Reirradiation Special Medical Physics Consultations: Lessons Learned From Nearly 3000 Courses of Treatment.

Purpose: Reirradiation (reRT) has become increasingly prevalent due to an aging population and advancements in cancer detection and treatment. However, the field is still lacking standardized dosimetric evaluation methods and reRT workflows, which leads to difficulty in correlating clinical outcomes with delivered dose. This study reports on the implementation and evolution of a standardized reRT workflow in the Department of Radiation Oncology at University of Michigan, describing insights gained from nearly 3000 external beam reirradiation courses delivered since 2017.

The implications of the American Board of Radiology's decision to relinquish its specialty board designation on prospective authorized medical physicists (AMPs) and radiation safety officers (RSOs).

In order to independently supervise the medical use of byproduct material, physicists in the United States (US) must legally meet the qualifications defined by the Nuclear Regulatory Commission (NRC) in the 35th part of the tenth title of the Code of Federal Regulations (§ 10 CFR Part 35). The American Board of Radiology (ABR) relinquished its NRC-recognized specialty board (NSB) status at the end of 2023, which eliminated the NSB application pathway for those who earn ABR certification in 2024 and beyond. While these changes in NSB status are not retroactive and will not affect eligibility for diplomates who already possess certificates, these changes will nonetheless have repercussions for those individuals who regularly provide training and experience (T&E) attestations to the NRC, such as residency program directors, brachytherapy rotation preceptors, or radiation safety officers.

Pelvic Recovery After Endometrial Cancer Treatment: Patient-Reported Outcomes and MRI Findings.

Rationale And Objectives: Most women with endometrial cancer (EC) have an excellent prognosis and may be cured. However, treatment-related pelvic functional impacts may affect long-term quality of life. To better understand these concerns, we explored correlations between patient-reported outcomes and pelvic magnetic resonance imaging (MRI) features in women treated for EC.

AAPM Task Group 298: Recommendations on certificate program/alternative pathway candidate education and training.

Entry into the field of clinical medical physics is most commonly accomplished through the completion of a Commission on Accreditation of Medical Physics Educational Programs (CAMPEP)-accredited graduate and residency program. To allow a mechanism to bring valuable expertise from other disciplines into clinical practice in medical physics, an "alternative pathway" approach was also established. To ensure those trainees who have completed a doctoral degree in physics or a related discipline have the appropriate background and didactic training in medical physics, certificate programs and a CAMPEP-accreditation process for these programs were initiated.

A qualitative investigation of resilience and well-being among medical physics residents.

Purpose: Medical physics residents (MPRs) will define and shape the future of physics in medicine. We sought to better understand the residency experience, as related to resilience and well-being, through the lens of current MPRs and medical physicists (MPs) working with residents.

Methods And Materials: From February-May 2019, we conducted 32, 1-h, confidential, semi-structured interviews with MPs either currently enrolled in an accredited residency (n = 16) or currently employed by a department with an accredited residency (n = 16).

Gender Differences in Work-Life Integration Among Medical Physicists.

Purpose: To generate an understanding of the primary concerns facing medical physicists regarding integration of a demanding technical career with their personal lives.

Methods And Materials: In 2019, we recruited 32 medical physics residents, faculty, and staff via emails to US medical physics residency program directors to participate in a 1-hour, semistructured interview that elicited their thoughts on several topics, including work-life integration. Standard techniques of qualitative thematic analysis were used to generate the research findings.

Development and comprehensive commissioning of an automated brachytherapy plan checker.

Purpose: To present on the commissioning of an automated brachytherapy plan checker (BPC) for the evaluation of high-dose-rate brachytherapy treatment plans in support of standardized workflows and patient safety.

Methods And Materials: A BPC was developed using an applications programming interface in a commercial treatment planning system based on different inputs (e.g.

AAPM medical physics practice guideline 7.a.: Supervision of medical physicist assistants.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States.

Interstitial High-Dose-Rate Gynecologic Brachytherapy: Clinical Workflow Experience From Three Academic Institutions.

An interstitial brachytherapy approach for gynecologic cancers is typically considered for patients with lesions exceeding 5 mm within tissue or that are not easily accessible for intracavitary applications. Recommendations for treating gynecologic malignancies with this approach are available through the American Brachytherapy Society, but vary based on available resources, staffing, and logistics. The intent of this manuscript is to share the collective experience of 3 academic centers that routinely perform interstitial gynecologic brachytherapy.

Dosimetric impact of interfractional organs at risk variation during high-dose rate interstitial brachytherapy for gynecologic malignancies.

We sought to develop a framework for the identification and management of patients at risk for organs at risk (OARs) overdosing due to interfractional anatomic variation during high-dose rate interstitial brachytherapy for gynecologic malignancies. We analyzed 40 high-dose rate interstitial brachytherapy fractions from 10 patients. Planned OAR doses were compared to delivered doses, which were calculated from computed tomography scans obtained prior to each treatment fraction.

Deformable image registration-based contour propagation yields clinically acceptable plans for MRI-based cervical cancer brachytherapy planning.

Purpose: To study the dosimetric impact of deformable image registration-based contour propagation on MRI-based cervical cancer brachytherapy planning.

