MEDICAL PHYSICS: A BRIEF HISTORY IN NEPAL.
Medical Physics is the application of physics to medicine .It uses physics concepts and procedures in the prevention, diagnosis and treatment of disease. Medical physics fulfils a key role in medicine, in biological and medical research, and in optimization of certain health related activities .Medical is a further specialization of advanced physics methods for patient diagnosis and therapy. Medical physics includes area such as radiotherapy physics, diagnostic radiology physics and nuclear medicine physics. Other areas of interest in medical physics include the measurement of ionizing radiation, magnetic resonance imaging and application of lasers, ultrasound and other technologies which utilize physics concepts as applied to medicine. The scope of duties of medical physicists covers a wide array of activities in modern hospitals where radiation technology is used. As part of a team of health professionals, medical physics play a significant role in assuring the safe and effective use of radiation in medicine. These goals of quality are achieved using quality assurance ,quality control protocols in the context of radiation related technologies ,radiation therapy ,dose planning, and verification ,diagnostic image optimization and dose reduction ,and data management and analysis all of which are based on an in depth understanding of radiation physics principles and radiation technology.
The history of medical physics in Nepal goes back to the late twenty century when X-ray imaging was introduced although medical physicists were not appointed until much later. The need for a medical physicist post in Nepal was first identified when a decision was made to start a radiotherapy service in 1990 at the Bir hospital (National Academy of Medical sciences at present) in Kathmandu. Nepal started using ionizing radiation for cancer treatment in 1991 with installation of first tele Cobalt machine. Radiotherapy with its use of ionizing radiation in the treatment of cancer relies heavily on modern technology and the collaborative effects of several professional whose coordinated team approach greatly influences the outcome of the cancer treatment. Current advances in radiation oncology are driven mainly by technological development of equipment for radiotherapy procedure and imaging however as in past there advances rely heavily on the underlying physics.
At present, there are nine radiotherapy centres in both government and private with linear accelerators, CT simulators and HDR brachytherapy machines in Nepal. There are 22 medical physicists working in different radiation oncology departments. In recent years, radiation therapy treatment is improving by techniqurs, almost all radiation therapy centers have been practicing advanced RT techniques IMRT/VMAT and some are treating with SBRT/SRS,Gated,DIBH etc.
The Nepalese Association of Medical Physicists (NAMP) was formally registered in 2009 to promote the medical physics profession. Nepalese medical physicists have participated in many colleges on medical physics organized by the Abdus Salam International Center of Theoretical Physics in Italy. It also associates with the Association of Medical Physics of India and the BMPS, Bangladesh.
There was a trend to appoint MSc physics and trained them or send them to complete masters in medical physics study. It is high time to start a postgraduate medical physics course in Nepal to meet the national demand. Professional recognition and accreditation is essential. Justification of the uses of ionizing radiation in human health, abreast with new advanced technologies in therapeutic and diagnostic imaging clinical application are challenging in Nepal. Only doing clinical routine medical physics work will not be enough, and research and education is also important.
The IOMP accepted the application of P. P. Chaurasia to represent Nepal in IOMP functions in 1998. Nepal became a member of the IAEA in 2008, but still there is no regulatory body in Nepal. Self-regulation based on best practices developed internally is the key to successful integration of technology by ensuring highest quality without compromising on safety. Radiology imaging departments with techniques such as CT, nuclear medicine facilities and academic teaching program must appoint a medical physicist for quality optimization.
Role and responsibility of medical physicist in hospital is to specification preparation of new machine, equipment, acceptance test, commissioning (beam data measurement, calibration ,data transfer to treatment planning system, beam modleing,model validation ), quality assurance of machines, planning and dose calculations, special techniques , radiation protection ,regulatory, surveying ,personnel monitoring services, facility design shielding ,academic and administrative . The physics component of quality assurance in radiation oncology is one of the major responsibilities of the radiation physicist. Adequate physics staffing in proportion to patient load and equipment is required to carry out the responsibilities properly. It is a high time to register medical physicists in a medical physicist council and accredit medical physics profession in Nepal. NAMP has to come forward to collaborate with ministry of health, Ministry of education, Science and technology like other health professionals.
Nothing in life is to be feared, it is only to be understood more, so that we may fear less.–Marie Curie.