Practical Medical Physics

A Guide to the Work of Hospital Clinical Scientists

Debbie Peet, Emma Chung, Debbie Peet, Emma Chung

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781351391719
• Edition: 1
• Topic: Medicina
• Subtopic: Oncología

This is the first all-encompassing textbook designed to support trainee clinical scientists in medical physics as they start work in a hospital setting whilst undertaking an academic master's course.

Developed by practising physicists and experienced academics using their experience of teaching trainee medical physicists, this book provides an accessible introduction to the daily tasks that clinical scientists perform in the course of their work. It bridges the gap between theory and practice, making the book also suitable for advanced undergraduate and graduate students in other disciplines studying modules on medical physics, including those who are considering a career in medical physics through applying to the NHS Scientist Training Programme (STP).

Features:

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• Provides an accessible introduction to practical medical physics within a hospital environment

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• Maps to the course content of the Scientist Training Programme in the NHS

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• Acts as a complement to the academic books often recommended for medical physics courses

1 Introduction

Debbie Peet, Emma Chung, Jasdip Mangat and Joanne Cowe

Contents

1.1 Medical Physicists and Healthcare Scientists

1.2 Clinical Scientist Training for Medical Physicists

1.2.1 Entry Requirements and Career Path

1.3 The Academy of Healthcare Science

1.4 The HCPC Standards of Proficiency

1.4.1 Good Scientific Practice

1.5 Continuous Professional Development and Progression

1.6 Links to Other Professions

1.7 Working with Medical Devices

1.8 Working Environment and Generic Skills

1.8.1 Clinical Skills

1.8.2 Research Skills

1.8.3 Service Improvement

1.8.4 Quality Management Systems

1.8.5 Audit and Service/Product Evaluation

1.8.6 Risk Assessment

1.8.7 QA Programmes and QC Checks

1.9 Working with Medical Images

1.9.1 Image Properties

1.9.1.1 Contrast and Greyscale

1.9.1.2 Signal to Noise

1.9.1.3 Contrast Resolution

1.9.1.4 Spatial Resolution

1.10 Sub-Specialties within Medical Physics

1.10.1 Part 1: Non-Ionising Imaging (MRI and Ultrasound)

1.10.2 Part 2: Ionising Radiation, Diagnostic X-rays, Nuclear Medicine and Radiotherapy

1.10.3 Radiotherapy

1.10.4 Radiation Safety

1.11 Summary

References

From the early days of hospital care and the inception of the NHS in 1948, the field of Medical Physics has driven advances in technology and aided innovations in healthcare. In 1901, the first Nobel Prize for Physics was awarded to Wilhelm Roentgen for his discovery of X-rays in 1895. Roentgen found that passing X-rays through human tissue revealed the structure of the bones (Figure 1.1). The increasing reliance of doctors on diagnostic X-ray imaging then paved the way for the development of X-ray computed tomography (CT) and further innovations including magnetic resonance imaging (MRI) and ultrasound. Today, high-energy X-rays generated by linear accelerators are also applied to radiotherapy treatment of cancer.

Figure 1.1 Wilhelm Roentgen's X-ray of his wife's hand, 1896.

In 1911, the Polish-born physicist Marie Sklodowska Curie was awarded the Nobel Prize for Chemistry for her discovery of the radioactive element, radium (Gasinska 2016). Her work demonstrated potential applications of radioactive sources in therapeutic medical procedures, leading to the development of Molecular Imaging and Radiotherapy techniques in the field of Nuclear Medicine and Radiotherapy.

Like many physicists, Marie Curie operated mobile X-ray imaging units during the First World War, training the first Radiologists, which contributed to saving millions of lives. Today, we face a very different set of challenges, but the essential role of Medical Physicists in advancing medical device development, training practitioners, and ensuring patient safety continues.

Although early clinical users of X-rays were unaware of the potential harmful effects of radiation exposure, injuries were quickly observed. The field of Health Physics and Radiation Safety developed further after the bombings of Hiroshima and Nagasaki, and the Chernobyl disaster. We now have a far better understanding of the risks associated with ionising radiation and have developed protocols to reduce unnecessary exposure.

The development of sonar during the First and Second World Wars paved the way for new medical ultrasound technologies, which began to become widely used clinically for obstetrics scanning during the 1960s. Ultrasound avoids the use of ionising radiation, so it is safer for use in pregnancy than X-rays. A further breakthrough in imaging occurred in the 1980s through the introduction of a further non-ionising imaging technique – MRI. Today, the use of medical imaging (diagnostic X-rays, ultrasound and MRI), together with other technologies and medical devices for diagnosis and treatment, forms a large part of the work conducted by Clinical Medical Physicists.

