Postgraduate School of Medical Physics

Integrated training objectives (i.e. common core)
Specialists must be equipped with the cultural and professional skills to carry out the relevant healthcare profession. They must also acquire:
- scientific bases and theoretical-practical preparation necessary to practice the profession of specialists and the methodology and culture necessary for the practice of lifelong learning, as well as a level of professional decision-making and operational autonomy;
- essential theoretical knowledge that derives from the basic sciences, underlying all the different articulations of the training courses;
- indispensable knowledge of equipment and methods, in order to collaborate with other professional figures in the assessment of risks, costs and benefits, also in compliance with current regulations in the field of radiation protection and safety;

Basic training objectives
The trainee must learn the fundamental knowledge of Physiology, Biology, Genetics, Anatomy, Biochemistry and Pharmacology. The knowledge of the trainee must be integrated with the knowledge of mathematical methods. He must develop the knowledge of Physics of Ionizing and Non-Ionizing Radiation and the associated topics of Dosimetry and Radiobiology. He must be informed about the fundamental aspects of Biophysics, Statistics, Computer Science and Electronics for Medicine. The trainee must know how to use the main measuring instruments used in the medical field.

Educational objectives of the School typology (Characterizing)
In the field of Radiation Therapies, the trainee must learn the fundamental knowledge of basic dosimetry and clinical dosimetry in radiotherapy with external beams and brachytherapy. He must know the most advanced techniques of radiotherapy treatment. He must be able to collaborate in the planning and implementation of therapeutic protocols and in the development of clinical experimentation methods. Furthermore, the trainee must acquire the theoretical and practical bases that allow the creation of a treatment plan with ionizing and non-ionizing radiation. He must know how to implement quality assurance and control programs in the therapeutic use of radiation.
In the field of Diagnostic Imaging, the trainee must learn the fundamental knowledge of methods and techniques of image formation. Furthermore, the trainee must acquire the theoretical and practical bases of the theory of tracers, of nuclear medicine, of systems for clinical diagnostics (CT, NMR, ultrasound, gamma-camera, SPECT, PET, endoscopy, microscopies, fluorescence, spectrophotometry). The trainee must be able to plan and implement guarantee programs, quality controls and clinical dosimetry in diagnostic imaging also for the purpose of patient protection.
In the field of Hospital Information Systems, the trainee must know the theoretical and technical bases of information systems of interest in the medical field, with particular attention to the processing of biomedical signals and images, to their archiving and transfer to the network, both at a local and territorial level. He must contribute to the IT aspects related to the flow of patients in the various hospital departments and to an automated management of the medical-surgical devices of the hospital facilities. The trainee must know the software and hardware for the control of biomedical equipment.
In the field of Radiation Protection, the trainee must learn the principles and operating procedures of Radiation Protection and, more generally, of prevention and the related national and international regulations. Must acquire scientific and operational knowledge for the physical surveillance of sources consisting of x-ray machines or radioactive materials, including neutron sources, in particular those used in the hospital field. Must also, during the attendance of the School, carry out the internship in accordance with the current legislation for registration in the list of qualified experts.

The trainee must also acquire the knowledge necessary to carry out physical surveillance in the diagnostic and therapeutic use of non-ionising radiation (NMR, laser, ultrasound, etc.) and in particular to carry out the functions of 'responsible expert' for NMR systems and 'laser safety officer' as per current legislation.

Related or Complementary Objectives
The specialist must acquire knowledge (for example: basic elements in the field of radiotherapy, nuclear medicine and diagnostic imaging; fundamentals of healthcare management, including safety aspects and occupational medicine, legislative provisions that regulate healthcare organization; medico-legal problems inherent to the profession of medical physicist; knowledge of ethics and bioethics) that allow him to express his professionalism as a healthcare worker and to interact positively with other professional figures in the healthcare area.

Mandatory professionalizing activities are:
the practical training activity of the specialists takes place in the university, hospital and territorial structures of the Health Authorities affiliated with the University. To achieve the educational objectives of the Medical Physics typology, the specialist must have collaborated in specialist acts, and in particular must have carried out at least 20% of each of the activities indicated below.

