A strategic development model for the role of the biomedical physicist in the education of healthcare professionals in Europe.

This is the third of a series of articles targeted at biomedical physicists providing educational services to other healthcare professions, whether in a university faculty of medicine/health sciences or otherwise (e.g., faculty of science, hospital-based medical physics department). The first paper identified the past and present role of the biomedical physicist in the education of the healthcare professions and highlighted issues of concern. The second paper reported the results of a comprehensive SWOT (strengths, weaknesses, opportunities, threats) audit of that role. In this paper we present a strategy for the development of the role based on the outcomes of the SWOT audit. The research methods adopted focus on the importance of strategic planning at all levels in the provision of educational services. The analytical process used in the study was a pragmatic blend of the various theoretical frameworks described in the literature on strategic planning research as adapted for use in academic role development. Important results included identification of the core competences of the biomedical physicist in this context; specification of benchmarking schemes based on experiences of other biomedical disciplines; formulation of detailed mission and vision statements; gap analysis for the role. The paper concludes with a set of strategies and specific actions for gap reduction.

A comprehensive SWOT audit of the role of the biomedical physicist in the education of healthcare professionals in Europe.

Although biomedical physicists provide educational services to the healthcare professions in the majority of universities in Europe, their precise role with respect to the education of the healthcare professions has not been studied systematically. To address this issue we are conducting a research project to produce a strategic development model for the role using the well-established SWOT (Strengths, Weaknesses, Opportunities, Threats) methodology. SWOT based strategic planning is a two-step process: one first carries out a SWOT position audit and then uses the identified SWOT themes to construct the strategic development model. This paper reports the results of a SWOT audit for the role of the biomedical physicist in the education of the healthcare professions in Europe. Internal Strengths and Weaknesses of the role were identified through a qualitative survey of biomedical physics departments and biomedical physics curricula delivered to healthcare professionals across Europe. External environmental Opportunities and Threats were identified through a systematic survey of the healthcare, healthcare professional education and higher education literature and categorized under standard PEST (Political, Economic, Social-Psychological, Technological-Scientific) categories. The paper includes an appendix of terminology. Defined terms are marked with an asterisk in the text.

The role of the biomedical physicist in the education of the healthcare professions: an EFOMP project.

The role of the biomedical physicist in the education of the healthcare professions has not yet been studied in a systematic manner. This article presents the first results of an EFOMP project aimed at researching and developing this important component of the role of the biomedical physicist. A background to the study expands on the reasons that led to the need for the project. This is followed by an extensive review of the published literature regarding the role. This focuses mainly on the teaching contributions within programmes for physicians, diagnostic radiographers, radiation therapists, and the postgraduate medical specializations of radiology, radiotherapy, interventional radiology and cardiology. Finally a summary list of the specific research objectives that need to be immediately addressed is presented. These are the carrying out of a Europe-wide position audit for the role, the construction of a strategic role development model and the design of a curriculum development model suitable for modern healthcare professional education.

Radiation risks in interventional radiology.

The number, diversity and complexity of interventional radiological examinations have all increased markedly in recent years, and it is widely recognized that some of these procedures carry greater risks than many other radiological procedures. This Commentary uses a meeting on "Radiation Protection in Interventional Radiology" held at the British Institute of Radiology on 28 March 2007 as a template to discuss recent progress in this area, some current problems and plans for the future.

Radiotherapy for glioma during pregnancy: fetal dose estimates, risk assessment and clinical management.

Cancer in pregnancy is relatively uncommon, but constitutes a major problem. We report the measurement of scatter dose to the fetus and the estimated fetal risk from that exposure in an illustrative case of a patient, 20 weeks pregnant, with a grade 3 anaplastic astrocytoma. A clinical decision was made to withhold radiotherapy, if possible, until after delivery. Sequential magnetic resonance imaging (MRI) showed no progression during the pregnancy. In the event, she was managed conservatively until the successful completion of her pregnancy. In case radiotherapy was required, an estimation of the fetal risk was made. Phantom measurements were undertaken to assess the likely fetal dose. Film badges were used to estimate the scattered radiation energy. Measurements were made on a Varian 600C at 6 MV and Asea Brown Boveri (ABB) accelerator at 8 and 16 MV. Doses were measured at 30, 45 and 60 cm from the isocentre; the fetus was assumed to lie at about 60 cm and not closer than 45 cm from the isocentre. Estimated doses to the position of the fetus were lowest with the 6 MV Varian accelerator. Using this machine without additional abdominal shielding, the estimated dose on the surface at 45 cm from the tumour volume was 2.2 cGy for a tumour dose of 54 Gy; using the ABB accelerator, the dose varied between 49-59 cGy. The energy of scattered radiation was in the range 208-688 keV, so that additional shielding would be practical to further reduce the fetal dose. The risk of cancer up to the age of 15 years attributable to radiation is 1 in 1700 per cGy, of which half will be fatal (i.e. 1 in 3300 per cGy). A dose of 2.2 cGy adds a risk of fatal cancer by the age 15 years of only 1 in 1500. Because the addition of shielding might halve the fetal dose, this risk should be reduced to 1 in 3000. For comparison, the overall UK risk of cancer up to the age 15 years is 1 in 650. In conclusion, careful choice of linear accelerator for the treatment of a pregnant woman and the use of additional shielding is valuable, as this can dramatically affect fetal dose.