Medical technologies often rely on software, information technology and artificial intelligence to generate diagnostically useful information. From simple measurements of pulse, temperature and blood pressure, to more complicated models and simulations, our reliance on healthcare technology requires specialist scientific knowledge and assessment skills.

All Clinical Scientists working in Medical Physics need to work closely with other NHS staff, to ensure safe and effective diagnostics and therapeutic care. General professional skills expected of Clinical Scientists are introduced later in this chapter. These include key clinical skills, the ability to conduct research and critically evaluate clinical services, development of quality assurance (QA) programmes, leadership and professional development. This book is not intended to cover the underlying theory of Medical Physics. There are many excellent specialist texts referenced in indiviual chapters. This book aims to bridge the disparity between the theory of Medical Physics described within university textbooks, and the “real-life” practice of Medical Physics by hospital Clinical Scientists. We illustrate how Medical Physics is applied within hospitals through the practical skills and knowledge that Clinical Scientists bring to their daily work.

1.1 Medical Physicists and Healthcare Scientists

Medical Physicists can be found in academia, industry and healthcare, leading device development and translation of scientific advances to a clinical setting. They are key workers within the healthcare workforce, supporting day-to-day delivery and improvements in patient care. Across most of the world, the title Medical Physicist is used to describe scientists working at masters/doctoral level in healthcare. In the UK, a protected broader title of Clinical Scientist has also been adopted. This brings Medical Physicists under the governance of the Health and Care Professions Council (HCPC 2020a), which requires Clinical Scientists to be listed on a statutory register.

Throughout this book, the title Clinical Scientist can be interchanged with “Medical Physicist” used elsewhere in the world, although it should be recognised that within healthcare Clinical Scientists can also hold other roles drawn from other specialties including engineering, biological sciences, mathematics, chemistry and informatics.

Clinical Scientists may be laboratory-based, engaged in testing samples, investigating genetics or developing and trialling new drugs. Others work directly with patients, performing scans, administering treatment or taking measurements. Scientists also work behind the scenes, ensuring that medical equipment is working safely, and driving the development and evaluation of advances in medical research. All Clinical Scientists are involved in research and innovation within and across specialist areas.

The title of Clinical Scientist forms part of a wider Healthcare Science career structure, which covers more junior Healthcare Science Practitioners and Healthcare Science Associates and Assistants, and more senior Consultant Clinical Scientists. All Healthcare Scientists (including Clinical Scientists) fall under the umbrella of the National School of Healthcare Science (NSHCS 2020). The place of Clinical Scientists within the NSHCS career structure is summarised in Figure 1.2. For more information, please see the NSHCS “Careers in healthcare science” webpage (NSHCS 2020).

Figure 1.2 Career structure for UK Healthcare Sciences.

In the UK, there are estimated to be over 50,000 Healthcare Scientists working in more than 50 specialist areas. Healthcare Scientists are estimated to be involved in 80% of all clinical decisions and are behind the introduction of life-saving clinical and technological advancements for preventing, diagnosing and treating a wide range of medical conditions (NHS England 2020a). If you have ever had a blood test, been given a new treatment, had an X-ray, or undergone a hearing test, it is more than likely that a healthcare scientist was involved. In this book, we focus on describing the role of NHS Clinical Scientists specialising in Medical Physics.

1.2 Clinical Scientist Training for Medical Physicists

A career in Medical Physics offers a stimulating and rewarding opportunity to apply the skills and knowledge gained as part of an undergraduate degree for patient benefit. Good communication and the ability to work as part of a team are essential. Clinical Scientists who specialise in Medical Physics usually have a strong background in physics, followed by a specialist master’s and/or doctoral degree.

1.2.1 Entry Requirements and Career Path

The NHS offers apprenticeship schemes to enable school leavers with GCSEs to train as Associate or Assistant Healthcare Scientists. School leavers with good A levels are also able to train as Healthcare Science Practitioners, which involves studying for a degree-level qualification through the Practitioner Training Programme (PTP).

If you are already working within the NHS as an Assistant Healthcare Scientist or Healthcare Science Practitioner, progression is possible through demonstrating equivalence to the next level without enrolling on a formal training programme. These equivalence progression routes allow existing NHS staff to transition between career paths and gradually “work their way up”.

If you have a good science degree, and are not already working in the NHS, you can apply directly to a “fast track” graduate-level Scientist Training Programme (STP). This provides a full salary during 3 years of hospital-based training, during which students also prepare for an MSc in Clinical Science. Successful completion of the STP training programme leads to registration as a Clinical Scientist working at Band 7 of the NHS pay scale. The STP scheme welcomes Healthcare Science Practitioners, graduates with higher level qualifications (such as doctorates), and scientists who have relevant experience working in industry. The STP scheme is understandably popular and places are limited. The selection process is therefore highly competitive. Successful candidates will typically have at least a 2:1 degre...