Education in Medical Physics in Argentina

1. Education in Medical Physics in Argentina American Association of Physicists in Medicine (AAPM) International Scientific Exchange Programs (ISEP) Diagnostic Imaging Workshop Buenos Aires, October 2012 Dr. Darío Esteban Sanz

2. Academic Programs • Graduate • Medical Physics Engineering (1): Universidad Favaloro (Buenos Aires) • Licenciatura in Medical Physics (2): Universidad Nacional de La Plata and Universidad Nacional de San Martin (UNSAM) • Postgraduate • Master in Medical Physics (2) (Universidad de Buenos Aires and Instituto Balseiro-FUESMEN)

3. Academic Programs • Courses or special trainings • Radiotherapy Physics (IDB: UNSAM and CNEA, 1979) • Dosimetry (FUESMEN, IDB) • Nuclear Medicine (UNSAM) New! • Methodology and use of radionuclides (IDB) • Tracers and Radiochemistry for researchers (FUESMEN, IMBECU) • PhD programs • Only trough classical careers: physics, engineering

4. Regulatory aspects • The above mentioned careers and courses are recognized by our Nuclear Regulatory Authority (ARN) and are required for professionals to work in the clinic. Usually the authorization is given after (only!) one year of clinical training.

5. Regulatory aspects • The ARN regulates and controls all nuclear activities concerning radiological and nuclear safety, security and no proliferation. • Normative for medical physicists: AR 8.11.3 (RT), AR 8.2.4 (NM). Residencies • Radiology (except NM): conventional imaging with X rays, CT, interventional, mammography, densitometry, US, MRI do not require an authorized medical physicist. This is regulated by the Health Authority.

6. Present situationas from ARN, Oct 2012 • Radiation Therapy Physicists: 106 • RT Dosimetrists (technologists): 57 • Nuclear Medicine Physicists: 9 ! • NM technologists: 142 All for: • 72 Linacs, 33 Co60 machines and 43 Brachytherapy departments. • 25 PET and 257 SPECT (majority).

7. Present situation. Needs • Requirement of Medical Physicists depends on [1]: • Management responsibilities • Number and complexity of equipment • Patient throughput and complexity • Time for teaching and training • Research dedication [1] El Fisico Medico: Criterios y recomendaciones para su formacion academica, entrenamiento clinico y certificacion en America Latina. IAEA, Viena 2010.

8. Present situation. Needs for the clinics • Radiation Therapy Physicists: 106150-200 • RT Dosimetrists (technologists): 57150-200 • Nuclear Medicine Physicists: 950-100 ! • NM technologists: 142500 Also, considering the need to: • Duplicate the number of Linear Accelerators (i.e. 5106) and PET facilities (i.e. 1106). • Improve/upgrading technology and applications. • Teaching and Research. • Medical Physicists in radiology and radiation protection. We roughly need: RT  4, NM  10, Radiology +100 or more  500 additional Medical Physicists should be necessary at the clinics.

9. Some data in education Other: Research, MSc or PhD career, radiology, teaching

10. Some data in education Average of (ONLY) 11 new Medical Physicist in RT/year (excluding those that leave Arg), 2 in NM/year and 4 in other disciplines/year.

11. Status of the Clinical Medical Physicist • There is no certification for Medical Physicists. Instead, the ARN gives individual authorization. The profession is not recognized by Health Authorities. • The Medical Physicist is not requested in radiology (except nuclear medicine). • The residency formalism (clinical training, as required by law) is not regulated and is very short termed (1 year). Scenario of the error some times delays more! • There are no audits in training places (only university evaluation and accreditation by CONEAU). • Technologists partially compensate the lack of professionals.

12. Status of the Research Medical Physicist What should be the educational structure (e.g., medical physics)? USA: 3% 48% 49% Argentina:5% PhD, 25% MSc, 70% Licenciados

13. Status of the Research Medical Physicist Number of people Clinical implementation Technology improvements MSc Translational research PhD Cutting edge research Now 1 2 5 10 20 Time(yrs) The Physical Basis and Future or Radiation Therapy. Bortfeld T and Jeraj R 2011, BJR 84, 485-498

14. Status of the Research Medical Physicist • There are not PhD programs for Med. Phys. • Most clinical Med. Phys. teachers or training advisors are not involved in systematic research. • Delay in technology incorporation expands the gap between the clinic and translational research. • Students that naturally point to a PhD career do not intersect with Med. Phys! • The low number of new professionals does not create the “critical mass”. • Graduated usually go for the clinics • Intensive clinic throughput and low number of professionals deviates priorities. • Clinic is much more profitable than teaching-researching: High differences between salaries and scholarships.

15. What is the trend? • The technological gap with developed countries use to be 10-20 years (e.g. 3DRT, HDR, IMRT, PET). Now it is 5-10 years (IGRT, PET-CT, Multi Slice CT) • Globalization • Better economical scenarios • Patients are more advised (internet) • Technology and new methodologies impose more challenges: • More QA and specificity. • Full time dedication. • Optimization to reduce operational costs.

16. What is the trend? • Imaging and therapy are now synergic: new needs • More technology. • More MP involvement in other areas (mixing). Example: it is now common to find early students very interested in learning PET and IMRT. • Research enter the clinic: clinical trials, customized tools (image QA, dosimetry procedures). • The rate of new professionals appears to increase. However, it is still very insufficient.

17. Conclusions: education • There is a consolidated education offer. • Efforts should be put to increase the graduationrate, specially at the level of graduate programs or to increase the number of programs. • More divulgation is needed. • Dead lines should be strict (not necessarily short). • More funds for scholarships are needed. • The clinical residencies should be longer and specific-boarded. • This would be harmonic with most standards • This would be useful to alleviate the controversial between graduate and postgraduate programs (e.g. SAFIM questionnaire 2008). • More dedication time for radiology is needed • This should have been mentioned first!

18. Conclusions: clinics • Imperative need to incorporate the medical physicists in radiology-imaging. • Work with health authorities (MS, ARN?) and scientific and professional associations (SAFIM, SAR, AFA, CNEA). • Certification and accreditation • Work with professional associations and universities. • Promote audits and visits • Work with professional associations, IAEA, AAPM, ALFIM. • Promote full time job

19. Conclusions: research • Promote research programs • More interaction between academic and clinical medical physicists is needed. • Strengthening the relationships between clinics and universities. • Help interested medical physicists to start/finish the PhD career, even from the clinic.

20. Muchas gracias! Agradezco especialmente los valiosos datos aportados por: Ing. Norma Acosta Lic. Victor Bourel Lic. Diana Feld Lic. Liliana Mairal Dr. Alejandro Valda