It has been suggested that Medical biophysics be merged into this article or section. (Discuss) Proposed since June 2011.

Medical physics is generally speaking the application of physics concepts, theories and methods to medicine. A medical physics department may be based in either a hospital or a university. Clinical medical physicists are often found in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiation Oncology. However, areas of specialty are widely varied in scope and breadth e.g., clinical physiology, neurophysiology (Finland), and audiology (Netherlands). In the case of research based university departments, the scope is even wider and may include anything from the study of biomolecular structure to microscopy and nanomedicine.

In the case of CLINICAL MEDICAL PHYSICS SERVICES the mission statement is as follows:

“Medical Physics Services will contribute to maintaining and improving the quality, safety, and cost-effectiveness of healthcare services through patient-oriented activities requiring expert action, involvement or advice regarding the specification, selection, acceptance testing, commissioning, quality assurance including quality control, and optimised clinical use of medical devices and regarding risks from associated physical agents; all activities will be based on current best evidence or own scientific research when the available evidence is not sufficient. The scope includes risks to volunteers in biomedical research, carers and comforters; it also includes risk to workers and the public when these have an impact on patient doses"

(based on a mission statement to be found in:'Guidelines on the Medical Physics Expert - Qualification and Curriculum Development Frameworks' (Caruana C. J. et al.) - a project funded by the European Commission)

The term ‘Physical Agents’ refers to ionising and non-ionising electromagnetic radiations, static electric and magnetic fields, ultrasound, laser light and any other Physical Agent associated with medical devices. As stated in the introduction at the moment the profession is mostly concerned with those devices used in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiation Oncology and associated physical agents (ionising radiation in X-ray based imaging, radionuclides in Nuclear Medicine, magnetic fields and radio-frequencies in Magnetic Resonance Imaging, ultrasound in Ultrasound imaging and Doppler measurement).

This mission includes the following 11 key activities:

1. Scientific problem solving service: Comprehensive problem solving service involving recognition of less than optimal performance or optimised use of medical devices, identification and elimination of possible causes or misuse, and confirmation that proposed solutions have restored device performance and use to acceptable status. All activities are to be based on current best scientific evidence or own research when the available evidence is not sufficient.

2. Dosimetry measurements: Measurement of doses suffered by patients, volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures (e.g., for legal or employment purposes); selection, calibration and maintenance of dosimetry related instrumentation; independent checking of dose related quantities provided by dose reporting devices (including software devices); measurement of dose related quantities required as inputs to dose reporting or estimating devices (including software). Measurements to be based on current recommended techniques and protocols. Includes dosimetry of all physical agents.

3. Patient safety / risk management (including volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures. Surveillance of medical devices and evaluation of clinical protocols to ensure the ongoing protection of patients, volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures from the deleterious effects of physical agents in accordance with the latest published evidence or own research when the available evidence is not sufficient. Includes the development of risk assessment protocols.

4. Occupational and public safety / risk management (when there is an impact on medical exposure or own safety). Surveillance of medical devices and evaluation of clinical protocols with respect to protection of workers and public when impacting the exposure of patients, volunteers in biomedical research, carers, comforters and persons subjected to non-medical imaging exposures or responsibility with respect to own safety. Includes the development of risk assessment protocols in conjunction with other experts involved in occupational / public risks.

5. Clinical medical device management: Specification, selection, acceptance testing, commissioning and quality assurance/ control of medical devices in accordance with the latest published European or International recommendations and the management and supervision of associated programmes. Testing to be based on current recommended techniques and protocols.

6. Clinical involvement: Carrying out, participating in and supervising everyday radiation protection and quality control procedures to ensure ongoing effective and optimised use of medical radiological devices and including patient specific optimization.

7: Development of service quality and cost-effectiveness: Leading the introduction of new medical radiological devices into clinical service, the introduction of new medical physics services and participating in the introduction/development of clinical protocols/techniques whilst giving due attention to economic issues.

8: Expert consultancy: Provision of expert advice to outside clients (e.g., clinics with no in-house medical physics expertise).

