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Recommended Core Curriculum
Proposed by the ASTRO Ad-hoc Committee on
Physics Curriculum for Radiation Oncology Residents


Eric E. Klein, M.S., Chair - Washington University
James M. Balter, Ph.D. - University of Michigan
Edward L. Chaney, Ph.D. - University of North Caroling
Bruce J. Gerbi, Ph.D. - University of Minnesota
Leslie Hughes, M.D. - Thomas Jefferson University

Subject Matter
Teaching Hours/Subject
Atomic and Nuclear Structure (including decay and Radioactivity)
3
Production of X-rays, photons and electrons
2
Radiation Interactions
3
Treatment Machines and Generators; Simulators (incl. CT)
3
Radiation Beam Quality and Dose
2
Radiation Measurement and Calibration
4*
Photons and x-rays (incl. concepts, isodoses, MU, heterogeneities, field shaping, compensation, field matching, etc.)
7*
Electrons (incl. concepts, isodoses, MU, heterogeneities, field shaping, field matching, etc.)
3*
External Beam Quality Assurance
2*
Radiation Protection and Shielding
2
Imaging for Radiation Oncology
4
3DCRT including ICRU concepts and beam related biology
3*
Assessment of Patient Setup and Treatment (incl. EPID, Immobilization, etc.)
2*
IMRT
2*
Special Procedures (incl. Radiosurgery, TBI, etc.)
3*
Brachytherapy (incl. Intracavitary, Interstitial, HDR, etc.)
7*
Hyperthermia
1
Particle Therapy
1
Total
54

*Indicates Subject Matter that should be Complemented During a Physics Rotation.