In the field of Radiation Therapies:
- 200 personalized treatment plans for therapies with external beams;
- 40 customized treatment plans for brachytherapy (contact, interstitial, endocavitary and vascular curietherapy;
- 10 customized treatment plans and related dosimetric controls for at least one of the following special treatment techniques: Total Body Irradiation, stereotactic radiotherapy, TBI with electrons, intraoperative radiotherapy, metabolic therapy with radionuclides.;
- 100 measurement and control sessions regarding: initial calibration and periodic verification of the different radiotherapy treatment machines according to national and international protocols; implementation of dosimetric data and machine parameters on the computerized system for processing treatment plans; control of the repeatability of the radiotherapy treatment for the different machines and irradiation techniques

In the field of Diagnostic Imaging:
- 10 quality controls of radiopharmaceuticals, short-half-life radioisotope generators, labeled products;
- 100 quality controls according to national and international protocols on equipment (radiological equipment, Planar Gamma Cameras, SPECT, PET, Bone Densitometry);
- 20 quality assessments on radiographic sensitive material and development factors;
- 20 quality assessments of digital radiology systems (DR, CR);
- 50 interventions for the measurement of Diagnostic Reference Levels (DRL), including the study of measures for their reduction;
- 20 quality controls on nuclear magnetic resonance tomographs and ultrasound scanners

In the field of Hospital Information Systems:
- 10 specific software applications for the collection, management, storage and transmission of physical-medical and clinical-biological data for different applications;
- 10 specific software applications for processing and post-processing of biomedical images for different applications

In the field of Radiation Protection from ionizing radiation:
a) Internship activities required for carrying out the professional activity of Qualified Expert with the first degree of qualification, in particular:
- 50 Determinations of the workload of X-ray sources;
- 30 designs and checks of primary and secondary barriers for X-ray sources;
- 50 checks of leakage radiation from radiogenic sources;
- 50 exposure measurements for X-ray sources;
- 100 personal dosimetry assessments for X-ray exposure for 100 workers (their classification and drafting of the related dosimetric sheets);
- 100 readings of thermoluminescence or film dosimeters;
- 10 dose calculations for the exposure of the reference group of the population;
- 20 classifications and delimitations of supervised and controlled areas;
- 10 risk assessments from radiogenic sources pursuant to Legislative Decree 230/95;
- 5 elaborations of internal radiation protection standards for radiological rooms

b) Internship activity required for carrying out the professional activity of Qualified Expert with the second level of qualification, in addition to what is provided for the first level, the specialist must participate in:
- 30 exposure measurements of X-rays with energy up to 10 MeV;
- 10 assessments of physical surveillance aspects in projects of Nuclear Medicine departments;
- 50 assessments of surface contamination;
- 20 determinations of internal dosimetry and calculation of the effective dose from internal contamination;
- 5 projects for the transport of radioactive material;
- 5 projects for the disposal of radioactive waste from a hospital facility;

c) Internship activity required for the performance of the professional activity of Qualified Expert with the third level of qualification; in addition to what is required for the second level, the trainee must participate in:
- 10 detection measurements and related spectrometry of neutron flows;
- 10 dosimetry measurements and detection of high-energy particles;
- 10 assessments of individual neutron dosimetry;
- 10 barrier projects for accelerators used in radiotherapy;
- 5 assessments of physical surveillance aspects in projects for radiotherapy departments

In the field of Radioprotection from Non-Ionizing Radiation:
- 10 mappings of dispersed magnetic fields around NMR systems or large instruments;
- 20 mappings of electromagnetic fields around therapy equipment;
- 20 measurements of electromagnetic fields around diagnostic equipment;
- 10 analysis and discussion of a project for the installation of class 3 or 4 LASER systems;
- 20 measurements of the parameters of a class 3 or 4 medical LASER beam;
- 10 assessments of the level of exposure of workers and drafting of internal safety regulations

Activities aimed at the final exam: the trainee must have personally participated in research and development activities of physical methods and techniques in the field of the characterizing Activities of the Medical Physics typology.

The trainee may compete for the diploma after completing the professionalizing activities.
The trainee, as part of the training path, must learn the scientific bases of the School typology in order to achieve full maturity and professional competence that includes an adequate ability to interpret scientific innovations and a critical knowledge that allows him to consciously manage both assistance and his own updating; in this area, participation in meetings, conferences and the production of scientific publications and periods of attendance at qualified Italian and foreign institutions useful for his training may be foreseen

The formal and professionalizing teaching activity is carried out in the following locations:

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
- U.O.S.D. of Medical Physics
- U.O.S.D. of Nuclear Medicine
- U.O.S.D. of Radiology
- U.O.C. of Neuroradiology

ASST Santi Paolo e Carlo
- Service of Health Physics and specialist structures of Radiology and Medicine of the ?San Paolo? Hospital

