Advisors Information Medical Dosimetry Program Jane Chapman, M.Ed, CMD

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Advisors InformationMedical Dosimetry
ProgramJane Chapman, M.Ed, CMD
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What is a dosimetrist?

• Medical Dosimetrists are members of the Medical
  Physics section of the Radiation Oncology Team.
  They work under the supervision of the Medical
  Physicist, and are skilled in calculating and
  planning radiation doses.

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Day in the Life

• The dosimetrist is often present with the
  Radiation Oncology physician at the time of
  examination and assessment of the patient.

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Patient Imaging

• The dosimetrist attends the patients radiation
  simulation and/or CT imaging to assure proper
  positioning to comply with the treatment design.

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I need help!

• With the information gathered from the physician
  and the patient simulation, the dosimetrist goes
  to the treatment planning computer. Often for
  complex plans, the planner calls for input from a
  senior dosimetrist or medical physicist.

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More

• The physician consults with the dosimetrist often
  at imaging or examination about the development
  of a treatment plan. Complexity often requires a
  presentation of more than one treatment plan.
  The physician and the physicist will decide on
  which is best for the patient. The dosimetrist
  translates the treatment plan into treatment
  parameters for the therapist.

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Calculations

• After the physician approves the treatment
  design, the dosimetrist performs calculations and
  data entry to translate the plan into treatment
  delivery.

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So we see that the dosimetrist is in the center
of a circle of health professionals which is good
when all goes well, but maybe not so wonderful
always.
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The Professional Background

• This is a very responsible and technical
  profession within the medical community, and the
  Medical Dosimetrist must have an extensive
  background in formal education and experience.
  They may have a B.S. degree in applied science or
  Radiation Therapist background, both categories
  with clinical training by Medical Physicists.

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Professional Development

• In the late 60s and early 70s, the medical
  physicist became more involved in radiation
  measurement and technology development to spend
  time performing the routine calculations and dose
  distribution maps for the individual patients.
  Many hired math or physics college graduates to
  serve as their assistants in this capacity.

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Professional Development

• At smaller centers in the late 60s and early
  70s, medical physicists trained the radiation
  therapist to perform routine beam on time
  calculations. As more calculations and dose maps
  became necessary for each patient, some
  therapists were moved to perform these tasks to
  the exclusion of therapy.

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Professional Development

• As knowledge and technology developed, a unique
  mix of expertise became necessary to perform the
  increasingly complex calculations and treatment
  designs.
• The dosimetrist became a distinct and integral
  component of the Radiation Oncology team.

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What kind of person?

• A close working relationship with physicians,
  physicists, and therapists, and an empathetic
  desire to help their patients is necessary. The
  Dosimetrist must also have the desire for and
  express the willingness to stay current through
  continuing education in this rapidly changing
  field.

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Definition

• Medical Dosimetry is the measurement and
  calculation of dose for the treatment of cancer
  patients. This is accomplished by various means
  the uses of meters, chemicals, detection devices
  and computers. Primarily, dosimetry is the
  metering and measurement of dose by whatever
  method is most suited to the current situation.

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Responsibilities

• The Medical Dosimetry Career has developed
  because of the necessity of precision in the
  treatment of cancer. Professional Dosimetrists
  use their knowledge of physics, anatomy and
  radiobiology to develop an optimal arrangement of
  radiation portals to spare normal tissues while
  applying a prescribed dose to the targeted
  disease.

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The dosimetrist plans for all areas of the body.
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Calculations

• The medical dosimetrist applies formulas and
  mathematical concepts to calculate beam on time
  for the appropriate delivery of dose. A high
  level of meticulous precision is necessary.

SSD2
SSD1
s1 s2
d
L1
L2
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Special Branch of Dosimetry

• Brachytherapy
• is the application of radioactive sources to the
  patient surface, intracavitarily, or
  interstitially. The dosimetrist often assays,
  prepares, and assists in implantation of the
  radioactive sources, as well as producing the
  dose map. The dosimetrist may also be
  responsible for the applicators as well as some
  radiation safety activities.

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Brachytherapy
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SEVERESHORTAGE
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Profession Growth

• M.D. Anderson had 4 dosimetrists in 1975.
• M.D. Anderson had 6 dosimetrists in 1980.
• M.D. Anderson had 9 dosimetrists in 1990.
• M.D. Anderson is staffed in 2008 with more than
  40 dosimetrists!!!
• WHY?

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WHY

• Complexity of radiation therapy

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Couch rotation to achieve match with inferior
border of supraclavicular field.
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WHY

• Technology

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Gantry rotation is used to line up the deep
borders of the tangentials in the transverse
plane. Collimator rotation is used to line up the
deep borders in the sagittal plane. Couch
rotation is used to line up the superior borders
in the coronal plane.
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Draw a block to cover the 114 dose cloud and
click yes to use MLCs.
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Inbound Outbound
Crossbound
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WHY

• TIME
• In 1980 it took ½ hour to 1 hour to plan a
  patient treatment
• In 2000 it took 1.5 hours to 2 days to plan a
  patient treatment

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WHY

• Few Education programs
• There are only 7 JRCERT accredited programs in
  the United States
• Many only accept 0 to 2 students annually. The
  Anderson program accepted 16 students this year.
• OJT dosimetrists have difficulty passing the
  certification exam.

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WHY

• Aging population
• The formal programs do not produce enough
  students to replace those dosimetrists retiring
  each year much less make progress on growth of
  demand
• The original dosimetrists are reaching retirement
  age

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What Does This Mean?

