Development and execution of a pandemic preparedness plan: Therapeutic medical physics and radiation dosimetry during the COVID-19 crisis.

The SARS-CoV-2 coronavirus pandemic has spread around the world including the United States. New York State has been hardest hit by the virus with over 380 000 citizens with confirmed COVID-19, the illness associated with the SARS-CoV-2 virus. At our institution, the medical physics and dosimetry group developed a pandemic preparedness plan to ensure continued operation of our service. Actions taken included launching remote access to clinical systems for all dosimetrists and physicists, establishing lines of communication among staff members, and altering coverage schedules to limit on-site presence and decrease risk of infection. The preparedness plan was activated March 23, 2020, and data were collected on treatment planning and chart checking efficiency for 6 weeks. External beam patient load decreased by 25% during the COVID-19 crisis, and special procedures were almost entirely eliminated excepting urgent stereotactic radiosurgery or brachytherapy. Efficiency of treatment planning and chart checking was slightly better than a comparable 6-week interval in 2019. This is most likely due to decreased patient load: Fewer plans to generate and more physicists available for checking without special procedure coverage. Physicists and dosimetrists completed a survey about their experience during the crisis and responded positively about the preparedness plan and their altered work arrangements, though technical problems and connectivity issues made the transition to remote work difficult. Overall, the medical physics and dosimetry group successfully maintained high-quality, efficient care while minimizing risk to the staff by minimizing on-site presence. Currently, the number of COVID-19 cases in our area is decreasing, but the preparedness plan has demonstrated efficacy, and we will be ready to activate the plan should COVID-19 return or an unknown virus manifest in the future.

The Medical Physics Management of Reirradiation Patients.

Medical physics consultation is critical to the safe and appropriate management of patients undergoing reirradiation. A rigorous and efficient workflow in radiation oncology departments is crucial to ensure the safety and quality of treatment. The need for this service is steadily increasing year after year with the increasing complexity of treatment. This article provides an overview of how the Retreatment Special Medical Physics Consult is performed at the University of Michigan, along with a detailed patient-specific example, the results of a survey of how other institutions approach this workflow, and recommendations for future work to improve this process.

Mitigating disruptions, and scalability of radiation oncology physics work during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic has led to disorder in work and livelihood of a majority of the modern world. In this work, we review its major impacts on procedures and workflow of clinical physics tasks, and suggest alternate pathways to avoid major disruption or discontinuity of physics tasks in the context of small, medium, and large radiation oncology clinics. We also evaluate scalability of medical physics under the stress of "social distancing". METHODS: Three models of facilities characterized by the number of clinical physicists, daily patient throughput, and equipment were identified for this purpose. For identical objectives of continuity of clinical operations, with constraints such as social distancing and unavailability of staff due to system strain, however with the possibility of remote operations, the performance of these models was investigated. General clinical tasks requiring on-site personnel presence or otherwise were evaluated to determine the scalability of the three models at this point in the course of disease spread within their surroundings. RESULTS: The clinical physics tasks within three models could be divided into two categories. The former, which requires individual presence, include safety-sensitive radiation delivery, high dose per fraction treatments, brachytherapy procedures, fulfilling state and nuclear regulatory commission's requirements, etc. The latter, which can be handled through remote means, include dose planning, physics plan review and supervision of quality assurance, general troubleshooting, etc. CONCLUSION: At the current level of disease in the United States, all three models have sustained major system stress in continuing reduced operation. However, the small clinic model may not perform if either the current level of infections is maintained for long or staff becomes unavailable due to health issues. With abundance, and diversity of innovative resources, medium and large clinic models can sustain further for physics-related radiotherapy services.

Difference Distributions Applicable to Certain Health Physics Measurements.

This paper discusses calculational methods for the determination of the difference distributions associated with certain health physics measurements. These measurements include the check-source response counts relative to an initial reference count, the Albatross (i.e., HPI model 2080B) neutron tube counts relative to the gamma tube counts, and those that involve the use of the automatic background subtraction feature of portable health physics instrumentation. Examples are provided that illustrate the methods for a few specific measurements. For the comparison of a daily source count to its previously determined reference value, minimum counts for various scenarios were presented in order to reliably meet required tolerance limits of ±10% and ±20%. In either case, it was found beneficial that the initial reference readings be established using a counting interval of longer length than the daily interval. For the comparison of Albatross neutron counts to the gamma counts, it was seen that the relative error in the difference distribution was still related to that of the parent distribution. It was seen, therefore, that an effective way of reducing the gamma influence on the Albatross was to increase the counting interval used, hence yielding a significantly larger mean count per interval. For the automatic background subtraction feature, it was noted that net count values near 0 counts would almost always have the negative values of the difference distribution truncated to 0 counts by commercially available off-the-shelf instrumentation, whereas significant net count values would be displayed correctly but with a larger associated variance than the gross count itself. This paper therefore also provides a technical basis for the necessary source strength of a check source in order to meet daily limits, the gamma field limitations of the HPI 2080B Albatross, as well as the consequences of automatic background subtraction.

