AFOMP policy number 6: code of ethics for medical physicists in AFOMP Countries.

This policy statement, which is the sixth of a series of documents prepared by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP) Professional Development Committee, gives guidance on how medical physicists in AFOMP countries should conduct themselves in an ethical manner in their professional practice (Ng et al. in Australas Phys Eng Sci Med 32:175-179, 2009; Round et al. in Australas Phys Eng Sci Med 33:7-10, 2010; Round et al. in Australas Phys Eng Sci Med 34:303-307, 2011; Round et al. in Australas Phys Eng Sci Med 35:393-398, 2012; Round et al. in Australas Phys Eng Sci Med 38:217-221, 2015). It was developed after the ethics policies and codes of conducts of several medical physics societies and other professional organisations were studied. The policy was adopted at the Annual General Meeting of AFOMP held in Jaipur, India, in November 2017.

AFOMP Policy No 5: career progression for clinical medical physicists in AFOMP countries.

This policy statement, which is the fifth of a series of documents being prepared by the Asia-Oceania Federation of Organizations for Medical Physics Professional Development Committee, gives guidance on how clinical medical physicists' careers should progress from their initial training to career end. It is not intended to be prescriptive as in some AFOMP countries career structures are already essentially defined by employment awards and because such matters will vary considerably from country to country depending on local culture, employment practices and legislation. It is intended to be advisory and set out options for member countries and employers of clinical medical physicists to develop suitable career structures.

Brief histories of medical physics in Asia-Oceania.

The history of medical physics in Asia-Oceania goes back to the late nineteenth century when X-ray imaging was introduced, although medical physicists were not appointed until much later. Medical physics developed very quickly in some countries, but in others the socio-economic situation as such prevented it being established for many years. In others, the political situation and war has impeded its development. In many countries their medical physics history has not been well recorded and there is a danger that it will be lost to future generations. In this paper, brief histories of the development of medical physics in most countries in Asia-Oceania are presented by a large number of authors to serve as a record. The histories are necessarily brief; otherwise the paper would quickly turn into a book of hundreds of pages. The emphasis in each history as recorded here varies as the focus and culture of the countries as well as the length of their histories varies considerably.

Patient-specific dosimetry in peptide receptor radionuclide therapy: a clinical review.

Neuroendocrine tumours (NETs) belong to a relatively rare class of neoplasms. Nonetheless, their prevalence has increased significantly during the last decades. Peptide receptor radionuclide therapy (PRRT) is a relatively new treatment approach for inoperable or metastasised NETs. The therapeutic effect is based on the binding of radiolabelled somatostatin analogue peptides with NETs' somatostatin receptors, resulting in internal irradiation of tumours. Pre-therapeutic patient-specific dosimetry is essential to ensure that a treatment course has high levels of safety and efficacy. This paper reviews the methods applied for PRRT dosimetry, as well as the dosimetric results presented in the literature. Focus is given on data concerning the therapeutic somatostatin analogue radiopeptides (111)In-[DTPA(0),D-Phe(1)]-octreotide ((111)In-DTPA-octreotide), (90)Y-[DOTA(0),Tyr(3)]-octreotide ((90)Y-DOTATOC) and (177)Lu-[DOTA(0),Tyr(3),Thr(8)]-octreotide ((177)Lu-DOTATATE). Following the Medical Internal Radiation Dose (MIRD) Committee formalism, dosimetric analysis demonstrates large interpatient variability in tumour and organ uptake, with kidneys and bone marrow being the critical organs. The results are dependent on the image acquisition and processing protocol, as well as the dosimetric imaging radiopharmaceutical.

Radiation exposure to caregivers from patients undergoing common radionuclide therapies: a review.

The contribution of radionuclide therapies (RNTs) to effective patient treatment is widely appreciated. The administration of high doses has necessitated investigating the potential radiation hazard to caregivers from patients undergoing RNTs. This work aimed to review the literature regarding measured effective doses to caregivers from such patients. The main selection criterion was the presence of real radiation exposure measurements. The results were categorised according to the treatment protocol and dose parameters. Analysis of the collected data demonstrated that the measured effective dose values were within the dose constraints defined by the International Commission on Radiological Protection, provided that the radiation protection instructions were followed by both patients and caregivers. In conclusion, the radiation risk for caregivers was almost negligible. In this context, treatments could be administered more often on an outpatient basis, once cost-effectiveness criteria were established and radiation protection training and procedures were appropriately applied.

