Introduction to the Medical Physics STP

Programme
(Northern Training Consortium)
Overview
Dr Alison Mackie
Degree Programme Director
(MSc Medical Physics)
Newcastle University
Dr Robyn Cooke
1
st
year STP Healthcare Science Trainee
(Medical Physics)
Dr Darren Thompson
1
st
year STP Healthcare Science Trainee
(Medical Physics)
Grace Keane
1
st
year STP Healthcare Science Trainee
(Medical Physics)
Jonathan Wyatt
2
nd
year STP Healthcare Science Trainee
(Medical Physics)
Masters Programme:
Clinical Science (Medical Physics)
- a Modernising Scientific Careers Vocational Programme
Dr Alison Mackie
Degree Programme Director
(Regional Professional Lead for Medical Physics and Clinical Engineering, Northern Training Consortium)
Teaching Locations:
Medical Physics, Freeman Hospital
Newcastle University
Programme Structure
Generic Module:
Common to all divisions of Healthcare Science

Division/Theme Specific Modules:
Common to a division or theme
Specialist Modules:
Specific to a specialism
Dissertation modules
Year 3
Specialist
Practice
Specialist Medical Physics
[30]
Research Project 2
MSC8004 [30]

Year 2
Specialist
Practice
Research Skills
for Health Care
Professionals
MCR8201 [10]
Specialist Medical Physics
[20]
Research Project 1
MSC8003 [30]
Year 1
Core
Modules
Introduction to Healthcare
Science, Professional Practice
and Clinical Leadership
MSC8001 [20]
Introduction to Medical Physics
MPY8001 [40]
MPY8001: Introduction to Medical Physics
First Year Module [40 credits]
Initial (6/52) residential block
Module Lead: Dr Alison Mackie
5 Themes:
Radiation Safety Physics (RS)
Radiotherapy Physics (RT)
Imaging with Ionising Radiation (IIR)
Imaging with Non-Ionising Radiation
(INIR)
Clinical Engineering (CE)
Claire-Louise
Chapple RS
Gill Lawrence RT
Ian
Driver
IIR
Mike
Drinnan
CE
Andy Blamire
INIR
Summative Assessment:
40% - unseen written exam
60% - assignments (x4)
Blended Learning Strategy
MPY8001
Face to Face (130 hrs)
Lectures (60 hrs)
Practicals (18 hrs) learning by doing
Tours (6 hrs) link theory to clinical practice
Tutorials (46 hrs) - problem based learning

Independent Learning (supported by VLE, Blackboard)
Directed reading & revision
4 summative assignments (aligned to workplace rotations)
Formative assessment
MSC8001: Introduction to Healthcare Science,
Professional Practice and Clinical Leadership
First Year Module [20 credits]
Initial (6/52) residential block + 9 days Mar
Module Lead: Dr Judith Kuit
Learning outcomes (know, understand, reflective learning & leadership skills):
Basic science underpinning healthcare
e.g. anatomy & physiology, physics, genomics, IT, bioinformatics
Walk a mile in the patients moccasins
The patient journey through the healthcare system & the integrated science
that underpins patients response to disease, injury and treatment.
5 domains of Good Scientific Practice
Professional
Scientific
Clinical
Research, Development & Innovation
Clinical Leadership
Summative Assessment:
25% - unseen 2 hr MCQ exam
75% - assignments (x2)
MCR8201: Research Skills for Health Care Professionals
Second Year e-Module [10 credits]
4 hrs/week for 13 weeks
Module Lead: Dr Jenny Yeo
Learning outcomes:
Know & Understand:
legal & ethical issues re different forms of clinical research
principles of research governance
Develop the skills to:
participate in NHS clinical research
be aware of the evidence base behind current practice
critically appraise published literature
recognise where research is relevant to development of clinical
practice
Summative Assessment:
10% - participation in discussion groups
90% - assignments (x2)
MSC8003: Identifying & Planning a Research Project
Second Year e-Module [30 credits]
Module Lead: Dr Mike Drinnan
Students are guided through project development in 4 stages:

1. Identifying a research question and methodology
2. Literature review
3. Research proposal
4. Approval planning

Supervision is from both the students workplace (professional / clinical mentor)
and from the module lead (with specialist support as required).
Aim: develop the necessary skills to develop a research
proposal & successfully complete & write a dissertation in the
third year.
Summative Assessment:
15% - Project administration summary document
35% - Project literature review and analysis
50% - Project proposal
Medical Physics Specialism Modules
Second Year Specialist Modules [20 credits]
10 day residential block (last week Feb Y2)
Module Leads:
MPY8005 (RT1): Gill Lawrence, Consultant Clinical Scientist, Head of Radiotherapy Physics, Newcastle Hospitals
MPY8007 (RS1): Dr Claire-Louise Chapple, Consultant Clinical Scientist, Head of Imaging Physics & Radiation Safety, Newcastle Hospitals
MPY8009 (IIR1): Dr Ian Driver, Consultant Clinical Scientist, Head of Nuclear Medicine Services, Newcastle Hospitals
MPY8011 (INIR1): Prof Andy Blamire, Professor of MRI Physics, Centre for Ageing & Vitality, Newcastle University
Summative Assessment:
40% - unseen written exam
60% - assignment (x1)
First Year of Specialism Teaching
MSC8004: Research Dissertation
Third Year e-Module [30 credits]
Module Lead: Dr Mike Drinnan
Students supported to complete their dissertation through:

1. Summary checklists available through the VLE;
2. Module lead & specialist support upon request;
3. Statistical advice & support upon request.

