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MASTER’SPROGRAMMEINMEDICALPHYSICS JointlyorganisedbyICTPandTriesteUniversity (ver10/12/2016) TheMasterisaddressedtostudentswithaMScinPhysics(orequivalentacademicdegree). Thecourse,takingintoaccountIAEAandIOMPrecommendations,isorganisedintwoyearsofactivities: - AfirstyearofacademiccoursesandpracticalexercisesinMedicalPhysics AsecondyearofsupervisedClinicalTraining AftertheMaster,therecommendationistofollowother1-2yearsofClinicalTraininginordertoberecognised asClinicallyQualifiedMedicalPhysicist(CQMP)oradifferentpathaccordingtotherequirementsofthe competentauthoritiesintheCountry.TheCertification/RegistrationasClinicallyQualifiedMedicalPhysicist (CQMP)hastofollowexistingStateregistrationrules.IAEAandIOMParerecommendingthatthecompetences havetobemaintainedwithaCPD(ContinuousProfessionalDevelopment)programme. MedicalPhysicsMaster-Year1 Theacademiceducationofthefirstyeariscoveringalltherelevantspecialtiesofmedicalphysicstoprepare thestudenttoenterinaformalclinicalmedicalphysicsresidency(secondyear).Itwillalsoprovidethestudent withthebasicknowledgeneededtoembarkonacareerintheregulatory,industry,metrology,researchand developmentorinnovationthroughresearchsectors,forinstance. Themajoroutcomeoftheacademicprogrammewouldbetoprovidestudentswithathoroughgroundingin thephysiologicalbasis,analyticalmethodsandfundamentalaspectsofmedicalphysicsandinstilanattitudeof integrity,professionalism,critical-thinkingandscientificrigor. Teachingisprovidedbothbyfulltimeacademicstaffandbyclinicalmedicalphysicistsandotherhealthcare professionals,likeradiobiologists,cliniciansandregulators. COREMODULES Thecoremodulesareprovidedbelow,includinganoutlineoftheircontent: Code No.hours oflectures ECTS* or supervised exercises Nameofcourseorpracticals L1 Typeof activity Examination type lesson Oral L2 AnatomyandPhysiologyasappliedtoMedical Physics Radiobiology L3 RadiationPhysics 4 32 lesson Oral L4 RadiationDosimetry 4 32 lesson Oral 4 32 1 8 lesson Oral L5 MedicalImagingFundamentals 24 lesson Oral 1 8 lesson Oral PhysicsofNuclearMedicine PhysicsofDiagnosticandInterventional RadiologywithX-ray1 PhysicsofDiagnosticandInterventional RadiologywithX-ray2 3 24 lesson Oral 2 16 lesson Oral 2 16 lesson Oral L10 PhysicsofDiagnosticRadiologywithUSandMR 4 32 lesson Oral L11 PhysicsofRadiationOncology1 4 32 lesson Oral L12 PhysicsofRadiationOncology2 4 32 lesson Oral L13 RadiationProtection1 2 16 lesson Oral L14 RadiationProtection2 TechnologyofInformationTechnologyfor MedicalPhysics 1 8 lesson Oral 2 16 lesson Oral L6 PhysicsofImagingDetectors L7 L8 L9 L15 3 Guidedexercisesandpracticals(228h): P1 Athospitalinradiology,nuclearmedicine, radiotherapyandmedicalphysicsdepts 3 36 P2 Radiology 3 P3 Nuclearmedicine P4 laboratory written 36 laboratory written 2 24 laboratory written Radiationoncology 8 96 laboratory written P5.1 Informationtechnologyandsoftwaretools: exerciseswithImageJ 1 12 laboratory written P5.2 Statisticsformedicine 1 12 laboratory written Montecarlosimulationmethods 1 12 laboratory written 60 556 P6 TOTALECTSANDHOURS European Credit Transfer and Accumulation System(ECTS) is a standard for comparing the study attainment and performance of students ofhigher educationacross theEuropean Unionand other collaborating European countries. For successfully completed studies, ECTS credits are awarded. One academic year corresponds to 60ECTS-creditsthat are equivalentto1500–1800hoursofstudyinallcountriesirrespectiveofstandardorqualificationtypeandisusedtofacilitate transferandprogressionthroughouttheUnion.Typically,aECTSisequivalentto25-30hoursofstudy. L1.AnatomyandPhysiologyasappliedtoMedicalPhysics o