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RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...
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RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is ...

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  • 1. Consultation Draft Radiation Oncology Training Curriculum Page 16 of 186 RADIATION ONCOLOGY PHYSICS Radiation Oncology Physics is inextricably linked to the practice of radiation oncology. Continuous learning in this subject from the start of training throughout the program and beyond is expected, and critical to effective and safe practice in this discipline. Much of the material below overlaps with the learning objectives contained within the ROCKSS and MES sections of the curriculum, as a detailed understanding of the physics of radiation and its application in the clinical setting is central to the Medical Expert and Clinical Decision-maker Role. PHASE 1 – FOUNDATION 1 Radiation and interactions with matter The trainee is able to: 1.1 Describe the fundamentals of an atom in terms of: [D] 1.1.1 Structure - nucleus, orbital shells, energy levels, binding energy 1.1.2 Particles - proton, neutron, electron, positron 1.1.3 Description - atomic number, atomic weight, isotope, isomer 1.1.4 Energy - conservation of mass and energy, mass-energy conversion 1.2 Describe the processes involved in photon absorption, scattering processes and electron interactions in terms of: [G] 1.2.1 Photon interactions i.e. coherent (elastic) scattering, photoelectric effect, Compton scattering, pair production, annihilation radiation, characteristic radiation, photonuclear reactions [D] 1.2.2 Processes of attenuation: exponential attenuation, energy transfer, energy absorption 1.2.3 Interaction coefficients: coefficients of attenuation, energy transfer and absorption (in relation to relative importance of interactions in photon beam therapy) 1.2.4 Electron interactions: ionization, excitation, heat production, radioactive interaction (bremsstrahlung), relative rate of energy loss and directional changes through collisional and radioactive processes, stopping power, range, scattering power, linear energy transfer 1.3 Describe the basic principles of X-ray production in terms of: 1.3.1 Bremsstrahlung and characteristic radiation by electron bombardment [D] 1.3.2 Efficiency of x-ray production and its dependence on electron energy and target atomic number [G] 2 Introduction to external photon beam radiation therapy [G] The trainee is able to: 2.1 Describe the construction of a linear accelerator, orthovoltage unit and superficial therapy unit and explain how a photon beam can be generated from each of these units 2.1.1 Discuss how the beam aperture can be altered using cerrobend blocking, multileaf collimators and independent jaws 2.1.2 Describe the different types of wedge filters e.g. physical wedges and dynamic wedging 2.2 Describe the characteristics of kV and MV photon beams in terms of: 2.2.1 Intensity and angular distribution 2.2.2 Beam quality e.g. energy spectra, effective energy, half value layer
  • 2. Consultation Draft Radiation Oncology Training Curriculum Page 17 of 186 3 Introduction to electron beam radiation therapy [G] The trainee is able to: 3.1 Explain how an electron beam can be generated from a linear accelerator 3.2 Describe the characteristics of an electron beam - energy spectra, energy specification, variation of mean energy with depth, photon contamination 4 Fundamentals of radiation protection [G] The trainee is able to describe and demonstrate understanding of: 4.1 The ALARA principle 4.2 ICPR recommended dose limits 4.3 Practical dose minimization practices and procedures (time, dose, distance, conformation, shielding) 5 Fundamental radiation terms and units [G] The trainee is able to define and give units for: 5.1 Absorbed dose, integral dose, kerma, equivalent dose, effective dose PHASE 1 - ADVANCED 6 Radioactivity The trainee is able to: 6.1 Describe radioactivity in terms of: [D] 6.1.1 Radionuclide decay processes e.g. alpha, beta, positron, gamma, electron capture, internal conversion 6.1.2 Radionuclide production e.g. natural and artificial radioactivity, [G] 6.1.3 Exponential radioactive decay e.g. decay constant, half life (physical, biological, effective), mean life, daughter products, radioactive equilibrium 6.2 Define the term and give units for: [G] 6.2.1 Activity, apparent activity, specific activity, air-kerma rate constant and reference air-kerma rate 7 Principles of image production and use in radiation therapy [D] The