Master of Science in Radiation Medicine

This course will consist of four sub-sections including 1) Fundamentals of the interactions of radiation and matter; 2) The concept of dose; 3) treatment planning; and 4) Hands on treatment planning

501.1 Fundamentals of the Interactions of Radiation with Matter: This course reviews of the basics of atomic and nuclear physics. Matter composition and law governing the interaction of radiation with matters, including energy to matter or waves equivalences, will be explained in very practical way and with quasi-exclusive use of visuals. Emphasis will be put on practical understanding of how radiations interact with matter. Basics of decay theories including Bateman equations will be explained. Particle interactions as well as beam attenuation including the Bert Lambert law will be described. The concept of KERMA and dose, energy degradation down to chemical reactions will be explained. Potential clinical and research applications will be reviewed.

501.2 The Concept of Dose – Theory, detectors, and applications: This chapter will review the quantification of energy deposition in matter, including cavity theories (Bragg & Gray, Attix and Burlin). The concepts of ionization, exposure, dose, and KERMA will be reviewed. Absolute and relative dosimeter. Chemistry under radiation and the Fricke dosimeter. Film dosimetry and nuclear track detectors. The simplifications that are commonly used will be explored. Innovative and future approaches of measuring absorbed dose (scintillation, calorimetry…) will be described.

501.3 Treatment planning and dose distribution optimization – Treatment Planning Systems (TPS) and calculation techniques to predict and estimate dose distributions will be presented. Computer algorithms designed to model dose deposition ranging from look-up tables with simple correction factors to scatter correction-based techniques, pencil beam, pencil kernel and convolution algorithms, to full Monte Carlo modeling of the radiation interactions will be reviewed. Classical dosimetry metrics including equivalent field size, inverse square law, CF, SF, RDF, PSF, TAR, SAR, TPR, TMR, Mayneord factor will be explained. The role of forward and inverse plan optimization will be examined, and the evolution of intensity modulation up to VMAT in modern radiation treatment introduced. Dose-volume histograms, beam weighting, dose normalization, radiotherapy prescription, and MU calculation models will be explained.

501.4 Hands on treatment planning – Basic workflow for treatment planning. Organ contouring and ICRU nomenclature, use of guidelines and peer review evaluation. Example of 2D planning, with pair or parallel-opposed beam with wedges, 3D planning, 3D-CRT, IMRT and VMAT. Electron dosimetry. MU calculation and Medical Physics QA.

This course will include five sub-sections including :1) History of accelerators, from radium bomb to modern linacs; 2) Linacs and Radiology Devices Commissioning; 3) Fundamentals of radiobiology; 4) Hadrontherapy; and 5) Hands-on Monte Carlo simulation.

502.1 History of accelerators, from radium bomb to modern linacs – Physics underlying charged particles accelerator will be discussed, from conventional electron accelerators to research cyclotrons. The engineering and complexity of a modern accelerator for improved accuracy and precision will be presented, with special focus on the technical requirements for high precision radiotherapy. This course includes a 2-hour hands-on session at the machine.

502.2  Linacs and Radiology Devices Commissioning – Machine acceptance, commissioning, and routine dosimetry QA. Imaging modalities QA. High precision radiotherapy QA, Winston Lutz, isocenter sphere. Use of various phantoms including water tank, and detectors including Gafchromic films, TLD and OSLD. Machine selection and tender process. This course includes a 2-hour hands-on session at the machine.

502.3 Fundamentals of radiobiology – This chapter will review the molecular, cellular, and tissue impact of radiation. Dose/fractionation, linear quadratic model, and dose/volume effect. The role of hyperthermia. Low and high dose rate. Impact of oxygen and LET. 

502.4 Hadrontherapy – This chapter will review various heavy particle therapies, including protontherapy, neutrontherapy, and carbon ion therapy. This includes particle production, functioning of a cyclotron, dose deposition in matter, beam diffraction and raster scanning, and the modulation of Bragg peak. For particles heavier than alpha this includes the radiobiology including RBE, oxygen effect to calculate the spread of Bragg peak in RBE equivalent. Worldwide development of the technique including pros and cons will be discussed, including clinical results and imaging research. Practical application includes the Model-based approach for protontherapy.

502.5 Hands on Monte Carlo simulation – Workshop on Monte Carlo simulation using research software, with practical examples on 60Co depth dose curve, 120kVp beam hardening, and LDR seeds dose distribution in heterogeneous media.

This course will include four sub-sections including: 1) Fundamentals of imaging in

Radiotherapy; 2) Advanced radiotherapy techniques; 3) Advanced imaging technique in IGRT and ART; and 4) Innovation in external beam radiotherapy.

