Medical Event Criteria in Prostate Seed Implant / Prostate Brachytherapy

Prostate brachytherapy implant is not going to be perfect all the time. The routine way to check the accuracy of an implant is to obtain a CT scan of the prostate after the implant, then run a post-treatment plan and compare it with the pre-treatment plan. Discrepancy in the delivered dose to the prostate (as well as to the surrounding organs) between the post and pre-plans could create a medical event or misadministration if one or both of the following NRC rules are not met: Read more

“Quality” Terms You Should Know As A Physicist

At a recent staff meeting, I realized that there are certain “quality” terms that are thrown around often in our line of work. You know which words I’m talking about: quality assurance, quality control, quality improvement, etc…Although we hear and use them often, I would bet few people know their exact definitions. Knowing their precise definitions is important to avoid using them incorrectly in a meeting or during a conversation with the boss, colleague or administrative staff. Being able to use these terms correctly is imperative in demonstrating our depth and level of knowledge concerning the subject matter. Here are the terms and their definitions as supplied by Critical Reviews in Oncology/Hematology 48 (2003) 1-17: Read more

A Reader’s Question: Losing CAMPEP Accreditation?

This past weekend, a reader sent in the following email. Since the question posed in the letter bears relevance to almost every graduate student studying medical physics, I am publishing the contents of the letter with my response (with the writer’s permission):

Have you ever heard of a school losing CAMPEP accreditation? I am concerned about an institution losing its accreditation, which would not be a very good thing, especially for those people who are intending to take the first part of the ABR exam next year and possibly find a job by June 2010…

Our response: The CAMPEP accreditation–like any other type of accreditation–is given only for a fixed period of time. After that period, the institution goes through a process of re-accreditation to demonstrate continued fulfillment of the standards and requirements set forth by CAMPEP. Read more

Two Studies on the Effectiveness of Prostate Seed Implant over Prostatectomy

September is National Prostate Cancer Awareness month, and what better timing for the release of two independent studies boosting the effectiveness of brachytherapy (radiation seed implants) as a modality for prostate cancer treatment. The two studies were done by The Prostate Cancer Foundation of Chicago and The Taussig Cancer Center at Cleveland Clinic. Is brachytherapy the best treatment for prostate cancer? That’s still up for debate. It is important to note that the studies were done in comparison to surgery (prostatectomy) and not to external beam radiation. In fact, the researchers at The Taussig Cancer Center said that brachytherapy was equally successful as external beam radiation for treatment of low-risk patients. Therefore, there is still no clear consensus on choosing brachytherapy over external beam radiation (i.e. IMRT technique) and vice-versa. However, considering brachytherapy and external beam radiation are equally successful techniques for early prostate cancer survival, as researchers in this study say, to me external beam radiation, such as IMRT, is more favorable. External beam IMRT technique is non-invasive–there is no pain, no incisions and no blood loss.

Read full articles on the two brachytherapy studies here and here.

Just as an aside, everyone knows that the pink ribbon is the symbol for breast cancer awareness, but did you know that the blue ribbon is the universal symbol of prostate cancer awareness?

For the ABR examinees this week: You Will Pass If…

These are some encouraging statements for those taking the ABR Physics exam next week. I learned them through different stages of my life (when I was taking either academic or board exams). Here they are:

1- If it has been a priority of yours to be ABR certified, you’ll pass.

2- If you have studied hard enough, you’ll pass.

3- If I and other physicists have passed the board, you’ll pass too.

4- If you have studied so hard that you feel you know nothing, you’ll pass.

5- If you have studied hard and still are panicking, you’ll pass.

6- If you think you know everything, you’ll fail.

7- The night before the exam, do whatever you feel like. The day of the exam, be relaxed and focused, have confidence. On the exam, do the ones you know first. If you’re stumped on one question, take a deep breath and go to the next one (repeat, if necessary).

8- If you don’t pass this year, you will pass eventually.