A 2012 survey of the Australasian clinical medical physics and biomedical engineering workforce.

A survey of the medical physics and biomedical engineering workforce in Australia and New Zealand was carried out in 2012 following on from similar surveys in 2009 and 2006. 761 positions (equivalent to 736 equivalent full time (EFT) positions) were captured by the survey. Of these, 428 EFT were in radiation oncology physics, 63 EFT were in radiology physics, 49 EFT were in nuclear medicine physics, 150 EFT were in biomedical engineering and 46 EFT were attributed to other activities. The survey reviewed the experience profile, the salary levels and the number of vacant positions in the workforce for the different disciplines in each Australian state and in New Zealand. Analysis of the data shows the changes to the workforce over the preceding 6 years and identifies shortfalls in the workforce.

AFOMP policy statement no. 4: recommendations for continuing professional development systems for medical physicists in AFOMP countries.

This policy statement, which is the fourth of a series of documents being prepared by the Asia-Oceania Federation of Organizations for Medical Physics Committees Professional Development Committee, gives guidance on how member countries could develop a continuing professional development system for ensuring that its clinical medical physicists are up-to-date in their knowledge and practice. It is not intended to be prescriptive as there are already several CPD systems successfully operated by AFOMP member countries and elsewhere that vary considerably in scope and structure according to local culture, practice and legislation but all of which are capable of ensuring that physicists are up-to-date. It is intended to be advisory and set out options for member countries to develop their individual CPD systems.

Evaluation of detector material and radiation source position on Compton camera's ability for multitracer imaging.

We present a study on the effects of detector material, radionuclide source and source position on the Compton camera aimed at realistic characterization of the camera's performance in multitracer imaging as it relates to brain imaging. The GEANT4 Monte Carlo simulation software was used to model the physics of radiation transport and interactions with matter. Silicon (Si) and germanium (Ge) detectors were evaluated for the scatterer, and cadmium zinc telluride (CZT) and cerium-doped lanthanum bromide (LaBr(3):Ce) were considered for the absorber. Image quality analyses suggest that the use of Si as the scatterer and CZT as the absorber would be preferred. Nevertheless, two simulated Compton camera models (Si/CZT and Si/LaBr(3):Ce Compton cameras) that are considered in this study demonstrated good capabilities for multitracer imaging in that four radiotracers within the nuclear medicine energy range are clearly visualized by the cameras. It is found however that beyond a range difference of about 2 cm for (113m)In and (18)F radiotracers in a brain phantom, there may be a need to rotate the Compton camera for efficient brain imaging.

The education and training of clinical medical physicists in 25 European, 2 North American and 2 Australasian countries: similarities and differences.

PURPOSE: The clinical medical physicist is part of a team responsible for safe and competent provision of radiation-based diagnostic examinations and therapeutic practices. To ensure that the physicist can provide an adequate service, sufficient education and training is indispensable. The aim of this study is to provide a structured description of the present status of the clinical medical physicist education and training framework in 25 European, 2 North American and 2 Australasian countries. METHODS: For this study, data collection was based on a questionnaire prepared by the European Federation of Organizations in Medical Physics (EFOMP) and filled-in either by the corresponding scientific societies-organizations or by the authors. RESULTS: In the majority of cases, a qualified medical physicist should have an MSc in medical physics and 1-3 years of clinical experience. Education and training takes place in both universities and hospitals and the total duration of the programs ranges from 2.5 to 9 years. In 56% of all European countries, it is mandatory to hold a diploma or license to work as a medical physicist, the situation being similar in Australasian and 4 states of USA. Generally, there are national registers of medical physicists with inclusion on the register being voluntary. There are renewal mechanisms in the registers usually based on a Continuing Professional Development (CPD) system. CONCLUSIONS: In conclusion, a common policy is followed in general, on topics concerning education and training as well as the practice of the medical physicist profession, notwithstanding the presence of a few differences.

AFOMP Policy Statement No. 3: recommendations for the education and training of medical physicists in AFOMP countries.

AFOMP recognizes that clinical medical physicists should demonstrate that they are competent to practice their profession by obtaining appropriate education, training and supervised experience in the specialties of medical physics in which they practice, as well as having a basic knowledge of other specialties. To help its member countries to achieve this, AFOMP has developed this policy to provide guidance when developing medical physicist education and training programs. The policy is compatible with the standards being promoted by the International Organization for Medical Physics and the International Medical Physics Certification Board.

