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0 Special Feature RADIATION PHYSICS INSTRUCTION FOR RESIDENTS ALFRED R. SMITH, PH.D. Dept. of Radiation Medicine, Massachusetts General Hospital, Cox Bldg., Boston, MA 02 I 14

Any survey of the physics component of residency training programs would show a wide variance in the quantity and type of instruction among the programs. For example, didactic lectures are given both every year and every other year with a frequency ranging from 2 hours per week to 1 hour every other week. This nonuniformity leads to a significant difference in the total hours of physics instruction residents in different programs might receive. Coupling this disparity to the differences in the quality of physics instruction could lead to wide differences in the total physics experience that residents in different programs can receive. This, perhaps, is the reason that in some programs, residents rarely fail the ABR physics examinations, while in others failure is not an uncommon occurence. In some residency training programs the residents have only the physics instructor’s notes as source material while in others there may be a text as well as other source material including computer-aided instruction. Also, those programs using texts may use texts which have a wide difference in levels of difficulty. 1 have not found a text that is totally satisfactory for residency teaching although the text by Professor Khan (5) comes as close as any. Increasingly, residents have had some formal instruction in calculus, in fact for the last 2 years all residents in my classes have had calculus; for those having familiarity with calculus the text by John and Cunningham is a good choice (6). It should be noted that the use of either of these texts requires supplemental material of a considerable variety if new technology, methods, and modalities are to be included. I believe there is a need for an up-todate physics text which is directed toward residents in radiation oncology. The amount of material which must be covered when teaching physics to residents suggests that residents need instruction for at least 1 hour per week, 9 months a year, for 3 years, in order to adequately cover the necessary ground. We have also found it very helpful to correlate physics, brachytherapy and clinical topics whenever possible, that is, present the physics, biology, and clinical aspects of brachytherapy back-to-fack in an integrated

The rationale for teaching physics to radiation oncology residents is based upon the historical and continuing role of physics in radiation oncology. Starting with the discoveries of X rays and radioactive isotopes and continuing to the present, physics has contributed significantly to the advancement of the practice, science, and technology of radiation oncology. A knowledge of radiation physics is considered essential for physicians entering into the field of radiation oncology and residents in radiation oncology are required to pass an examination in physics for their certification. Physics instruction for radiation oncology residents in the United States might be characterized by the following: 1. Widespread agreement upon the traditional curriculum. 2. Considerable variance in the inclusion of special topics. 3. Little uniformity in the quality, quantity or type of instruction. 4. Insufficient correlation in the instruction of clinical, biology, and physics topics. The traditional curriculum for the physics component of residents’ instruction is essentially codified and there is little disagreement as to its contents (1, 2, 3, 4). Reference 3 gives the most detailed accounting of the traditional subject matter and required number of lectures for each topic. Reference 4 is a Syllabus and Study Guide for the residency examination in physics and gives a fairly exhaustive listing of the traditional material a resident is required to master. During the past 15 years there have been many exciting new technologies and methodologies entering into the practice of radiation oncology including digital imaging, hyperthermia, 3-D treatment planning, radiosurgery, high dose rate brachytherapy, and labeled antibodies. In addition to new modalities and technologies, topics such as statistics, quality assurance, quality control, and federal regulations have grown in importance. The inclusion of the above special topics in residency training curriculums is highly variable and many of the topics are often left out of otherwise good programs. Accepted for publication

30 June 1992. 851

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fashion instead of having a large temporal separation of these instructional elements. When any of the three topics are given in isolation, the appropriate connections to the other disciplines are difficult to make. I think there is a need for more standardization in the physics instruction of radiation oncology residents. There is little reason to have widely varying quality or quantity in physics teaching programs. Unlike clinical training where the size and diversity of the local patient population, the therapy equipment and the diversity of treatment related technologies affect the quality of training, physics instruction can be quite successful regardless of these factors. Standardization should seek to increase the quality and improve the uniformity of physics instruction so that the level of instruction would not depend so much on the particular institution where training takes place. In an era

Volume 24, Number 5, 1992

of rapid changes in the technology of radiation oncology and the introduction of many new radiation therapy modalities, there is a tremendous challenge to provide upto-date physics instruction. If a standard text were developed in a loose-leaf form, updates to the teaching material could be provided periodically. In this manner, all residents would have access to complete and up-to-date material. Computer aided instruction and self testing might also prove to be very useful and there is at least one software package which has been developed for residents (Boyer, A. L., private communication). It is my impression that the intellectual and academic quality of radiation oncology residents has improved significantly in recent years and there is little reason for a willing resident to fail the ABR physics exam if adequate personnel and materials are allocated to physics instruction.

REFERENCES 1. Davis, L. W.; Moss, W.; Leibel, S.; Newall, J.; Sagerman, R.; Sunthalingama N.; Wassermann, T. Essentials and guidelines for radiation oncology residency training programs, Int. J. Radia. Oncol. Biol. Phys. 1l(5): 1009- 10 16; 1985. 2. A guide to the teaching of clinical radiological physics to residents in radiology: AAPM Report No. I 1. American Association of Physicists in Medicine, 335 E. 45th St., New York, NY 10017; 1982. 3. Purdy, J. A. Physics teaching for radiotherapy residents. In: Waggener, R. G., Kereikes, J. G., Shalek, R. J., eds. CRC

handbook of medical physics, Vol. III, CRC Press, Boca Raton, FL: CRC Press; 1984: 57-7 I. 4. The physics of therapeutic radiology, syllabus and study guide, November 1987, 4th edition, American College of Radiology and American Association of Physicists in Medicine. Available from ACR, 189 1 Preston White Dr., Reston, VA 2209 I. 5. Khan, F. M. The physics of radiation therapy. Baltimore, MD: Wilkins and Wilkins; 1984. 6. Johns, H. F.; Cunningham, J. R. The physics of radiology, 4th edition. Springfield, IL: Charles C. Thomas; 1983.

Radiation physics instruction for residents.

In/ J Radumn Onculo~v Bwl. Phys., Vol Printed in the U.S A. All rights resewed. 24, pp. t .oO 0360-3016/92 $5.00 Copyright 0 1992 Pergmon Press Ltd...
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