Practical Medical Physics: A Guide to the Work of Hospital Clinical Scientists

Description

This is the first all-encompassing textbook designed to support trainee clinical scientists in medical physics as they start work in a hospital setting whilst undertaking an academic master’s course. Developed by practising physicists and experienced academics using their experience of teaching trainee medical physicists, this book provides an accessible introduction to the daily tasks that clinical scientists perform in the course of their work. It bridges the gap between theory and practice, making the book also suitable for advanced undergraduate and graduate students in other disciplines studying modules on medical physics, including those who are considering a career in medical physics through applying to the NHS Scientist Training Programme (STP). Features: Provides an accessible introduction to practical medical physics within a hospital environment Maps to the course content of the Scientist Training Programme in the NHS Acts as a complement to the academic books often recommended for medical physics courses Cover Half Title Title Page Copyright Page Contents Preface Acknowledgements Contributors 1. Introduction 1.1 Medical Physicists and Healthcare Scientists 1.2 Clinical Scientist Training for Medical Physicists 1.2.1 Entry Requirements and Career Path 1.3 The Academy of Healthcare Science 1.4 The HCPC Standards of Proficiency 1.4.1 Good Scientific Practice 1.5 Continuous Professional Development and Progression 1.6 Links to Other Professions 1.7 Working with Medical Devices 1.8 Working Environment and Generic Skills 1.8.1 Clinical Skills 1.8.2 Research Skills 1.8.3 Service Improvement 1.8.4 Quality Management Systems 1.8.5 Audit and Service/Product Evaluation 1.8.6 Risk Assessment 1.8.7 QA Programmes and QC Checks 1.9 Working with Medical Images 1.9.1 Image Properties 1.9.1.1 Contrast and Greyscale 1.9.1.2 Signal to Noise 1.9.1.3 Contrast Resolution 1.9.1.4 Spatial Resolution 1.10 Sub-Specialties within Medical Physics 1.10.1 Part 1: Non-Ionising Imaging (MRI and Ultrasound) 1.10.2 Part 2: Ionising Radiation, Diagnostic X-rays, Nuclear Medicine and Radiotherapy 1.10.3 Radiotherapy 1.10.4 Radiation Safety 1.11 Summary References Part I: Non-Ionising Imaging 2. Magnetic Resonance Imaging Physics 2.1 How Does MRI Work? 2.2 The MRI Scanner 2.3 Setting Up an MRI Scan and Choice of Sequences 2.4 Performing a Scan 2.5 MR Safety 2.5.1 Static Magnetic Field 2.5.2 Time-Varying Magnetic Fields 2.5.3 RF Fields 2.5.4 The MR Controlled Access Area 2.5.5 Use of Liquid Helium 2.5.6 Implanted Devices and Ancillary Equipment 2.5.7 Hearing Protection 2.5.8 Safety of MR Contrast Agents 2.5.9 MR Safety during Pregnancy 2.6 MRI QC 2.7 The Future of MRI References 3. Ultrasound Physics 3.1 How Does Ultrasound Work? 3.1.1 Doppler Ultrasound 3.2 Links to Other Professions 3.3 Ultrasound Equipment 3.3.1 Ultrasound Transducers 3.3.2 The Scan Engine - Knobology 3.4 Safety of Diagnostic Ultrasound 3.4.1 Thermal Index 3.4.2 Mechanical Index 3.4.3 Safety Tests of Non-CE