48 Oncology IssuesSeptember/October 2010
In BriefA commitment to having a strong medical physics program to complement a highly experienced radiation oncology team led to a unique partnership between Mary Bird Perkins Cancer Center and Louisiana State University (LSU). The goal: to build a nationally acclaimed medical physics program. Here is how we used multiple coordinated components to accomplish our goal.
edical physics graduate education in BatonRougebeganin1981,whenanMSdegreewasoffered as part of the LSU Nuclear Scienceand Engineering Program. Mary Bird Per-kinsbecameaclinicalpartnerintheprogram
withmedicalphysicistOscarHidalgo,PhD,andradiationoncologist Sheldon Johnson,MD, serving asLSUadjunctfaculty.In1999LSUmovedthisprogramintotheDepart-ment of Physics and Astronomy, establishing the MS inMedicalPhysicsandHealthPhysicsProgram.Alongwiththisnewprogramnamecametwokeyrequisites fromthestate—nationalaccreditationandaminimumgraduationrateof25perfiveyears.
In2004MaryBirdPerkinsandLSUtookamajorstepforward by entering into a formal contractual agreementthatfacilitatedtheoperationofthisjointprogram.Shortlythereafter, IcametoLSUas itsnewprogramdirectorofMedical Physics with LSU contracting 40 percent of mytimetoMaryBirdPerkinstoallowmetoserveaschiefofPhysics.My16yearsaschairoftheDepartmentofRadia-tion Physics at The University of Texas M.D. AndersonCancerCenterand20yearsasdirectorofTheUniversityofTexasHealthSciencesCenterMedicalPhysicsGraduateProgrampreparedmewellfortheseroles.
Medical Physics Graduate Program TheLSU-MaryBirdPerkinsgraduateprograminmedicalphysicsconsistsprimarilyofourMSinMedicalPhysicsandHealth Physics Program, which is one of 18 Commissionon Accreditation of Medical Physics Education Programs(CAMPEP)-accreditedmedicalphysicsgraduateprogramsin theU.S.OurMS inMedicalPhysicsandHealthPhys-ics Program requires a publishable-quality research thesisin addition to its curricula and clinical rotations at MaryBird Perkins Cancer Center. Since restructuring in 2004,theLSU-MaryBirdPerkinsmedicalphysicsprogramhasgraduated27students.Twenty-sixof thosegraduateshavebecomemedicalphysicistsinradiationoncologycentersorcontinuedinPhDorresidencyprogramsinmedicalphysics.
TwoattributesthatdifferentiateourMSprogramfrom
Academic Medical Physics at Mary Bird Perkins Cancer CenterA university and community cancer center partner to train medical physicists
by Kenneth R. Hogstrom, PhD
most other programs are our research requirement andtheprogramsupport jointlyprovidedbyMaryBirdPer-kinsandLSU.TheresearchrequisitehelpsstudentsdecidewhethertheyshouldcontinuetopursueaPhDinmedicalphysics,therebyincludingresearchaspartoftheirfuturemedicalphysicscareer.Also,students’thesescontributetoouradjunctfacultyeffortstoimprovepatientcarethroughresearch.Suchactivitiesareconsistentwithourprogram’slong-termgoalforhalfofourstudentstobepursuingtheirPhDs.Presently,2of the24students inourprogramareworkingonPhDdegreesinphysicswithspecializationinmedicalphysics.
Any program’s quality is dependent upon adequateresourcestobesuccessful,andourprogramisequallywell-supportedbyMaryBirdPerkinsandLSU.TheUniversityprovidesteachingassistantshipsforourfirst-yearstudents,whobenefitourDepartmentofPhysicsandAstronomybyteaching undergraduate physics labs and tutoring under-graduatestudentsinphysics.MaryBirdPerkinsandLSUshare the cost of graduate assistantships for the secondyearoftheprogramduringwhichstudentscompletetheircoursework and clinical rotations and develop a researchplan for their MS theses. Mary Bird Perkins providesresearch assistantships for third-year students while theyperformresearchandwriteanddefendtheirtheses.
