Download 五．课程科目内在联系

北美医学物理师义讲团
第一讲：Big Picture, 治病流程，课程内在联系
一．国际医学物理界 (IOMP)
二．医疗行业 (non-profit)
三．癌症管理(Cancer Management)
四．治病流程
五．课程科目内在联系
一．国际医学物理界
1) UN – IAEA – Department of Nuclear Sciences and Applications –
Division of Human Health – Dosimetry and Medical Radiation Physics
Section. (Free hand book from Dr. Ervin Podgorsak).
2) International Organization for Medical Physics (IOMP) 1963, Canada,
Sweden, UK, USA, etc 80 national organizations. 18,500 medical
physicists.
AFOMP 亚太 16 countries.
EFOMP 欧洲 38 countries.
SEAFOMP 东南亚 7 countries.
ALFIM 拉美 13 countries.
AAPM 美国 (7000 members).
COMP 加拿大 (>500 members)
中东、非洲
3) Journals & Meetings:
Medical Physics journal – AAPM, CCPM, COMP, IOMP.
Physics in Medicine and Biology – IOP, IPEM
Physica Medica – Europe
AAPM 年会，COMP 年会，每四年合开一次年会。
 Canada/US = 11%人口，~23%论文
 AAPM Awards:
--- Farrington Daniels Award: 64% Canadian (ttl: 36)
--- Sylvia Sorkin Greenfield Award: 30% Canadian (ttl: 28)
--- Colidge Award: 12% Canadian (ttl: 39)
4) Education, Training, Certification (Career Path).
B.Sc in Physics  M.Sc. and/or Ph.D. in medical physics (CAMPEP) 
Residency (CAMPEP)  Certificate Exam (DABR, MCCPM opens to
world), or FAAPM, FCCPM  MOC (maintenance of certification).
 CAMPEP accredited M.Sc. 28% in Canada, Residency 20% in
Canada.
5) IMPCB: International Medical Physics Certification Board (2010).
The objectives and purposes are:
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To define minimum professional standards and improve the practice
of …
to establish the infrastructure, requirements and assessment
procedures for the accreditation of medical physics certification
programs …
to establish the infrastructure, requirements and examination
procedures for the certification of medical physicists
……
to establish a continuing education and professional development
system for certified medical physicists
二．医疗行业 (non-profit)
1) HCA (Hospital Corporation of America)
 … is an American for-profit operator of health care facilities, the largest
in the world. It … manages 162 hospitals and 113 freestanding
surgery centers in US and UK. … … (204,000 employees, Revenue:
$33 billions).
Compared to Fortune 500: Microsoft $78 billions
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2) US renowned hospitals
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East: UCLA/UCSF, Stanford U
North: Mayo Clinic, Cleveland clinic, UPMC
West: Harvard U, John Hopkins U, Duke U, Memorial Sloan, U of
Washington
South: MD Anderson.
3) US has most private hospitals in the world.
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2013 US has 5686 hospitals, private not-for-profit 60%, government
21%, private for-profit 19%. (from www.aha.org)
Japan, Taiwan similar to US.
Hong Kong, Singapore, Canada: government >70%.
4) Not-for-profit is the mainstream in healthcare.
一个健康的人可以有一百个愿望
一个生病的人只有一个愿望！
专心做事，好好做人
三．癌症管理(Cancer Management)
1) Management (team work!!)
112 type of cancers, per NIH, NCI. (PDQ database for patients and
professionals)
http://www.cancer.gov/cancertopics/pdq/adulttreatment
Examples:
Lung SCLC (8 tx options):
--- LS-SCLC: 1) chemo&RT, may RT to whole brain. 2) chemo. 3)
surgery+chemo. 4) surgery+(chemo&RT).
--- ES-SCLC: 4+
Lung NSCLC (45+ tx options):
--- stage 0: 3+. Stage I: 5+. Stage II: 5+. Stage IIIA: 5+4+5+5.
Stage IIIB: 6+. Stage IV: 7+.
Breast: chemo + surgery + RT, etc.
Prostate: no treatment, observe, or treat with RT or PSI + hormonal.
Rectum: RT before surgery, etc.
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2) types of treatment
治愈：Curative
姑息：palliative.
辅助：adjuvant/adjunct/adjunctive (to suppress like treating chronic disease)
3) 8000+ clinical trials (with NCI).
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“瞎猫碰死老鼠”：
--- biology of cancer and radiobiology lagging behind practices, need
10+ yrs to mature.
Results or reports from 19,000 trials since 1970s.
4) Effective Treatment
 Surgery 50%, RT 40%, chemo 10%.
 Cancer is caused by ~12 gene mutations. (human: 2 / day!)
--- Possibility of one gene mutation connected to next:
If 1/2, Prob.=(2^12)/2/365 = 5.6 yrs. If 1/3, Prob.= 728 yrs.
--- Surgery and RT remove or destroy all cancer cells, chemo acts on
1-2 gene mutations. (chemo 鸡尾酒疗法)
四． 治病流程
1) Diagnosis
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Wrong cancer diagnosis in US: 6%
--- False negative and false positive. (有病说没病，没病说有病)
--- pathologist in China? 30%??
2) Where patients from?
--- Diagnosed: from symptoms.
--- Screening: e.g. mamography, PSA, lung, etc. depends on age, sex,
risk factors, diagnostic testing, etc.
>> cancer is 老年病, incidence increase exponentially.
>> now 1/4 cancer in life, future 1/2 cancer in life!!
--- Found by chance: when doing other tests or examinations.
3) 放疗中心角色分工
RO: contour oriented. (radiation oncologist)
MP: technique oriented. (medical physicist)
RTT: reproducibility oriented. (radiation therapy technician)
4) RT Patient Work Flow
 (See illustration in Paint)
五．课程科目内在联系
 (See illustration in Paint)