Marked Ultrasound Equipment 3.5 Ultrasound Quality Control 3.5.1 Acceptance (Baseline Tests) 3.5.2 Annual QC Tests 3.5.3 User-Led Tests 3.6 The Future of Ultrasound Physics References Part II: Imaging and Therapy Using Ionising Radiation 2.1.1 Ionising Radiation - Quantities, Units and Weighting Factors 2.1.2 Radioactive Material - Quantities and Units 2.1.3 Ionising Radiation Interactions with Matter References 4. Diagnostic Imaging Using X-rays 4.1 Generation of Diagnostic X-rays 4.2 X-ray Imaging Modalities 4.2.1 Conventional 2D X-ray Projections 4.2.2 Fluoroscopy 4.2.3 Angiography 4.2.4 Computerised Tomography 4.2.5 Cone Beam CT (CBCT) 4.2.6 Other Forms of Equipment and Hybrid Imaging 4.3 Performance Measurements 4.3.1 Qualitative vs Quantitative QC 4.4 Patient Dose Measurement and Calculations 4.4.1 The Basics of Patient Dose 4.4.2 Deterministic Effects 4.4.3 Stochastic Risk 4.4.4 Monte Carlo Simulations 4.4.5 Standard Dose Assessments 4.4.6 Diagnostic Reference Levels 4.4.6.1 Why DRLS? 4.4.6.2 How Are DRLs Produced? 4.4.6.3 Practical Considerations 4.4.7 Optimisation 4.4.7.1 Optimisation Strategy 4.4.7.1.1 Observer Studies 4.5 The Future of X-ray Imaging Physics References 5. Nuclear Medicine Imaging and Therapy 5.1 Introduction 5.2 Patient Flow through Nuclear Medicine 5.3 The Professional Role of a Clinical Scientist in Nuclear Medicine 5.4 Referral Guidelines 5.5 Facility Design 5.6 Production of Radiopharmaceuticals 5.6.1 Radiopharmacy Management and Regulations 5.6.2 Technetium-99m Generators and Kits 5.6.3 Radionuclide Calibrators 5.7 Administration of Radiopharmaceuticals 5.8 Radionuclide Imaging Equipment 5.8.1 Gamma Cameras 5.8.1.1 Image Parameters and Image Quality 5.8.1.2 Static (Planar) Gamma Camera Imaging 5.8.1.3 Dynamic Imaging 5.8.1.4 SPECT Imaging 5.8.1.5 Gated Imaging 5.8.2 PET-CT 5.8.3 Hybrid Imaging 5.9 Equipment Management of Gamma Cameras and PET/CT Scanners 5.9.1 Acceptance Testing and Commissioning 5.9.2 Routine Quality Control 5.10 Optimisation of Imaging Parameters in Nuclear Medicine 5.10.1 The NEMA/IEC NU2 Image Quality Phantom 5.10.2 The Jaszczak Phantom 5.10.3 Anthropomorphic Torso Phantom 5.10.4 Brain Phantoms 5.10.5 Protocol Optimisation 5.11 Image Processing 5.11.1 Image Quantification in Nuclear Medicine 5.12 Non-Imaging Radionuclide Tests 5.12.1 Glomerular Filtration Rate 5.12.2 Bile Acid Malabsorption 5.13 Radiation Protection for Unsealed Radioactive Material 5.14 Therapeutic Techniques in Nuclear Medicine 5.14.1 Radionuclides 5.14.2 Clinical Scientist Involvement with Therapeutic Techniques 5.15 Patient Dosimetry in Nuclear Medicine 5.16 Future Developments References 6. Radiotherapy Physics 6.1 Introduction 6.2 Radiobiology 6.2.1 Radiation Damage 6.2.2 Radiation Modifiers and the "5 Rs" of Radiobiology 6.2.2.1 Radiosensitivity and Repair 6.2.2.2 Redistribution and Repopulation 6.2.2.3 Reoxygenation 6.2.2.4 Radiosensitivity 6.3 Therapeutic Index 6.4 Accounting for Gaps in Treatment 6.5 Linear Accelerators 6.5.1 Major Linear Accelerator Components 6.5.1.1 The Electron Gun 6.5.1.2 Microwave