A New Paradigm: Medical Physics Residency EducationUpon graduation, students have typically taken positionsas juniormedicalphysicistswhere they receiveon-the-jobclinicaltrainingunderthesupervisionofaqualifiedmedicalphysicist.Threeyearsofsuchclinicalexperienceispresentlyrequiredtositforthefinal,oralcomponentofthecertifica-tion exam in therapeutic radiologic physics offered by theAmericanBoardofRadiology(ABR).However,thistrain-ingpathwillendin2014,afterwhichtheABRwillrequirethat students must graduate from a CAMPEP-accreditedmedicalphysicsresidencyprogramtobeeligiblefortheABRcertification exam. This new requirement, similar to thetrainingpathofourphysiciancolleagues,willimprovethequalityofjuniormedicalphysicistsenteringtheworkforce.
Atpresent,thenationalcapacityofresidencyprogramsisinadequateforthenumberofmedicalphysicistsenteringthefield,includingthosegraduatingfromMSorPhDpro-gramsinmedicalphysics.Hence,inthenearfuture,gradu-ateeducationprogramswillbeunderpressuretoaffiliatewitharesidencyprogramuntilsuchtimeasresidencypro-gramshaveadequatecapacity.Toaccomplishthisstrategicgoal,MaryBirdPerkinshasestablishedaRadiationOncol-ogyPhysicsResidencyProgramledbyProgramDirectorBrentParker,PhD,andChiefofClinicalPhysicsJohnGib-bons,PhD.Theresidencyprogramwillreplaceon-the-job
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Oncology IssuesSeptember/October 2010 49
training. During training, residents will perform clinicalmedical physics services under the supervision of a staffmedical physicist, which will help offset the costs of theprogram.TheprogrammatriculateditsfirstresidentinJuly2009anditssecondinJuly2010.
Tomeet theneedsofourgraduateprogram,sixnewresidentpositionsarerequiredannually,equaling12resi-dentpositions for the two-yearprogram.TheMaryBirdPerkinscliniccanaccommodatesixresidents,soourstrat-egyistopartnerwithmedicalphysicistsatotherradiationoncologycenters inLouisianawhowillhaveoneor tworadiationoncologyphysicsresidents.Wewillprovidetheadministrativeinfrastructureforthepartnersites.Togetherwe will be contributing to the responsibility of medicalphysicists to train our own. Our first partner, OchsnerClinicFoundationinNewOrleans,isexpectedtoacceptitsfirstresidentinsummer2010.Discussionswithothermedi-calphysicsgroupsinLouisianaareinprogress.
Medical Physics ResearchMedical physics research at Mary Bird Perkins CancerCenter is a thrivingenterprise thathasbeenmadepossi-blebytheLSUMedicalPhysicsandHealthPhysicsPro-gram,whichprovidesaccesstograduatestudentsandmanyresearchresourcesatLSU.Muchofourresearchisappliedinthesensethatitofferspotentialpatientbenefitsintheshortterm.Thisresearchusuallyincludesaccesstonewtechnol-ogyandisfundedbyindustryresearchgrants.Currently,MaryBirdPerkinshasresearchgrantswithTomoTherapy,Inc.,.decimal,Inc.,BrainLab,Inc.,andElektaLtd.
Someofourresearchisbasicscience,whichislongertermandinwhichpatientbenefitislesspredictable.MaryBirdPerkinswasrecentlyawardeda$2.215milliongrantfromtheU.S.ArmyMedicalResearchAcquisitionActiv-ity, for which I serve as principal investigator. The grantsupportsbasicresearchofAugerelectrontherapyandpro-tontherapy.Augerelectrontherapyisanewparadigmthatismeant topreferentially target individualcancercellsasopposedtocurrentradiationtherapytechniquesthatirradi-ateavolumeconsistingofamixtureofcancercellsandnor-maltissue.Futuremajorgainsinradiationtherapyrequirelookingatnewparadigms,andAugerelectrontherapy isoneofthem.ThisresearchwouldnotbepossiblewithoutresourcesatLSU,particularlytheLSUsynchrotronlightlaboratory,knownasCAMD,andthecellculturelabora-toryattheLSUPenningtonBiomedicalResearchFacility.
