Skip to main content

Training

Physics Residency Structure (Basic Structure)

The Radiation Oncology Medical Physics residency program is a part of the Department of Radiation Medicine in the College of Medicine at the Medical University of South Carolina (MUSC). The Medical University Hospital Authority (MUHA) advances the clinical mission through support of the facility, equipment, and technical staff (radiation therapists, dosimetrists, nurses, and hospital clerical staff). The professional and academic components are under MUSC. The department’s seven radiation oncologists and eight medical physicists are medical school faculty. MUHA and the Department of Radiation Medicine provide the funding for all radiation medicine residents, including the two physics positions in this program. There is one opening in the physics residency program each year with a start date of July 1. The Radiation Oncology Medical Physics Residency is a companion program to the Radiation Medicine Medical Residency. Currently, the medical residency program is approved for seven total positions. The physics residents also interface with the Department of Radiology physics faculty and the Radiation Safety Office. The physics residents attend didactic lectures with medical residents in radiobiology, radiation oncology physics, and imaging physics.

The Department of Radiation Medicine is a part of the interdepartmental collaborative oncology group within the Hollings Cancer Center, a National Cancer Center Institute (NCI) Designated Cancer Center since 2009. As a part of their interprofessional training, the physics residents attend various multi-disciplinary tumor boards at Hollings Cancer Center, creating opportunities to observe and directly interact with neurosurgeons, urologists, and other medical specialists.

Physics Faculty Structure

The Radiation Oncology Medical Physics section includes the Chief of Medical Physics plus seven additional physics faculty members. The Chief of Medical Physics is responsible for the technical direction of the five medical dosimetrists who are employees of the Medical University Hospital Authority (MUHA) and the direct supervisor of other physicists. Dan McDonald, M.S. has been appointed by the Radiation Oncology Department Chairman and Radiation Oncology Physics Residency Program Committee to develop and direct the physics residency program as its program director. William Godwin, Ph.D is the associate program director.

Radiation Oncology Physics Residency Program Committee

A Radiation Oncology Physics Residency Program Committee (aka the Program Committee) consists of the radiation oncology physics faculty, a certified medical dosimetrist, and a radiation oncologist. The committee evaluates the program on a bi-annual basis, approves any significant changes in curriculum or procedures, reviews resident performance and approves plans for remedial training, if needed. The committee members, along with the department chairman, serve on the Selection Committee. Minutes of the Committee meeting are kept on file.

Physics Residency Rotation Primary Objectives

Below are the primary objectives of each rotation cycle. In addition, resident specific objectives are assigned that extend the rotation’s primary objectives but are specifically tailored to the experience base and skills of the individual resident. The residents continue to build clinical experience through increasing participation in daily clinical functions.

Overview & Safety (4 weeks)

  • Participate in MUSC and graduate medical education (GME) resident orientation and complete all prerequisite training.
  • Become familiar with radiation oncology equipment, processes, procedures, and operations at MUSC.
  • Become acquainted with faculty and staff.
  • Become familiar with the responsibilities of the Radiation Safety Department.
  • Develop didactic knowledge of regulations pertaining to radiation oncology.

Basic Treatment Planning (12 weeks)

  • Learn the external beam treatment planning software and the treatment planning process including treatment planning strategies, prescription doeses and limiting doses to critical structures.
  • Be able to plan 3D conformal cases and understand basic steps of IMRT planning. Areas of focus include CT simulation, treatment planning system operation and planning experiences/techniques, electron and photon block fabrication, plan evaluation tools, manual and computerized MU calculations, digital DICOM files importing and exporting, patient setup imaging guidance, billing and quality check list.

Equipment QA & Performance Testing (14 weeks)

  • Thoroughly understand and perform Quality Assurance testing on physics measurement equipment, imaging equipment and treatment equipment. Treatment equipment covered during this rotation includes conventional linear accelerators and RadiXact.
  • Brachytherapy and Gamma Knife equipment will be covered in separate rotations.

Brachytherapy (12 weeks)

  • Become familiar with all Brachytherapy procedures at MUSC.
  • Understand basic brachytherapy principles.
  • Be able to calibrate Brachytherapy sources.
  • Be able to plan Brachytherapy procedures.
  • Become knowledgeable about Brachytherapy QMP.
  • Become knowledgeable about pertinent radiation safety regulations.
  • Become familiar with various Brachytherapy references.

Radiation Measurements (15 weeks)

  • Gain a working knowledge and familiarity of the various types of radiation detectors and scanning equipment for linear accelerators.
  • Begin a collection of beam data for the commissioning of a treatment planning system during Rotation VI.

Treatment Planning System Commissioning (15 weeks)

  • Thoroughly understand the process of commissioning a new treatment planning system (Eclipse) for clinical use with a traditional linear accelerator. This includes collection of necessary data, creation of beam model and validation.