Generator 6.5.1.3 Modulator 6.5.1.4 Accelerating Waveguide 6.5.1.5 Electron Beam Transport and Photon Production 6.5.1.6 Primary Collimator 6.5.1.7 Dual Ionisation Chamber 6.5.1.8 Secondary Collimators 6.5.1.9 Wedges 6.5.1.10 Multi-Leaf Collimator (MLC) 6.6 Treatment Planning 6.6.1 Principles Underlying Treatment Planning 6.6.1.1 The PDD 6.6.1.2 PDD for Electron Beams 6.6.1.3 PDD Characteristics for Superficial X-rays 6.7 Preparation for Treatment 6.7.1 Patient Immobilisation 6.7.1.2 Use of Imaging Data for the Treatment Planning Process 6.7.2 Data Pathway 6.7.3 Clinical Protocols and Dose Prescription 6.7.3.1 Capabilities and Limitations of Treatment Machines and Associated Equipment 6.7.3.2 Steps Taken to Produce a Treatment Plan 6.7.4 Outlining 6.7.5 Image Registration 6.7.6 Criteria for an Acceptable Plan 6.7.7 Appraisal of Treatment Plans 6.8 Manual Treatment Calculations 6.8.1 MV Photon Treatment Calculations 6.8.1.1 Output or Field Size Factor (Incorporating Head Scatter and Phantom Scatter) 6.8.1.2 Equivalent Square 6.8.1.3 Tissue Phantom Ratio and Tissue Maximum Ratio 6.8.1.4 Manual Calculation of Monitor Units 6.8.1.5 Radiological Depth 6.8.1.6 Wedge Factor 6.8.1.7 Off-Axis Factors 6.9 Checks on Complex Plans 6.9.1 Electron Treatment Calculations and Measurements 6.9.2 kV photon treatment QC 6.10 Beam Characteristics 6.10.1 Absolute Dosimetry 6.10.2 Standard Output and Relation to TPS 6.10.3 Quality Control 6.11 System Upgrades 6.12 Incidents in Radiotherapy 6.13 Brachytherapy and Sealed Sources 6.13.1 Radionuclides Used 6.13.2 Clinical Applications 6.13.3 Sealed Sources - Checks and Calculations Required 6.14 Strontium-90 Checks 6.15 The Future of Radiotherapy References Part III: Radiation Safety 7. Radiation Safety 7.1 The Role of the Clinical Scientist in Radiation Safety 7.2 Non-Ionising Radiation Safety 7.2.1 Phototherapy 7.2.2 Lasers 7.3 Ionising Radiation Safety - Key Concepts 7.3.1 Ionising Radiation Effects - Stochastic and Deterministic 7.3.2 Legislative Requirements for the Use of Ionising Radiation 7.3.3 Dose Limitation 7.4 Hospital Ionising Radiation Hazards 7.4.1 Diagnostic X-ray Imaging 7.4.2 Nuclear Medicine 7.4.3 Radiotherapy 7.5 Room Design 7.5.1 Engineering Controls/Interlocks/Warning Signs 7.5.2 During Construction 7.5.3 Attenuation/Transmission Measurements 7.5.4 Post Installation Equipment checks 7.5.5 Environmental Monitoring 7.5.6 Diagnostic Radiology Room Design 7.5.7 Radiotherapy Room Design 7.5.8 Nuclear Medicine Room Design 7.5.9 Dose Rate Measurements 7.6 Radiation Safety Risk Assessments 7.6.1 What Should a Radiation Safety Risk Assessment Consider? 7.6.2 Radon Risk Assessments 7.7 Controlled Areas 7.8 Local Rules 7.8.1 Classified Radiation Workers 7.8.2 Personal Dose Monitoring 7.9 Patient Safety 7.10 Radiation Safety Culture 7.11 Monitoring Radiation Safety 7.11.1 Radiation Safety Audits 7.12 Contingency Planning 7.12.1 Local Contingency Planning 7.12.2 National Arrangements for Incidents Involving Radioactive Material 7.13 Investigating an Incident 7.14 The Future of Radiation Safety References Index