AnatomicalNomenclature § Originofanatomicalnames § Prefixesandsuffixes § Anatomicalpositionandbodyplaneterminology o Structure,Physiology,Pathology,andRadiographicappearance(x-ray,CT,MRIand nuclearmedicineimaging)of: § BonesandBoneMarrow § BrainandCNS § Thorax § Abdomen Page2 § § Pelvis Respiratory,Digestive,Urinary,Reproductive,Circulatory,Lymphatic, EndocrineSystems L2.Radiobiology o ClassificationofRadiationinradiobiology o Cell-Cycleandcelldeath o Effectofcellularradiation,oxygeneffect o Typeofradiationdamage o Cellsurvivalcurve o Dose-responsecurve o Earlyandlateeffectsofradiation o Modelling,LinearQuadraticModel,α/βRatio o Fractionation,EQD2Gy o DoseRateEffect o TumourControlProbability(TCP),NormalTissueComplicationProbability(NTCP), EquivalentUniformDose(EUD) o ToleranceDosesandVolumes,QuantitativeAnalysisofNormalTissueEffectsinthe Clinic(QUANTEC)[10] o Normalandtumourcelltherapeuticratio o Radio-sensitizers,Protectors L3.RadiationPhysics o Briefreviewofquantummechanicsandmodernphysics o X-raysradiology-introduction o 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 Page3 o o o o o o o o o o o o o Stochastic,non-stochasticquantities Fluence,Exposure,KERMA,Absorbeddose Radiation,chargedparticleequilibrium NeutronInteractions Multiplescatteringtheories StoppingPower § Restricted,Unrestricted § LinearEnergyTransfer(LET) TransportEquation § ChargedParticleslowingdown § ContinuousSlowingDownApproximation(CSDA) Fanotheorem CavityTheory § Large,smallcavity RadiationDosimetersandinstrumentation RadiationStandards CalibrationChain AbsolutedosimetryprotocolsandIAEAcodesofpractice L5.MedicalImagingFundamentals o MathematicalMethods o TomographicReconstructionTechniques o LinearSystems o Acquisition,formation,processinganddisplayofmedicalimages o Perception o EvaluationofImageQuality L6.PhysicsofImagingDetectors o Basics:IntroductiontoPoissonstatistics o Physicsofgenericphotondetectors § Quantumefficiency • Directconversiondetectors o Chargegenerationandchargecollection • Indirectconversiondetectors o Scintillators § Integratingdetectors § Countingdetectors § Spectroscopicdetectors o Sampling § Space § Time o Noiseconsiderations Page4 § Signaltonoiseratio o Photontransfercurve o Conceptofspatialfrequencydependingdetectivequantumefficiency § Integratingdetectors § Countingdetectors L7.PhysicsofNuclearMedicine o Shortelementsofnucleardecays o Radioisotopeimaginggeneralities o Imagesfromradioisotopes o Radioisotopesproduction § Batemanequations o Radionuclidesadministration o Themostfrequentyusedradioisotopes o ImagingInstrumentation § Planar,Whole-body § SPECT § PET § HybridImaging o Medicalapplicationsofspectandpet o ImageQualityandnoise o Non-imagingInstrumentation § Dosecalibrators,Wellcounters § Probes o InternalDosimetry o QuantitativeImaging o RadionuclideTherapy o Acceptancetestingandcommissioning o 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 Page5 o o DualandMulti-modalityImaging 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 Overviewofclinicalradiotherapy o Radiationtherapyequipment(accelerators,cobalt60,cyclotrons,kVgenerators) o Basicphotonradiationtherapy(dosimetricfunctions,etc.) o Basictreatmentplanning o Simulation,virtualsimulation,DRR’s,imageregistration o Patientsetup,includingpositioningandimmobilization o ICRUReports50,62and83 o Basicelectronradiationtherapy,ICRUReport71 o Kilovoltageradiotherapy o Dosecalculationalgorithmsandheterogeneitycorrections o Brachytherapy,ICRUReport38,AAPMTG43formalism § HDR/LDR,Equipment,TreatmentPlanning o InversePlanning,optimization,IMRT o Smallfielddosimetry(fundamentalaspects,protocols) o Small-fieldradiotherapyequipmentandtechniques(StereotacticRadiotherapyand