Supervision is primarily from the students workplace
(professional / clinical mentor). Intellectual Property Rights
therefore remain with the workplace.
Summative Assessment:
5% - 250 word Abstract (akin to a scientific conference submission)
15% - E-poster (akin to a scientific conference poster - standard PowerPoint)
15% - Oral presentation of project (workplace: 10 minutes + 5 minutes
questions)
65% - Dissertation ( 3500 in a research paper format)
Medical Physics Specialism Modules
Third Year Specialist Modules [30 credits]
13 day residential block (mid-Sept Y3)
Module Leads:
MPY8006 (RT2): Gill Lawrence, Consultant Clinical Scientist, Head of Radiotherapy Physics, Newcastle Hospitals
MPY8008 (RS2): Dr Claire-Louise Chapple, Consultant Clinical Scientist, Head of Imaging Physics & Radiation Safety, Newcastle Hospitals
MPY8010 (IIR2): Dr Ian Driver, Consultant Clinical Scientist, Head of Nuclear Medicine Services, Newcastle Hospitals
MPY8012 (INIR2): Prof Andy Blamire, Professor of MRI Physics, Centre for Ageing & Vitality, Newcastle University
Summative Assessment:
40% - unseen written exam
60% - assignment (x1)
Second Year of Specialism Teaching
Medical Physics Programme Strategies
to Support STP Programme Outcomes:
1
st
academic year aligned to STP workplace rotations
All underpinning medical physics knowledge delivered in the initial academic block (no restriction on rotation order).
Clinical practice and academic learning support each other.
Blended learning
Supports different learning styles through a variety of teaching methods.
Distance learning
Formative assessment opportunities e.g. self-assessment question sets, example examination papers, formative
assessment opportunities for most summative assignments.
Academic assessments (ALL modules): 2 birds with 1 stone
Relevant evidence for workplace competencies can upload to OLAT.
Developing the medical physicists/innovators of the future
Teaching to support students to be able to develop and deliver the scientific services/technologies of the future
(horizon scanning 5+y) e.g. proton therapy, novel techniques, specialist applications.
2013 Medical Physics Students
Thanks to our lovely lecturers for being amazing!
From the STP trainees 2013
Imaging with Ionising
Radiation (IIR)
Dr Robyn Cooke
1
st
year STP trainee
Imaging with Ionising Radiation
Nuclear Medicine:
Functional imaging using
radioactive isotopes
Diagnostic Radiology:
Anatomical imaging using
transmission of x rays
+
radioisotope
Site-specific
pharmaceutical
Image with gamma
camera
Examples of nuclear medicine scans:
Glomerular Filtration Rate (GFR) examinations
Inject patient with radiopharmaceutical filtered by kidneys
Assess blood activity in time


Dynamic kidney function scan (Renogram)
As above take images at snapshots in time




Myocardial Perfusion scan/ MUGA scan
Assess blood flow/ heart muscle perfusion using 4D reconstructions
Lung perfusion and ventilation:
Compare ventilation and perfusion images identify blood clots
Positron Emission Tomography (PET)
Uses positron emitting isotope attached to pharmaceutical
Often combined with CT to give functional+anatomical
information e.g., location/size of tumours
PET CT PET/CT
Examples of rotation activities (nuclear medicine)
Preparing
radioactive
samples:
Investigating
gamma camera
parameters using
various phantoms:
Write case studies
of patient scans:
Perform quality control
(QC) testing on
equipment:
Fluoroscopy
Live snapshots of x-ray often used to place devices in
position during surgery




Examples of diagnostic radiology scans:
Planar x-ray
Transmission of x-rays for diagnostic imaging


CT
3D reconstruction of many x-ray images


Examples of diagnostic radiology scans:
Mammography
Low energy x-ray image to identify potentially cancerous growths


Dual Energy X-ray Absorptiometry (DEXA)
Measure bone-density by using 2 x-ray energies



Angiography
Use contrast agents to obtain an image of blood vessels




normal abnormal
Examples of rotation activities (diagnostic radiology)
Consider safety,
e.g., x-ray room
design.
Radiation Safety
considered in this
rotation: see
Graces talk!
Performing QC on
equipment:
Investigating
acquisition settings on
imaging:
Quality Control (QC) &
Quality Assurance (QA)
Quality Control (QC):
Regular testing of equipment to assess performance in clinical use
Tolerance limits set on test results to indicate whether maintenance is required or
whether the machine can remain in clinical use
Examples for IIR include:
Spatial resolution of detectors
Energy resolution of detectors
Image uniformity and linearity
Identifying artefacts
Calibration