trainee is able to: 7.1 Describe the principles of imaging modalities used for treatment planning: 7.1.1 CT scanning 7.1.2 Plain film, fluoroscopy, MRI, PET, ultrasonography, nuclear medicine imaging [G] 7.2 Describe imaging techniques used to verify treatment accuracy e.g. port films, electronic portal imaging, cone beam CT 8 External photon beam radiation therapy The trainee is able to: 8.1 Describe the construction of a Cobalt–60 unit and explain how a useful therapeutic radiation beam is generated from it [G] 8.2 Describe the following beam parameters: [G] 8.2.1 Intensity and angular distribution 8.2.2 Beam quality e.g. energy spectra, effective energy, half value layer 8.2.3 Beam variation e.g. change in characteristics with maximum electron energy, voltage, current and filtration as applicable
  • 3. Consultation Draft Radiation Oncology Training Curriculum Page 18 of 186 8.3 Describe the measurement of an external photon beam, including choice of suitable radiation detector, specifically: [D] 8.3.1 Beam measurement: radiation quality and output 8.3.2 Measurement protocols i.e. IAEA megavoltage absolute dosimetry protocol for megavoltage photon beams [G] 8.3.3 Dose distribution - kV and MV beam profiles, depth dose curves, construction of isodose charts 8.4 Describe, with the aid of figures, the dose distribution in tissue produced by external beam photon radiation in terms of: [D] 8.4.1 Radiation components i.e. primary and scattered radiation 8.4.2 Descriptors of dose distribution i.e. percentage depth dose, beam profile, isodose charts, flatness and symmetry, penumbra, surface dose (entrance and exit) and skin sparing 8.4.3 Factors affecting dose distribution and beam output i.e. effects of field size and shape, source-skin distance, beam quality or energy and beam modifying devices on dose distribution and beam output 8.4.4 Effects of tissue heterogeneity and irregularity i.e. effects on dose distribution of patient contour, bone, lung, air cavities and prostheses; and also dose within bone cavities, interface effects, effects of electronic disequilibrium 8.5 Define the following terms and discuss how each is used to calculate dose: tissue-air ratio, scatter-air ratio, tissue phantom ratio, tissue-maximum ratio, output factor, back scatter factor, peak scatter factor, off-axis ratio, percentage depth dose [G] 8.6 Describe the effect on the parameters listed in 8.5 produced by varying depth, field size and shape, source-skin distance, beam quality and energy [G] 9 Electron beam radiation therapy [D] The trainee is able to: 9.1 Describe the measurement of electron beam radiation, including choice of suitable radiation detector, specifically: 9.1.1 Beam measurement: radiation quality, output 9.1.2 Measurement Protocols i.e. the IAEA megavoltage dosimetry protocol for MeV electron beams [G] 9.1.3 Dose Distribution - beam profiles, depth dose curves, construction of isodose charts 9.2 Describe, (including graphical presentation), the dose distribution in tissue from an electron beam in terms of: 9.2.1 Dose distribution i.e. percentage depth dose, beam profiles, isodose charts, flatness and symmetry, penumbra, surface dose 9.2.2 Effects of field size and shape, source-skin distance, energy, beam collimation on dose distribution and beam output 9.2.3 Effects of heterogeneity and patient irregularity i.e. effect on dose distribution of surface obliquity, air gaps, lung, bone, air filled cavities, external and internal shielding
  • 4. Consultation Draft Radiation Oncology Training Curriculum Page 19 of 186 10 Radiation Measuring Devices [G] The trainee is able to: 10.1 Recognise and describe the principles of operation of radiation measuring devices 10.1.1 Ionization chambers, semi-conductor detectors, thermoluminescent dosimeters, [D] 10.1.2 Photographic film, radiochromic film, Geiger-Muller counters, scintillation counters, chemical dosimeters 10.2 Discuss the use of radiation phantoms and dedicated dosimetry tools for fixed SSD and isocentric patient treatments 11 Treatment planning and delivery for photon and electron beams The trainee is able to: 11.1 Discuss different equipment and methods for patient simulation [D] 11.2 Display a working knowledge of current ICRU recommendations including definitions of the terms used in these documents and choice of prescription points or areas [D] 11.3 Describe and compare the processes of 2-D and 3-D planning [D] 11.4 Describe the principles of intensity modulated radiotherapy and inverse treatment planning [G] 11.5 Describe methods of determining body contour, location of