Teaching and Training in Medical Physics in Italy. C.Peroni Universita di Torino e Istituto Nazionale di Fisica Nucleare

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1 Teaching and Training in Medical Physics in Italy C.Peroni Universita di Torino e Istituto Nazionale di Fisica Nucleare

2 Brief history of Medical Physics in Italy Beginning of the 60 s ~ 5 Physicists officially enrolled in hospitals mainly concerned with radioprotection and marginally with Radiotherapy Teaching and training programs exist in various sites Little or no connection with Universities and research environment 1985 Scuole di Specializzazione are instituted by the Ministry with unified programs 2

3 Present ~ 600 Medical Physicists operating in major hospitals trained in 15 University based Scuole di Specializzazione in close collaborations with medical doctors AIFM Associazione Italiana di Research in Medical Physics has started and is gaining momentum 3

4 Scuole di Specializzazione in Admission requirements Laurea in Fisica (3+2 years of University education) Entrance examinations Duration 4 years Education 200 hrs courses/year taught by academic and professional personnel Training in agreed hospitals 4

5 Courses and Training Recently a set of minimal requirements has been issued by the Ministry of Instruction, University and Research for all Scuole di Specializzazione di Area Medica to which the Schools of Medical Physics belong. Minimal requirements concern: qualification of teaching personnel courses contents hospitals and laboratories resources specific activities of students administrative resources 5

6 Teaching Personnel Requisiti Livelli fondamentali di accettabilità MODALITA DI VERIFICA A) Personale docente e tutor coinvolti nella formazione La Scuola deve disporre di un documento che descriva il proprio assetto didattico e i diversi ruoli professionali coinvolti Esame documentale B) Personale docente specifico della tipologia, come da tabella relativa Docenti universitari: professori e ricercatori, di cui almeno 1 professore di ruolo del settore scientifico di riferimento della tipologia della Scuola, in numero non inferiore al 70% dei docenti della scuola Docenti non universitari in servizio in strutture della rete formativa: personale con esperienza didattico formativa documentata e con servizio di almeno 10 anni presso strutture specialistiche accreditate/convenzionate inserite nella rete formativa, (in numero massimo del 30% del corpo docente - inquadrato a contratto). Assunzione degli impegni Assunzione degli impegni Docenti a contratto: esperti del settore scientifico disciplinare (in numero massimo del 10% del corpo docente); quest ultimi possono essere chiamati solo in caso di mancanza di docenti universitari. Assunzione degli impegni C) Tutor Presenza di un tutor (per un massimo di 3 specializzandi) Assunzione degli impegni 6

7 Requisiti disciplinari Esempio di lista dei corsi (Torino) Modalità d verifica 1 Anatomia, Fisiologia, Epidemiologia, Fondamenti di dosimetria, Radioprotezione (1), Acustica, Calcolo delle probabilita e statistica, Strumentazione e misure elettroniche, Strumentazione fisica per medicina e biologia(1), Dispersione di inquinanti atmosferici Insegnamenti fondamentali 2 3 Calcolo numerico e programmazione, Metodi fisici della biologia, Radiobiologia, Medicina nucleare, Radioprotezione (2), Radioterapia e QA (1), Fisica dei laser, Misure di spettroscopia nucleare, Radiazioni non ionizzanti, Strumentazione fisica per medicina e biologia (2) Radioterapia e QA (2), Statistica clinica e biometria, Radiodiagnostica, Angiografia e radiologia interventistica, Brachiterapia e QA Esame documentale Eventuale accertamento diretto 4 Strumentazione fisica per medicina e biologia(2),positron Emission Tomography, MRI, Radioterapia e piani di trattamento, Radioprotezione (3), Bioelettronica e biomateriali University personnel: Physics University personnel:medicine Hospital personnel: Medical Physicists (5 partecipating hospitals in Torino and Piemonte) 7

