Physics Residency Program: Overview

Program Objectives

The Radiation Oncology Physics Residency Program is designed for individuals with an M.S. or Ph.D. (D.Sc.) degree who seek training in clinical radiation oncology physics in preparation for a clinically‑oriented career. The Program's objective is to provide clinical training in radiation oncology physics that will prepare the graduate for board certification and a professional career in radiation oncology.

This Residency Program training involves full participation of the physics resident in the clinical routine, under the supervision of experienced radiation oncology physicists. Comprehensive training and experience is provided in the areas of dosimetry, treatment planning, treatment aid design and fabrication, brachytherapy, radiation safety, radiation machine calibration, imaging, special procedures, and quality assurance.

Training from this Program should prepare the graduate for certification in the specialty of Therapeutic Radiological Physics by the American Board of Radiology. Graduates of the Program will have received sufficient clinical training that should prepare them for work as a radiation oncology physicist.

This program received CAMPEP accreditation in October 1997 and re-accreditation in 2003 and again in 2008. We are accredited through the end of 2013.

Organizational Structure

The Radiation Oncology Physics Residency Program is an official program within the Washington University Medical Center/Barnes-Jewish Hospital Radiation Oncology Department.  Barnes-Jewish Hospital is responsible for all technical components of radiation oncology while Washington University is responsible for all professional components (including the employment of physicians, physicists, physics residents, cancer biologists, bioinformatics faculty, and other academic faculty and staff).  In this academic medical center partnership, Barnes-Jewish Hospital and Washington University work together to provide the highest quality of patient care, conduct world-class research, and outstanding instruction in our education and training programs.  The Department of Radiation Oncology is governed by Barnes-Jewish Hospital and the Washington University School of Medicine (WUSM) rules and policies. The physics residency program faculty consists of faculty within the Medical School and staff of the Barnes-Jewish Hospital Department of Radiation Oncology.

The Washington University Medical Center is a federation of several institutions owned by the University and other independent institutions.  It is the central radiation therapy and diagnosis facility for the entire complex of hospitals and clinics associated with Washington University School of Medicine which combined have nearly 2000 beds. The Radiation Oncology Department resides in the new Siteman Cancer Center (that opened in November 2001).  Our facility is a designated NCI Comprehensive Cancer Center facility.  The Physics Residency Program utilizes other facilities within the Washington University Medical Center including Barnes-Jewish Hospital South, the Clinical Sciences Research Building, and 4511 Forest Park Medical Center Building (WUSM).

The Department of Radiation Oncology operates one of the largest clinical services in the country.  Thirteen staff radiation oncologists and twelve physician residents are involved in the provision of patient care and intramural and cooperative group clinical protocols. The physician faculty is responsible for the treatment of approximately 2,200 new cancer patients per year, representing 50% of all cancer patients in the St. Louis area, or about 30% of all cancer patients in the State of Missouri requiring this form of treatment.

The Physics Division of the Department of Radiation Oncology includes 16 radiation oncology physicists, 2 computer scientists, 12 dosimetrists, 3 brachytherapy technicians, 4 clinical engineers, and 6 physics residents.  The Physics Division is organized into three main activity sections:  research (Dr. Low), education (Dr. Klein), and clinical (Mr. Sasa Mutic).  The clinical activities include specific services:  treatment planning, brachytherapy imaging, Trilogy (localization), stereotatic, protons, QA, and Tomotherapy.  All physics faculty participate in the various education and training programs that include the Physics Residency Program, Physician Residency Program, Dosimetrist Training Program through Southern Illinois University (SIU), and Therapist Training Program (SIU and St. Louis University).

As will be described in later sections, residents have access to a wide range of dosimetry instrumentation, radiation treatment planning systems, imaging and localization systems, simulators, and treatment machines.

History of Program Development

It is well established in radiation oncology that patient care relies not only on physicians, but also on radiation oncology physicists and other technical personnel. Whereas, physicians have established residency programs, physicists have in the past lacked organized clinical training beyond individual apprenticeships or self-training on the job. This was probably adequate in the early days of physics involvement in radiation oncology. However, as radiation oncology has become increasingly more sophisticated and complex, this strategy is no longer acceptable. The practice of hiring inadequately trained medical physicists, who are allowed to perform patient related tasks, must be discontinued.

The lack of proper clinical training of medical physicists reached a serious level in the late 1980's. There was, (and continues to be) an acute shortage of qualified clinical physicists, i.e., physicists with adequate clinical training and board certification. There was (and continues to be) a growing abundance of physics graduates with little or no clinical training applying (and being hired) for hospital positions.  The American Association of Physicists in Medicine (AAPM) recognized this problem and in 1988-89 developed a comprehensive document entitled AAPM Report Number 36, "Essentials and Guidelines for Hospital‑Based Medical Physics Residency Training Programs", which sets down the educational and administrative requirements for a hospital-based residency training program. The AAPM Report recommended two years of clinical physics training beyond an M.S. or Ph.D. degree in physics or a closely related field. The organization of the recommended program was patterned after physician residency programs. In the words of the Committee that developed the recommendations, "this document will hopefully encourage the development of a high quality clinical medical physics instructional environment on a nationwide basis and make an important contribution to the protection of the public health, safety, and welfare."  In 2006, AAPM Report 90, an update to Report 36, was published and is being followed by our program.  The program director, Eric E. Klein, was an author on Report 90.

In light of these developments, the Barnes-Jewish Hospital/Washington University Medical Center Radiation Oncology Center formalized their previous "post-doctoral" training approach and established the Radiation Oncology Physics Residency Program in 1992.  Dr. James A. Purdy was the founding Director for the Physics Residency Program and Eric Klein was Co-Director until 2003, when he became Director.  Daniel A. Low, Ph.D. and Director of Medical Physics served as co-chair until 2009 when Jacqueline Esthappan became Associate Director of the Physics Residency Program.

Since the Program's beginning, 23 physicists have completed their residency training. In addition, there are six physicists currently receiving their physics residency training in this program.   The program is equipped for up to six residents.  All of our past graduates except one are practicing radiation oncology physicists, and those have received their board certification or are in the process of obtaining certification.  The exception is the individual who has an academic position in health physics.

Our program has been recognized for its excellence as evidenced by prior recipients of the ASTRO/AAPM Physics Residency Program, Varian/AAPM and Elekta/AAPM Fellowship Awards.    In total, 7 two-year awards were received.  Unfortunately, these fellowship awards no longer exist. 

Table 1:
Data on Graduates of Radiation Oncology Physics Residency Program