Thomas Jefferson UniversityJefferson Medical College

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Clinical Rotations

Dosimetry Rotation 1

Weeks 1-2: Resident to follow POD/ medical dosimetrists

Weeks 3-12: Resident to have hands on training with each staff medical dosimetrist.

Completion of competencies in dosimetry for the first rotations:

  • Irregular fields/MU calculations/electron calculations
  • 3D breast
  • 3D lung
  • 3D prostate
  • 3D brain

This rotation will teach basic 2D/3D planning and introduce the concepts of IMRT. The goals of this rotation do not include IMRT planning of any nature.

Dosimetry Rotation 2

Residents will complete:

  • 5 Prostate IMRT cases with use of the XIO or Eclipse
  • 5 Head and Neck IMRT cases with use of XIO or Eclipse
  • 10 VMAT cases with Eclipse, Monaco, or Oncentra
  • 1 Other site with the use of XIO
  • Will learn OAR/PTV critical structures, fluence, segmentation, power and weight tools for planning
  • Will use all fusion tools available on Focal and MIM
  • Will explore the specifications of PET and MRI

POD/Plan Check/Weeklies

Weeks 1-12: Completion of competencies in rotations:

  • Overview of QA, policy and procedures
  • QA of delivery system performance, Daily, Monthly, Annual
  • QA of planning process for patient treatment
  • QA of delivery parameters for patient treatment
  • Special procedures
  • Resolve/Triage clinical issues
  • Basic responsibilities of a clinical medical physicist as he/she functions in routine clinic operations.

Brachytherapy Rotation 1

3 months: Completion of competencies in rotations:

  • Radioactive Source Production
  • Radioactive Source Characteristics
  • Practical Protection Procedures LDR
  • Radiation Protection
  • Inventory of isotopes
  • Brachytherapy treatment planning
  • Paris, Quimby and Manchester systems
  • 5 Prostate seed implants using Variseed
  • 5 HDR cases
  • 5 Microsphere cases

The resident will be accountable for but not limited to treatment planning, with BPS, NPS, Variseed, and pertinent hand calculations for both LDR and HDR. A presentation/project will be due near the end of the rotation.

Brachytherapy Rotation 2

3 months: Completion of competencies in rotations:

  • Spot check and calibration of HDR
  • Practical Protection Procedures HDR
  • General shielding of isotopes
  • Accountability of isotopes
  • Brachytherapy treatment planning
  • 5 Prostate seed implants using Variseed
  • 5 HDR cases
  • 5 Microsphere cases

RTP Acceptance Testing/Commissioning & Quality Assurance

Weeks 1-2: Read manuals of equipment to be tested

Weeks 3-12: Completion of competencies in rotations:

  • RTP configurations; XiO, Monaco, Eclipse, and Oncentra
  • Appropriate files for QA and data export for verification of IMRT/3D QA/VMAT
  • Source File Maintenance and Patient File Maintenance; location of appropriate files for patient data and LINAC configuration files
  • Machine configuration for photon and electron, import radiation data for beam modeling
  • Export feature for treatment; DICOM export of RTP plan,CT/MRI and DRR’s datasets for import into RADCALC, MiMVista, IView and XVI
  • QA and documentation of commissioning

This rotation will teach the resident how to accept an RTP for treatment planning, how to input and model beam data, export functionality for treatment verification.

Treatment Machine Acceptance/Commissioning/Survey

Weeks 1-2: Read manuals of all systems to be tested

Weeks 3-12: Completion of competencies in rotations:

  • Initial inspection of LINAC installation as specified by vendor (Light vs Radiation, MLC and Jaw bank calibrations, Mechanical and Radiation isocenters, Accessory equipment; IView and XVi)
  • Photon and Electron: beam quality and field flatness/symmetry
  • Radiation room survey for shielding and neutron production
  • RTP data needed for a complete specification of LINAC; PDD and scanning for different modalities, diagonal scanning, and output factors needed for dose calculations

This rotation will teach the procedure for how a linear accelerator is accepted and the steps involved in commissioning and surveying the installation.

Total Body Irradiation (TBI) and Intraoperative Radiation Therapy (IORT)

Completion of competencies in rotations:

  • Read all relevant texts
  • TBI Simulation
  • TBI and IORT patient setup (lateral, AP/AP, multifield: advantages and disadvantages)
  • Dosimetry
  • Selection of energy, field size, distance, dose-rate considerations
  • TBI and IORT MU calculations

Radiation Shielding & Room Design

Completion of competencies in rotations:

  • Stochastic versus Deterministic radiation effects
  • Radiation terminology and equivalents
  • Permissible dose levels (weekly, monthly, and yearly) for radiation workers and non-radiation workers
  • What is the appropriate protocol for shielding (NCRP151, NCRP 49) calculations
  • From above, definitions of workload, occupancy factor and use factor
  • IMRT/TBI/IORT affects on workload
  • Neutron production and measurements
  • Shortcuts for TVL and HVL
  • Homogeneity coefficients relating to energy selection for concrete thickness
  • HDR/LDR shielding for patients adjacent or visiting family
  • Brachytherapy storage / Handling of or transportation of sources

This rotation will teach the resident the concepts of radiation shielding, room design and the appropriate protocols to use.

Advanced Technology (Gamma Knife/SRT)

This rotation will expose the resident to radiosurgical techniques employed with linear accelerator-based radiosurgery, specifically with BrainLab/Novalis system and also with Gamma Knife radiosurgery.

Duration: 2 months.

Completed competencies at the end of the rotation:

Gamma Knife:

  • Observe the treatment planning for Gamma Knife radiosurgery
  • Understand differences in the planning and dose prescription approaches for tumors, AVMs and functional cases
  • Understand and be able to explain treatment planning steps, eg., imaging, localization, shot selection, and differences between the Gamma Knife planning and conventional 3D planning
  • Observe and then perform under minimal supervision the daily Gamma Knife QA – understand the rationale of different QA tests and basic terminology associated with Gamma Knife
  • Observe patient treatment and understand the steps involved in the treatment preparation and QA

BrainLab/Novalis:

  • Observe and understand the treatment planning with the BrainScan planning software
  • Understand and be able to explain/discuss treatment planning steps, eg., imaging, fusion, localization, selection of the treatment modality (dynamic arcs, static fields or IMRT), and differences between the BrainScan planning and conventional 3D planning
  • Observe the linac daily warm-up and understand the rationale behind various tests; observe and understand the steps involved in calibration of the ExacTrac keV image guidance system
  • Observe patient treatment and image-guided positioning using ExacTrac system and robotic table; understand the flow (steps) of the procedure
  • Observe and understand the immobilization principles of various immobilization devices: relocatable head and neck masks, invasive frames and body immobilization

Regional Practice Rotation - Aria Health

Residents will complete:

  • Working knowledge of Varian Trilogy Linac with OBI
  • Clinical use of Varian Trilogy Stereotactic System
  • Clinical use of RPM Respiratory Gating System
  • Treatment planning with Pinnacle
  • Physics QA with Mapchek, Daily QA3 and Profiler

This rotation will teach Varian 4DTC environment with Mosaiq R&V system, treatment planning, several unique clinical treatment modalities, physicis QA with multiple QA devices, and working in an alternate paperless clinical environment.

Additionally, residents should be reading AAPM reports and relevant TG guides for clinical topics that arise during their clinical training or lectures.

PLEASE NOTE: Residents maintain standard clinical duties including attendance at morning QA conference, IMRT QA's, monthlies, annuals, MOSFETs during all rotations. Also, cross coverage must always be provided.