8 Requisiti assistenziali STUDENT TRAINING ACTIVITIES Prestazioni minime per tutto il percorso formativo di uno specializzando da distribuire negli anni in funzione del piano formativo (N) Volume minimo complessivo della attività assistenziale annuale della rete con uno specializzando per ogni anno ^ e * (a) piani di trattamento per terapie con fasci esterni 40^ piani di trattamento per brachiterapia 10^ Volume minimo della attività assistenziale annuale della rete per l attivazione della Scuola (b) piani di trattamento per terapia metabolica con radionuclidi 4^ piani di trattamento per almeno una tecnica speciale di trattamento 2^ 7 10 sessioni di misura e controllo per: taratura iniziale e verifica periodica delle diverse macchine di trattamento radioterapeutico controlli di qualità dei radiofarmaci, dei generatori di radioisotopi a breve emivita e dei prodotti marcati 25* * 7 7 controlli di qualità sulle apparecchiature 20* valutazioni di qualità su materiale radiografico e sistemi per radiografia digitale 8* interventi per la misura di livelli diagnostici di riferimento 10* controlli di qualità su tomografi a risonanza magnetica nucleare ed ecografi 4* applicazioni di software specifico per la raccolta e l'archiviazione di dati 2* 7 7 trasferimenti in rete di immagini biomediche 2* 7 7 progetti per l' automatizzazione di strumentazioni biomediche 2* 7 7 progetti e verifiche di barriere primarie e secondarie per sorgenti a raggi X e acceleratori per radioterapia 10* verifiche di radiazione di fuga e misure di esposizione per sorgenti a raggi X 20* valutazioni di dosimetria personale 20* spettrometria di neutroni; dosimetria neutronica; dosimetria di particelle ad energia elevata mappature di campi elettromagnetici attorno ad impianti RM, ciclotroni, apparecchiature per diagnostica e terapia 10* *

9 Purposes: AIFM Italian Association of Medical Physics promuovere, sviluppare e coordinare le attività scientifiche e professionali; promuovere e sviluppare la formazione, l'informazione e l'aggiornamento dei soci; partecipare al programma nazionale di Educazione Continua in Medicina (ECM); promuovere e sviluppare l'applicazione delle metodologie fisiche alla diagnosi, terapia e prevenzione nell'ambiente di vita e di lavoro; favorire la cooperazione con le strutture sanitarie, con gli Enti di Ricerca, con le Università e con particolare riguardo ai Dipartimenti di Scienze Fisiche alle Facoltà di Medicina ed alle Scuole di Specializzazione in Fisica Sanitaria e con le Istituzioni operanti nei diversi settori della. 9

10 European Federation of Organisations for Medical Physics The European Federation of Organisations in MedicalPhysics (EFOMP) was founded in The current membership covers 35 national organisations which together represent more than 5000 physicists and engineers in the field of Medical Physics. Report by the EFOMP Education, Training and Professional Committee: The Present Status of Medical Physics Education and Training in Europe. New perspectives and EFOMP Recommendations,

11 EFOMP reccomendations EFOMP strongly encourage National Organisation for Medical Physics (NMO) to strive to make a university master degree in Medical Physics available at their universities holding a university Master s Degree in Medical Physics, is not a sufficient qualification to work as a Medical Physicist in a hospital environment: at least 2 more years training experience on the job Health Authorities should be involved in the education and training programmes in order to obtain official recognition as a health profession NMO s to set up continuing education programs (ECM) based on credit points NMO s to start their own register of professionals 11

12 Research in Medical Physics in Italy Mainly in Universities, national health institutions (Istituto Superiore della Sanita ), research institutions (Istituto Nazionale di Fisica Nucleare, Comitato Nazionale per la Ricerca) often in collaboration with hospitals a non exaustive list: radiation dosimetry: photon, electron,hadron radiobiology and microdosimetry syncrotron radiation applications MRI techniques analysis of medical images with CAD (Computer Aided Detection) and GRID (Distributed Computer Infrastructure) ultrasound techniques new irradiation techniques, hadrontherapy 12

13 1992 Medical Physics in Torino the TERA group ~ 3 researchers (INFN and University,high energy particle background) start collaboration with Ugo Amaldi s TERA (TERapia con Adroni) 3D sampling calorimeter for proton and C ion beams made of 12 ionization chambers segmented in strips (256 ch/pl) read out by VLSI electronics at high rate (~ khz) Magic Cube at the LLUMC (California) proton beam Bragg peak of a 270 MeV/u carbon ion beam 13 reconstructed with the Magic Cube

14 Strip and Pixel Chambers as beam monitors Installed and operating on proton beam treating facilities: CATANA INFN LNS Catania ICPO Orsay Getting ready for CNAO! (Alejandra) Collected charge from a cm 2 14 uniform field irradiation

