to complete the 12 core rotations successfully and on-time. Research topic(s) can be elected based on the resident’s interest and availability of a suitable guide/ supervisor.