Clinical Rotations

Two-weeks orientation of the new resident is followed by the Dosimetry Planning rotation. It consists of two parts as Dosimetry Planning Rotation-Basic: observing and producing 3D planning for multiple anatomical sites (Brain, Head and Neck, Lung & Esophagus, Breast, Abdomen & Rectum, Pelvis & Bladder, Skin, Sarcoma, whole CNS, and Prostate); and Dosimetry Planning Rotation-Advanced: with focus on Intensity Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), and Stereotactic Body Radiotherapy (SBRT). Theory understanding includes different 3D photon beam dose algorithms, electron beam dose algorithms, non-dosimetric calculations performed by the planning system (e.g., DRRs, contouring tools, etc.), dose evaluation tools, optimization, critical organ doses, parallel vs. serial organs, typical dose-volume constraints etc. Understanding of simulation procedure of different clinical sites as well as the utilization of 4D-CT is also required. The rotation concludes with an oral exam and several oral presentations with topics organized by rotation leaders.  

Residents are expected to have thorough understanding of the design of external beam machines as well as the machine calibration with multiple phantom systems. The residents are also expected to develop understanding of design, and specification of various radiation measurement systems: ionization chambers, radiographic and radiochromic film,  diodes, thermoluminescent dosimeters, diode arrays and ion chamber arrays. The rotation concludes with an oral exam and several oral presentations with topics organized by rotation leaders. Besides clinical training rotation, residents are expected to perform machine QAs including monthly and annual QA with physics faculty members during their two-year residency training, to help them gain hands-on experience with external beam machine and the associated calibration process.

This rotation is designed to provide residents to understand brachytherapy related radiation safety and be able to perform various brachytherapy applications. Theories include radioactive decay, source calibration, calculation of dose distribution, calculation of dose distribution, different systems of implant dosimetry and implantation techniques, overview of remote afterloader systems and various applicators. Residents are expected to be familiar with various clinical procedures of prostate seed implant, as well as interstitial and intracavity HDR, and perform those procedures under the supervision of board-certified physicists. Several oral presentations are required and oral exam will be provided at the end of the rotation.  

This rotation will overlap 1-month with brachy rotation and 1-month with special procedure rotation, as we typically have 3-day brachy per week, or 2 to 3-clinical day for special procedure. For non-clinical days, residents are expected to be cross-trained by our imaging rotation leaders. This is coordinated by imaging rotation leaders. In this rotation, residents are expected to gain thorough knowledge regarding image modalities used in radiation treatment. Residents are expected to follow patients through the simulation process using CT/conventional simulator/4D-CT/PET-CT, with an emphasis being on geometric aspects of the process (setup geometry specification, immobilization, marking, tattoos, CT including x-ray technique, and transfer to planning system). The resident is also expected to learn image match, image transfer, image registration with different modalities. Quality assurance of every aspect of each IGRT system will be studied, from image acquisition through verification and treatment delivery. The resident will be given opportunities to observe the ultrasound and MRI based planning and practice on related machine QAs. Basic imaging physics and the terms that impact image quality will be discussed between rotation leaders and residents. The design and application of different electronic portal imaging systems, and the necessary processes for commissioning and continuing quality assurance of portal imaging systems will be performed. The rotation concludes with an oral exam at the end of the rotation. 

The rotation is designed to give the medical physics resident experience with special procedures as SRS with Gamma Knife and/or Linacs, and TBI, TSET. Residents will review key principles of SRS or hypofractionated stereotactic radiotherapy with Gamma Knife and conventional Linacs. The resident will participate alongside physics faculty in clinical SRS/SRT treatments. The rotation also prepares resident to thoroughly understand the procedure of TBI and TSET. Equipment, dosimetry issues, field uniformity, beam energy/penetration, blocking, dose verification, patient positioning/set up, prescribing scheme, and shielding will be discussed. Commissioning data will also be provided to and discussed with the residents. The rotation concludes with an oral exam or a presentation organized by the mentor.  

 In this rotation, the residents are expected to understand the physics principle and theories of different proton systems, derivation of CT curve for proton TPS, derivation of absolute dose calibration, understanding of patient MU determination and rationale. The resident will learn through observation and direct participation in the clinical physics activities. In addition, residents are expected to gain direct experience with proton planning with various clinical sites (Brain, Head & Neck, Breast, Prostate, Spine, GI, Pelvis, Lung, and CSI). Heavy particle and proton related radiation safety issues will also be discussed. Residents should continue to rotate the duty of patient specific QA and assist machine monthly and annual QA throughout the residency. This rotation includes 3 oral presentations and an oral exam at the end.  

During this rotation, the resident will develop an understanding of linac fundamentals related to acceptance and commissioning. Residents will perform machine configuration, photon and electron beam modeling with prior acquired data on Eclipse test box. This rotation also includes general radiation safety with NRC and state regulations. Shielding designs includes hand-on calculation of Linacs room, CT and PET/CT room, HDR suite, as well as gamma knife suite. The resident is also expected to perform portions of a radiation survey around existing vaults to gain practical experience in obtaining and analyzing low level radiation data. The rotation concludes with an oral exam or a presentation organized by the mentor.  

This 2-month block is reserved for resident to finish up independent research or clinical projects, provided he/she is in a good position to complete other clinical rotations successfully and on-time. Residents may also use this to continue providing clinical physics service in a more independent manner. Or this can be reserved for remediation of previous clinical rotations. If needed, formal training in leadership and professionalism may be taken at this time.