Characterization and use of a commercial n-type diode system.

The characteristics of n-type diodes (linearity, temperature, dose rate, radiation damage response, directional dependence, output factors, wedge factors and percentage depth dose determinations) were investigated. Subsequently, the diodes were used clinically for in vivo dose verification during external megavoltage photon beam therapy. It has been shown that n-type diodes are easy to use and the results obtained are comparable to those reported for p-type diodes. On most occasions, n-type diodes can be used without any additional correction factors apart from regular monthly calibration. There is good agreement between the uncertainty limits estimated from the diodes' characteristics and those obtained on the basis of 2261 patient measurements.

A search for sonoluminescence in vivo in the human cheek.

In a previous experiment, sonoluminescence was observed in aerated water, especially at the pressure antinodes in the standing-wave field of a physiotherapeutic ultrasound device (Therasonic 1030). Mammalian cells in vitro showed growth inhibition when placed at the pressure antinodes but not at adjacent pressure nodes. In the light of these results, we looked for sonoluminescence in vivo when a similar standing-wave field was set up. To detect luminescence, a light guide was held against the inner surface of the human cheek. This would channel any luminescence photons to a cooled, red-sensitive photomultiplier which would quantify the light. Direct insonation of the cheek produced no detectable luminescence. Similarly when a water bag was placed against the outer surface of the cheek, and the latter was insonated through the bag, no luminescence was detected. Sonoluminescence from the water bag was, however, detected when the bag was placed against the inner surface of the cheek, showing that absorption of sound by the cheek tissue was not preventing cavitation. Further analysis showed that if cavitation had been occurring in the cheek without detection using the system employed, then the resulting sonoluminescence would have to be at most 0.025 times as intense as that produced by an equivalent volume of aerated water.

Studies of the cavitational effects of clinical ultrasound by sonoluminescence: 4. The effect of therapeutic ultrasound on cells in monolayer culture in a standing wave field.

In previous work the phenomenon of sonoluminescence (SL) has been used to find the conditions in which transient cavitation during exposure to ultrasound is likely to be maximum. This paper reports the effect of therapeutic ultrasound on growth of mouse tumour cells in monolayer culture when the cells are insonated either at a pressure antinode or at a pressure node in a standing wave ultrasound field that is known to produce strong bands of SL at the pressure antinodes. Reduced cell numbers 72 h after insonation were recorded when the cells were insonated at an antinode but not when they were at a node. The possibility that this effect might be an artefact of the experimental system, and further experiments that could elucidate the nature of the damage, are discussed.

Sites of deposition of aqueous aerosols: a study of efficiency of delivery systems for lung ventilation imaging in man.

A study was made of the deposition of 99Tcm-DTPA aerosol in the components of a jet nebulizer-based aerosol production system. Three impaction devices were compared: a ball-bearing separator, a virtual impactor and a step separator. In addition a comparison was made of two types of tubing which carried aerosol from nebulizer to mouthpiece: corrugated and smooth-walled tubing. The retention of aerosol following inhalation was measured in five normal volunteers using different patterns of breathing. Using an aerosol production system which included a ball-bearing separator only a mean of 11% of the radioactivity loaded into the nebulizer was emitted as an aerosol. Some 18% remained in the ball-bearing separator. The ball-bearing and step separators produced similar total outputs (7% and 6% minimum), the step separator producing marginally higher mean output/min. The virtual impactor produced a lower output than the other two impactors studied, only 1%. A larger proportion of the aerosol output was deposited on corrugated tubing (7%) compared with smooth-walled tubing (1%). The retained fraction of the aerosol inhaled by subjects ranged from 16% to 43%. A higher fraction was retained when subjects inhaled deeply and held their breath for 10 s between each breath. The efficiency of radionuclide deposition from aerosol generator to patient ranged from 1.1% to 6% and was determined more by the retention in the subject than by choice of separator or tubing.