Staffing in radiation oncology practices has always been plagued with administrative issues. The process of radiation therapy consists of a series of steps and often involves a number of different individuals. Each practice should establish a staffing program consistent with patient care, administrative, research and other responsibilities. It is recognized that talent, training and work preferences may vary from individual to individual; therefore, it is appropriate to factor these aspects into a staffing program. Since the 1980’s many organizations have published benchmarks for radiation therapy staffing. Among these organizations are AAPM, ACR, ACRO, AAMD, ASRT and a few private market research institutions. These reports provide benchmarks for the staffing of not only medical physicists, but also dosimetrists, radiation therapists, and nurses. It is worth noting that some of these reports were generated before computer information system technology became a part of radiation treatment systems. We believe that development of benchmarks for staffing in radiation therapy practices is very important and directly affects the quality of patient care and safety. Until we finalize this study, here are some recent staffing levels in radiation therapy practices as published by the ACR for the purpose of radiation oncology program accreditation.

According to the ACR, for accreditation purposes “the facility’s staffing levels for radiation oncologists, physicists, radiation therapists and dosimetrists are compared to the accredited facility averages and averages for the facility’s stratum as defined in the following table. The table allows facilities to identify personnel and equipment utilization issues. Staffing recommendations may be part of the final report; however, variations from these levels generally do not result in withholding of accreditation unless inadequate staffing levels result in non-compliance with ACR Practice Guidelines and Technical Standards and/or compromise patient safety.”

We will post more articles on this topic in a timely fashion and encourage our readers to send us their thoughts and comments on this issue.

According to NRC 10 CFR part 35.690, if you are not a board certified radiation oncologist, the law requires that you have the following training in order to be listed as an AU in the HDR material license and to treat patients with HDR independently:

You must have completed a structured educational program in basic radionuclide techniques applicable to the use of a sealed source in a therapeutic medical unit that includes:

(i)  200 hours of classroom and laboratory training in the following areas—
(A) Radiation physics and instrumentation;
(B) Radiation protection;
(C) Mathematics pertaining to the use and measurement of radioactivity; and
(D) Radiation biology; and

ii) 500 hours of work experience, under the supervision of an authorized user who meets the requirements in §35.690 or, equivalent Agreement State requirements at a medical institution, involving—
(A) Reviewing full calibration measurements and periodic spot-checks;
(B) Preparing treatment plans and calculating treatment doses and times;
(C) Using administrative controls to prevent a medical event involving the use of byproduct material;
(D) Implementing emergency procedures to be followed in the event of the abnormal operation of the medical unit or console;
(E) Checking and using survey meters; and
(F) Selecting the proper dose and how it is to be administered;
(G) Device operation
(H) Safety procedures for the device use
(I) Clinical use of the device

For more information, visit: http://www.nrc.gov/reading-rm/doc-collections/cfr/part035/part035-0690.html

Considering the above guidelines, these are some useful tips to the following groups of individuals:

For ASTRO: Inform all the Radiation Oncology Residency Program Directors about the law.

For Residency Program Directors:  If you don’t have an HDR in your facility, try to get one. HDR training should be a part of every physics residency program.

For Residents: If your program does not have an HDR after-loader or offer HDR after-loader training, make arrangements with sites nearby that possess an HDR after-loader and arrange to complete your 500 hours training there during your residency program.

For Medical Physicists: Share this information with your radiation oncologist colleagues. If you are responsible for amending the material license and are expecting a new radiation oncologist to join the group, be sure he or she has all the relevant paper work (documenting the necessary training) available before leaving his/her institution.

Finally, there is a similar law for medical physicist to be listed as an Authorized Medical Physicist that was previously posted on this blog. Click on this link for further information.

http://www.nrc.gov/reading-rm/doc-collections/cfr/part035/part035-0051.html

I found this link to be quite useful, and I refer to it many times, so I am putting it here for your reference. This is especially useful for and applicable to new physicists who need to do HDR or for the RSOs who need to amend the material license to include new physicists in the license. I am guessing that all the agreement states have adopted this regulation from the NRC (or something similar to it).

Further, if you are changing your job and are already listed as an AMP in the material license in your present job, it’s important to take a copy of the material license with you to your new job! Believe me, this will save you, the RSO, and the institution a lot of time and possibly spare all of you a headache.

Recent post-doctorate positions open in medical physics:

Position 1
The Department of Radiation Physics at the M. D. Anderson Cancer Center in Orlando, Florida, is looking for a medical physics post-doctoral fellow. The successful fellow will work under the supervision of Dr. Katja Langen. The fellow is expected to work on a project that is designed to assess the dosimetric effect of intra-fraction motion. This project is funded by one of our industrial partners. It will be conducted in a clinical setting, using research platforms of commercial treatment planning systems. Ideally we hope to recruit a person with a medical physics degree or someone with closely related experience. The applicant is expected to assist on all levels of this project, including code development, data generation, and publication.

