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.