9- We’d like you to post exam questions on this blog for discussion, so please post them soon afterward before you forget them! (Trust me, I forgot my questions within several days after my exam)

10- Good luck!

ABR Practice Exam Question 6 – D90/V100 Prostate Seed Implant

From a post-plan CT following a prostate seed implant, a physicist reported that D90 is equal to 80% of the prescribed dose and V100 is 95. What does he means by that statement?

1- The minimum dose to 90% of the target volume is equal to 80% of prescribed dose; and, 100% of the target volume receives 95% of prescribed dose.

2- The 90% isodose line covers 80% of the target volume; and, 95% of the target volume receives 100% of the prescribed dose.

3- 100% of the target volume receives 95% of the prescribed dose; and, the 90% isodose line covers 80% of the target volume.

4- The minimum dose to 90% of the target volume is equal to 80% of prescribed dose; and, 95% of the target volume receives 100% of the dose.

Click here for the answer to ABR Practice Exam Question 6

NEJM Article Questions Safety of Medical Imaging Procedures

An Original Article in the August 27, 2009 issue of the New England Journal of Medicine raises concerns that imaging procedures, such as CT scans, that expose patients to low-dose ionizing radiation may be increasing their risk for cancer.

Fazel et al of Emory University obtained utilization data from just under 1 million nonelderly adults between January 1, 2005 and December 31, 2007 in five areas in the U.S. Using this data, the authors estimated the cumulative effective doses of radiation from imaging procedures and calculated population-based rates of exposure. Annual effective doses were defined as low, moderate, high or very high.

The authors found that almost 70 percent of those studied were exposed to radiation by at least one imaging procedure. Read more

ABR Practice Exam Question 5 – Cesium-131 Brachytherapy

Which of these statements is/are correct regarding a Cesium-131 brachytherapy source?

1- It emits gamma rays with a peak energy of 662 KeV.

2- Its half-value layer is around 5.5 mm lead.

3- Its half-life is 9.7 days.

4- Statements 1 and 2 are correct only.

5- None of the statements are correct.

Click here for the answer to ABR Practice Exam Question 5.

Interview Preparation for Medical Physics Graduate, Post-Doctoral and Residency Programs

Whether it’s getting admissions to a medical physics graduate or residency program or securing a position as a medical physics post-doctoral fellow, one thing is for sure: it’s competitive–and it’s only going to get more competitive with time. There are many top-notch students vying for a spot in these programs. Having a strong academic background (e.g. good grades in relevant coursework) and stellar recommendation letters are definitely a must, but they’re not everything when the applicant pool is both large and well-qualified. Strong interviewing skills is one (often overlooked) way to set yourself apart from the rest of the applicants. Being well-prepared, confident and articulate at your admissions interview will not only put you in serious contention, but can also often seal the deal when it comes to admissions. Read more

ABR Practice Exam Question 4 – Accelerated Partial Breast Irradiation (APBI)

Which of these statements is/are not correct regarding “Accelerated Partial Breast Irradiation” (APBI)?

1- APBI can be treated with external beam and mammosite only.

2- External beam based approaches seem to minimize the risk of seroma formation and infection compared to brachytherapy.

3- Radiation dose to uninvolved ipsilateral breast, heart and lung using brachytherapy technique is lower than other techniques.

4- IMRT technique improves upon 3D-CRT approach by enhancing conformity dose to tumor with a possible increase radiation dose to the uninvolved ipsilateral breast, heart and lung.

5- The PTV used for brachytherapy planning is typically smaller than the PTV for external beam technique, however, brachytherapy results in a significant dose inhomogenity.

Don’t take the exam if you don’t know the answer of this question.

Some of our readers have recommended that we do not post the answer at the same time as we post the question. We think it is a good suggestion, as it gives the readers a chance to think about the answer. Therefore, the answer will be posted within a couple of days.

Click here for the answer to ABR Practice Exam Question 4.

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