Townsville Cancer Center, Douglas, QLD, Australia.
Austin Health, Heidelberg, VIC, Australia.
Phys Eng Sci Med. 2023 Jun;46(2):521-527. doi: 10.1007/s13246-023-01253-4.
The purpose of this position paper is to outline the ACPSEM recommendations on Medical Physicist scope of practice and staffing levels, as they relate to the use of dedicated MRI-Linacs in the treatment of patients. A core function of Medical Physicists is to safely implement changes in medical practice via the introduction of new technology and to ensure high quality radiation oncology services are provided to patients. Determining the feasibility of MRI-Linacs in any existing setting, or in establishing a new site, mandates the knowledge and services of Radiation Oncology Medical Physicists (ROMPs) as the Qualified Experts within this setting. ROMPs are key members of the multi-disciplinary team which will be required to steer the successful establishment of MRI Linac infrastructure within departments. To support efficient implementation, ROMPs must be embedded in the process from the start, including any feasibility study, initiation of the project, and development of the business case. ROMPs must be retained throughout all stages of acquisition, service development, and ongoing clinical use and expansion. The number of MRI-Linacs in Australia and New Zealand is growing. This expansion is occurring in parallel with rapid technological evolution, expanding tumour stream applications, and increasing consumer uptake. Growth and applications of MRI-Linac therapy will continue to occur beyond current known horizons, via development on the MR-Linac platform itself and through the migration of learning from this platform to conventional Linacs (known horizons for example include the use of daily, online image guided adaptive radiotherapy and MRI data informing decision making for planning and treatment before and throughout treatment courses). Clinical use, research and development will be a significant component of expanding patient access to MRI-Linac treatment and there will be an ongoing need to attract and retain ROMPs to initially establish services and in particular to drive service development and delivery for the life of the Linacs. MRI and Linac technologies mean it is necessary to perform a specialized workforce assessment for these devices, distinct from those employed for conventional Linacs and associated services. MRI-Linacs are complex, have a heightened risk profile compared to standard Linacs, and are unique in their treatment of patients. Accordingly, the workforce needs for MRI-Linacs are greater than for standard Linacs. To ensure safe and high-quality Radiation Oncology patient services are provided, it is recommended that staffing levels should be based on the 2021 ACPSEM Australian Radiation Workforce model and calculator using the MRI-Linac specific ROMP workforce modelling guidelines outlined in this paper. The ACPSEM workforce model and calculator are closely aligned with other Australian/New Zealand and international benchmarks.
本立场文件旨在概述 ACPSEM 关于医学物理学家实践范围和人员配备水平的建议，这些建议与在患者治疗中使用专用 MRI 直线加速器有关。医学物理学家的核心职能是通过引入新技术安全地实施医疗实践的变革，并确保为患者提供高质量的放射肿瘤学服务。确定在任何现有环境中使用 MRI 直线加速器的可行性，或在建立新站点时，都需要在该环境中作为合格专家的放射肿瘤学医学物理学家 (ROMP) 的知识和服务。ROMP 是将需要引导 MRI 直线加速器基础设施在部门内成功建立的多学科团队的关键成员。为了支持高效实施，ROMP 必须从一开始就嵌入到该过程中，包括任何可行性研究、项目启动和商业案例开发。ROMP 必须在收购、服务开发以及临床使用和扩展的所有阶段保留。澳大利亚和新西兰的 MRI 直线加速器数量正在增加。这种扩张是与快速技术发展、扩大肿瘤治疗应用以及消费者接受度提高同时发生的。随着 MR-Linac 平台本身的发展以及通过从该平台向常规直线加速器迁移学习（例如，已知的范围包括使用日常在线图像引导自适应放射治疗以及在治疗前后和整个治疗过程中使用 MRI 数据为计划和治疗做出决策），MRI 直线加速器治疗的应用和发展将继续超出当前已知的范围。临床应用、研究和开发将是扩大患者获得 MRI 直线加速器治疗机会的重要组成部分，并且需要不断吸引和留住 ROMP，以最初建立服务，特别是为直线加速器的整个生命周期驱动服务的开发和交付。MRI 和直线加速器技术意味着需要对这些设备进行专门的劳动力评估，这与用于常规直线加速器和相关服务的劳动力评估不同。MRI 直线加速器复杂，与标准直线加速器相比风险更高，并且在治疗患者方面具有独特性。因此，MRI 直线加速器的劳动力需求大于标准直线加速器。为了确保为放射肿瘤学患者提供安全和高质量的服务，建议人员配备水平应基于 2021 年 ACPSEM 澳大利亚放射工作人员模型和计算器，并使用本文概述的 MRI 直线加速器专用 ROMP 劳动力建模指南。ACSEM 劳动力模型和计算器与其他澳大利亚/新西兰和国际基准密切一致。