Practical recommendations for the application of DE 59/2013.

The changes introduced with Council Directive 2013/59/Euratom will require European Member States adapt their regulations, procedures and equipment to the new high standards of radiation safety. These new requirements will have an impact, in particular, on the radiology community (including medical physics experts) and on industry. Relevant changes include new definitions, a new dose limit for the eye lens, non-medical imaging exposures, procedures in asymptomatic individuals, the use and regular review of diagnostic reference levels (including interventional procedures), dosimetric information in imaging systems and its transfer to the examination report, new requirements on responsibilities, the registry and analysis of accidental or unintended exposure and population dose evaluation (based on age and gender distribution). Furthermore, the Directive emphasises the need for justification of medical exposure (including asymptomatic individuals), introduces requirements concerning patient information and strengthens those for recording and reporting doses from radiological procedures, the use of diagnostic reference levels, the availability of dose-indicating devices and the improved role and support of the medical physics experts in imaging.

A review of international and developed practices of medical physics from a legislative and regulatory point of view and its applicability and comparison with Pakistan.

The importance of the medical physics profession and medical physicists is widely recognized by the international bodies like ILO, IAEA, EC, etc. The description of a medical physicist's qualification framework, their role and responsibilities have been addressed in the legislative and regulatory frameworks of developed countries like the USA (in 10CFR) and the EC (EC RP 174) and less comprehensively in developing counties like Pakistan. AFOMP has contributed positively in various regulatory and policy matters regarding the medical physics practices in Asian countries. Furthermore, the recommendations of IAEA's regional meeting on "Medical Physics in Europe-Current Status and Future Perspective" in Vienna, 2015, address the need and mechanism of a harmonized framework for medical physicists' qualifications. The lack of a comprehensive professional recognition framework becomes more challenging when we see that hi-tech diagnostic (e.g. PET CT) and therapeutic (e.g. cyberknife, VMAT, tomotherapy, etc.) modalities are now available in many parts of the world, including Pakistan which still have a basic level of medical physics qualification and practices. Therefore, international efforts like the above-mentioned IAEA-EC meeting in 2015; and by AFOMP activities related to training, qualification and recognition of medical physicists can provide a pathway to further improve medical physics practices in the developing world. The objective of this review is to (i) summarize the international practices for the legislation and regulation of medical physics, (ii) provide a brief overview of the medical physics practices in Pakistan and (iii) discuss the applicability of the IAEA-EC meeting's recommendations to the case of Pakistan. The review highlights the areas which are addressed in IAEA-EC meeting and could be beneficial to other nations as well, particularly, for low and middle income countries. The review also presents few suggestions how to progress with the medical physics profession in developing countries in general, and in Pakistan in particular. These suggestions also include further possible pathway the IAEA could consider, like IAEA project or meetings, to further strengthen the medical physics profession globally.

Synopsis of the Oak Ridge Radiation Protection Research Needs Workshop.

Radiation protection is foundational to harnessing the societal benefits of radiation in nuclear energy, security, and medicine applications. Significant challenges in radiation protection remain unaddressed for the nuclear fuel cycle, nuclear medicine, emergency response, national defense, and space exploration, as the United States is lacking a coherent research strategy prioritizing radiation protection mission needs and gaps in scientific knowledge to meet these needs. Research and development in the field of radiation protection calls for cooperation among governmental agencies, emergency responders, research organizations, and the academic community. Amidst atrophying national expertise in radiation protection, the Radiation Protection Research Needs Workshop was spearheaded by the Oak Ridge Associated Universities, Oak Ridge National Laboratory, and the Health Physics Society. This workshop facilitated critical dialogue among radiation stakeholders in the governmental and scientific communities, including national laboratories, academic institutions, and industry partners. The workshop featured presentations representing 12 federal agencies and breakout sessions involving the identification of scientific drivers by subject matter experts in each of the following areas: new fuel cycles/reactors, dosimetry, medical physics, instrumentation and operations, decontamination and decommissioning, space radiation, national defense, emergency response, environmental modeling, and low-dose effects. The goal of this workshop was to seek stakeholder input toward the development of a national strategic research agenda in the field of radiation protection. Consequently, the Health Physics Society has established a Special Task Force on Health Physics Research Needs, tasked with the prioritization of scientific drivers in radiation protection for the development of a national strategic research agenda.

Code of ethics for the American Association of Physicists in Medicine (Revised): Report of Task Group 109.

