The Role of Key Professionals in Improving Patient Outcome ... · 1 The Role of Key Professionals...
Transcript of The Role of Key Professionals in Improving Patient Outcome ... · 1 The Role of Key Professionals...
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The Role of Key Professionals in
Improving Patient Outcome
through Technology Life Cycle
Management – Medical Physicists
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Cari Borrás, D.Sc., FACR, FAAPM, FIOMPChair, IUPESM Health Technology Task Group (HTTG)
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Medical Physicist Functions (1)Medical Physicist Functions (1)
• Develop / Review Equipment* Purchase Specifications
• Acceptance Testing
• Agreement with Manufacturer’’’’s Specifications
• Setting Base Line Values for QC Tests
• Commissioning
• Data Acquisition for Clinical Use
• Develop / Review Equipment* Purchase Specifications
• Acceptance Testing
• Agreement with Manufacturer’’’’s Specifications
• Setting Base Line Values for QC Tests
• Commissioning
• Data Acquisition for Clinical Use
* Equipment = Hardware & Software!
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Acceptance Testing and
Commissioning – Radiation Therapy
Acceptance Testing and
Commissioning – Radiation Therapy
▲Non-dosimetric testing
� Image import, segmentation, densities
�Machine & beam characterization
�Plan evaluation, output, implementation
▲Dose calculations
�Data measurement, entry
�External beam calculation verification
�Brachytherapy calculation verification
�Absolute dose, plan normalization
▲Non-dosimetric testing
� Image import, segmentation, densities
�Machine & beam characterization
�Plan evaluation, output, implementation
▲Dose calculations
�Data measurement, entry
�External beam calculation verification
�Brachytherapy calculation verification
�Absolute dose, plan normalization
G. Ibbott 2007
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Commission Radiological EquipmentCommission Radiological Equipment
Patient Protocols
• Adult
• Pediatric
Patient Protocols
• Adult
• Pediatric
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Medical Physicist Functions (2)Medical Physicist Functions (2)•Calibrate Radiation Sources•Calibrate Radiation Sources
Brachytherapy
External Beam
Activity Meters
(Dose
Calibrators)
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Medical Physicist Functions (3)Medical Physicist Functions (3)
• Evaluate Medical Imaging Equipment
• Performance
• Image Quality
• Evaluate Medical Imaging Equipment
• Performance
• Image Quality
• Conventional and Digital Radiology
• Computed Tomography
• Ultrasound
• Magnetic Resonance Imaging
• Nuclear Medicine / Hybrids
• Gamma Camera, SPECT, PET
• PET/CT, SPECT/CT, MR/PET, MR/US
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MASS
0.25 - 2.00
0.75
SPECK
0.16 - 0.4
0.2
FIBER
0.40 - 1.56
0.75Tolerances (mm)Tolerances (mm)
Mammogram
Image Quality Test
Using ACR Phantom
Simulating 4.2 cm Compressed Breast
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CT image quality evaluation
Old Era New Era
phantom
analysis
results
simple more sophisticated
2( )
( )
( )
ifxLSF x e dx
MTF f
LSF x dx
π
∞
−
−∞
∞
−∞
=
∫
∫
complicated basic
useful & quantitativeperfunctory
J. Boone RSNA 2009
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Medical Physicist Functions (4)•Ensure interconnectivity & interoperability of networked equipment
Acquisition Systems: Portal Database Hard Copy
(CT, MR etc) Imaging (Printer, Camera)
Simulator Virtual Simulator Treatment Review Station Linac
Planning System
Images Images All All
Image SS, Plan , Image SS, Plan, Dose All Record
Image Image, SS, Plan Plan
HR Sethi
22.06.1999
HIS / RIS / PACS
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Medical Physicist Functions (5)Medical Physicist Functions (5)
• Electrometers & Ionization Chambers
• TLDs & TLD Reader
• OSL / Diodes & Readers
• Film (Silver Halide
• & Radiochromic)
• Densitometers / Scanners
• Gas-Filled Survey Meters
• Scintillation Detectors
• Gel-Based Dosimeters
• Electrometers & Ionization Chambers
• TLDs & TLD Reader
• OSL / Diodes & Readers
• Film (Silver Halide
• & Radiochromic)
• Densitometers / Scanners
• Gas-Filled Survey Meters
• Scintillation Detectors
• Gel-Based Dosimeters
• Test / Calibrate Physics Equipment
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Medical Physicist Functions (6)Medical Physicist Functions (6)
• Participate in the Treatment Planning Process
• Interventional Radiology
• Radiation Oncology• Physical / Virtual Simulation
• Navigational and Robotics Techniques
• Conventional CT
• Cone Beam CT
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Medical Physicist Functions (7a)Medical Physicist Functions (7a)
• Perform / Supervise Clinical Dosimetry
▲ Establish Diagnostic Reference Levels
• Conventional Radiography / Fluoroscopy
• CR / DR
• CT
• Interventional Radiology (Analogical / Digital)
In Radiology Departments:
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Automatic Input
3-D Dose Distributions
Surface & Volume Rendering
Dose / Volume Histograms
Inverse Planning
SoftwareMedical Physicist
Functions (7b)
• Perform / Supervise
Clinical Dosimetry
In Radiation Oncology
Departments:
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• Supervise Patient Accessory Construction• Supervise Patient Accessory Construction
• Immobilizers
• Masks
• Blocks
• Cut outs
• Compensators
• Immobilizers
• Masks
• Blocks
• Cut outs
• Compensators
Medical Physicist Functions (8)
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• Sources
• Dummy Sources
• Source Guides
• Cables
• Templates