9. Education of healthcare professionals (including medical physics trainees: Contributing to quality healthcare professional education through knowledge transfer activities concerning the technical-scientific knowledge, skills and competences supporting the clinically-effective, safe, evidence-based and economical use of medical radiological devices. Participation in the education of medical physics students and organisation of medical physics residency programmes.

10. Health technology assessment (HTA): Taking responsibility for the physics component of health technology assessments related to medical radiological devices and /or the medical uses of radioactive substances/sources.

11: Innovation: Developing new or modifing existing devices (including software) and protocols for the solution of hitherto unresolved clinical problems.

In the case of RESEARCH BASED UNIVERSITY departments the mission is wider and to emphasize this fact we often speak of BIOMEDICAL PHYSICS (formerly Medical Biophysics): Biomedical physics is the use of physics concepts, theories and methods for the greater understanding and development of clinical practice AND EXPERIMENTAL MEDICINE. This is a wider definition than Clinical Medical Physics Services and would include physics based aspects of life science research which would have a future impact on clinical practice (e.g., various forms of microscopy, nanodevices, spectrometry, biomolecular structure, cell biology physics). Most basic science departments within faculties of medicine / health science are now being grouped under the generic term ‘biomedical sciences’. Many biomedical physics departments today are of necessity multi-disciplinary and may include not only physicists but also engineers, mathematicians and sometimes chemists and physicians. (Ref: Caruana C.J., Wasilewska-Radwanska M., Aurengo A., Dendy P.P., Karenauskaite V., Malisan M.R., Meijer J.H., Mornstein V., Rokita E., Vano E., Wucherer M. (2008). The role of the biomedical physicist in the education of the healthcare professions: an EFOMP project. Physica Medica - European J of Medical Physics, 25, 133-40).

Areas of specialty[link]

Medical imaging[link]

Para-sagittal MRI of the head in a patient with benign familial macrocephaly.

• Diagnostic radiology, including X-rays, fluoroscopy, mammography, dual energy X-ray absorptiometry, angiography and computed tomography
• Ultrasound, including intravascular ultrasound
• Non-ionizing radiation (Lasers, Ultraviolet etc.)
• Nuclear medicine, including single photon emission computed tomography (SPECT) and positron emission tomography (PET)
• Magnetic resonance imaging (MRI), including functional magnetic resonance imaging (fMRI) and other methods for functional neuroimaging of the brain.
  • For example, nuclear magnetic resonance (often referred to as magnetic resonance imaging to avoid the common concerns about radiation), uses the phenomenon of nuclear resonance to image the human body.
• Magnetoencephalography
• Electrical impedance tomography
• Diffuse optical imaging
• Optical coherence tomography

Treatment of disease[link]

• Defibrillation
• Treatment of disease
• High intensity focussed ultrasound, including lithotripsy
• Interventional radiology
• Non-ionising radiation Lasers, Ultraviolet etc. including photodynamic therapy and Lasik
• Nuclear medicine, including unsealed source radiotherapy
• Photomedicine, the use of light to treat and diagnose disease
• Radiotherapy
  • TomoTherapy
  • Gamma knife
  • Cyberknife
  • Proton therapy
  • Brachytherapy
  • Boron Neutron Capture Therapy
• Sealed source radiotherapy
• Terahertz radiation

Physiological measurement techniques[link]

ECG trace

Used to monitor and measure various physiological parameters. Many physiological measurement techniques are non-invasive and can be used in conjunction with, or as an alternative to, other invasive methods.

• Electrocardiography
• electric current
• Electromyography
• Electroencephalography
• Electronystagmography
• Endoscopy
• Medical ultrasonography
• Non-ionising radiation (Lasers, Ultraviolet etc.)
• Near infrared spectroscopy
• Pulse oximetry
• Blood gas monitor
• Blood pressure measurement

Radiation protection[link]

• Background radiation
• Radiation protection
• Dosimetry
• Health Physics
• Radiological Protection of Patients

Medical computing and mathematics[link]

CT image reconstruction

• Medical informatics
• Telemedicine
• Picture archiving and communication systems (PACS)
• DICOM
• Tomographic reconstruction, an ill-posed inverse problem

Education and training[link]

In North America[link]

In North America,^[1] medical physics training is offered at the bachelor's, master's, doctorate, post-doctorate and/or residency levels. Several universities offer these degrees in Canada and the United States.