1. Atomic and Nuclear Structure (3 Lectures)
  A. The atom
    - Protons, Neutrons, Electrons (charge, rest mass)
    - Atomic Number and Atomic Mass
    - Orbital electron shells (binding energy, transitions)
  B. Wave and quantum models of radiation
    - Energy and wavelength, energy spectrum
  C. Radioactivity and decay
    - Decay processes
    - Probability and decay constant
    - Activity, half life, mean life
    - Radioactive series
    - Parent-daughter relationships and equilibrium
    - Nuclear reactions, bombardment, and reactors
2. Production of photons and electrons (2 Lectures)
  A. Physics concepts of beam production
    - Concept of Bremsstrahlung
    - X-Ray tube design
    - Energy spectrum
    - Characteristic radiation
  B. Generation of Beams
    - Filters
    - Gamma- radiation teletherapy sources (Co-60, Cs-137)
    - Linear accelerator production
3. Radiation Interactions (3 Lectures)
  A. Interactions of x and ‚ rays with matter
    - Scatter vs absorption
    - Coherent scatter
    - Photoelectric effect
    - Compton effect
    - Pair production
    - Photonuclear disintegration
  B. Attenuation of Photon Beams
    - Attenuation, energy transfer, and energy absorption
    - Exponential attenuation equation
    - Attenuation coefficients
    - Half-value layer
    - Beam geometry
  C. Interactions of particulate radiation
    - Directly and indirectly ionizing particles
    - Elastic and inelastic collisions with orbital electrons and the nucleus
    - Linear energy transfer, specific ionization, mass stopping power, range
    - Interactions of electrons
    - Interactions of heavy charged particles
    - Interactions of neutrons
4. Treatment Machines and Generators; Simulators (3 Lectures)
  A. Linear accelerators
    - Operational theory of wave guides
    - Bending magnet systems
    - Photon beam Delivery
    - Electron beam delivery
    - Beam energy
    - Monitor chamber
  B. Linac Collimation systems and other Teletherapy
    - Primary and secondary collimators
    - Multileaf collimators
    - Other collimation systems
    - Radiation and light fields (including field size definition)
    - Cobalt units
    - Therapeutic x-ray (<300 kVp)
  C. Simulators
    - Mechanical and Radiographic Operation
    - Fluoroscopy and Intensifiers
    - CT Simulation Machinery
    - CT Simulation Operation
5. Radiation Beam Quality And Dose (2 Lectures)
  A. Monoenergetic and Heteroenergetic bremsstrahlung beams
    - Energy spectra for bremsstrahlung beams
    - Effects of electron energy, filtration, beam geometry
    - Homogeneity coefficient
    - Effective energy
    - Clinical indices for megavoltage beams (e.g., PDD at reference depth)
  B. Dose quantities and units
    - kerma
    - Exposure
    - Absorbed dose
    - Dose equivalent
    - RBE dose
    - Calculation of absorbed dose from exposure Bragg-Gray cavity theory
6. Radiation Measurement and Calibration (4 Lectures)
  A. Dose and Relationships
    - Radiation Absorbed Dose - definition and units
    - Relationship between Kerma, Exposure, and Absorbed Dose
    - Bragg-Gray Cavity Theory - Stopping Powers
  B. Ionization Chambers
    - Cylindrical
    - Parallel-Plate
    - Effective Points of Measurement
  C. Calibration of Megavoltage Beams
    - Photon beams
    - Electron beams
    - Dose calibration parameters
    - TG-21 & TG-51
  D. Other Methods of Measuring Absorbed Dose
    - Calorimetry
    - Chemical Dosimetry
    - Solid State Detectors
        TLDs
        Diode detectors
        FET detectors
        Diamond detectors
    - Film Dosimetry
        XV2 film
        EDR2 film
        Radiochromic film
7. Photons and x-rays (7 Lectures)
  A. External Beam Dosimetry Concepts (Part I)
    - Dosimetric Variables
        Inverse Square Law
        Backscatter factor
        Electron Buildup
        Percent Depth Dose
          Mayneord F factor
          TAR Correction to F factor
        Equivalent Squares
  B. External Beam Dosimetry Concepts (Part II)
    - Tissue air Ratio
    - Scatter air Ratio
    - Tissue phantom Ratio
    - Tissue maximum Ratio
  C. System of Dose Calculations
    - Monitor Unit Calculations
        Output Factor
        Field Size Correction Factors
        Collimator Scatter Factor and Phantom Scatter Factor
        Beam Modifier Factors
        Patient Attenuation Factors
    - Calculations in Practice
        SSD Technique
          SSD Treatment same as SSD of Calibration
          SSD Treatment Different from SSD of Calibration
          SSD Treatment and SAD Calibration
        SAD Technique
          SAD Treatment and SAD Calibration
          SAD Treatment and SSD Calibration
          SAD Rotational Treatment
  D. Translation of Planning to Calculations
    - Beam Parameters
    - Beam Weighting
    - Arc rotation therapy
    - Irregular Fields
  E. Computerized Treatment Planning
    - Isodose curves (beam characteristics)
    - Surface Dose
    - Parallel Opposed Beam Combination
    - Wedge Isodose Curves
        Wedge Angle and Hinge Angle
        Wedge Factor
    - Wedge Techniques
        Wedge Pair
        Open and Wedged Field Combination
        Skin Compensation
    - Beam Combination (3-,4-,6- field techniques)
  F. Surface Corrections & Hetereogeneities
    - Corrections for Surface Obliquities
    - Corrections for Inhomogeneities
        Linear (1-D) Attenuation Method
        2-D Methods
        Volumetric Methods
        Dose Perturbations at Interfaces
  G. Adjoining fields & Special Dosimetry Problems
    - Two-Field Problem
    - Three-Field Problem
    - Craniospinal Gapping
    - Pacemaker
    - Gonadal Dose
    - Pregnant Patient
8. Electron Beam (3 Lectures)
  A. Basic Characteristics
    - Depth-dose/Isodose characteristics
    - Electron interactions
    - CSDA and range
    - Dose versus depth
    - Isodoses
    - Oblique incidence
    - AAPM TG-25
  B. Treatment Planning with Electron
    - Rules of Thumb
    - Selection of energy, field size
    - Electron Skin Dose
    - Electron Bolus
    - Electron Field Shaping
  C. Field Matching and other considerations
    - Electron electron Gapping
    - Electron photon Gapping
    - Electron Backscatter
    - Inhomogeneities
    - Internal shielding
9. External Beam Quality Assurance (2 Lectures)
  A. Overview of Quality Assurance in Radiation Therapy
    - Goals
    - JCAHO
    - ACR
    - AAPM TG-40
    - Staffing
    - Roles, training, duties & responsibilities of individuals
    - Equipment Selection and Specifications
  B. Linac QA
    - Acceptance Testing - Linac
    - Commissioning - Linac
        Data Required
        Computer Commissioning
    - Routine Quality Assurance and Tolerances
        Daily QA
        Monthly QA
        Yearly QA
10. Radiation Protection and Shielding (2 Lectures)
  A. Radiation Safety
    - Concepts and Units
        Radiation Protection Standards
        Quality Factors
        Definitions for Radiation Protection
        Dose Equivalent
        Effective Dose Equivalent
    - Types of Radiation Exposure
        Natural Background Radiation
        Man Made Radiation
        NCRP #91 Recommendations on Exposure Limits
    - Protection Regulations
        NRC Definitions
          Recordable Event
          Misadministration
        NRC Administrative Requirements
          Radiation Safety Program
          Radiation Safety Officer
          Radiation Safety Committee
          Quality Management Program
        NRC Regulatory Requirements
        Personnel Monitoring
  B. Radiation Shielding
    - Treatment Room Design
        Controlled/Uncontrolled Areas
        Types of Barriers
        Factors in Shielding Calculations
          Workload (W)
          Use factor (U)
          Occupancy factor (T)
          Distance
    - Shielding Calculations