TT10-An Integrated Department of Medical Physics in a Cancer Center
C Clifton Ling, PhD
Departments of Medical Physics
Memorial Sloan Kettering Cancer Center
New York, NY 10021
In this presentation, I shall discuss the structure and function of an independent and integrated department of medical physics in a cancer center. Our department is organized into Sections and Services (with Sections nested in some Services). Some sections have Center-wide responsibilities, others have assignments specific to individual clinical departments. The departmental structure fosters intra-department interactions between sections, which in turn facilitate technology transfer to clinical departments and promote the application of a multiplicity of technical expertise to any given problem. In addition to providing support for clinical service, there is also much activity in research and training, relative to the diagnosis, management and understanding of cancer. The following is a brief narrative of the clinical functions and activities of the Services/Sections.
The Radiation Protection Section monitors radiation exposure of personnel, patients and laboratories. They interview patients implanted with radioactive materials and their families prior to discharge. The section also manages the radioactive wastes generated by patient and research applications. Another function of this section is the planning and design of radiation installations and the documentation of radiation exposure patterns.
The Clinical Physics Service is composed of four sections:
1. The Radiation Dosimetry Section performs calibration and quality assurance procedures for radioactive sources and radiation producing machines employed for cancer treatment. They perform dosimetry measurements for special procedures, in-vivo patient dosimetry monitoring, acceptance testing and dosimetry data acquisition.
2. The Brachytherapy Physics Section provides services related to the planning, optimization and implementation of brachytherapy procedures, and to the calculation and documentation of dose delivery. They are also responsible for the maintenance and provision of radioactive sources for use in interstitial and intracavitary implants.
3. The External Beam Treatment Design Section is responsible for the design of treatment plans for patients undergoing external beam radiotherapy. Their activities include acquisition of patients' anatomical data, design of radiation treatment, calculation of dose distribution, computation of machine parameters, quality assurance of the patient's treatment record, and verification of treatment delivery.
4. Regional Center Physics Section is responsible for the clinical physics support at the following regional radiotherapy centers of MSKCC: Mercy Hospital (Rockville Center, Long Island), Northwest Convenant Hospitals (Dover and Denville, New Jersey), Phelps Hospital (Tarrytown, New York), MSKCC at Commack (Long Island), New York.
The Imaging and Spectroscopic Physics Service comprises three sections:
1. Magnetic Resonance Imaging and Spectroscopic Physics Section provides clinical support in the use of magnetic resonance for the Department of Radiology. This Section is involved in many clinical and developmental projects pertaining to the use of NMR in diagnosis, disease evaluation, function assessment, predictive assay, and in assessing tumor response by monitoring tumor metabolism.
2. Diagnostic Radiological Physics Section support the clinical functions of the Department of Radiology in conventional, tomographic, and digital diagnostic radiology. Their activities include quality assurance, equipment evaluation/acquisition, and technological development. Included is the responsibility to develop techniques to enhance image quality and to minimize patient exposure in diagnostic procedures. A full scale hospital-wide PACS (picture archive communication system) has been implemented and integrated with radiological and hospital information systems.
3. The Nuclear Imaging Physics Section provide clinical support to the Nuclear Medicine Service, Department of Radiology. This group performs quality assurance procedures for gamma-cameras, single photon emission tomographic systems and the positron emission tomographic unit. They also develop and implement radionuclide dosimetry pertaining to the use of radiolabelled antibodies in cancer diagnosis and therapy. A GE PET/CT and a Siemens PET/CT (combination positron emission tomography and computed tomography system) units are used for clinical and research applications using positron emitting radioactive tracers.
The Medical Physics Computer Service develop and maintain computer software for radiation treatment design, for the record and verification system in radiation delivery, for radiation beam data acquisition, and for treatment scheduling and charge capture. They perform system management and upgrades for the computer systems in the Department, and provide computer support to other Sections of the Department.