internal structures including critical tissues and target volume including comparison of CT, MRI and PET [D] 11.6 Discuss the choice of beam energy, field size, beam arrangement and the use of bolus [D] 11.7 Discuss the use of, and problems associated with, field junctions in terms of: [D] 11.7.1 Photon-photon junctions 11.7.2 Photon-electron junctions 11.7.3 Electron-electron junctions 11.8 Discuss the process involved in calculation of monitor units and treatment time [G] 11.9 Discuss dose algorithms including Clarkson (including equivalent tissue-air ratio corrections), superposition/convolution, Monte Carlo and pencil beam methods, their comparative advantages and limitations [G] 11.10 Describe the accuracy of treatment planning and delivery in terms of: 11.10.1 Methods of patient monitoring and ensuring reproducibility of patient positioning throughout treatment and planning including immobilisation methods, treatment set-up, lasers, portal imaging [D] 11.10.2 Image-guided radiation therapy, including the use of cone beam CT and fiducial markers [G] 11.10.3 Consistency of patient contour and position of normal and tumour tissues during the course of treatment [D] 11.10.4 Accuracy of calibration, stability of beam parameters, accuracy of isodose calculation [G] 11.10.5 Determination of mechanical and radiation accuracy of treatment machines and simulators including the light field, cross-wire images, optical distance indicators [G] 11.10.6 Systematic and random errors [D] 11.10.7 Avoidance and detection of dose delivery errors including record and verify systems, select and confirm procedures, and interlocks [D] 11.10.8 Potential errors arising from computer control of set up and treatment machine operation [G] 11.10.9 In-vivo dosimetry techniques [D]
  • 5. Consultation Draft Radiation Oncology Training Curriculum Page 20 of 186 12 Fundamentals of sealed source radionuclides and brachytherapy The trainee is able to: 12.1 Discuss the radioactive sources used in sealed source brachytherapy in terms of: 12.1.1 Construction: source construction, including filtration [G] 12.1.2 Properties: spectra of radiation emitted, half-life, usual specific activity [D] 12.1.3 Measurement of source activity and dose rates, choice of suitable detectors and calibration [G] 12.1.4 Clinical decision-making: compare the advantages of radionuclides in various clinical circumstances 12.1.4.1 Commonly used: Caesium-137, Iridium-192, Iodine-125, Palladium-106, Strontium-90 [D] 12.1.4.2 Historical and less commonly used: Radium-226, Cobalt- 60, Yttrium-90 [G] 12.1.5 Management: handling, cleaning, inspection, storage and transport [G] 12.2 Describe sealed source brachytherapy in terms of: [G] 12.2.1 Types of procedures: surface applications, eye plaques, interstitial implants, intracavitary techniques 12.2.2 Source Dose Rate: low, medium, high and pulsed dose rate 12.2.3 Delivery techniques: remote afterloading machines, manual afterloading 13 Unsealed source radionuclide therapy The trainee is able to: 13.1 Discuss the concepts of uptake, distribution and elimination [D] 13.2 Discuss methods of dose estimation: the MIRD method of estimating dose to target tissues and critical organs [G] 13.3 Discuss the radioactive sources used in unsealed source therapy in terms of: 13.3.1 Properties: spectra of radiation emitted, half-life, physical form and technique of delivery to patient, use in clinical practice [G] 13.3.2 Measurement of activity and dose rates [D] 13.3.2.1 Commonly used: Iodine-131, Strontium-89, Samarium- 153 13.3.2.2 Less commonly used: Phosphorus-32, Yttrium-90 [G] 13.3.2.3 Management: safe handling, storage, transport, clean up of spills 14 Radiation protection [D] The trainee is able to: 14.1 Describe the principles of radiation protection in terms of: 14.1.1 Data: basis for international recommended limits, specific ICRP and national radiation protection standards, regulatory frameworks in Australia and New Zealand (as applicable) 14.1.2 Definitions of the ALARA Principle, Radiation Incident, Radiation Accident