Methods And Materials: High-risk clinical target volume (HRCTV) and organ-at-risk (OAR) contours were delineated on MR images of 10 patients who underwent ring and tandem brachytherapy. A second set of contours were propagated using a commercially available deformable registration algorithm.

Revisiting fetal dose during radiation therapy: evaluating treatment techniques and a custom shield.

To create a comprehensive dataset of peripheral dose (PD) measurements from a new generation of linear accelerators with and without the presence of a newly designed fetal shield, PD measurements were performed to evaluate the effects of depth, field size, distance from the field edge, collimator angle, and beam modi-fiers for common treatment protocols and modalities. A custom fetal lead shield was designed and made for our department that allows external beam treatments from multiple angles while minimizing the need to adjust the shield during patient treatments. PD measurements were acquired for a comprehensive series of static fields on a stack of Solid Water.

Failure mode and effects analysis in a dual-product microsphere brachytherapy environment.

Purpose: We performed a failure mode and effects analysis (FMEA) during the addition of a new microspheres product into our existing microsphere brachytherapy program to identify areas for safety improvements.

Methods And Materials: A diverse group of team members from the microsphere program participated in the project to create a process map, identify and score failure modes, and discuss programmatic changes to address the highest ranking items. We developed custom severity ranking scales for staff- and institution-related failure modes to encompass possible risks that may exist outside of patient-based effects.

MRI-Based Evaluation of the Vaginal Cuff in Brachytherapy Planning: Are We Missing the Target?

Purpose: Although recurrences and toxicity occur after vaginal cuff (VC) brachytherapy, little is known about dosimetry due to the inability to clearly visualize the VC on computed tomography (CT). T2-weighted (T2W) magnetic resonance imaging (MRI) is superior to CT in this setting, and we hypothesized that it could provide previously unascertainable dosimetric information.

Methods And Materials: In a cohort of 32 patients who underwent cylinder-based brachytherapy for endometrial cancer with available MR simulation images, the VC was retrospectively contoured on T2W images, and cases were replanned to treat the upper VC to a dose of 7 Gy/fraction prescribed to 5 mm.

Clinical implementation of MR-guided vaginal cylinder brachytherapy.

We present an institutional experience on the clinical implementation of magnetic resonance (MR)-guided vaginal brachytherapy using commercially available solid applicator models. To test the fidelity of solid applicator models to digitize vaginal cylinder applicators, three datasets were evaluated. The first included 15 patients who were simulated with CT alone.

Magnetic resonance imaging-guided brachytherapy for cervical cancer: initiating a program.

Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer. To implement a high quality image guided brachytherapy program, a multidisciplinary team is required with appropriate expertise as well as an adequate patient load to ensure a sustainable program. It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized.

Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy.

A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed.

Essentials and guidelines for clinical medical physics residency training programs: executive summary of AAPM Report Number 249.

There is a clear need for established standards for medical physics residency training. The complexity of techniques in imaging, nuclear medicine, and radiation oncology continues to increase with each passing year. It is therefore imperative that training requirements and competencies are routinely reviewed and updated to reflect the changing environment in hospitals and clinics across the country.

Primary peritoneal clear cell carcinoma treated with IMRT and interstitial HDR brachytherapy: a case report.

Primary peritoneal clear cell carcinoma (PP-CCC), which is a rare tumor with poor prognosis, is typically managed with surgery and/or chemotherapy. We present a unique treatment approach for a patient with a pelvic PP-CCC, consisting of postchemotherapy intensity-modulated radiation therapy (IMRT) followed by interstitial high-dose-rate (HDR) brachytherapy. A 54-year-old female with an inoperable pelvic-supravaginal 5.

The dosimetric impact of single, dual, and triple tandem applicators in the treatment of intact uterine cancer.

Purpose: To identify an optimal afterloading technique for high-dose-rate brachytherapy treatments in patients with medically inoperable uterine cancer.

Methods And Materials: Eighteen treatment plans were generated using point and volume-based techniques for three patients using a single, dual, and triple tandem. Dosimetric parameters of the target and critical structures were evaluated.

Medical Physics Practice Guidelines - the AAPM's minimum practice recommendations for medical physicists.

The AAPM has long advocated a consistent level of medical physics practice, and has published many recommendations and position statements toward that goal, such as Science Council Task Group reports related to calibration and quality assurance, Education Council and Professional Council Task Group reports related to education, training, and peer review, and Board-approved Position Statements related to the Scope of Practice, physicist qualifications, and other aspects of medical physics practice. Despite these concerted and enduring efforts, the profession does not have clear and concise statements of the acceptable practice guidelines for routine clinical medical physics. As accreditation of clinical practices becomes more common, Medical Physics Practice Guidelines (MPPGs) will be crucial to ensuring a consistent benchmark for accreditation programs.

Review of online educational resources for medical physicists.

Medical physicists are often involved in the didactic training of graduate students, residents (both physics and physicians), and technologists. As part of continuing medical education, we are also involved in maintenance of certification projects to assist in the education of our peers. As such, it is imperative that we remain current concerning available educational resources.