15 Photon Beams collaboration with industry Prototype: 32x32 pixels, 24x24 cm2 active area, 1024 channels, 7.5x7.5 mm2 pixel 15

16 The prototype developed by INFN and University of Torino became a clinical dosimeter, I'mRT MatriXX, commercialized by Scanditronix-Wellhöfer (IBA) I'mRT MatriXX: 1020 pixels, 24.3x24.3 cm2 active area, single pixel Ø=4.5x5 mm2, 0.07 cm3 volume, resolution 7.62 mm. Fastest read-out 20msec. 16

17 CLICK Time: sec Deposited dose measured during the treatment 17

18 Treatment Planning Our group has developed a program to calculate the treatment planning for voxel scan with proton or ion beams. The package (ANCOD, ANalytical CODe) computes the fluencies to equalize the physical dose in the target volume. The treatment planning can be verified by a Monte Carlo simulation which, together to the charged particle interactions with matter, implements a simplified algorithm of the ion fragmentation. Due to the peculiar radiobiological behavior of hadrons, physical and equivalent dose distributions can deeply differ. We foresee to implement also radiobiological effects in our codes 18

19 Analitical Code The analytical code (ANCOD), in C++ object oriented environment, is under development. The technique of the inverse planning allows to estimate the best parameterizations and the optimal treatment; it has been implemented in the frame of the voxel scan technique with pencil beams. Considering as input a CT and the target volume definition, ANCOD provides for each field and for each elementary voxel the energy and the fluence of the pencil beam. A full MC simulation (GEANT 3) is used to verify the results of ANCOD. 19

20 Montecarlo Simulation The treatment plan can be verified with a full simulation to ensure the correctness of the analytical code calculation. The beam parameters (direction and energy) and the fluence determined with ANCOD are the input to the simulation. The package we have been using is GEANT3 20

21 Modulated arc therapy for breast tumor:comparison between the Pixel Chamber and the TPS 21

22 Radiobiological Effects The interaction of radiation with cells has to be taken into account in treatment planning when hadrons are used. This is important for protons where, in the Bragg peak, the Relative Biological Effectiveness RBE can be much larger than one and it is mandatory for light ions. We have implemented a code starting from the Kraft-Scholz method, developed at GSI. Our implementation takes into account the cell sensitive area with respect to cellular growth phase. 22

23 Dose deposition in a cell by a single Carbon ion: the energy deposition is strongly localized within the cell. 23

24 Cell survival probability as a function of the dose (Gy): triangles are the experimental data (from GSI: 11 GeV/u Carbon ion beam ), dots are the simulation results. 24

25 Medical Images w/ CAD (Computer Aided Design) and GRID (distributed computing) RESEARCH in TORINO OVERVIEW 25

26 RESEARCH in TORINO cont d Dual energy X-ray for angiography and mammography with Si-microstrip detectors X-ray tube with dual energy output 6.4 mm Phantom Detector box with 2 26

27 Angiography at the Iodine K-edge (II) Iodine injected in patient vessels acts as radio-opaque contrast medium Dramatic change of iodine absorption coeff. at K-edge energy ( 33 kev) Subtraction of 2 images taken with photons of 2 energies (below and above the K-edge) in the resulting image only the iodine signal remains and all other materials are canceled 27

28 Neutron Dosimetry Measurement of the unwanted neutron dose to the patient in treatments with high energy Linac photon beam testata neutroni di leakage Fascio gamma Neutroni nel corpo Fantoccio Jimmy and 28

29 Boron Neutron Capture Therapy Studies of new compact neutron sources 29

30 PHONES: a novel approach to BNCT based on photo-neutron production with high energy (18MV-25MV) radiotherapy LINAC. Status of the project A feasibility study was completed: Analysis of materials for neutron photoproduction and moderation Study of gamma shielding and neutron reflector Experimental measurements with a simple prototype installed at LINAC 18 MV Design of suitable photo-converter to: increase the photo-neutron production moderate neutron to the desired energy range Neutron imaging 30

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32 From research to teaching Research activities in Medical Physics attract many students 1995 Master Program in Biomedical Physics starts at Torino University: Laurea Magistrale in Fisica Ambientale e Biomedica 1999 Scuola di Specializzazione in 32

33 Summer 2006 Intense research activities take place in the hills around Torino 33