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News from ICTP 113 - Features - Physics for Health
ICTP, together with the International Atomic Energy Agency (IAEA) and a group of European hospitals and medical research institutes, has become a focal point for the training of medical physicists.
Physics for Health
When people think of the impact
of science on medicine, they think of biology, they think of chemistry,
they may even think of ecology.
But they rarely think of physics.
Yet a strong case can be made that advances in fundamental physics
have been responsible for many of the most important breakthroughs
in medical science over the past half century.
Think of magnetic resonance imaging; laser surgery; even chemotherapy.
All have relied on dramatic breakthroughs in our knowledge of
physics.
Indeed medical physicists are responsible for the design and development
of much of the high-tech equipment used for the diagnosis and
treatment of a broad range of diseases, including cancer and cardiovascular
and neurological disorders.
Equally important, one of the primary gaps in advanced medical
care between the developed and developing world lies in access
to high-technology equipment and well-trained personnel who can
operate the equipment.
ICTP recognised the relationship between physics and cutting-edge
medical research and clinical applications more than two decades
ago when it organised its first College of Medical Physics in
1983. Since then, more than 3000 participants have attended this
biennial activity.
Making sure that scientists and technicians receive adequate training
in both understanding the behaviour of ionising radionuclides
and overseeing safe radiation treatments in clinics and hospitals
were the primary goals of ICTP's early courses in medical physics.
"These goals have remained central to the Centre's training
and research activities to this day," says Luciano Bertocchi,
a long-time ICTP scientist and former acting director who played
a central role in the launch and development of the medical physics
programme.
"The key responsibility of medical physicists," adds
Franco Milano, from the University of Florence, who has participated
in many of ICTP's research and training activities in medical
physics, "is to develop and apply radiation regimes that
maximise the regime's therapeutic value while minimising any adverse
health impact for patients. This requires knowledge and skills
in such areas as dose optimisation and radiation protection."
"The governments of most nations have also passed strict
laws and regulations designed to protect both the rights and health
of patients," adds Milano. "Such international 'watch
dog' agencies as the International Commission on Radiological
Protection (ICRP), headquartered in Stockholm, Sweden, have similar
mandates. Medical physicists," he notes, "must keep
abreast of these rules and regulations to be assured that their
efforts conform to governmental and intergovernmental directives.
Again ICTP's College on Medical Physics has been a critical source
of information for these matters."
At a more technical level, ICTP has provided research and training
for:
-- Diagnostic radiological physics focussing on the use
of x-rays, ultrasound, radiofrequency radiation and magnetic fields.
-- Radiotherapy physics focussing on x-rays, gamma rays,
electron particle beams and neutrons.
-- Nuclear medicine physics focussing on the therapeutic
and diagnostic applications of radionuclides.
-- Medical health physics focussing on x-rays and gamma
rays, electron and other charged particle beams, and radionuclides.
As Slavik Tabakov, medical physicist at King's College London,
UK, who has also participated in many ICTP medical physics research
and training activities, states: "The goal in each of these
cases is the same---to increase the knowledge and skills of the
participants in a broad range of areas related to medical physics
and to enhance their abilities to safely and efficiently operate
the high-tech equipment that is part and parcel of this field."
To accomplish the latter goal, the Centre has partnered with universities,
medical research centres and hospitals throughout Europe.
"With the help of its partners, ICTP's fundamental contribution,"
says Bertocchi, "has been to provide advanced training to
scientists and technicians who often come from developing countries
where classroom learning may be adequate but where access to equipment
for the purposes of training is not." Many research institutions
and hospitals in developing countries don't have such equipment
and even for those that do, the equipment is simply too expensive
to be used for anything other than the diagnosis and treatment
of patients. Training is a luxury that they cannot afford. As
a result, they choose to leave this critical challenge largely
to institutions in the North.
The widespread public health challenge posed by issues related
to medical physics led the European Union (EU) to launch the European
Medical Radiation Learning Development (EMERALD) project in 1995
under its Leonardus Programme.
EMERALD seeks to provide training opportunities for medical radiation
physicists via the new information technologies. Universities
and hospitals in France, Italy, Sweden, and the United Kingdom
joined the initiative as did ICTP. The result was the creation
of a set of compact disk (CD) training modules and related instructional
materials in the fields of x-ray diagnostic radiology, nuclear
medicine and radiotherapy. Previously such training material could
only be found in bulky and expensive print volumes that were difficult
to use and even more difficult to keep current in these rapidly
changing fields.
"EMERALD's success," says Tabakov, "can be measured
by its popularity. More than 250 hospitals and universities in
some 60 countries have used this material."
In 2001, the EU decided to broaden the scope of its activities
in medical physics by funding---again under its Leonardus Programme---the
European Medical Imaging Technology (EMIT) project, a consortium
of universities and hospitals from the same four European countries
as EMERALD as well as several international organisations, including
ICTP. EMIT provides work-linked training programmes to medical
physics graduates and other health care professionals. The centrepiece
of EMIT's efforts lie in the creation of internet- and computer-based
instruction modules focussing on how to properly use ultrasound
and magnetic resonance imaging technologies.
Magnetic Resonance (MR) imaging of backbone
While the modules are no substitute for face-to-face classroom
learning, they do have certain advantages. First, they can be
updated quickly and inexpensively, which allows recipients to
receive the most recent information. Secondly, they can be easily
modified to address regional and national needs, which, as Milano,
notes, "gives them enormous flexibility in meeting the requirements
of a diverse group of learners. All we have to do is to add a
segment to the electronic file (or disk) focussing on a set of
issues that pertain only to a particular area. This provides added
value at very little cost."
The modules' content was first put in place in November 2003 at
the EuroConference hosted by ICTP and attended by representatives
from EMIT's partner institutions. Following one year of preparation,
coordinated by King's College, the 'draft' modules were tested
at the 2004 ICTP College on Medical Physics, a two-week activity
held in September and attended by more than 90 participants from
37 countries. Participants went through modules step-by-step at
computer stations located in the Centre. They also received classroom
instruction designed to enhance the learning process. The final
stage of the review process entailed sending the modules to institutions
in 65 countries that included 43 developing countries.
"The modules, now available in institutions in 79 countries,
have become the most widely used training programmes of their
kind," says Milano, "providing state-of-the-art instruction
for scientists and technicians operating high-technology ultrasound
and magnetic resonance imaging equipment."
The modules are both 'easy-to-access' (they are available on the
web) and 'easy-to-use' (all lessons are task-oriented, enabling
users to know when they have successfully completed each assignment).
In the past year, an 'image database' that contains more than
1100 'generic' images and a 'searchable' electronic medical physics
dictionary that lists more than 25,000 terms, have become the
two newest additions to the consortium's 'distant learning' strategy.
To celebrate the Leonardus Programme's tenth anniversary, the
EU decided to award a series of prizes honouring the programme's
best projects. Some 4000 projects were in the running. EMIT received
the first-ever Leonardo da Vinci Award for their "pioneering
e-learning materials." The ceremony took place in Maastricht,
The Netherlands, in December 2004.
"The award," notes Bertocchi, "is an indication
of how effective this initiative has been. This success is due
to the energy, commitment, innovation and intelligence of the
consortium's partners. ICTP is certainly delighted to have played
a role in the development and testing of the modules and we look
forward to continuing our participation in the years ahead serving
as a valuable bridge between our colleagues in Europe and those
in developing countries."Æ
For additional information about EMERALD and EMIT, see www.emerald2.net.