The Radiation Physics Department is equipped with 2 modern Varian accelerators, a Novalis unit, two TomoTherapy units, a HDR unit, and a Calypso system. It is staffed by 6 full time physicists, 1 physics associate, 2 medical phyics residence, and 2 post-doctoral fellows.

The M. D. Anderson Cancer Center Orlando is part of the Orlando Health system. We are located in downtown Orlando, Florida.

Interested applications are encouraged to submit an application to:
Katja Langen, Ph. D.
M.D. Anderson Cancer Center Orlando
1400 S. Orange Av., MP-730
Orlando, FL 32806
E-mail: Katja.Langen@orlandohealth.com

Position 2
The Department of Radiation Oncology, Division of Medical Physics is currently recruiting for a medical physics resident. We expect the chosen candidate to start in the summer of 2009. Preference will be given to candidates holding a graduate degree in medical physics, physics or related sciences.

The department is offers cutting edge technology, with active programs in Intensity Modulated Radiotherapy and RadioSurgery, Stereotactic Body Radiation Therapy, Image Guided Radiotherapy and CT and Ultrasound based Brachytherapy.

We are outfitted with two in house multi slice CT simulators with 4D capabilities. The Division of Medical Physics maintains 6 Varian linear accelerators with IMRT and IGRT capabilities including a Novalis Tx machine and a TomoTherapy unit. Additional equipment includes two
Nucletron HDR units, and an in-house dedicated imaging center including a GE PET/CT unit and SPECT. The operating rooms at CTRC are used for LDR and HDR brachytherapy implants. We also have a very active total body photon and electron (TBI and TSE) irradiation program.

There are several active research programs in the areas of IMRT, IMRS, SBRT, Monte Carlo simulations, 4D treatment planning, IGRT and adaptive radiotherapy. The Division of Medical Physics is comprised of 5 faculty physicists, 5 dosimetrists, 13 doctoral students, three postdoc fellows, 5 dosimetry students, and a physics assistant.

The successful candidate will possess the ability to work well in a strong team environment, and contribute to our clinical programs. The residency program is structured based on the AAPM residency recommendations in therapy physics and we are currently seeking
accreditation from CAMPEP.

Interested candidates should submit an interest letter (personal statement), a CV and three letters of recommendation to: Dr Niko Papanikolaou, Residency Program Director, Department of Radiation Oncology. Cancer Therapy and Research Center at UTHSCSA, 7979 Wurzbach Rd, San Antonio, TX 78229.

All residency appointments are designated as security sensitive positions.

The University of Texas Health Science Center at San Antonio is an Equal Employment Opportunity/Affirmative Action Employer.

Niko Papanikolaou, PhD
Professor, Radiation Oncology and Radiology
Chief, Division of Medical Physics
University of Texas Health Science Center
Department of Radiation Oncology
7979 Wurzbach Rd, MC 7889
San Antonio TX 78229-4427
E-mail: papanikolaou@uthscsa.edu

Position 3
The Department of Radiation Oncology, Physics Section, invites applications for a “Clinical Physics Associate” to begin on or before July 1, 2009. This is a clinical medical physics residency position and no prior clinical medical physics experience is required. This physics professional receives training and provides clinical medical physics service in radiation oncology under the supervision of qualified medical physicists. The Clinical Physics Associate is expected to: provide all treatment planning and quality assurance aspects for external beam radiotherapy and brachytherapy; perform acceptance testing, commissioning, and calibration of therapy equipment, computer systems, instruments, and devices; provide clear written documentation as required; participate in the selection and evaluation of new therapy equipment and systems; participate in the development of new treatment programs; participate in clinical and didactic instruction, all under the direction and guidance of faculty physicists. Minimum qualifications are a M.S. in medical physics or a Ph.D. in a related field. Strong preference is given to candidates having an advanced degree (M.S. or Ph.D.) in medical physics from a CAMPEP accredited program.

The Radiation Oncology Department is part of the Arizona Cancer Center a NCI designated Comprehensive Cancer Center. Five attending physicians and six medical residents see approximately 1200 new patient consults annually and provide treatments using three linear
accelerators (Novalis/Varian, Elekta SLi and TomoTherapy HiArt), HDR brachythearpy (Varian VariSource), LDR prostate seed implants, eye plaques, and cervical implants and other special procedures performed in our department including SRS, SBRT, and IGRT. The physics section
is comprised of four physics faculty and two medical physics residents (clinical physics associates). The University of Arizona is a major research university having excellent resources and abundant opportunities for collaborations and career growth, providing
exceptional benefits, and many educational, cultural, and recreational experiences. It is located in Tucson, Arizona in the heart of the Sonoran Desert.

Application must be made online at http://www.hr.arizona.edu (Job #42717).

Application review begins 04/24/2009 and continues until the open position is filled.

The University of Arizona is an EEO/AA Employer-M/W/D/V.

Russell J. Hamilton, Ph.D.
Associate Professor, Head of Physics Section
The University of Arizona, Department of Radiation Oncology
1501 N. Campbell Avenue
P.O. Box 245081
Tucson, AZ 85724-5081
E-mail: rjh@email.arizona.edu