Radiosurgery,StereotacticBodyRadiotherapy,IntensityModulatedRadiotherapy, TomotherapyTM,CyberknifeTM,GammaknifeTM,etc.) o Imageguidanceandverificationinradiotherapy(ConebeamCT,ultrasound,Portal imaging,in-vivodosimetry,imageregistration) o Radiationtherapyinformationsystems o Acceptancetestingandcommissioning Page6 o Qualitymanagementofradiotherapy L13-L14.RadiationProtection o SourcesofRadiation o Activity,half-life,exponentialattenuation,half-valuelayer(HVL),inversesquarelaw, tenth-valuelayer(TVL) o BiologicalEffectsofRadiation o RadiationQualityfactor,Equivalentdose,Effectivedose o Legalframeworkforradiationprotection(BSS) o Aslowasreasonablyachievable(ALARA)concept o Occupational,publicexposureandannuallimits o Radiationprotectiondetectors(Ionizationchambers,Geiger-Mueller,Proportional counters,Scintillators,ThermoluninescentDosimeters(TLDs),neutrondetectors) o Personalandenvironmentaldosimetry o Shieldingcalculation o Radioactivetransportandwastemanagement o Emergencyprocedures o Radiationprotectionprogrammedesign,implementationandmanagementinthe medicalsector L15.TechnologyofInformationTechnologyforMedicalPhysics o Internationalstandards § IEC,DICOM,IHE o HIS/RIS/PACS o RadiotherapyR&Vsystems o Navigationsystems o Registration,segmentation Seminarscoveringfollowingtopics: • ICTPandICTP/IAEAtrainingcourses • ProfessionalandScientificDevelopment o Ethics,professionalism • PresentationSkills o ScientificCommunication o TechniquesofInstruction PRACTICALSESSIONS P1.Practicalsessionswithahospitalfacilities 3hourssessionstobeheldattheTriesteHospitalfacilities. Page7 Session1 Session2 Session3 Session4 Session5 Session6 Interventionaland Diagnostic Radiology Interventionaland Diagnostic Radiology Interventionaland Diagnostic Radiology Interventionaland Diagnostic Radiology NuclearMedicine NuclearMedicine Conventional radiography Mammography Interventional Radiology Computed Tomography Non-imaging InstrumentationQC Imaging Instrumentation (SPECT)QC Session7 Session8 Session9 Session10 Session11 Session12 RadiationDosimetry Radiation Protection RadiochromicFilm Dosimetry RadiationOncology RadiationOncology RadiationOncology RadiationOncology WaterTank RadiationSurveyof ScanningofPhotons aclinicalinstallation clinicalbeams WaterTank Scanningof Electronsclinical beams QConLinac QConMLC P2.Radiology • Generalradiology:QA,patientdosimetry(softwaretools) • Interventionalradiology: o EquipmentQA o Procedureoptimisation:DRLs,equipmentset-up,protocoloptimisation o Preventionofskinburns:skindosimetry,triggerlevel,protocoloptimisation,clinical follow-upofhighdosepatients • IntroductionanduseofIDLtoolsforimageanalysis P3.NuclearMedicine • Imagequalityassessment • QCofnuclmedicineinstrumentation • Patientinternaldosimetry(useofsoftwaretools) P4.RadiationOncology • CommissioningandbasicQC o Linac(AAPMTG106and142) o Simulators(AAPMRPT83) o Epid o kVImager,R&V • MUcalculation(ESTRO) • QAofaTPS(AAPMTG43) • Externalbeamphotontherapyplanning(ICRU50&62) • Electronbeamelectrontherapyplanning(ICRU71) • 3DCRTplanning Page8 • • • • • 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:quantitativeimagequalityassessment P5.2StatisticsforMedicine:Statisticsasausefulandnecessarytoolforthehealthprofessions. • Descriptivestatistics: o Charts /tables, box-plot, measures of central tendency, measures of dispersion and their'critical'use.ExamplesandexerciseswithRinthefieldofbio-medical. o Elementsofprobabilitytheory:definitionsandproblems,theconditionalprobability. o DiagnostictestsandROCcurve:ExamplesandexerciseswithR o PopulationsofGaussiandataandtheirproperties. • Elementsofstatisticalinference: o