Advanced Treatment Planning (16 weeks)

  • Increase knowledge of intensity modulated radiotherapy (IMRT), conformal arc and volume modulated radiotherapy (VMAT) treatment planning techniques.
  • Become familiar with RadiXact treatment planning and optimization parameters.
  • Learn how to compare and evaluate the optimal planning techniques among IMRT, VMAT and RadiXact in variable cases.
  • To become proficient in hypo-fractionated stereotactic body radiotherapy (SBRT) CT simulation applied 4D-CT scanning and planning including technique selections (3D, IMRT, conformal Arc or VMAT), margin definition and plan evaluation.

External Beam Special Procedures (10 weeks)

  • Know and perform all QA and physics-related treatment procedures used with the Gamma Knife Esprit and Linac-based SRS.
  • Knowledgeable in contemporary methods used to deliver total body irradiation (TBI) and demonstrated competency in performing annual QA of TBI equipment and devices.
  • Knowledgeable in contemporary methods and practical aspects used to deliver Total Skin Electron Irradiation (TSEI).
  • Provide and defend your recommendations for motion management given realistic patient scenarios.
  • Knowledgeable in the benefits and limitations of patient alignment and monitoring using real-time 3D surface matching.
  • Demonstrate the ability to perform all QA for a 3D surface imaging system.
  • Demonstrate a basic understanding of the algorithms available in commercial systems used to register image datasets both rigidly and non-rigidly, in particular the benefits and limitations of each.

Shield, Licensing, & Administrative (6 weeks)

  • One goal of this rotation is to be familiar with the issues involved in designing a radiation oncology department. This includes designing structural shielding for beam radiotherapy, HDR brachytherapy, Gamma Knife and other relevant situations. The resident will also learn how to perform a facility radiation shielding survey.
  • In addtion, this rotation covers professional issues in radiation oncology physics. This includes ethics, professionalism and the role of the physicists in audits and accreditation.

Program Goals & Expectations for Residents

Program Objectives

The Radiation Oncology Physics Residency Program at MUSC is a two-year comprehensive post-graduate program whose aims are to provide clinical training and experience in radiation oncology physics, to prepare the resident for ABR certification and to practice radiation oncology physics independently. The program is designed to meet the standards recommended by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP). The knowledge and skills the resident will attain during residency training include:

  • The technical knowledge and skills related to the sophisticated technologies used in the practice of radiation oncology medical physics;
  • A critical awareness and evaluation of research and scholarship in the field;
  • An understanding of the protocols and practices essential to the deployment of technologies to detect, diagnose and treat various illnesses and injuries;
  • The ability to use analytical and research methods to solve problems arising in the clinical environment;
  • The professional attributes and the ethical conduct and actions that are required of medical physicists;
  • The communication and interpersonal skills that are necessary to function in a collaborative environment;
  • An awareness of the complexity of knowledge in the field and receptiveness to other interpretations, new knowledge, and different approaches to solving problems;
  • An awareness of the need for confidentiality of patient information and familiarity with relevant regulations;
  • An appreciation of the clinical purpose and applications of sophisticated technologies;
  • The acknowledgement of the role of medical physicists in a clinical environment in which physicians, nurses, technologists and others work in cooperation;
  • The sensitivity to potential hazards that residents may encounter and appropriate measures to take to prevent risks to themselves and equipment;
  • The recognition and correction of suboptimal application or unsafe use of technologies;
  • The commitment to continued education so that practice knowledge and skills remain current.

Completion Requirements

The resident is expected to satisfactorily complete all nine clinical rotations and any special projects within a 24-month period. Completion of a rotation consists of accomplishing all rotation objectives with a satisfactory rating from the chief rotation mentor, the program director, and receiving a satisfactory rating on the rotation oral examination. A rating of unsatisfactory by two or more oral examiners will result in failure of the oral exam necessitating a repeat examination for that rotation. Failure of the second oral examination will be cause for remedial training and assignments. The resident will be given a third opportunity to pass the oral examination. Failure on the third attempt will result in termination from the program. Should the educational objectives of the program be delayed due to extended medical leave or other circumstances that may take time away from the program, the resident may be required to extend their residency beyond 24 months in order to successfully complete the program. The duration of the extension and the specific completion requirements will be determined by the program director on a case-by-case basis and approved by the Physics Residency Program Committee. Due to limited funding, the required extension time may be without pay. Exit or termination from the program without successful completion of all requirement or prior to 24 months after the start of the program is unsatisfactory and a certificate of training completion will not be awarded.

Procedures for addressing deficiencies and termination from the program are discussed separately.

