The Medical Physicist

Table of contents

1. Roles and responsibilities of a CQMP
2. Academic education
3. Clinical training
4. Professional ethics
5. Certification and recognition
6. International Day of Medical Physics

Roles and responsibilities of a CQMP

The medical physicist is an expert in physics and instrumentation with a good knowledge of the relevant biology, and provides technical support for therapeutic and diagnostic medical procedures and treatments as a member of a team of health care professionals.

The roles and responsibilities for clinical medical physicists vary depending upon the sub-specialty in which they are employed. However, the tasks are mainly related to the safety and performance of related equipment and computer systems. Sub-specialties include Radiotherapy, Diagnostic Imaging, and Nuclear Medicine. Medical physicist's roles often also include radiation protection responsibilities.

The IAEA has undertaken several initiatives to strengthen the field of medical physics through publications of guidelines and factsheets, organization of seminars for health care professionals and decision makers and collaboration with professional societies. A large part of this initiative is to define internationally endorsed roles and responsibilities of a Medical Physicist, and standard requirements for their education and training, including clinical preparation. A report has been published, as “Human Health Series No. 25”, to provide specific guidelines on the role and responsibilities of clinically qualified medical physicists and includes the basic requirements for their education and clinical training. The IAEA publication has been endorsed by the by the International Organization for Medical Physics and the American Association of Physicists in Medicine. A recorded PowerPoint presentation of the first part of the Human Health Series No. 25 dealing with the roles and responsibilities of clinically qualified medical physicists is available under this link.

The IAEA in collaboration with IOMP has also developed concise fact sheets describing in simple words what a medical physicist is and his/her role in the clinic: Medical Physics: Safety and Accuracy in Radiation Medical Procedures, also available in Russian and Spanish and Medical Physics: Ensuring Safety and Accuracy in Radiation Medical Procedures, also available in French, Russian, and Spanish.

To date, several organizations have published guidelines and prepared presentations and videos that outline the specific responsibilities of a clinical medical physicist. The relevant links are given under “Professional Societies Guidelines and related presentations”.

Academic education

An ideal education for a medical physicist consists of (a) appropriate academic qualifications at the postgraduate level, and (b) clinical training and (c) professional accreditation or registration with a competent body.

While different countries have varying structures for the education and certification of medical physicists, the need for quality, structured, educational standards is ubiquitous. The role of clinical medical physicists in supporting quality health care is becoming more recognized, and so is the need for development and refinement of robust educational programmes for the training of competent medical physicists. Both the AAPM and EFOMP have taken proactive roles in assessing medical physics educational system which are in place, and defining what goals should be sought for improving the current system.

The IAEA worked on an inter-regional initiative to strengthen the field of medical physics through addressing a number of issues focusing on achieving recognition. The project was a joint effort, involving input from a cross section of experts and organizations from all regions. A report has been prepared to provide specific guidelines on the role and responsibilities of clinically qualified medical physicists and the basic requirements for their education and clinical training. The IAEA report has been published as Human Health Series No. 25. The IAEA publication has been endorsed by the International Organization for Medical Physics and the American Association of Physicists in Medicine.

The IAEA has published a harmonized academic syllabus (postgraduate level) and will support its adaptation to specific national or regional needs. (IAEA Technical Course Series No. 56).

In this context, a regional harmonized medical physics academic syllabus has been developed by experts in the African region and endorsed by FAMPO. Similarly, a regional clinical training programme for radiotherapy medical physicists has also been developed using the IAEA Training Course Series No. 37 as well as a companion logbook to be used by residents and trainers as a portfolio of clinical training. Corresponding regional clinical training programmes and portfolios for Diagnostic Radiology and Nuclear Medicine medical physics have also been developed, using the IAEA Training Course Series No. 47 and IAEA Training Course Series No. 50. This endeavour was supported through regional AFRA technical co-operation projects in support of medical physics.

The regional harmonized medical physics academic syllabus, clinical training programmes and portfolios for the different disciplines have been combined into a single document endorsed by AFRA which can be downloaded here.

Clinical training, according to IAEA guidelines is competency-based. Consequently, clinical training programmes can run in one hospital or collaboratively between hospitals, to offer to the residents exposure to all the different modules and competencies. To support Member States in establishing or coordinating clinical training programmes, the IAEA has made available forms to:

• help Programme coordinators structure and maintain records of the clinical training programme
• ease the review of the clinical training programme overall structure.

The forms are available on this page for the TCS clinical training guidelines, and for the programmes based on the AFRA guidelines.

Clinical training

While the shortage of clinically qualified medical physicists is a worldwide problem it is most acute in developing nations. The need for medical physicists is becoming more evident due to the increasing complexity of both treatment and diagnostic equipment coupled to the raising expectations of good health care in all parts of the world as well as the implementation of radiation protection and safety standards, however the supply of suitably qualified and trained personnel has not kept up with these developments and hence this shortage is worsening. Another important reason for this is the migration of promising physics professionals from developing countries to more developed countries where the recognition of the medical physicists is better established. The introduction of a programme of clinical training, to supplement academic qualifications has the dual purpose of providing skilled professionals for the developing country as well as providing standards that can be used to raise the recognition of medical physicists.