ASST Grande Ospedale Metropolitano Niguarda
- S.C. of Health Physics, Specialist S.C. of Radiology, Interventional Radiology, Neuroradiology, Epilepsy Surgery, Radiotherapy and Nuclear Medicine

Fondazione IRCCS - Istituto Nazionale dei Tumori
- S.S.D. of Medical Physics and structures of Radiation Protection and Nuclear Medicine

Fondazione IRCCS - Istituto Neurologico "C. Besta"
- Service of Health Physics
- U.O.C. of Radiotherapy
- U.O.C. of Neuroradiology

IEO - European Institute of Oncology
- Departmental Unit of Radiation Research, Specialist Divisions of Radiotherapy, Nuclear Medicine and Radiology

IRCCS Policlinico San Donato
- S.S. of Health Physics and specialist structures of Radiotherapy, Radiology, Multimodal Cardiac Imaging, Electrophysiology and Interventional Cardiology/Hemodynamics

ASST of the Spedali Civili of Brescia
- S.C. Health Physics
- S.C. Nuclear Medicine
- S.C. Radiotherapy
- S.C. Diagnostic Radiology 1
- S.C. Diagnostic Radiology 2
- S.C. Neuroradiology

ASST of Valtellina and Alto Lario
- UOSD Health Physics and Specialist Structures of Radiology and Nuclear Medicine and Radiotherapy

ASST of Cremona - Hospital Institutes
- U.O.C. of Health Physics and Specialist Structures of Radiodiagnostics, Radiotherapy and Nuclear Medicine

ASST of Lecco
- SSD of Health Physics and specialist structures of Radiotherapy, Nuclear Medicine and Radiodiagnostics of the ?Alessandro Manzoni? Hospital

ASST of Mantua
- S.C. of Health Physics and specialized structures of Radiodiagnostics, Radiotherapy and Nuclear Medicine of the ?Carlo Poma? Hospital

ASST of Monza
- U.O.C. of Health Physics and specialized structures of Radiodiagnostics, Radiotherapy and Nuclear Medicine of the ?San Gerardo? Hospital

ASST Lariana
- S.C. Health Physics, S.C. Nuclear Medicine, S.C. Radiotherapy, S.C. Radiology of the ?Sant?Anna di Como? Hospital

ASST Papa Giovanni XXIII of Bergamo
- U.O.C. of Health Physics - Specialist Structures of Radiodiagnostics, Radiotherapy and Nuclear Medicine

ASST Sette Laghi
- S.C. of Health Physics and S.C. Specializations in Radiotherapy, Radiodiagnostics and Nuclear Medicine of the Hospital Presidium ?Fondazione Macchi di Varese?

ASST Valle Olona
- S.C. of Health Physics and specialized structures of Radiodiagnostics, Radiotherapy and Nuclear Medicine of the Hospital Presidium of Busto Arsizio

San Raffaele Hospital
- S.C. of Health Physics, U.O. of Nuclear Medicine and PET center, U.O. of Radiotherapy, U.O. of Diagnostic Radiology, U.O. of Neuroradiology, Core Research Structure of Imaging

CDI - Italian Diagnostic Center
- Department of Diagnostic Imaging and Stereotactic Radiotherapy

Monzino Cardiology Center
- S.C. of Radiodiagnostics, Hemodynamics and Electrophysiology operating within the Cardiovascular Imaging Area

CNAO Foundation of Pavia
- Medical Physics Unit, specialized activity of Radiodiagnostics (CT) and Nuclear Medicine (PET/CT)

IRCCS Foundation Policlinico San Matteo of Pavia
- S.C. of Health Physics specialized structures of Radiodiagnostics, Radiotherapy and Nuclear Medicine

Maugeri Foundation of Pavia
- Physics Structure and specialized structures of Radiotherapy, Radiodiagnostics and Nuclear Medicine

Poliambulanza Foundation of Brescia
- Health Physics Service

Multimedica Group
- Specialist structures of Radiotherapy and Nuclear Medicine of the Sesto San Giovanni Hospital
- S.C. of Radiotherapy of the Castellanza Hospital (VA)

IRCCS Istituto Clinico Humanitas
- Health Physics Service
- U.O. Nuclear Medicine
- Diagnostic Radiology Service, Oncological and Interventional Radiology, Ultrasound Service
- Radiotherapy and Radiosurgery Unit

Humanitas Cliniche Gavazzeni SpA
- Health Physics Unit - Diagnostic Radiology - Radiotherapy - Nuclear Medicine