Certification and licensing of clinical medical physicists in AFOMP countries.

In many countries the education and training of medical physicists has changed over the last few decades from being rather ad hoc to becoming structured with residency programs becoming quite common. These are often followed by formal certification by independent bodies, and medical physics professional organizations (MPPOs) affirming the quality of certified physicists and recognizing their competence and ability to practice independently. Policies on the training and education of medical physicists have been developed by the International Organization for Medical Physics (IOMP) and by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP). Currently nine countries in Asia-Oceania operate systems for the certification of clinical medical physicists and four others are planning or implementing such systems. The existing systems, which are described in this paper, generally conform to the policies. Licensing of medical physicists, which is primarily the responsibility of government bodies, is almost unknown in that region.

A Monte Carlo evaluation of three Compton camera absorbers.

We present a quantitative study on the performance of cadmium zinc telluride (CZT), thallium-doped sodium iodide (NaI(Tl)) and germanium (Ge) detectors as potential Compton camera absorbers. The GEANT4 toolkit was used to model the performance of these materials over the nuclear medicine energy range. CZT and Ge demonstrate the highest and lowest efficiencies respectively. Although the best spatial resolution was attained for Ge, its lowest ratio of single photoelectric to multiple interactions suggests that it is most prone to inter-pixel cross-talk. In contrast, CZT, which demonstrates the least positioning error due to multiple interactions, has a comparable spatial resolution with Ge. Therefore, we modelled a Compton camera system based on silicon (Si) and CZT as the scatterer and absorber respectively. The effects of the detector parameters of our proposed system on image resolution were evaluated and our results show good agreement with previous studies. Interestingly, spatial resolution which accounted for the least image degradation at 140.5 keV became the dominant degrading factor at 511 keV, indicating that the absorber parameters play some key roles at higher energies. The results of this study have validated the predictions by An et al. which state that the use of a higher energy gamma source together with reduction of the absorber segmentation to sub-millimetre could achieve the image resolution of 5 mm required in medical imaging.

GEANT4 simulation of the effects of Doppler energy broadening in Compton imaging.

A Monte Carlo approach was used to study the effects of Doppler energy broadening on Compton camera performance. The GEANT4 simulation toolkit was used to model the radiation transport and interactions with matter in a simulated Compton camera. The low energy electromagnetic physics model of GEANT4 incorporating Doppler broadening developed by Longo et al. was used in the simulations. The camera had a 9 × 9 cm scatterer and a 10 × 10 cm absorber with a scatterer to-absorber separation of 5 cm. Modelling was done such that only the effects of Doppler broadening were taken into consideration and effects of scatterer and absorber thickness and pixelation were not taken into account, thus a 'perfect' Compton camera was assumed. Scatterer materials were either silicon or germanium and the absorber material was cadmium zinc telluride. Simulations were done for point sources 10 cm in front of the scatterer. The results of the simulations validated the use of the low energy model of GEANT4. As expected, Doppler broadening was found to degrade the Compton camera imaging resolution. For a 140.5 keV source the resulting full-width-at-half-maximum (FWHM) of the point source image without accounting for Doppler broadening and using a silicon scatterer was 0.58 mm. This degraded to 7.1 mm when Doppler broadening was introduced and degraded further to 12.3 mm when a germanium scatterer was used instead of silicon. But for a 511 keV source, the FWHM was better than for a 140 keV source. The FWHM improved to 2.4 mm for a silicon scatterer and 4.6 mm for a germanium scatterer. Our result for silicon at 140.5 keV is in very good agreement with that published by An et al.

AFOMP POLICY STATEMENT No. 2: recommended clinical radiation oncology medical physicist staffing levels in AFOMP countries.

This document is the second of a series of policy statements being issued by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP). The document was developed by the AFOMP Professional Development Committee (PDC) and was released by the AFOMP Council in 2009. The main purpose of the document is to give guidance as to how many medical physicists are required to staff a radiation oncology department. Strict guidelines are difficult to define as work practices vary from country-to-country and from hospital-to-hospital. A calculation scheme is presented to aid in estimating medical physics staffing requirements that is primarily based on equipment levels and patient numbers but also with allowances for staff training, professional development and leave requirements.

A survey of the Australasian clinical medical physics and biomedical engineering workforce.