The American Association of Physicists in Medicine (AAPM) has established a comprehensive Code of Ethics for its members. The Code is a formal part of AAPM governance, maintained as Professional Policy 24, and includes both principles of ethical practice and the rules by which a complaint will be adjudicated. The structure and content of the Code have been crafted to also serve the much broader purpose of giving practical ethical guidance to AAPM members for making sound decisions in their professional lives. The Code is structured in four major parts: a Preamble, a set of ten guiding Principles, Guidelines that elucidate the application of the Principles in various practice settings, and the formal Complaint process. Guidelines have been included to address evolving social and cultural norms, such as the use of social media and the broadening scope of considerations important in an evolving workplace. The document presented here is the first major revision of the AAPM Code of Ethics since 2008. This revision was approved by the Board of Directors to become effective 1 January 2019.

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.

Australasian recommendations for quality assurance in kilovoltage radiation therapy from the Kilovoltage Dosimetry Working Group of the Australasian College of Physical Scientists and Engineers in Medicine.

The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Radiation Oncology Specialty Group (ROSG) formed a series of working groups to develop recommendations for guidance of radiation oncology medical physics practice within the Australasian setting. These recommendations provide a standard for safe work practices and quality control. It is the responsibility of the medical physicist to ensure that locally available equipment and procedures are sufficiently sensitive to establish compliance. The recommendations are endorsed by the ROSG, have been subject to independent expert reviews and have also been approved by the ACPSEM Council. For the Australian audience, these recommendations should be read in conjunction with the Tripartite Radiation Oncology Practice Standards and should be read in conjunction with relevant national, state or territory legislation which take precedence over the ACPSEM publication Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group, RANZCR, 2011a; Kron et al. Clin Oncol 27(6):325-329, 2015; Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group, RANZCR, 2018a, b).

AAPM medical physics practice guideline 10.a.: Scope of practice for clinical medical physics.

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 8000 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. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline (MPPG) represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiation requires specific training, skills, and techniques as described in each document. As the review of the previous version of AAPM Professional Policy (PP)-17 (Scope of Practice) progressed, the writing group focused on one of the main goals: to have this document accepted by regulatory and accrediting bodies. After much discussion, it was decided that this goal would be better served through a MPPG. To further advance this goal, the text was updated to reflect the rationale and processes by which the activities in the scope of practice were identified and categorized. Lastly, the AAPM Professional Council believes that this document has benefitted from public comment which is part of the MPPG process but not the AAPM Professional Policy approval process. The following terms are used in the AAPM's MPPGs: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Consolidation of Health Physics Computer Codes: Sustainable Gains in Efficiency, Innovation, and Collaboration.

A decade ago, the nuclear power industry in the United States was on the verge of a nuclear renaissance with the potential to create jobs, funding streams, and great demand for radiation protection personnel. However, based on the high capital investment cost of building and licensing nuclear reactors and declining fossil fuel prices, the renaissance did not reach its full potential. Radiation protection initiatives were developed to bring attention to the profession in order to increase funding for the health physics community during these times of declining resources. It is now essential that the community be innovative in how it uses existing funds and acquires resources. This paper describes a radiation protection computer code program that uses existing resources and international funding to sustain computer codes and tools used in the health physics profession. The program is called the U.S. Nuclear Regulatory Commission's Radiation Protection Computer Code Analysis and Maintenance Program or RAMP. This collaborative, innovative, and transformative model can be followed by others seeking to alleviate the resource issues that exist within the health physics field.

NCRP Vision for the Future and Program Area Committee Activities in 2017.

The National Council on Radiation Protection and Measurements' (NCRP) vision for the future is to improve radiation protection for the general public and workers. This vision is embodied within NCRP's ongoing initiatives: preparedness for nuclear terrorism, increasing the number of radiation professionals critically needed for the nation, providing new guidance for radiation protection in the United States, addressing the protection issues surrounding the ever-increasing use of ionizing radiation in medicine, assessing the radiation doses to aircrew due to higher altitude and longer flights, providing guidance on emerging radiation issues such as the radioactive waste from hydraulic fracturing, focusing on difficult issues such as high-level waste management, and providing better estimates of radiation risks at low doses within the framework of the Million Person Study of Low Dose Radiation Health Effects. Cutting-edge initiatives include a re-evaluation of the science behind recommendations for lens of the eye dose, recommendations for emergency responders on dosimetry after a major radiological incident, guidance to the National Aeronautics and Space Administration with regard to possible central nervous system effects from galactic cosmic rays (the high-energy, high-mass particles bounding through space), re-evaluating the population exposure to medical radiation, and addressing whether the linear non-threshold model is still the best available for purposes of radiation protection (not for risk assessment). To address these initiatives and goals, NCRP has seven Program Area Committees on biology and epidemiology, operational concerns, emergency response and preparedness, medicine, environmental issues and waste management, dosimetry, and communications. The NCRP vision for the future received a quantum boost in 2016 when Dr. Kathryn D. Held (Massachusetts General Hospital and Harvard Medical School) accepted the position of NCRP Executive Director and Chief Science Officer. The NCRP quest to improve radiation protection for the public is hindered only by limited resources, both human capital and financial.