In an increasing number of countries graduate level courses in medical physics are offered by universities. The clinical in-service training component however is in many cases small or missing. This has resulted in incomplete preparation of the medical physicists to practice independently as important aspects of training cannot be completed in the university setting. A structured in-service clinical training programme provides a better preparation for medical physicists to ensure that they are capable of independent, safe and effective practice. Such a programme should reduce the total time needed for medical physicists, referred to as residents in these programmes, to reach clinical competence and also to prepare them to undertake the more advanced methodologies which are being rapidly introduced in the specializations of medical physics. Relatively few countries have developed national standards of clinical training, which are an essential part of ensuring high quality and consistent training throughout a country.

The IAEA has a long history of involvement in medical physics education and training and has recently developed a set of guides and other material to be used in the clinical training of the next generation of medical physicists specialising in radiation oncology, diagnostic radiology and nuclear medicine.

Objective of the IAEA Clinical Training Guide

The objective of the clinical training programme for medical physicists specialising in either radiation oncology, diagnostic radiology or nuclear medicine is to produce an independent practitioner who is a lifelong learner and who can work unsupervised at a safe and highly professional standard.

The clinical training programme is seeking to assist this objective through

• Provision of this detailed guide to clinical training
• Provision of an implementation strategy to allow effective clinical training. Forming a basis for a national or regional qualification (education and clinical training) standard
• Providing assistance to national bodies and departments to deliver the training programme through a pilot programme
• Promoting quality improvement of the programme, and
• Strengthening of the national capacity to sustain such a clinical training programme
  after initial introduction.

Professional ethics

Appendix I of the IAEA Human Health Series No. 25 provides a Code of Ethics for Medical Physicists working in the medical environment. It is based on standards published by the American Association of Physicists in Medicine (AAPM) and the Health and Care Professions Council in the UK.

Certification and recognition

The IAEA recommends that a clinically qualified medical physicist (CQMP) undergoes the following education and training: firstly a postgraduate degree in medical physics covering a core syllabus as given in the IAEA TCS 56 publication and secondly a period of structured clinical training in a hospital in one of the specialties of medical physics including radiotherapy, nuclear medicine and diagnostic radiology.

Accreditation refers to the process of assessing that academic institutions and clinical departments meet necessary requirements to educate students and train residents in medical physics. The requirements for accreditation need to be developed at the national level and would include consideration of:

• Human resources (PhD level lecturers [academic] and senior medical physicists [clinical]);
• Physical resources (classrooms [academic], library, offices, IT infrastructure);
• Equipment (demonstration equipment [academic] and treatment, imaging and dosimetry equipment [clinical]);
• A core syllabus suitable for medical physics education [academic] and a comprehensive clinical training programme [clinical];
• Quality indicators (staff publications [academic] and adherence to quality management [clinical]).

Accreditation is awarded by an authorised body such has an Accreditation and Certification Board established by a ministry or the national medical physics professional body. Accreditation may be provisional and time-limited. Accreditation of clinical departments may be awarded on the basis of agreed shared resources with other clinical departments, for example in PET-CT quality assurance, where a resident in one clinical department without a PET-CT scanner would undertake training in PET-CT at another department, with the first department maintaining responsibility for the resident.

Certification refers to the process of assessment of the individual resident at the end of their clinical training program. Certification could involve written, practical and oral examinations but could also include other elements depending on the national requirements including satisfactory completion of competencies, maintenance and presentation of a portfolio of best work and evidence of a scientific publication or conference presentation. Certification is awarded by an authorised body such as an Accreditation and Certification Board which would likely be made up of senior CQMPs. Certification demonstrates the ability of the resident to be an independent medical physics practitioner or CQMP. Certification is followed by registration as a CQMP and maintenance of registration is achieved through continual professional development (CPD).

The IAEA is not an accreditation body, but it cooperates with the International Medical Physics Certification Board (IMPCB) to support requests from Member States for the accreditation of medical physics certification boards and  the certification of medical physicists in countries where such systems do not exist. Member States are encouraged to consider including accreditation and certification when setting up medical physics programmes to ensure that graduates of these programmes fulfil the internationally harmonised criteria for clinical qualified medical physicists. The IAEA support is delivered through its Technical Cooperation programme. 

IAEA Human Health Series No. 25 presents IAEA recommendations on education and training of medical physicists, while IAEA TCS 56 gives a core syllabus for postgraduate medical physics education. IAEA TCS 37, 47 and 50 publications present clinical training guides and recommendations for the conduct of clinical training programmes. A report (downloadable from this page) arising from an IAEA/RCA Asia Pacific technical cooperation project on strengthening medical physics presents recommendations on accreditation and certification for medical physics.

International Day of Medical Physics

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