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.

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.

The Radiation Safety Officer as an Advocate for Patient Safety.

The role of the radiation safety officer is to maintain radiation exposures as low as reasonably achievable. Traditionally, the focus has been on reducing or eliminating unnecessary occupational exposure to employees and ensuring exposure of visitors and members of the public is maintained below regulatory limits. Over the last three decades there has been increasing concern expressed in the medical literature on the potential risks of radiation exposure to patients undergoing diagnostic medical imaging procedures. This paper will discuss the need for advocacy and processes by which the radiation safety officer can expand the focus of a medical radiation safety program to include advocacy for applying the principles and practices of maintaining exposures as low as reasonably achievable to patients.

Introducing Health and Medical Physics to Young Learners in Preschool to Fifth Grade.

A hands-on learning activity was developed to introduce young learners to concepts and careers in health and medical physics. Inexpensive materials were used to create a work station with learning tools that were designed to be approachable and accessible for this audience. Visitors to a local independent, nonprofit science museum may interact with the activity work station to learn basic information regarding radiation in everyday life and to hear about careers in radiation sciences. Approximately 60 volunteer hours have been contributed associated with the activity. Interested physicists may adapt the lesson plan as a simple and straightforward way to participate in public education efforts in their own communities. A detailed lesson plan, equipment list, and electronic media are available upon request.

Design, Development, and Content Creation for an Open Education Physics Website for MRT Education.

BACKGROUND: As health care technologies continue to advance rapidly, resulting in improved standards of practice, it is essential for health care professionals to continually expand on their current skills and knowledge. We describe here an initiative to use open education resources to provide ongoing education in radiation medical sciences and imaging. AIMS: The aim of this study to design an interactive, engaging, multilevel radiation medical physics resource, which is fully open to the public, and functional on all types of computing devices. Our primary target audiences are students and workers in medical radiation technology and other health care professionals as part of their continuing professional development. DESIGN AND DEVELOPMENT: The three tasks of design, development, and content creation were most efficiently performed in parallel wherever possible. A modern responsive web design was adopted to target all desktop and mobile devices. Only open-source tools and libraries were used in developing the OpenPhys website. OVERALL WEBSITE DESIGN AND NAVIGATION: The homepage is a modern tile-based design containing one coloured tile for each lesson. Clicking anywhere on a coloured lesson tile will open up a two-dimensional interactive concept map linking to content pages. Currently, 10 lessons are available online ranging from the electronic structure of the atom to MRI basics: "NMR" and "Inside a Pixel". Lesson pages include text, images, graphics, equations, quizzes, and interactive animations. USER FEEDBACK: An online questionnaire was emailed to current radiation therapy students at the University of Alberta and alumni regarding the functionality and navigation of the website. DISCUSSION/CONCLUSION: To our knowledge, OpenPhys is the first open education resource specializing in radiation physics and medical imaging. We believe OpenPhys will fill existing gaps in the realm of physics education delivery and could be a component of a blended learning initiative. Future steps will include a formal evaluation of the website and content.

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).

Presidential Perspectives: Women's Views From the Top.

This paper presents the perspectives of past presidents of the Health Physics Society who also happen to be women. Only 6 out of 63 Society presidents have been women, and of these six, five are still living and briefly reflect on their experiences here, alongside a brief discussion of the first female president of the Society. These perspectives provide historical insight into the evolution and happenings of the Society as well as adding personal touches to the office of the president that hopefully will encourage junior Society members to consider serving.

The Impact of Military Women in Health Physics.

Some of the finest women in the U.S. military serve with distinction in the health physics field. These talented women consistently rise above the norm and lead the way in science and in military service. There are over 200 military health or medical physicists, 35 (17%) of whom are female, supporting over one million Department of Defense personnel. They serve in the U.S. Air Force, Army, and Navy. Health physics and medical physics career fields in the military provide a unique opportunity for women to excel, and they have made monumental contributions to the medical community, to the military, and to the nation. This paper highlights just some of the impressive accomplishments of female military health and medical physicists in the service of their nation.

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.

Establishing a New Clinical Role for Medical Physicists: A Prospective Phase II Trial.

PURPOSE: To investigate a new clinical role for medical physicists in direct patient care with a prospective phase 2 clinical trial. MATERIALS AND METHODS: Medical physicists participated in the Physics Direct Patient Care (PDPC) protocol, establishing independent professional relationships with radiation oncology patients. After attending a dedicated patient communication training program, medical physicists routinely met with patients for 2 physicist-patient consults to explain the treatment planning and delivery process, review the patient's treatment plan, and answer all technical questions. The first physicist-patient consult took place immediately before the computed tomography simulation, and the second took place immediately before the first treatment. Questionnaires were administered to each patient on the PDPC protocol at 3 time points to assess both anxiety and satisfaction. The first questionnaire was given shortly after the first physicist-patient consult, the second questionnaire was given shortly after the second physicist-patient consult, and the third questionnaire was given after the last treatment appointment, with no associated physicist-patient consult. RESULTS: The mean patient anxiety score was considered to be low at all questionnaire time points. There was a statistically significant decrease (P < .0001) in anxiety from the simulation time point to the first treatment time point. The mean patient technical satisfaction score was considered to be high at all measurement time points. There was a statistically significant increase (P = .0012) in technical satisfaction from the simulation time point to the first treatment time point. There was a statistically significant decrease (P < .023) in technical satisfaction from the first treatment time point to the last treatment time point. CONCLUSIONS: Establishing a new clinical role for medical physicists and investigating its effects on patient anxiety and satisfaction have created the foundation for future studies. Based on the results of this trial, the PDPC protocol will be expanded to a larger group of medical physicists, radiation oncologists, and patient disease sites and investigated with a randomized phase 3 clinical trial.

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.

Using the Health Physics Student Volunteer Program for a Research Project Sponsored by the Medical Section of the Health Physics Society.

The Health Physics Society (HPS) Medical Health Physics Section (MHPS) received a request to research data on radiation safety guidance related to the death of patients who have recently received therapeutic doses of sealed or unsealed therapy sources. The MHPS elected to use student volunteers to perform this research. The purpose of this manuscript is to describe and provide a template for the process used by the MHPS to develop a student volunteer program. To implement the student volunteer program, the MHPS collaborated with the HPS Student Support Committee to develop a research proposal and a student volunteer selection process. The research proposal was sent to HPS student members in a call for volunteers. Two student volunteers were chosen based on predetermined qualifications to complete the work effort outlined in the research proposal. This project progressed with the use of milestones and culminated with the students presenting their findings at the annual HPS meeting. The students received HPS student travel awards to present at the conference. This work effort proved to be extremely beneficial to all parties involved.