A survey of the medical physics and biomedical engineering workforce was carried out in 2006. 495 positions (equivalent to 478 equivalent full time (EFT) positions) were captured by the survey. Of these 268 EFT were in radiation oncology physics, 36 EFT were in radiology physics, 44 were in nuclear medicine physics, 101 EFT were in biomedical engineering and 29 EFT were attributed to other activities. The survey reviewed the experience profile, the salary levels and the number of vacant positions in the workforce for the different disciplines in each Australian state and in New Zealand. Analysis of the data identifies staffing shortfalls in the various disciplines and demonstrates the difficulties that will occur in trying to train sufficient physicists to raise staffing to an acceptable level.

A study of objective functions for organs with parallel and serial architecture.

An objective function analysis when target volumes are deliberately enlarged to account for tumour mobility and consecutive uncertainty in the tumour position in external beam radiotherapy has been carried out. The dose distribution inside the tumour is assumed to have logarithmic dependence on the tumour cell density which assures an iso-local tumour control probability. The normal tissue immediately surrounding the tumour is irradiated homogeneously at a dose level equal to the dose D(R) delivered at the edge of the tumour. The normal tissue in the high dose field is modelled as being organized in identical functional subunits (FSUs) composed of a relatively large number of cells. Two types of organs--having serial and parallel architecture are considered. Implicit averaging over intrapatient normal tissue radiosensitivity variations is done. A function describing the normal tissue survival probability S0 is constructed. The objective function is given as a product of the total tumour control probability (TCP) and the normal tissue survival probability S0. The values of the dose D(R) which result in a maximum of the objective function are obtained for different combinations of tumour and normal tissue parameters, such as tumour and normal tissue radiosensitivities, number of cells constituting a normal tissue functional unit, total number of normal cells under high dose (D(R)) exposure and functional reserve for organs having parallel architecture. The corresponding TCP and S0 values are computed and discussed.

A new method for optimum dose distribution determination taking tumour mobility into account.

A method for determining the optimum dose distribution in the planning target volume is proposed when target volumes are deliberately enlarged to account for tumour mobility in external beam radiotherapy. The optimum dose distribution is a dose distribution that will result in an acceptable level of tumour control probability (TCP) in most of the arising cases of tumour dislocation. An assumption is made that the possible shifts of the tumour are subject to a Gaussian distribution with mean zero and known variance. The idea of a reduced (mean in ensemble) tumour cell density is introduced. On this basis, the target volume and dose distribution in it are determined. The tumour control probability as a function of the shift of the tumour has been calculated. The Monte Carlo method has been used to simulate TCP distributions corresponding to tumour mobility characterized by different variances. The obtained TCP distributions are independent of the variance of the mobility because the dose distribution in the planning target volume is prescribed so that the mobility variance is taken into account. For simplicity a one-dimensional model is used but three-dimensional generalization can be done.

A variational approach to the problem of optimizing the radiation dose distribution in tumours.

This paper presents a precise mathematical formulation of a biological criterion by which the radiation dose distribution in tumours homogeneous or heterogeneous in cell density and radiosensitivity can be optimized. The criterion is formulated as search for a dose distribution that would minimize the mean dose delivered to the tumour under the constraint that the tumour control probability reaches a given desired value. Using a method from the calculus of variations it has been proven that a homogeneous dose distribution is the solution in case of tumours homogeneous in radiosensitivity independent of their cell spatial density status. Thus the usual requirement for homogeneous dose distribution in case of homogeneous tumours is proven if the leading clinical criterion is the described one. The formula for the dose distribution in case of tumours heterogeneous in cell radiosensitivity is given too.

A mathematical approach to optimizing the radiation dose distribution in heterogeneous tumours.

This paper offers a general mathematical approach to dose distribution optimization which allows tumours with different degrees of complexity to be considered. Two different biological criteria - A) keeping the control probability of the different parts of the tumour (local tumour control probability) uniform throughout the tumour and B) minimizing the mean dose delivered to the tumour are studied. For both criteria we impose the requirement that the whole tumour control probability be kept on a certain desired level. It is proved that the adoption of the first criterion requires a dose distribution logarithmic with the cell density and proportional to the inverse of the cell radiosensitivity while the adoption of the second criterion necessitates a homogeneous dose distribution when the cell radiosensitivity is constant. The corresponding formula for the dose distribution in case of heterogeneous cell radiosensitivity is also given. The two criteria are compared in terms of local tumour control probability and mean dose delivered to the tumour. It is concluded that maintaining constant local tumour control probability (criterion A) may be of greater clinical importance then minimizing the mean dose (criterion B).