  • 6. Consultation Draft Radiation Oncology Training Curriculum Page 21 of 186 14.2 Evaluate the practice of radiation protection in terms of: 14.2.1 Working procedures for use with radiation sources including simulators, CT, external beam therapy, brachytherapy and unsealed sources 14.2.2 Minimisation of dose to patients, staff and general public including safety procedures for staff, control of areas and radiation sources, radiation protection surveys, personal monitoring, area monitoring, construction of rooms to house sources and radiation generators 14.2.3 Documentation relating to radiation incidents and accidents PHASE 2 15 Applied external photon beam radiation therapy [D] The trainee is able to: 15.1 Describe the effects on dose distribution of irregular or offset fields and the associated clinical implications of changes in beam aperture: compare and contrast the use of cerrobend blocking, multileaf collimators and independent jaws 15.2 Discuss dose modification techniques in terms of: 15.2.1 Methods of compensation for patient contour variation and/or tissue inhomogeneity including wedging and compensating filters 15.2.2 Shielding of dose-limiting tissues 15.2.3 The use of bolus and build-up material 15.3 Discuss the clinical advantages and disadvantages of intensity modulated radiation therapy 15.4 Discuss and compare image-guided radiotherapy techniques 15.5 Interpret 3-D rendering and dose-volume histograms 15.6 Describe and contrast the physical aspects of the following treatment techniques, namely: 15.6.1 Fixed SSD and isocentric techniques 15.6.2 Simple techniques: parallel opposed fields, multiple fields 15.6.3 Complex techniques: rotation therapy (full or partial), conformal therapy 15.6.4 Specialised techniques: total body irradiation, stereotactic radiosurgery or radiotherapy [D] and tomotherapy [G] 16 Applied electron beam radiation therapy [D] The trainee is able to: 16.1 Select, compare and describe the physical aspects of treatment techniques in terms of 16.1.1 Simple techniques: single fields, multiple adjacent fields, multiple energy 16.1.2 Specialised techniques: electron arc therapy, total skin electron irradiation [G] 17 Applied sealed source radionuclides and brachytherapy [D] The trainee is able to: 17.1 Discuss sealed source brachytherapy in terms of: 17.1.1 Clinical uses of surface applications, eye plaques, interstitial implants, intracavitary techniques 17.1.2 Selection of source dose rate: low, medium, high and pulsed dose rate 17.1.3 Brachytherapy planning: methods of reconstruction and dosage calculation using radiography, CT and MRI 17.1.4 Dose distributions: compare isodoses surrounding ideal source and clinical source
  • 7. Consultation Draft Radiation Oncology Training Curriculum Page 22 of 186 17.1.5 ICRU dose specification system: current ICRU recommendations for interstitial and gynaecological treatment specifications 17.1.6 Current dosage systems: Paris system, production of conformal dose distributions using a single, stepping source 17.1.7 Procedures for beta emitters: surface and opthalmic applications, intravascular techniques, techniques of delivery - unique applicators and methods of use [G] 18 Hadron beam radiation therapy [G] The trainee is able to: 18.1 Describe the production of proton beams for clinical use including the principles of the cyclotron and synchrotron 18.2 Describe, including graphical presentation, the dose distribution in tissue produced by proton beam radiation in terms of 18.2.1 Beam profile and percentage depth dose 18.2.2 Clinical modification of Bragg peak and beam collimation 18.3 Describe the production of carbon ions and the characteristics of carbon ion beams 19 Selection of an appropriate modality and technique to solve clinical problems [D] The trainee is able to: 19.1 Select and justify the choice of treatment modality and technique for specific clinical circumstances including choice of photons versus electrons; external beam versus brachytherapy; selection of beam arrangements and energies and choice of other technical parameters 20 Commissioning and quality assurance of external photon and electron beam radiation therapy equipment [G] The trainee is able to: 20.1 Discuss the process of acceptance testing, including the mechanical, optical, radiation and safety considerations 20.2 Discuss the process of commissioning including data acquisition and establishment of baseline values for quality management of installation 20.3 Discuss quality assurance relating to radiation therapy equipment including mechanical, optical and radiation parameters for quality management including frequency of testing 20.4 Exhibit an understanding of the concept of tolerances in relation to quality assurance measures 21 Management of departmental issues [G] The trainee is able to: 21.1 Describe departmental radiotherapy policies in terms of 21.1.1 Regulations governing data storage and availability 21.1.2 Regulations governing radiation generators and radiation personnel 21.1.3 Quality management of radiation therapy equipment

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