Table Of ContentAbsolute
Therapeutic Medical
Physics Review
Questions and Detailed
Answers
Malcolm Heard
Raghavendiran Boopathy
Charles R. Thomas, Jr.
Editors
123
Absolute Therapeutic Medical Physics Review
Malcolm Heard • Raghavendiran Boopathy
Charles R. Thomas, Jr.
Editors
Absolute Therapeutic
Medical Physics Review
Questions and Detailed Answers
Editors
Malcolm Heard Raghavendiran Boopathy
Department of Radiation Medicine OU Stephenson Cancer Center
Oregon Health & Science University University of Oklahoma Health
Portland, OR, USA Science Center
Oklahoma City, OK, USA
Charles R. Thomas, Jr.
Dartmouth Cancer Center
Department of Radiation Oncology, Geisel
School of Medicine
Lebanon, NH, USA
ISBN 978-3-031-14670-1 ISBN 978-3-031-14671-8 (eBook)
https://doi.org/10.1007/978-3-031-14671-8
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Foreword
There are few careers more important and rewarding than therapeutic medical phys-
ics. Radiation therapy (RT) is a leading treatment for cancer and involves the use of
potentially lethal doses of radiation with a universally accepted absolute tolerance
for delivery of 5%. RT is a medicine, so physicians are responsible for the patient,
appropriateness of radiation therapy, dose prescriptions, and treatment plans.
However, it is the responsibility of the medical physicist to assure that the treatment
plan is technically appropriate and is accurately delivered. This is a significant and
complex responsibility. Expertise in the physical principles underlying RT is critical
to the medical physicist, which is why physics courses are a required prerequisite.
Additionally, deep operational understanding of treatment equipment, techniques,
safety issues, calculation algorithms, computer connectivity and data management,
radiation safety, and general management of complex systems is also required.
My career in medical physics started on a plane. I was at the time earning my
Ph.D. in Nuclear Physics from Indiana University. I was getting ready to graduate
when, during a return flight from a vacation, I began chatting with the person next
to me. He said that he was flying to Indianapolis to install a microtron, a device used
to deliver electron beam radiation therapy. He told me that he was a medical physi-
cist, and I asked, “What is medical physics?” He explained as much as he could, and
short story long upon graduating, I joined MD Anderson as a postdoctoral fellow
under the tutelage of Dr. Starkschall and Dr. Hogstrom. At the time, MD Anderson
allowed their postdoctoral fellows to attend the master’s in medical physics courses,
and I took advantage of that to learn about diagnostic imaging, radiation therapy,
and anatomy. After completing my postdoctoral fellowship, I joined Washington
University under the supervision and guidance of Dr. James Purdy, Ph.D., as an
instructor, a rank I maintained temporarily to effectively extend my tenure deadline.
Unlike myself, Dr. Purdy was well aware of the differences in knowledge gained
during academic instruction versus clinical instruction. He made me a sort of proto-
resident for a year, spending 6 months in dosimetry, 3 months in brachytherapy, and
3 months as a physics trainee with the physics group. This was in 1991, 7 years
before Washington University became the first accredited residency program. Dr.
Purdy’s commitment to clinical education has guided me since, keeping the clinical
v
vi Foreword
mission at the forefront even through my research and administrative careers both at
Washington University and now at UCLA.
Clinical medical physics education processes have deepened and been formal-
ized since I joined Washington University with the advent of medical physics resi-
dencies. These residencies teach the profession of medical physics, including the
broad array of information and technical skills previously mentioned. Accreditation
of these residency programs assures a level of quality uniformity, while formal cer-
tification by the American Board of Radiology (ABR) provides evidence that the
medical physicist has been suitably educated and is qualified independently as a
clinical medical physicist. ABR certification currently requires two written and one
oral examination. While the knowledge gained during the education one receives
during the formal degree program and residency is sufficient to pass these tests,
each candidate can and should refresh their knowledge, if only to update and empha-
size what they have already learned, prior to taking the exams.
It is to aid these candidates, as well as anyone refreshing their knowledge, that
resources such as these are critical, and I am excited and thankful that Drs. Heard,
Boopathy, and Thomas elected to gather experts throughout our community to pre-
pare this study guide. They have done a wonderful job, and I applaud their hard work.
Radiation Oncology, UCLA Daniel Low
Los Angeles, CA, USA
Contents
1 Conformal Radiation Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Raghavendiran Boopathy and Malcolm Heard
2 IMRT/VMAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Matthew G. Rodriguez
3 Stereotactic Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Matthew G. Rodriguez and Malcolm Heard
4 Brachytherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Arjit K. Baghwala and Richard J. Crilly
5 Electron Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Ganesh Tharmarnadar
6 Proton Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Charles Bloch
7 Total Skin Electron Therapy (TSET) and Total
Body Irradiation (TBI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Susha Pillai
8 Machine QA, Commissioning, and Calibration . . . . . . . . . . . . . . . . . . . 69
Prema Rassiah-Szegedi and Martin Szegedi
9 Radiation Protection and Shielding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Max Amurao
10 Incidents and Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Erli Chen and Benjamin B. Williams
vii
viii Contents
11 Integrity, Professionalism, and Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Nina Bahar
12 Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Vasanthan Sakthivel and Raghavendiran Boopathy
13 Treatment Planning Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Brandon Merz
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Contributors
Max Amurao Department of Radiation Oncology, Washington University in St.
Louis, St. Louis, MO, USA
Arjit K. Baghwala Department of Radiation Oncology, Houston Methodist
Hospital, Houston, TX, USA
Nina Bahar Radiation Oncology, St. Peter’s Hospital, Albany, NY, USA
Charles Bloch Radiation Oncology, University of Washington School of Medicine,
Seattle, WA, USA
Raghavendiran Boopathy Department of Radiation Oncology, OU Stephenson
Cancer Center, University of Oklahoma Health Science Center, Oklahoma
City, OK, USA
Erli Chen Radiation Oncology Department, Cheshire Medical Center,
Keene, NH, USA
Richard J. Crilly Radiation Medicine, Oregon Health and Science University,
Portland, OR, USA
Malcolm Heard Radiation Medicine, Oregon Health and Science University,
Portland, OR, USA
Brandon Merz Radiation Medicine, Oregon Health and Science University,
Portland, OR, USA
Susha Pillai Radiation Medicine, Oregon Health and Science University,
Portland, OR, USA
Prema Rassiah-Szegedi Radiation Oncology, Huntsman Cancer Hospital,
University of Utah, Salt Lake City, UT, USA
Matthew G. Rodriguez Radiation Oncology, NorthShore University Health
System, Evanston, IL, USA
ix
x Contributors
Vasanthan Sakthivel Department of Radiation Oncology, Cancer Specialists of
North Florida, Jacksonville, FL, USA
Martin Szegedi Radiation Oncology, University of Utah, Huntsman Cancer
Hospital, Salt Lake City, UT, USA
Ganesh Tharmarnadar Manipal Hospitals Dwaraka, Dwaraka, New Delhi, India
Benjamin B. Williams Radiation Oncology Department, Dartmouth Hitchcock
Medical Center, Lebanon, NH, USA