• Jobs everywhere high demand for program
  graduates.
• Rising salaries institutions can only fill their
  positions by attracting other institutions
  dosimetrists.
• Last years graduates started at approximately at
  a low end salary of 75,000.

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AAMD

• American Association of Medical Dosimetrists
  (AAMD), www.medicaldosimetry.org
• The American Association of Medical Dosimetrists
  was incorporated in 1975, organized for
  charitable, educational and scientific purposes.
  There are approximately 1500 members. The AAMD
  provides survey information on job skills, salary
  levels, academic profiles, and work environment.

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AAMD Publication

• Medical Dosimetry
• Medical dosimetry, the official journal of the
  AAMD is the key source of information on new
  developments for the medical dosimetrist.
  Practical and comprehensive in coverage, the
  journal features original contributions and
  review articles by dosimetrists, oncologists,
  physicists and therapists.

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Certification

• MDCB www.mdcb.org
• Mission Statement
• The mission of the Medical Dosimetrist
  Certification Board is to certify and advance the
  profession of medical dosimetry. This is
  accomplished by designing the examination and
  continuing education certification process.

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THE UNIVERSITY OF TEXAS M.D.ANDERSON CANCER
CENTER MEDICAL DOSIMETRY PROGRAM
The Anderson program has been granting Medical
Dosimetry certificates every year for 16 years.
Each year at least 3 students finished the
program, last year 12 students received their
certificates or degrees. The program accepted 16
students for the 2008-2009 school year.
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CURRICULUM
As a program recognized by the AAMD, the Anderson
program follows the Curriculum Guidelines for
Formal Dosimetry Training Programs as published
in Medical Dosimetry, Vol. 23, No. 4, pp 311-332,
1998. The guidelines are in the outline format
with main subject titles with detailed breakdown
of what is to be included under each main subject
title.
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MAIN SUBJECT TITLES
Applied Mathematics Dose
Determination - External Beam Medical Imaging
Electron Beam Therapy Treatment Modalities
Clinical Characteristics of e- Beams Clinical
Oncology Nuclear Physics Treatment Planning
Clinical Brachytherapy Isodose
Distributions Radiation Protection External
Beam Dose Calculation 3D Treatment
Planning Radiation Biology Stereotactic
Radiosurgery Treatment Preparation Quality
Assurance
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THE ANDERSON CURRICULUM

• The University of Texas M.D. Anderson Cancer
  Center Program in Medical Dosimetry is a 12-month
  program with approximately 700 hours of didactic
  instruction and 1,000 hours of clinical
  education. Classes include
• Introduction to Medical Dosimetry
• Orientation to Radiation Oncology
• Topographic Anatomy
• Physics for Medical Dosimetrists
• Scientific Paper and Poster Presentation
• Oncologic Pathology
• Brachytherapy Theory and Practice
• Radiation Biology
• Radiation Safety and Practice

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CLINICAL TRAINING
UTMDACC is one of the largest cancer centers in
the world the Department of Radiation Oncology
treats more than 4000 new patients annually. The
Program utilizes these resources to enhance the
students professional educational experience.
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ADMISSION REQUIREMENTS

• Minimum requirements for consideration are
• 90 college credit hours including the
  pre-requisites
• Baccalaureate degree in mathematics or a physical
  science including pre-requisites.
• OR
• Graduate of an accredited Radiation Therapy
  Program prior work experience preferred
• All students should have proof of prior class
  work in algebra and physics.

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Baccalaureate Degree
The Allied Health Programs of M.D. Anderson
Cancer Center offer the opportunity to earn a
baccalaureate degree from Anderson. The student
will have completed 90 college hours with the
required pre-requisites and may spend the last
year at Anderson in the Program in the same
classes as the certificate students, but will
graduate the Program with a B. S. degree in
Medical Dosimetry issued by The University of
Texas M.D. Anderson Cancer Center School of
Health Sciences.
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CLINICAL REQUIREMENTS
The student will complete four clinical rotations
during the school year. A well-balanced clinical
experience is planned for each student to include
daily and weekly quality assurance checks,
external beam and brachytherapy, 2 and 3D/IMRT
treatment planning.
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CLINICAL COMPETENCIES
Each year the competency list should be reviewed
in light of the rapidly changing technology and
dosimetry involvement in all aspects of the
patients radiation oncology experience.
Competency List Thorax Sagittal for Gapped
Fields SAD Tangential Breast Electron Chest
Wall 3-Field Belly Board 4-Field Pancreas Photon
Arc Rotation Parallel-Opposed Larynx Standard
Head Neck Plan Tangential Chest Wall with
Bolus Simple Mantle Standard Lung Wedge Pair 3D
Conformal Prostate Gynecological
Intracavitary Interstitial Implant
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MORE OPPORTUNITIES
The Anderson student is also invited to attend
the various seminars, presentations, and training
opportunities taking place year round at the
center.
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RESEARCH PROJECT
The Anderson students have received awards in the
AAMD student paper competition many years, and
had the honor to have their papers published in
the Medical Dosimetry Journal.
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OUR GOAL
The program strives to provide quality education
in medical dosimetry to prepare our graduates for
careers as professional medical dosimetrists and
provide the background necessary to achieve
certification. This integrates with the
institutional mission which states that the
mission of The University of Texas M.D. Anderson
Cancer Center is to eliminate cancer in Texas,
the nation and the world through outstanding
integrated programs in patient care, research,
education and prevention.
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More Information

• Please log onto www.mdanders
  on.org/healthsciences for more
  information and to apply.