Radiotherapy FCPS new syllabus (Radio Physics)

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Radiotherapy FCPS new syllabus (Radio Physics)

This entry is part 4 of 7 in the series Radiotherapy FCPS syllabus

Radio Physics (50 marks, 25 questions) 


1. Physics relevant to radiotherapy:

Describes atomic structure, atomic and mass numbers Describes electron shells and energy levels. Describes electromagnetic radiation and the electromagnetic spectrum. Describes energy quantization Explains the relationship between wavelength, frequency and energy. Describes an x- or gamma-ray beam (quality, energy. intensity, size), Explains the basic principles of production of x- or gamma-rays, Contrasts continuous and discrete. Describes attenuation, absorption, scattering of x-rays spectra, Defines attenuation coefficients and half value layer.

2. Electromagnetic Radiation and its Interaction with Matter:

Discusses the nature of the following effects and their dependence on the properties of the irradiated material (e.g. density. atomic number), their variation with energy and their relative importance in therapy and imaging. Elastic scattering. Compton effect, Photoelectric effect, Pair production, Photonuclear interactions. Auger effect, Scattered radiation, Secondary electrons, Linear energy transfer and Dependence of range of electrons on their energy.

3. Interaction of Sub-atomic Particles with Matter:

ionization and excitation due to charged particles, Electrons, collision loss, radiative loss, stopping power due to each and total stopping power, particle range, Bragg peak, bremsstrahlung, Neutrons, elastic and inelastic collisions. Protons, ionization profile, Elementary Knowledge of pions and heavy ions.

4. Radiation Dosimetry:

Discusses variation of absorbed dose in different tissues and materials, Concept of exposure and KERMA, The principles of the relationship between exposure. KERMA and absorbed dose, ionization in gasses. The physical principles underlying radiation dose measurement, Concepts and practice of dose measurement, Relationship between measurement of ionization and derived measurement of dose, Measurement of exposure, Free air ionization chamber, Methods of measurement, The advantages and disadvantages of the following: ionization methods (ionization chamber, Geiger counter, diodes), chemical methods, primarily films thermo luminescence (TLD), scintillation counters, calorimetry, Calibration methods, intercomparisons, standards (local and national), corrections, constancy checks. Practical dose measurements, introduction to the derivation of isodose curves, central axis depth dose profiles use of phantoms.

5. Physics of Teletherapy Beams :

Describes energy ranges of x-rays used in clinical practice. discusses the dose distribution for therapeutic x-rays noting the effects on the isodose curve (% depth dose and beam profile) of energy, FSD (focus to skin distance), beam modifying devices such as wedges, tissue compensators, build-up and skin sparing, Field size, surface obliquity, inhomogeneous media.

6. Electron Beam Physics:

Describes the dose distribution of electron beams used in clinical practice, noting the effect on the isodose curve (% depth dose and beam profiles) of Energy. Tissue factors affecting dose at depth (eg. lung), Field size, Build up and skin sparing. Surface obliquity and inhomogeneities and Shielding.

7. Radiotherapy Treatment Planning:

Explains the principles of radiotherapy treatment planning. Discusses the techniques available to optimize patient set-up. Discusses the effects of patient and organ movement, Describes the methods of tumour volume definition, clinical examination, radiograph, CT, MRI, ultrasound, functional imaging. Explains the concept of planning volumes (ICRU 50, 62), Gross Tumour Volume (GTV), Clinical Target Volume (CTV), Planning Target Volume (PTV), Planning organ at Risk Volume (PRV), Internal Target Volume (ITV), Set-up Margin (SM), Treated Volume, Irradiated Volume, Organs at risk (OAR), Explains the methods of planning volume localization. Clinical mark-up, CT, MRI or PET simulation, Ultrasound, Compares fixed FSD versus isocentric planning, Describes isodose distributions, their uses and critical assessment in each of the following situations. Single field, Multi field (coplanar and non-coplanar), Are and rotational therapy, Weighting, Outlines the principles of beam shaping including conformal therapy and IMRT, Outlines the principles of forward and inverse planning, Discusses dose prescription including ICRU 50, 62,83, Outlines the principles of dose calculations in the presence of extensive shielding, Explains the principles of field matching, Describes the principles of plan evaluation and verification using isodose display, dose volume histogram (DVH, cumulative and frequency) and digitally reconstructed radiographs (DRR).

