Our residents develop skills to practice competently as medical physicists, including commissioning equipment, implementation of new techniques, consultation in radiotherapy simulation, planning, and treatment, and equipment and patient quality-assurance. Example experiences include linac commissioning (Varian TrueBeam and Ethos), CT- and MR-Simulation, treatment planning on various platforms (Eclipse and RayStation), stereotactic radiosurgery, surface-guided radiation therapy and HDR- and LDR-brachytherapy.
Program Structure
Learning is experience-centered, and includes individual and team activities alongside radiation oncologists, therapists, physics associates, engineers and hospital leaders. Training also includes a clinical development project, selected according to the interest of the residents. Residents are encouraged to present their work at a national or international conference and to publish their work in a peer-reviewed journal.
We typically train three (3) residents at a time, with a faculty of 18 full-time physicists. Our program is primarily competency-based and is facilitated through various sessions with medical physicists, observations, and direct participation in the clinic.
Residents will participate in all the rotations detailed below in the approximate order listed.
Orientation Rotation
Approximate duration: Two months
New residents will familiarize themselves with the workings of the radiation therapy department while meeting and shadowing all members of the radiation therapy team and learning about their respective roles within the clinic.
Highlights include:
- Facilitated targeted observerships (CT-sim, mould room, external beam dosimetry, brachytherapy, and common treatment sites)
- Early training in radiation safety and electrical/mechanical safety.
- Hands on experience with treatment units through participation in QA activities
Imaging for Radiation Therapy
Approximate Duration: Two months
Throughout the rotation, residents will be exposed to a multi-disciplinary perspective of how imaging is used in radiation therapy through interactions with various clinical staff (e.g., radiation therapists, medical physicists, radiation oncologists, radiologists). The rotation will focus on three core imaging techniques: x-ray (planar & CT), MRI, and PET. The intent of the imaging rotation is to help residents gain an understanding of technical aspects of these modalities and provide relevant clinical context on how various imaging techniques are used within the radiation therapy process (diagnosis, treatment planning, dose calculation, and patient set-up verification).
Highlights include:
- Hands-on experience with various vendor-based imaging hardware and software (PACS, image registration, treatment planning)
- Hands-on experience and working knowledge of the quality assurance phantoms and procedures used to assess geometric accuracy, image quality, and dosimetry for various imaging modalities.
- Facilitated imaging-specific clinical project
External Beam Treatment Planning
Approximate Duration: Eight to eleven months
The treatment planning rotation is separated into two components. The first component is composed of a two-month rotation dedicated to the theory and principles of treatment planning. Once residents gain the theoretical foundation and the basics of radiation oncology treatment planning, they will proceed to the second part which is focused on resident participation in the clinic and structured as a series of sub-rotations through each clinical site (e.g., breast, lung, GU, etc.).
Highlights for part one include:
- Guided learning activities and resources to build strong knowledge of the fundamentals of external beam treatment planning
- Facilitated clinical shadowing of the following techniques: 1) sim-and-treat, 2) electron markups, 3) orthovoltage treatments
- Regularly scheduled oral-style evaluations to give residents practice in oral exams
- Highlights for part two include:
- MDT (multidisciplinary team)-clinic attendance
- Weekly dosimetry buddies to gain hands-on and comprehensive planning experience
- A structured approach to develop competency in physics plan evaluation
- Comprehensive experience in all the common disease-sites
Radiation Safety
Approximate Duration: One month
During this rotation, the resident will become familiar with the regulations and guidelines set out by the Canadian Nuclear Safety Commission (CNSC), the Ontario Healing Arts and Protection Act (HARP), and transportation of dangerous goods (TDG) governing the use of radiation equipment, transportation, and exposure limits. Residents will gain experience in considering these regulations under many different scenarios due to the diverse set of equipment that we have.
Highlights include:
- Resident participation in facility surveys
- Participation in licensing of all new equipment
- Understanding and participating in radiation bunker design considerations
- Hands-on experience with all commonly used radiation safety measurement devices
Brachytherapy
Approximate duration: Four months
The Verspeeten Family Cancer Centre is a leader in brachytherapy and has an active and comprehensive brachytherapy program, providing valuable and broad training experience for medical physics residents. We provide clinical service in high dose rate (HDR) brachytherapy for prostate, cervix and vaginal vault, serving about 200 patients per year, and for low dose rate (LDR) permanent seed prostate implants, serving approximately 40 patients per year.
Highlights include:
- Diverse experience in several different HDR techniques
- Hands-on experience performing planning for all cases
- Hands-on experience running treatments in the operating room under the direct supervision of a medical physicist
- Direct participation in source exchanges and measurements
Commissioning/External Beam Dosimetry Rotation
Approximate Duration: Four Months (non-contiguous)
Residents will be expected to be involved in and/or lead the implementation of devices entering our clinic. While this is generally framed around acceptance testing and commissioning of linear accelerators, there are many devices and techniques that are being implemented at the Verspeeten, and so residents will gain diverse knowledge of this topic, allowing them to take on the task of implementing any new device.
Highlights include:
- Experience with a diverse set of measurement devices including OSLs, film, ion chambers, diodes
- Experience implementing and evaluating QA programs for any new medical device
Other Activities
Residents can expect to have access to the following additional activities to enhance their learning:
- A rigorous applied physics program where residents will work with radiation oncology residents, oncologists, and medical physics to learn about treatment of cancer framed around answering questions about specific cases, both from a clinical and medical physics perspective
- Conference attendance is encouraged for residents
- Opportunities to work with and mentor undergraduate students and co-op students on clinical projects
- Teaching opportunities
Evaluation Structure
As part of competency-based education, our program employs a variety of evaluation tools to ensure that residents are learning the content, and just as importantly, can apply their knowledge clinically. These evaluation tools allow the program to provide feedback to residents and to help guide residents in their learning. This is a continually evolving area in our program that relies heavily on resident feedback.
- As residents rotate through different topics, they are primarily evaluated by independently performing clinical activities specific to each rotation under supervision of a preceptor. For example, planning a practice HDR prostate brachytherapy case.
- Mandatory and optional “whiteboard sessions” are focused on a specific topic. Residents are expected to prepare and are asked questions by a physicist. These sessions are a blend of oral evaluation, discussion and teaching.
- Preparation and presentation of a topic. An example of this might be that a resident is asked to prepare a presentation on clinical management, treatment planning and treatment delivery of prostate cancer.
- Oral exams: Most rotations have a cumulative oral exam in which a panel of physicists ask questions representative of the array of knowledge that a resident should have gained throughout the rotation. These provide an excellent opportunity to gain CCPM/ABR style examination experience to capstone each rotation.
