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.

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