• Sources
• Dummy Sources
• Source Guides
• Cables
• Templates
• Supervise Applicator /
Catheter Preparation
Medical Physicist Functions (9)
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• Supervise /
Perform Dosimetry
Accessory
Construction
• Supervise /
Perform Dosimetry
Accessory
Construction
• Jig for Orthogonal Film
Radiography
• Dosimetry Phantoms
• Water, Plastic &
Anatomical
• Autoradiography Jig /
Phantom
• Source Holders for Well Type
Ionization Chambers
• Thimble Ionization Chamber
Holders / Supports
• Treatment Templates
• Jig for Orthogonal Film
Radiography
• Dosimetry Phantoms
• Water, Plastic &
Anatomical
• Autoradiography Jig /
Phantom
• Source Holders for Well Type
Ionization Chambers
• Thimble Ionization Chamber
Holders / Supports
• Treatment Templates
Medical Physicist Functions (10)
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Medical Physicist Functions (11)Medical Physicist Functions (11)
• Verify Treatment / Supervise Radiotherapists
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Chart Checking (Second Review)
(First Reviewer: Dosimetrist)
Chart Checking (Second Review)
(First Reviewer: Dosimetrist)
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Evaluate Daily Dose Distributions
R. Mackie 2009
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Medical Physicist Functions (12)
• Make In Vivo Patient Dosimetry
Determinations
• Make In Vivo Patient Dosimetry
Determinations
TLDs
Diodes
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In Interventional Exams, Maximum
Skin Dose Can Be Determined With
Radiochromic Film
In Interventional Exams, Maximum
Skin Dose Can Be Determined With
Radiochromic Film
Loc Dose (Gy)
A 0,34
B 1,81
C 3,54
D 0,46
E 3,54
F 1,97
G 1,26
H 0,65
I 0,31
J 1,20
L 1,03
M 0,19
N 0,03Coronary Angioplasty
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Quantificação em PET com (18F)FDGQuantificação em PET com (18F)FDG
( )
( ))(__/__
/_
gpacientedomassainjetadatotalatividade
mlmédiaatividadeSUV tecido
massa=
( )
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mlmédiaatividadeSUV tecido
massa=
( )
( )eironticorpo
tecido
mlinjetadatotalatividade
mlmédiaatividadeSUV
_/__
/_=
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tecido
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SUV Standardized Uptake Values
Dificuldades na quantificação:1. Correções e aquisição das imagens2. Características próprias do paciente e da biodistribuição do radiofármaco.
L.Pozzo
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Medical Physicist
Functions (13)
Medical Physicist
Functions (13)• Supervise Maintenance Program
• Develop & Supervise QC Program
• Promote / Develop / Participate in
Research
• Supervise Maintenance Program
• Develop & Supervise QC Program
• Promote / Develop / Participate in
Research
Micro PET / MR (Cambridge University)
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Medical
physicists
also perform
radiation
safety
functions
Medical
physicists
also perform
radiation
safety
functions BSS
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Radiation Safety Functions (1)Radiation Safety Functions (1)
▲ Prepare License
for Regulatory
Authority (RA)
▲ Review Floor
Plans, Controlled
& Supervised
Areas
▲ Perform and/or
Review Structural
Shielding
Calculations
▲ Prepare License
for Regulatory
Authority (RA)
▲ Review Floor
Plans, Controlled
& Supervised
Areas
▲ Perform and/or
Review Structural
Shielding
Calculations
High Energy LinacHigh Energy Linac
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PET - Solange A. Nogueira 2009
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Radiation Safety Functions (3)Radiation Safety Functions (3)▲ Verify
• Equipment Compliance with IEC Safety Features and/or Equivalent National Standards
• Radiation Warning Signs
• Door Interlocks
• Radiation Emergency Controls
▲ Perform Radiation Safety Surveys
▲ Establish
• Dose Constraints
• Operational Limits
▲ Verify
• Equipment Compliance with IEC Safety Features and/or Equivalent National Standards
• Radiation Warning Signs
• Door Interlocks
• Radiation Emergency Controls
▲ Perform Radiation Safety Surveys
▲ Establish
• Dose Constraints
• Operational Limits
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Photograph of a Co-60 Source ChangePhotograph of a Co-60 Source Change
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Radiation Safety Functions (4)Radiation Safety Functions (4)
▲ Document Staff and Consultants’ Qualifications
▲ Develop Radiation Safety QC Program
▲ Chair Radiation Safety Committee
▲ Impart Radiation Safety Training Courses
▲ Document Staff and Consultants’ Qualifications
▲ Develop Radiation Safety QC Program
▲ Chair Radiation Safety Committee
▲ Impart Radiation Safety Training Courses
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Radiation Safety Functions (5)Radiation Safety Functions (5)
▲Maintain Inventory of all Radioactive Sources
• Receipt, Use, Disposal
▲ Maintain up-to date license-related documents
▲ Keep up on staff changes & qualifications
▲ Liaise with the Regulatory Authorities
▲Maintain Inventory of all Radioactive Sources
• Receipt, Use, Disposal
▲ Maintain up-to date license-related documents
▲ Keep up on staff changes & qualifications
▲ Liaise with the Regulatory Authorities
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Medical Physics /
Radiation Safety Functions
Medical Physics /
Radiation Safety Functions
• Participate in
QA Program
• Investigate
Accidental
Medical
Exposures
• Participate in
QA Program
• Investigate
Accidental
Medical
Exposures
• Participate in Accreditation Process• Participate in Accreditation Process