Asecondprojectinvolvesresearchingmethodsforcal-culatingdoseandperformingqualityassuranceofprotontherapyusinganewtypeofaccelerator,thedielectricwallprotonaccelerator(DWPA).Thisresearchwillallowustobecomeacontributorintheprotontherapyresearcharena.Ourinitialprojectwillfocusonanewprotonacceleratortechnology that is being developed by Compact ParticleAccelerator Corporation, a subsidiary of TomoTherapy,Inc.Becauseofourexpertiseinradiationphysics,ourexist-ing research partnership with TomoTherapy, and MaryBirdPerkins’planstoacquireclinicalprotontherapycapa-bilityinthenearfuture,thisisanidealareaofresearchinwhichtogetinvolved.
ThesuccessofmedicalphysicsresearchatMaryBirdPerkins can be appreciated by looking at what has beenaccomplishedinthepastsixyears.Duringthistime,medi-calphysicsresearchhasgrownfromnograntfundingor
publicationstohavingsevenresearchgrantswithfundingin excessof $3million and12 articlespublished inpeer-reviewedscientificjournalswithmanyotherarticlescur-rentlyinpreparationforjournalreview.
Impact on the ClinicResearchactivitiesandtheavailabilityofgraduatestudentsresult in improved technology for our clinical practice.Research on our TomoTherapy grant has led to use of anewtechnology,helicaltomotherapy,forpost-mastectomychestwallradiationtherapy.Thismodalityoffersimprovednormal tissue sparingandmorehomogenousdose to theradiation target, the latter providing greater cosmesis forthepatient.
Research with BrainLab led to developing a uniquemethodforevaluatingtheuncertaintyinthevolumeofirra-diatedbrainwhenusingimage-guidedradiotherapy(IGRT),importanttotheradiationonologistinspecifyingthetargetvolume.ThismethodiscurrentlybeingusedtomeasuretheaccuracyofTomoTherapyandElektaIGRTsystems.
Morerecently,MaryBirdPerkinshasbeentheacademicpartner for .decimal, Inc., which is making bolus electronconformal therapy (ECT) technology clinically availabletotheworld.BolusECTistheelectronbeamequivalentofintensity-modulatedradiationtherapy(IMRT)withX-raysandisbasedonresearchbymyformerresearchteamatTheUniversityofTexasM.D.AndersonCancerCenterinHous-ton.BolusECTbenefitstreatmentofcancerwithin6cmofthesurface,particularlyheadandneckcancersandspecialconditionsofthepost-mastectomychestwall.
Resultsofourresearchactivitiescontinuetobepub-lished in peer-reviewed medical journals, making themavailable forothers touse,whichextends their impact toradiationtherapyfacilitiesthroughouttheworld.
Locally,academicactivitiesimpactourabilitytorecruitandsustainahigh-qualitymedicalphysicsstaff.Weareabletoattractbothgraduatesofourprogram,aswellasmedicalphysicistswhoareinterestedinsupplementingtheirclinicalmedicalphysicsdutieswithresearchandteaching.Gradu-ates of our program are also employed in many medicalphysicspositionsinLouisianaandthroughouttheUnitedStates.Presently,fiveofour12clinicalmedicalphysicsstaffat Mary Bird Perkins are graduates of our program, andapproximately17of59medicalphysicists inthestateareprogramgraduates.
Future PlansAgoodacademicprogramcontinuallyevolvesandthatisthecaseforourprograms.Overthenextyear,ourgoalisto achieve CAMPEP accreditation of our PhD Programin Medical Physics at LSU and our Radiation OncologyPhysicsResidencyProgramatMaryBirdPerkins.AsourresearchprogramsatMaryBirdPerkinscontinuetogrow,wehopetoincreasethenumberofPhDstudents.Weareworkingtoaddaresearchprograminbrachytherapy,whilemaintainingthemomentumofourexistingresearchpro-grams.Aspartoftheseefforts,weexpecttogrowouraca-demicmedicalphysicsstaff.
Kenneth R. Hogstrom, PhD, is chief of Physics at Mary Bird Perkins Cancer Center and professor and director of the Medical Physics Program in the Department of Physics and Astronomy at Louisiana State University.