Additional Training Requirements for Program Completion

  • Ethics and Professional Training
    • CAMPEP requires the completion of ethics and professionalism training. In order to meet this requirement, the MUSC physics resident is required to complete the ABR/ACR/RSNA/AAPM/ASTRO/ARR/ARS Online Modules on Ethics and Professionalism. All modules shall be completed prior to end of the first rotation and a certification of completion for each module shall be provided to the Physics Residency Program Director.
  • Diagnostic Imaging Physics Training
    • In order to insure a fundamental knowledge of imaging physics, the MUSC physics resident is also required to complete the RSNA/AAPM Physics Education Modules. All modules shall be completed prior to end of the first year and a certification of completion for each module shall be provided to the Physics Residency Program Director.
  • Didactic Training
    • Physics residents attend the formal medical resident lectures in radiobiology and radiation oncology physics. They also take the RAPHEX examination. During their second year of residency, the resident presents at least two of the radiation oncology physics lectures. The resident is expected to attend all lectures unless superseded (with approval of the Program Director) by a special clinical procedure or approved leave.
  • Daily Morning Rounds
    • Each morning from 8:00am to 9:00am, the physics resident meets with the medical residents and various faculty members for morning rounds. Morning rounds consist of a variety of venues including journal club, special topics, chart rounds, and guest lecturers. Periodically, special procedures may take priority over morning rounds, but not on a frequent basis. Attendance is mandatory unless superseded (with approval of the Program Director) by a special clinical procedure or approved leave.
  • Tumor Boards, Seminars, Special Topics
    • Physics residents attend various multi-disciplinary tumor boards throughout their training. In addition, they participate in periodic seminars and special topics sessions. Residents are expected to attend at least two sessions each of the Head & Neck, Thoracic, GYN, Pediatric, Neurosurgery, Breast, and GU tumor boards. The Melanoma and Leukemia Tumor Boards are optional. Residents log each of these activities.
  • Optional Research
    • Challenges that often arise in the clinic as well as projects related to new technology are potential research projects for residents. The chief rotation mentor determines if any projects are applicable to the individual resident based on the individual resident’s knowledge, motivation, and ability to successfully complete the project while simultaneously meeting all of the basic and special rotation objectives. If the resident is having difficulty with the basic objectives of the rotation, the chief rotation mentor will not assign any additional projects that may further hinder the successful completion of the rotation’s core objectives.
    • Residents are encouraged to present their research findings at chapter or national AAPM conferences. Costs may be covered by funds from the department or the resident's educational expense account.
  • Clinical Training and Practical Experience
    • As previously stated, the physics resident rotates through all nine focused rotations. Each rotation has a chief mentor who is responsible for coordinating the resident’s activities during that rotation towards meeting all rotation objectives and acquiring valuable clinical experience. There may be occasions when the resident will be asked to participate in a procedure outside the focused rotation in order to gain opportunistic experience in a specific area, so long as the primary rotation focus is not compromised. The resident keeps a log of the clinical procedures they have performed. These procedures are recorded under the applicable rotation as well as their general ledger. Each rotation has rotation objectives, specific tasks, conferences, and reading assignments. Some reading assignments are for general familiarity while others require a more detailed study. The reading assignments serve to familiarize the resident with various resources as well as to increase their professional knowledge. The resident works closely with the rotation’s chief mentor and meets at least monthly with the program director to discuss their progress in the residency program and address any potential problems or deficiencies.
  • Professional Knowledge
    • During the course of the residency training, the resident is expected to become familiar with all applicable AAPM Task Group Reports as well as major textbooks and references. Many of these are listed in the description of the rotation, but the resident is expected to search the literature and review current issues of Medical Physics, the Journal of Applied Clinical Medical Physics, the physics section of the International Journal of Radiation Oncology Biology and Physics, and Physics in Medicine and Biology. The resident is expected to take the RAPHEX exam with the medical residents as well as Part 1 of the American Board of Radiology examination in addition to Part 2, if qualified according to ABR guidelines.
  • Professional Conduct
    • Physics residents are expected to conduct themselves professionally at all times. This includes maintaining a professional appearance and conducting themselves in a professional manner. The AAPM Code of Ethics is used as the guideline for professional behavior. They are expected to be familiar with this document and adhere to the standards developed and promoted by this professional organization.

In addition, the guidelines and intent of the ACGME policy on professionalism in the ACGME resident handbook is followed.

Program Changes

Resident performance and completion requirements shall be those in effect at the time the resident enters the program. Improvements and minor changes may be approved by the Physics Residency Committee but shall not extend the overall length of the program.

Certificate of Program Completion

Upon successful completion of all residency program requirements, the resident will be issued a completion certificate attesting to satisfactory completion of the Radiation Oncology Medical Physics Residency Program.