medical physics in Mexico

Professional

Professional

and

and

academic

academic

issues

issues

of

of

medical

medical

physics

physics

in

in

Mexico

Mexico

Mar

Marííaa--Ester Brandan Ester Brandan Mar

Maríía del Carmen Francoa del Carmen Franco--CabreraCabrera

SWAAPM

SWAAPM –– FMOFM Joint MeetingFMOFM Joint Meeting Quer

• Professional issues

¾ The situation of Radiotherapy and Nuclear Medicine ¾ The situation of Diagnostic Imaging

OUTLINE

• Academic issues

• Mexican Federation of Organizations

for Medical Physics (FMOFM)

¾ Brief background and organization

¾ Education ¾ Research

¾

First discussion during SWAAPM in Puerto Vallarta, 2000

Legally constituted in 2003

FMOFM

Mission Statement

FMOFM is a civil association dedicated to develop,

promote, and dignify the practice of Medical Physics,

congregating related professional and academic

societies, and representing them national and

¾

First discussion during SWAAPM in Puerto Vallarta, 2000

Legally constituted in 2003

STRUCTURE

AMFM

SOFIMED

NL

Government Board

Board of Directors

SMF

STRUCTURE

AMFM

SOFIMED

NL

Government Board

Board of Directors

SMF

Brief historic notes

Professional issues: Radiotherapy

• 1960’s: First hospital physicist

positions in Radiotherapy.

• Next three decades:

¾ Wide variety of status, from technologist to specialist,

influenced by the medical staff background.

Brief historic notes

Professional issues: Radiotherapy

• Last 15 years

¾ Growing number of facilities

¾ Growing technology level in Radiotherapy, Nuclear

Medicine, and Diagnostic Imaging

¾ Pressure from regulators to meet national laws and

international standards.

¾ Radiotherapy and Nuclear Medicine practice is regulated by

“Comisión Nacional de Seguridad Nuclear y Salvaguardias” (CNSNS) since 1988.

Professional issues: Radiotherapy

¾ Source: Comisión Nacional de Seguridad Nuclear y Salvaguardias. February 2007

Number of Licensed Facilities in Mexico

7 31 20 0 14 31 0 5 38 3 18 3 9 1 28 90 2 20 0 20 40 60 80 100 120 140 Private 3 20 18 2 3 9 1 28 90 Public 7 31 20 0 14 31 0 5 38

Orthovoltage Cobalt-60 Linear Accelerators Gamma Knife Brachytherap y HDR Brachytherap y LDR Intraocular Brachy Oftalmology Nuclear Medicine

¾ In addition: 17 ongoing construction licenses, 6 for linacs.

Public Private Or thovoltage Co-60 Linacs Gamma Knife Brachytherapy HDR Brachytherapy LDR Intraocular Brachytherapy Oftalmology Nuclear Medicine Total RT (157): 58 brachy 51 Cobalt, 38 linac facilities,

10 ortho Total MN (128)

“Authorized” Medical Physicist

Professional issues: Radiotherapy

• Required in Radiotherapy

• Not required in Nuclear Medicine

• Authorizations evaluated and issued by

CNSNS.

“Authorized” Medical Physicist

Professional issues: Radiotherapy

• Recognized training options today

¾ Clinical rotation in a Radiotherapy facility under supervision of

senior physicists (typically 1 year).

¾ Available today at 3 major public institutions (not exclusively):

Hospital General de México, Centro Médico Nacional, Instituto Nacional de Cancerología.

¾ No standardized application, curricula or evaluation process.

¾ Specific requirements to recognize the training are established at

the discretion of the regulatory commission.

¾ Graduate degree in Medical Physics

¾ Clinical experience may be required at the discretion of the

“Authorized” Medical Physicist

Professional issues

¾ Radiation safety regulators in Radiotherapy have undertaken

the task to evaluate the credentials of clinical Medical Physicists.

¾ We are well aware that this is our right and responsibility as

a professional community.

¾ The creation of a certification process appropriate to the

Academic degrees and experience of the clinical

full members affiliated to the FMOFM societies

Professional issues: Radiotherapy

AMFM SOFIMED DFM TOTAL

Full members 22 27 10 (clinical) 59

% Ph.D 12% 4% 0% 7%

% MSc 31% 22% 100% 39%

%BSc 57% 74% 0% 54%

AMFM SOFIMED DFM TOTAL

Full members 22 27 10 (clinical) 59

Years of experience Percentage

>20 17% 7% 10% 12%

15 to 20 36% 7% 0% 17%

10 to 15 27% 41% 0% 29%

5 to 10 16% 26% 0% 19%

Other concerns

Professional issues: Radiotherapy

¾ The pressure from regulators is more noticed and felt by

employers than the pressure by the introduction of new technologies in the medical practice.

¾ Null to scarce planning and support for the continuing

education of clinical physicists.

¾ Resistance to allot appropriate budget for dosimetry and QC

equipment required.

¾ Underused technology due to insufficient physics equipment

and training.

¾ Disproportion between clinical physicist’s salary and growing

Salary Survey

Professional issues: Radiotherapy

¾ Limited statistics, but illustrative results (49 responses

among members of the Federation).