As of October 2010, twenty-seven universities in North America have medical physics graduate programs that are accredited by The Commission on Accreditation of Medical Physics Education Programs (CAMPEP).^[2] The same organization has accredited forty-three medical physics clinical residency programs.^[2]

Professional certification is obtained from the American Board of Radiology, the American Board of Medical Physics, the American Board of Science in Nuclear Medicine, and the Canadian College of Physicists in Medicine. As of 2012, enrollment in a CAMPEP-accredited residency or graduate program is required to start the ABR certification process. Starting in 2014, completion of a CAMPEP-accredited residency will be required to advance to part 2 of the ABR certification process.^[3]

In the United Kingdom[link]

The person concerned must first gain a first or upper second-class honours degree in a physical or engineering science subject before they can start the Part I medical physics training within the National Health Service.^[4][5]

Trainees can complete Part I training in fifteen months provided they hold an MSc from an IPEM accredited center in the United Kingdom or the Republic of Ireland (National University of Ireland, Galway). For these candidates, the Part I training consists of pure clinical experience. Trainees applying for Part I trainee holding only a degree in a engineering or physical science subject must undertake a combined study and clinical training programme. This programme consists of two years of clinical placement, during which the trainee will study for an MSc in Medical Physics which is approved by the Institute of Physics and Engineering in Medicine (IPEM). The MSc will be either at University College London, Swansea, Sheffield, Surrey, Birmingham, Leeds, Manchester, Aberdeen, Glasgow, King's or Queen Mary's. Open University also offers a Master of Science in Medical Physics, but the prospective student should first check that this degree will satisfy the accreditation requirements or that it is accepted before embarking on it. Successful completion of the Part I training programme leads to an IPEM Diploma. The trainee can then apply for a Part II position, which consists of the IPEM's Part II training which takes a further two years and leads to Corporate Membership of the IPEM, and registration as a Clinical Scientist (if successful).

Note that some training centres offer a contract for the full four (three) years of the scheme, while some offer only part I training, with a requirement to reapply for part II.

As of October 2011, the scheme will be changing again as part of Modernising Scientific Careers.

Legislative and advisory bodies[link]

• ICRU: International Commission on Radiation Units and Measurements
• ICRP: International Commission on Radiological Protection
• NCRP: National Council on Radiation Protection & Measurements
• NRC: Nuclear Regulatory Commission
• FDA: Food and Drug Administration
• IAEA: International Atomic Energy Agency

See also[link]

• Medical biophysics
• Medical biology
• Medical history
• Medical chemistry
• Biomedical engineering
• Biomechanics
• Functional electrical stimulation
• Dialysis
• Gait analysis
• Prosthetics
• Cochlear implants
• Nanomedicine
• Important publications in medical physics

References[link]

Further reading[link]

• Amador Kane, Suzanne (2009). Introduction to Physics in Modern Medicine, Second Edition. CRC Press. ISBN 978-1-58488-943-4. 

• Khan, Faiz (2003). The Physics of Radiation Therapy. Lippincott Williams & Wilkin. ISBN 978-0-7817-3065-5. 

• Attix, Frank (1986). Introduction to Radiological Physics and Radiation Dosimetry. Wiley-VCH. ISBN 978-0-471-01146-0. 

• American Association of Physicists in Medicine (AAPM). What Do Medical Physicists Do?.

External links[link]

Wikimedia Commons has media related to: Medical Physics

• Human Health Campus, The official website of the International Atomic Energy Agency dedicated to Professionals in Radiation Medicine. This site is managed by the Division of Human Health, Department of Nuclear Sciences and Applications
• The American Association of Physicists in Medicine
• medicalphysicsweb.org from the Institute of Physics
• AIP Medical Physics portal
• Institute of Physics & Engineering in Medicine (IPEM) - UK
• European Federation of Organizations for Medical Physics (EFOMP)