Quality Assurance (QA):
Overarching programme concerning QC
Includes staff training, working practices, programme for QC, etc.
Why is it important?
VITAL to know that what you image in a patient REPRESENTS what is in the patient!
VITAL in ALL aspects of medical physics, not just IRR!
Radiation Safety
Grace Keane
Trainee Clinical Scientist
Medical Physics

Contents
About Me

Radiation Safety

Radiation safety then and now
Competencies
Radiation Risks
Patient Dose audit




About Me
University of York (2010 2013)
BSc Hons Physics

Talk given by an STP Trainee
Background reading on the scheme
Open days
2 weeks work experience at Newcastle Hospitals NHS Trust





Recruited onto STP as a medical physics trainee at Newcastle
Started training in September 2013
Completed the first 6 week teaching block at Newcastle
University
In the midst of my second rotation

Radiation Safety
3 million CT scans per
year

Cancer risks from DR, The British Journal
of Radiology, 81 (2008), 362378
Radiation Safety
Radiation
Safety
Competencies
Undertake room design from first principles for a diagnostic X-ray
facility and surgical laser facility

Identify and plan an exercise to rehearse contingency plans (e.g.
contamination incident, loss of source).


Undertake measurements to assess patient dose
and image quality

Analyse recent radiation incidents and
summarise the types and causes of incidents




Radiation Risks
Industries
Fishing
Construction
Clothing and Footwear
Coal Mining
Radiation workers
Risk of death per year
1 in 6000
Average annual risk of death in the UK from accidents in various industries and cancers
Potentially induced in radiation workers
1 in 800
1 in 10,000
1 in 57,000

1 in 250,000
Patient Dose Audit


Participate in or review patient dose audit data
and compare and contrast against national standards

Patient Dose Audit
Thanks for listening
&
Good luck!
Imaging with Non-
Ionising Radiation
Dr Darren Thompson
STP Trainee (Medical Physics)
Imaging with Non-Ionising
Radiation Rotation
Magnetic Resonance Imaging (MRI) ~ 1 month

Ultrasound ~ 1 month

Lasers
Infra-red
Ultraviolet
Visible Light
~ 1 month
MRI Magnetic Resonance
Imaging
Clinical and research scanners
available in Newcastle hospitals
Very strong magnetic fields ~ 1.5 or
3 T
Hydrogen protons align with field
Radio waves flip protons
Return to normal at characteristic
rates for each tissue

Image contrast
MRI
You will:

Observe and report case
studies
Perform Quality Control
checks
Perform experiments to
investigate different types of
contrast

E.g. T1 and T2 weighted
images
Each shows up different
pathologies
MRI
Non-ionising radiation = safe ?
Risk Assessment more important in MRI than many
think
High frequency vibrations from crystal
transducer.
Tissues of different density reflect sound
differently.
Familiar images from obstetrics, check
foetal development.
Other uses include:
Echocardiogram (heart function)
Distinguishing between cysts / tumours
Examining blood flow
(Doppler Imaging)
+ many others
Ultrasound
Ultrasound

Generally very safe but risks
include:
Thermal and mechanical tissue
effects
US scanners may be unstable, change
over time
Misleading image artefacts

Therefore Quality Control and
safety still very important.
Lasers
Various powers and wavelengths for many different clinical
applications.
IR Laser surgery using endoscope (prostate, breaking up urinary
stones).
Hair removal penetrate just below skin surface.
LASIK eye surgery ablates surface with UV rather than penetrating
like visible light.
Safety practices very important!
Infra-Red
Thermal Imaging
Detect Raynauds
Phenomenon
Temporary
restriction of blood
flow due to
cold/stress/anxiety
Delay in re-
warming indicates
severity
Ultraviolet
Phototherapy treats
psoriasis, eczema.

Uses fluorescent UV lamps
(similar to sunbed)
Risk of skin cancer

UV Laser for eye surgery
Visible Light
Capillaroscopy
Assess microangiopathy
E.g. Normal compared to systemic
sclerosis

(autoimmune disease with abnormal
growth of connective tissue)
Radiotherapy Physics
Jonathan Wyatt
What is Radiotherapy?
Killing tumours
using radiation

From megavoltage
linear accelerators
The Radiotherapy Process
1. CT Scan
2. Treatment
Planning
3. Treatment
Delivery
Radiotherapy Physics
1. Quality Assurance and Calibration
Radiotherapy Physics
2. Treatment Planning
Radiotherapy Physics
3. Research and Development
Radiotherapy Physics
4. Medical Physics Expert
Summary
50% of cancer patients would benefit from
radiotherapy in their treatment.
Radiotherapy physicists are essential
members of the radiotherapy team.
Radiotherapy physics combines interesting
and demanding physics with helping to cure
people of cancer.