Pointestimates,estimatesofintervals,the'confidenceintervals'.Estimationofthe meanofapopulationofGaussiandata.ExamplesandexerciseswithR; o Statisticaltests:thechi-squaretest,Fisher'sexacttest,thettestStudent,MannWhitneytestandtheWilcoxontest.ExamplesandexerciseswithR o Riskmeasures:relativerisk(RR)andoddsratio(OR) o Linearregression:ExamplesandexerciseswithR • Criticalreadingofascientificarticle P6.MonteCarlosimulationmethodsformedicalphysics • GeneralIntroductiontoMonteCarlomethods • UseofMonteCarlomethodsinMedicalPhysics • BasicofMonteCarlosimulationwithintheGeant4framework • PracticalsessionofGeant4simulation • BasicinformationaboutotherMCtools Page9 MedicalPhysicsMaster-Year2 Year2isdevotedtoasupervisedfulltimeclinicaltrainingtobeperformedinoneaccreditated hospitals. Thestudentshould\practicescoveringmainlyaspecificareaofmedicalphysics(medicalphysicsfor diagnosticimagingormedicalphysicsforradiationtherapy. Activitiestoperform,assessmentoftheskillsandcompetencesacquiredineachfieldareadapted fromtheIAEAandAFRAclinicaltrainingofmedicalphysicistsguidelines. ECTS* MinimumNo.Of hours Clinicaltraininginahospitalofthenetwork 55 1200 Finalthesis 5 125 60 1325 Activitytype TOTALECTSANDHOURS Theassignmenttohospitalswillbenotleesthan45weeks(about1700hours)thatincludesthework forthedevelopmentofthethesiswork. Clinicaltrainingcontentandassessmentagreement Twoprogrammesareidentified: • thefirstforthetraininginradiotherapy, • thesecondfordiagnosticradiologyandnuclearmedicine. Thecontentanddurationoftheclinicaltrainingwillbetailoredtothebackgroundandknowledgeof theResidenttakingintoaccountthefollowingtables. AnindividualPortfoliowillbedevelopedbytheClinicalMedicalPhysicistSupervisortailoredtothe Residentbackgroundandknowledgebeforethebeginningoftheclinicaltraining. 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 3 2-4 Radiationprotectionandsafety Page10 Equipmentspecificationandacquisition Qualitymanagement Professionalethics 1.5 1-2 8 6-10 Entireprogramme46weeks 46 Totalweeks Diagnosticandinterventionalradiology&nuclearmedicine Module Duration(weeks) Clinicalawareness Priorities Entireprogramme23wks Radiationprotectionandsafety 3 Dosimetryinstrumentationandcalibration 1 Performancetestingofimagingequipment 13 1 Patientdoseaudit 2 4 Technologymanagementofimagingequipment 1 2 Optimisationofclinicalprocedure 3 3 Entireprogramme23wks 23 Professionalethics Totalweeks (Thetrainingcanbeexpandedupto36wksincludingangiographyunitsandMRIimagingandsafety.The remaining10weekswillbedevotedtoperformancetestingmodulesofnuclearmedicineequipment)– Priorities:1basic–4highestcompetences Module Duration(weeks) Clinicalawareness Priorities Entireprogramme23wks Radiationprotectionandsafety 4 4* TechnologymanagementinNM 2 Radioactivitymeasurementandinternaldosimetry 3 PerformancetestingofNNMequipment 7 1 Preparationandqualitycontrolofradiopharmaceuticals 1 Radionuclidetherapyusingunsealedsources 2 3 Optimisationinclinicalapplication 4 2 Entireprogramme23wks 23 Professionalethics Totalweeks (Thetrainingcanbeexpandedupto36wksincludingalsoPET/CT.Theremaining10weekswillbe devotedtoperformancetestingmodulesofdiagnosticradiologyequipment)–Priorities:1basic–4 highestcompetences Page11 (*)designoftheNMDpt Fordiagnosticandinterventionalradiology&nuclearmedicineitisstatedthatthe2subprogrammescanshareequallythetimeor,inthecaseofspecificresidenttrainingneeds,asubprogrammecanbeenlargedmaintainingsomemodulesofthesecondprogrammethathastobe includedfollowingtheindicatedpriorities(priority1indicatethemandatorymodule) Thestudents,attheendofthefirstyearoftheCoursewillbeassignedtoahospitaloftheNetwork ofaccreditedhospitals. 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 Page12 Page13