Medical Health Physics Part III

AMERICAN BOARD OF MEDICAL PHYSICS, INC.
STUDY GUIDE
“Part III – Medical Health Physics”

TOPICS FOR ORAL EXAMINATION

The oral examination is conducted by a multi-member examination panel and is designed to determine the candidate’s knowledge and fitness to practice in a clinical environment.  In general, questions will seek to determine the candidate’s practical experience as well as his/her understanding of current radiation protection standards.  Whereas through Parts I and II we test the candidate’s level of knowledge, the goal of this examination is to determine whether this knowledge can be applied correctly and effectively in a hospital setting.

During the oral examination the candidate will be asked by the panel members to demonstrate understanding of the following 9 topics:

Content Categories    

I. Instrumentation 10%
II. Laboratory Design 5%
III. Standards and Regulations 15%
IV. Radiation Oncology – Including brachytherapy 15%
V. Structural Shielding Design 15%
VI. Imaging-Quality Assurance – Including Nuclear Medicine 20%
VII. Radiobiology 5%
VIII. Radiopharmaceutical Therapy 10%
IX. Non-Ionizing Radiation 5%

Subjects Covered

Instrumentation

  1.  Characteristics and limitations of Portable ionization chambers
  2.  Geiger-Muller counters
  3.  Scintillation counters
  4. Liquid Scintillation counting systems
  5. Multi-channel analyzers
  6. Gamma counting systems
  7. Uses of instrumentation in the field and in emergency situations

Laboratory Design

  1.  Ventilation systems
  2.  Hood design
  3.  Contamination control

Standards and Regulations

  1.  Risk Estimates
  2.  Radiobiological basis for permissible doses
  3.  Permissible Doses
  4.  Familiarity with Regulatory Codes
  5.  Familiarity with NRC/NCRP Guidelines

Radiation Oncology/Brachytherapy Quality Assurance

  1.  Elements of Quality Management Program
  2.  JCAHO Requirements
  3.  Inventory Control-Brachytherapy
  4.  Exposure Control
  5.  Misadministrations
  6.  Incident Investigation
  7.  Quality Control Testing

Structural Shielding Design

  1.  Diagnostic Installations
  2.  Accelerator Shielding and Upgrades
  3.  Neutron Protection
  4.  Sealed Source Protection

Imaging-Quality Assurance

  1.  FDA Regulations
  2.  Elements of Quality Management Program
  3.  JCAHO Requirements
  4.  Quality Control Testing

Radiobiology

  1.  BEIR Reports
  2.  NCRP Recommendations

Radiopharmaceutical Therapy
I-131 Therapy:

  1. Typical Doses
  2. Exposure Control
  3. Contamination Control
  4. Release Criteria
  5. Radioimmunotherapy

Non-Ionizing Radiation

  1. Laser Safety Standards
  2. MRI Design and Hazard

Reference Study Material

The following text provides a listing of books or reports that are intended to assist persons preparing for the examination.  This list is not all-inclusive.

A basic understanding of medical physics practices is necessary in addition to standard health physics practices and principles.  An understanding of diagnostic radiology to the level of S. Bushong, Radiological Science for Technologist, (latest edition Mosby-Year Book, St. Louis) is needed.  For radiation therapy, a level midway between say Applied Physics for Radiation Oncology, (R. Stanton and I. Stinson, Med. Physics. Pub., Madison, 1996) and The Physics of Radiation Therapy ( F. Kahn ,Second Edition, Williams & Wilkens, Baltimore) is desirable.  For nuclear medicine, the text Physics in Nuclear Medicine, J. Sorenson and M. Phelps, Gruine and Stratton, latest edition is helpful.

Other texts of interest are

Hospital Health Physics, Proceedings of the 1993 HPS Summer School, Eds., G.G. Eichholz & J.J. Shanka.

Radiation Instruments, Ed., H.Cember, Health Physics Summer School, 2001.

Shielding Techniques, P. McGinleySecond Edition, Med. Physics Pub., 2002.

US Nuclear Regulatory Commission

Title 10, Parts 20 and 35

Regulatory Guides, including 8.39

Licensing Guide for Medical Licenses of Broad Scope

Licensing Guide for Specific Scope Licenses

American Association of Physicists in Medicine

Report of Task Group 40

Report of Task Group 53

National Council on Radiation Protection and Measurements

Report No. 37, “Precautions in the Management of Patients Who Have Received Therapeutic Amounts of Radionuclides”

Report No. 49, “Structural Shielding Design and Evaluation for Medical Use of X Rays and Gamma Rays Up to 10 MeV”

Report No. 54, “Medical Radiation Exposure of Pregnant and Potentially Pregnant Women”

Report No. 65, “Management of Persons Accidentally Contaminated with Radionuclides”

Report No. 79, “Neutron Contamination from Medical Electron Accelerators”

Report No. 102, “Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV”

Report No. 115, “Risk Estimates for Radiation Protection”

Report No. 116, “Limitation of Exposure to Ionizing Radiation”

Report No. 127, “Operational Radiation Safety Program”

Sample Questions

1.  What elements would you present in a plan to deal with a teletherapy Co-60 source or HDR source (your choice) that will not automatically retract and continues to irradiate a patient.

2.    What specification would you require from (a) the architect and (b) the linear accelerator manufacture before beginning a therapy shielding design.

3.    A radiation worker 3 months pregnant is given a lumbar spine series. You are asked to calculate fetal dose.  What facts would you like to know from the Radiology Department before beginning your calculations?  How would you communicate your results?

Note 1: You should make an effort to see as many different QC procedures as practical in various areas.  You are responsible for expert knowledge in all medical radiation safety areas regardless of your past and present employment.

Note 2:  If you have not done so before, it is worthwhile to borrow a blueprint of a diagnostic room and a therapy vault and calculate the shielding requirements.