8. Explains the principles of beam therapy equipment:

Beam Therapy Equipment. Outlines the principles of superficial and ortho-voltage x-ray production. Outlines the principles of the linear acceleration, including: Electron beam production, X-ray production, beam control and stability. Output, IMRT, Describes the concept and definition of the isocenter, Describes techniques for defining the beam geometry, Collimators, Applicators, Multi leaf collimators, Explains the factors influencing penumbra Defines beam quality, Describes the shielding techniques available and the materials used in their construction, Explains the concepts of transmission, scatter and doses under shields, Discusses the factors involved in accurately irradiating the target. The treatment couch, Positioning the patient, Lasers, Light fields and Monitoring radiation output, Describes the functioning of multi leaf collimators: Edge definition, Leaf leakage, Influence of leaf size and Outlines the principles of stereotactic equipment.

9. Quality Assurance in radiotherapy:

Defines quality assurance and quality control in radiotherapy. Lists the parameters that should be included when writing a radiotherapy prescription. Describes the processes that are undertaken to ensure that the prescription is correctly implemented. The role of computer verification, Manual checking, Monitoring accuracy of treated volume, verification films, mega-voltage imaging, awareness of IGRT, Monitoring accuracy of positioning (laser, light-fields, mechanical pointers, tolerances). Monitoring accuracy of radiation output, symmetry and field flatness (tolerances) and In vivo dosimetry Outlines monitoring to assure accuracy of; Radiation output, Symmetry and Field flatness, Beam energy, Field size, Describes the rules for reporting near misses and errors including the legal requirements.

10. Radioactive Sources in Therapy: Describes the basic principles of radioactivity including:

types of radiation and radioactive decay, isotopes, concepts, definitions and units of activity and half-life, characteristics of radiation, parent and daughter decay series, Definitions and units of activity and half-life including physiological biological half life, radioactive equilibrium sealed and unsealed sources, Types of sources and their construction (wires, hairpins, seeds tubes, needles, ovoids etc.) specific forms of sources (198 Au, 1921r, 137Cs, 1251, 1311, 1921 90Sr, 895r.60 Co, 223Ra, 90y), inverse square law, specifications of source strength, air KERMA rate, calculation of absorbed dose from a source, dose distributions around standard sources, hazards with sealed sources, control and testing of sealed sources, methods of measurement of activity, principles of storage and movement control, methods of source handling, aware of leak testing and inspection of sources, safety devices available, Compares and contrasts use of teletherapy and brachytherapy methods of measurement in air KERMA rate, Explains the principles of after loading, Explains principles of brachytherapy treatment planning

11. Brachytherapy:

Discusses the principles of brachytherapy, Outlines the principles of clinical

use, Describes the distribution rules and dose calculation basis for Paris system, Describes the gynaecological intracavitary brachytherapy systems, Describes the sources used and the dose distributions, Describes how the dose is specified, Explains the principles of after loading. Discusses the types of after loading, including manual, remote, low, intermediate and high dose rate and Discusses use of imaging in brachytherapy.

12. Unsealed Sources in Therapy:

Discusses the principles of the use of unsealed sources in therapy. Describes the concepts of stability and shelf life. Defines the difference between physical and biological half life Lists the radiopharmaceuticals in common clinical use in oncology. Describes their therapeutic applications. Explains methods for dose calculation

13. Radiation Protection

Discusses the principles of radiation protection, Discusses the risks of radiation, Describes the effects of total body irradiation at different dose levels, Compares stochastic and non-stochastic processes, Discusses quality factors and dose equivalent, Describes the statutory framework, Discusses background radiation, Describes low level exposure effects Lists the radiation exposure limits for different groups, Describes the classification of staff, designated areas, Outlines ionizing Radiation regulations (IRR) 1999, Outlines Ionizing Radiation (Medical Exposure) Regulations 2000, Outlines Administration of radioactive Substances Advisory Committee (ARSAC), Outlines Radioactive Substances Act 1993, Discusses local rules, Nuclear Safety & radiation Control (NSRC) Act, 1993, Bangladesh Atomic Energy Regulatory Authority (BAERA) Act, 2012, Defines controlled areas Explains protection mechanisms, including time, distance, shielding Explains the design of treatment rooms: Primary/secondary barriers, Transmission through barriers, elementary calculations. Mazes, doors and interlocks, Leakage and scattered radiation Describes the monitoring of personnel: Construction and operating of film badge, TLD badge and direct reading dosimeter.

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