Challenges and opportunities of medical physicist
Each teaching
hospital/hospital should have at least one medical physicist for awareness and
application of physics in diagnostic imaging and treatment. It is ironic we do
not have a medical physicist even in so called big hospitals. It is the fact
one cannot imagine radiotherapy medical physicist and cancer center without
radiotherapy.
Imaging is central to each
step in the process of radiation therapy (diagnosis→precription→simulation or
CT→planning→verification→treatment delivery→evaluation). Imaging modality in
radiation therapy are radiography/fluoroscopy, CT Fan- beam, PET, MRI, optical,
MV portal, CT-Cone beam, SPECT, Microwave, ultrasound and hybrid
imaging(CT-PET,CT-SPECT, CT-MRI and Optical-MRI). Expanding breadth and depth
of knowledge in above imaging modality as well as commissioning/dosimetry/quality
assurance/radiation protection for physicist are big challenges because such
type of academic facility is not accessible in Nepal. We depend on foreign
source which is also rare to get. There is no national or institutional scheme
so that physicist can gain expertise in imaging and implement knowledge
radiotherapy. Physicists are teaching physics to radiologists, radiation
oncologist and technologist but they are still facing trouble for their
reorganization in national or international level. For instance, one physicist
of B.P. Koirala Memorial Cancer hospital has been teaching physics to MD
student of NAMS for long period but he has not got any position like lecturer
or professor. We have an
organization“Neplese Association of Medical Physicist” which has no fund so
that we can educate more and more health professional s by organizing
academic/training program. We want to see in best postion in development of
radiation therapy(Orthovolatage→megavoltage→3DCRT→IMRT→IGRT→proton
therapy→Heavy Ion therapy).In development of radiotherapy service, where we
are? We are in beginning of IMRT. It does not mean we are in worst stage like
some of African countries where there is still no radiotherapy service.
In developed countries, the
number of megavoltage unit per million population is 3 or more (e.g. 179 units
in 60 million population in France ,210 units in 80 million population in
Germany) but in low/middle income countries it has been recommended 1-2 units
per million population. International Atomic Energy Agency( IAEA)recommends that
every megavoltage radiotherapy unit should treat between 350 (cobalt) and
400(linac) patients per year. Nepal being developing country, how many
radiotherapy units should have? Nepal should have 30-60 units but only 6 units
are across the country. Accordingly qualified clinical medical physicist should
be more than 60. If it would be, the new comer physicist would have ample
opportunity. But we are only ten working in health sectors. These numbers are
really insufficient to provide quality radiotherapy services for our huge
population about 30 million. It is therefore that Nepal government and health
ministry must be accountable to set up required number of megavoltage units
according to our population and train the sufficient manpower like radiation
oncologist, physicist, radiotherapy technician and technologist for better
radiotherapy service comparable to international society. Nepal has still no
academic program to produce well trained clinical medical physicist and
diagnostic physicist like nuclear medicine physicist. The department of
radiation oncology of BPKMCH tried many time to conduct the course of medical
physicist but it could not be possible till now due to like of interest of
concerned body.
There is no any national council to certify
who is medical physicist and regulatory
board/ nuclear act passed by government to monitor the activities of radiation
and its source though Nepal is member of IAea
Medical Physicist
Ram Narayan Yadav
M.Sc., M.S. (Physics)