The Biomedical Engineering Section provide electronic support to Radiation Oncology, Radiology, Cytology, Anesthesiology, Pulmonary Function, Blood Bank, and other units of the Center. Recently the group has been expanded to provide engineering expertise to minimally invasive and robotic surgery. They also participate in procuring and installing new equipment, in-service training for technologists and radiologists, and general consultation, thus providing a comprehensive biomedical engineering service to the hospital. In addition, they provide Mechanical Instrumentation support, in designing and fabricating custom instrumentation and of special devices.
The number of faculty is about 30, with another 120 staff members, including post-doctoral trainees, dosimetrists, biomedical engineers, computer scientists and other professional personnel.
TT10 - 癌症中心的医学物理科
C Clifton Ling, PhD
Departments of Medical Physics
Memorial Sloan Kettering Cancer Center
New York, NY 10021
本讲将介绍癌症中心中的独立医学物理科的构成和职责。我科分为组和室，组下属于室，有些组的职责面向全中心，有些只针对个别临床科室。这种结构有利于科内的各个组相互沟通，便于技术转入临床科室，并促进多学科技术共同解决某一特定问题。除了配合临床工作，还有很多研究和培训工作，涉及癌症的诊断、管理及认识。下面简单介绍室/组的临床职责和工作。
放射防护组 监测工作人员、患者和实验室的辐射接触情况。对于体内植入放射性材料的患者，要在患者出院前会见他们和他们的家属。此小组还负责管理患者和研究科研工作中产生的放射性废弃物。
临床物理室分为4个组：
1．辐射剂量组 进行放射源和放疗治疗机的刻度和质量保证、特殊治疗的剂量测量、患者体内剂量监测、验收测试以及剂量数据获取。
2．近距离治疗物理组 负责近距离治疗的计划、优化和执行，并计算、记录实施剂量，还负责组织间插植和腔内植入放射源的维护与供应。
3．外照射治疗设计组 负责设计接受外照射治疗患者的治疗计划，工作包括获取患者的解剖数据、放疗设计、计算剂量分布、计算机器参数、患者治疗记录的质量保证、以及治疗实施的验证。
4．分中心物理组 负责支持以下MSKCC放疗分中心的临床物理工作：Mercy Hospital (Rockville Center, Long Island), Northwest Convenant Hospitals (Dover and Denville, New Jersey), Phelps Hospital (Tarrytown, New York), MSKCC at Commack (Long Island), New York.
影像和光谱物理室分为3个组：
1．磁共振成像和光谱物理组 为放射科使用磁共振提供临床技术支持。该小组参入很多临床研究项目。这些研究项目利用NMR进行诊断、病变评估、功能评价、预测、以及通过监测肿瘤的代谢评估肿瘤响应。
2．放射诊断物理组 支持放射科常规、断层及数字化诊断放射成像的临床工作。其工作包括质量保证、设备评估/采购、技术开发。改进技术，增强图像质量，使患者在诊断过程中受到的辐射最少。整合了放射影像和医院信息系统的医院范围的PACS已使用。
3．核医学成像物理组 为放射科的核医学室提供临床技术支持，对Υ相机、SPECT和PET系统进行质量保证。针对在癌症诊断和治疗中使用放射性标记抗体的情况，发展和应用放射性核素剂量学。使用正电子放射性示踪物的一台GE PET/CT和一台Siemens PET/CT被用于临床和研究。
医学物理计算机室 开发和维护计算机软件，包括放疗计划设计、放疗实施记录与验证系统、射线数据测量、治疗时间安排、收费系统。进行科室的系统管理和计算机系统升级，为其它小组提供计算机技术支持。
生物医学工程组 为放射肿瘤科、放射科、细胞学科、麻醉科、肺功能科、血库和中心的其它部门提供电器方面的技术支持。最近，此小组扩充了工程专家，从事减小创伤和机器人手术的工作。他们也参与新设备的采购与安装，培训技师、放射科医生，提供一般的咨询，为医院提供全面的生物医学工程服务。此外，他们还提供机械仪器的技术支持，设计、制作专用的仪器和设备。
科室约有30名教员(faculty)，120名一般工作人员，包括博士后、剂量师、生物医学工程师、计算机专家和其他专业人员。