Program Structure

Residency training begins with an orientation period during which the resident will become familiar with equipment, personnel, policies and procedures for the residency program and the Radiation Oncology department. In particular, residents will learn about the entire clinical workflow from initial consult to initial treatment through shadowing of all disciplines within the department. Residents will also complete online learning modules on ethics.

This rotation broadly covers topics related to the production and measurement of radiation, including particle acceleration, radiation beam production, radiation detectors, quality assurance of a medical accelerator and clinical reference dosimetry. By the conclusion of this rotation, the resident is expected to be able to safely and independently operate a linear accelerator with an understanding of each of the subsystems. The resident will also learn about the operation of various radiation detectors, including advantages and disadvantages, appropriate uses, and methods for performance assessment for each detector. The resident will learn about quality assurance of a medical linear accelerator and will begin performing routine quality assurance. Lastly, the resident will learn about clinical reference dosimetry, including ionization chamber dosimetry, cavity theory, dosimetry standards and the process for clinical reference dosimetry measurements.

Residents will learn about all aspects of treatment planning, including patient immobilization and simulation, treatment planning systems, treatment planning and delivery techniques, dose calculation algorithms, plan evaluation, manual MU calculations, and chart checks. Proton treatment systems are not available within the UPMC network, but residents will also review reading materials covering planning techniques for proton treatment. Residents will also learn about electronic data management, including data transfer, charting, and standards.

The resident will be expected to demonstrate a basic understanding of the characteristics of imaging systems and techniques used in radiation therapy, including CT, MRI, PET, and in-room imaging systems, with emphasis on the clinical applications, limitations, and quality assurance recommendations of each. Additionally, the resident will learn the methods and applications of image registration.

This rotation covers all aspects of stereotactic radiosurgery and stereotactic body radiation therapy, including the rationale for these techniques, immobilization (including frame-based and frameless systems), stereotactic localization, commissioning of a stereotactic program, quality assurance requirements, dosimetry of small fields, and SRS/SBRT treatment planning. Residents will receive training in both linac-based and Gamma Knife radiosurgery. Beginning with this rotation, and continuing for the duration of the program, residents will assist with the planning and delivery of stereotactic treatments.

The goal of this rotation is for residents to understand the process of accepting and commissioning new equipment, including equipment selection and performance specification, with an emphasis on medical linear accelerators. To this end, general topics covered in this rotation include acceptance testing and commissioning, data acquisition for treatment planning system (TPS) commissioning, and TPS beam modeling.

If a new treatment system is installed during a resident’s training, then the resident will work closely with the site physicists to perform the acceptance testing and commissioning. Otherwise, the resident will complete a mock acceptance and commissioning process, following the documented Varian TrueBeam Customer Acceptance Procedure. The resident will then collect the necessary data to develop a beam model. Lastly, the resident will perform the necessary measurements to validate the beam model.

Among the myriad responsibilities of medical physicists, ensuring the safe use of radiation is paramount. During this rotation residents will rotate with the University of Pittsburgh Radiation Safety Office to learn about regulations pertaining to the medical use of ionizing radiation and the medical use, storage, and transport of radioactive material, including the ordering, receipt, and disposal of radioactive sources. Residents will observe therapeutic procedures with unsealed radioactive sources. Residents will also learn about shielding design, designation, and monitoring of radiation areas. In particular residents will complete vault-design exercises for a high-energy linear accelerator, an HDR brachytherapy suite, and a CT simulation suite. To support ongoing quality management in radiation therapy, residents will learn about risk analysis and incident learning methods, including FMEA, RCA, and event reporting. Residents will compete a FMEA project during this rotation.

Residents will be trained in all brachytherapy procedures performed at UPMC Magee-Womens Hospital and UPMC Mercy, including HDR Ir-192 brachytherapy with MR guidance for gynecologic malignancies and LDR PSI and eye plaque brachytherapy. Residents will learn about the calibration and use of radiation detectors for brachytherapy applications, commissioning of brachytherapy afterloaders and applicators, ultrasound image guidance, quality assurance requirements, dose calculation and treatment planning, post-implant dosimetry, patient release criteria, and emergency procedures. By the conclusion of the rotation, residents will be actively engaged, with appropriate supervision, in all steps of the brachytherapy process.

Many radiation therapy procedures are performed clinically, without use of CT simulation or treatment planning systems. Residents will learn about this special class of procedures during this rotation, including clinical electron treatments, total skin electron therapy, total body irradiation, and intraoperative radiation therapy. Additionally, residents will learn about the measurement of out-of-field dose for the assessment of patient-specific shielding needs, such as for pacemakers, lenses, testicles, and pregnant patients.

The Clinical Coverage rotation will occur at the conclusion of the resident’s training. During this rotation, residents will continue performing the same clinical tasks that they have performed throughout their training, but on a full-time basis. If they have not already, it is expected that residents will be credentialed to perform clinical tasks with increased independence during this time. In addition to clinical coverage responsibilities, residents will also complete reading assignments covering specialized treatment machines that are not available within the UPMC network. Residents also have the option of completing a one-month rotation at UPMC Hillman Cancer Center San Pietro FBF in Rome, Italy during the Clinical Coverage rotation.

If all conditions are satisfied, then medical physics residents have the option to complete a rotation at UPMC Hillman Cancer Center San Pietro FBF in Rome, Italy during the Clinical Coverage rotation. This rotation allows residents to work within a different healthcare and regulatory environment, and also exposes residents to new clinical practices and technologies, including an MR-linac. Residents that elect to complete the International rotation must make their own travel arrangements and cover all expenses for the trip.

Medical physicists are important members of the radiation oncology team whose activities span development and implementation of quality assurance programs, broadly championing quality and patient safety, process engineering, strategic planning, and capital equipment acquisition. These functions are performed within a team of people with different personal and professional backgrounds.  Furthermore, radiation oncology departments often exist within larger organizations that provide functions such as IT support, human resources management, strategic planning, budgeting, and policy and procedure development.  Highly effective physicists understand how to operate within these settings and influence their colleagues and leaders to effectively advocate on behalf of patient safety and quality.  This rotation provides a broad survey of professionalism and leadership concepts, and describes the organizational structure, budgeting processes, and financial concepts that medical physicists must become familiar with to maximize their impact on patient care.