¾ Large gap between salary for medical physicists and

physicians.

¾ Range of medical physicist salary: from US $6,000 to

$24,000 per year (39 / 49 answers).

¾ 6 / 49 answers refer payment above $36,000 a year.

¾ A large majority of clinical medical physicists have, at least,

Diagnostic Imaging

Professional issues: Diagnostic Imaging

¾

Large number of facilities

¾ 1999 census: 3510 establishments, 6663 x-ray units: 76%

radiography, 15% fluoroscopy, 5% mammography, 4% CT.

¾

Regulations (1997, revised 2006) apply to

radiographic facilities, personnel, equipment.

¾

No regulations or quality standards for sonography,

Diagnostic Imaging

Professional issues: Diagnostic Imaging

¾ Regulations do not specify the role of a Medical Physicist, but define a “Specialized Radiation Safety Consultant” that must be authorized by

the Health Secretary and is responsible for acceptance testing, QC, and radiation safety surveys ordered.

¾ GREAT NEED for qualified professionals in QC and radiation safety.

Large number of neglected imaging equipment in suburban and rural regions.

¾ Difficult job and business market. About 5% of the professional

associates in the Federation have activities in Diagnostic Imaging, very few on a full time basis.

¾ High technology imaging equipment (public and private) slowly

Two graduate programs

Academic issues: Education

¾

Since 1996, the University of the State of Mexico

(UAEM), Toluca, offers M.Sc. and Ph.D. in Medical

Physics.

¾ Areas: RT, NM, DI, dosimetry and radiobiology

¾ Graduates: 23 M.Sc., 5 Ph.D. (2 in the last year)

¾ Regular students: 13 (M), 5 (D)

¾ 57% (16) of graduates in clinical jobs, 43% (12) in

research activities

Academic issues: Education

¾

Since 1997, the National University of Mexico, (UNAM),

Mexico City, offers M.Sc. in Medical Physics.

¾ Core education in RT and DI, and thesis areas: RT, DI, MRI

and fMR, lithotripsy, optics and lasers, biological effects of radiation, optics and lasers, etc.

¾ Graduates: 33 M. Sc. (9 in the last year)

¾ Regular students: 18

¾ 48% (16) of graduates in clinical RT and NM, 15% (5) in clinical

MRI and fMR, 6% (2) in related activities, and 21% (7) do or did a Ph.D. (Medical Physics) abroad or in Mexico (Physics).

Research activities

Academic issues: Research

¾

Since 1996, the graduate programs have served as

catalysts for research projects

¾

Institutions

¾ UNAM, Mexico City, (RT, DI, MRI, fMR, optics, lithotripsy,

mathematical models in biology, image processing…) ≈ 60%

¾ Universidad de Guanajuato, León, (biomagnetism) ≈ 25%

¾ Instituto Politécnico Nacional, Cinvestav, UAM-Iztapalapa,

The 9 Mexican symposia on

Medical Physics

Academic issues: Research

¾

Since March 1997, it is the academic event of the Medical

Physics Division

of the

Mexican Physics Society

0 20 40 60 80 100 120 140 1 2 3 4 5 6 7 8 9

¾ It has taken place in Mexico City

(4 times, Cinvestav and UNAM),

twice in León- Guanajuato,

Mérida- Yucatán,

Juriquilla-Querétaro, Guadalajara, and next year in Monterrey.

1997 ₂₀₀₆

Sci

The 9th Mexican Symposium on

Medical Physics, March 2006

Academic issues: Research

¾

Since March 1997, it is the academic event of the Medical

Physics Division

of the

Mexican Physics Society

0 20 40 60 80 100 120 140 1 2 3 4 5 6 7 8 9

¾ It has taken place in Mexico

City (Cinvestav and UNAM, 4 times), Mérida-Yucatán, León-Guanajuato twice, Juriquilla-Querétaro, Guadalajara, and next year in Monterrey.

1997 ₂₀₀₆

Sci

This meeting:

First FMOFM activity

Joint issues

¾

97 registered attendants from Mexico

¾ 8 AMFM, 9 SOFIMED, 20 DFM (60 non - FMOFM)

¾

49 posters from Mexico

¾ 16 RT, 10 DI, 18 General Medical Physics, 5 Education/ Societies

Final comments

• During the last 10 - 15 years, medical physics in Mexico has shown an accelerated growth, due to

– Need of qualified professionals in the clinical field – Creation of graduate educational programs

– Promotion of scientific research

• However, as the rest of Latinamerican countries, Mexico still suffers a severe shortage of clinical medical physicists, as well as urgent need for better education and training of those in the job.

• The challenges that we face require an organized effort from our professional and academic community through the Federation.

• The Medical Physics community realizes its due responsibility to create a certification process that considers the means to develop, evaluate, and certify the knowledge and competence level of clinical medical physicists.

Acknowledgements

• Special thanks for the input and contributions from:

– Aurora Aldana Herrera

– Georgina Benites Villalobos – David Espejo Villalobos

– Eleni Mitsoura