503.1 Fundamentals of imaging in Radiotherapy – This course discusses the fundamentals, production, benefits, and limitations of imaging modalities currently in use in radiation oncology (X-Ray, CT, Ultrasound), as well as those (MRI/MRSI, MRI and spectrometry and hyperpolarized atoms, PET/SPECT, single photon counting) that will play an increasingly important role in tumor identification/ delineation, radiation treatment planning and patient follow-up.

503.2 Advanced radiotherapy techniques – This course covers the description of highly sophisticated and advanced techniques used daily in modern radiation oncology for selected patient’s presentations, often for a small number and delivered in highly specialized/academic centers. The goal of those innovations is both to improve radiotherapy precision, corresponding to the dose distribution conformality around the target, and accuracy, or adequacy between the dose distribution and target geographical accuracy. Those techniques include SRS (stereotactic radiosurgery), SRT (stereotactic radiotherapy), ZAP and g-knife, SBRT (stereotactic body radiotherapy), IGRT (image guided radiotherapy) and SGRT (surface guided radiotherapy).

503.3 Advanced imaging technique in IGRT and ART – There has been a large range of innovation in image guided radiotherapy to enable more precise registration (shifts of the patient on the treatment table to ensure accuracy) and to enable ART (adaptive radiotherapy). Many of those modalities are still at the research stage. They include the MR-linac, various CT-linacs with 3D portal images that are very close to CT-scanner quality and resolution, and PET-Linacs. The development of each platform led to engineering choices that could prevent their application to all patients. The pros and cons of those technologies will be thoroughly reviewed.

503.4 Innovation in external beam radiotherapy – This course will review innovative research in radiation oncology with promising or failing clinical applications. The concept of the therapy, the clinical application status worldwide and the limitation to adoption will be explained. The purpose of this lecture is to learn from success and failures, and to help students to select sound projects for their academic carrier. At a higher altitude the course will help clarifying the difference between the academic goal, where grants and publications count most, and the health care needs, where treating efficiently and resourcefully patients is essential. The technique which will be reviewed include boron neutron capture therapy, hyperthermia, flash therapy, and gold nanoparticle radiosensitization.

This course will include 4 subsections including: 1) Brachytherapy dosimetry; 2) Brachytherapy clinical applications; 3) Radioprotection and patient’s safety; and 4) Patient workflow and radiation program management.

504.1 Brachytherapy dosimetry 

Brachytherapy is a technique where a radioactive source is inserted into a body cavity or percutaneously to irradiate a tumor, limiting hence the tissue architecture destruction following surgical procedures. This lecture covers the radiation sources used in brachytherapy, historically, currently, and as well as potentially future sources. Historical systems and dose calculation algorithms, including the TG43 and TG186 formalism, will be detailed. This lectures also detail in vivo dosimetry applications. 

504.2 Brachytherapy clinical applications 

This course review applications of brachytherapy, including the patient’s workflow, US, CT or MRI image acquisition pre-implant or intra-operative planning, as well as the clinical outcomes of specific brachytherapy applications including H&N brachytherapy, partial breast brachytherapy, gynecology brachytherapy, and prostate brachytherapy. The lecture will end with a 4hour hands on brachytherapy dosimetry exercise. 

504.3 Radioprotection and patient’s safety 

Radiation safety standards from basic dose/response data will be discussed. Practical shielding calculations in a modern radiation therapy department will be discussed. Patient’s lifetime risk of secondary cancer will be demonstrated, using as example lowrisk breast cancer patients treated with various techniques.

504.4 Patient workflow and radiation program management 

This lecture will present the evolution of patient’s workflow and care path and review how innovation in SBRT, IGRT and ART are complexifying beyond logic treatment processes. Starting from classical in room treatment start, to the introduction of CTsimulation, contouring and peer review. SBRT workflow, and its difference with standard workflow will be presented. The benefit and challenge of the current workflow with the introduction of IGRT will be highlighted. Possible solutions will be presented. The course will also review the evolution of manpower and training in radiation oncology. Finally, the course will present the basic device requirements needed to start-up a radiotherapy program.

This course will include the following two sub-sections

505.1 Academic research techniques and definition of research subjects

This lecture will add to the core course REC 503 – Research methodologies and focus more specifically on Radiation Oncology research, using multiple examples of successful research done by prominent researchers in Radiation Oncology and Medical Physics. This lecture will emphasize the metrics used to judge the research quality and productivity which are mostly based on citations. More specifically this lecture aims to develop the communication skills to ensure achieving academic success in a competitive North American environment, addressing questions like: How is research valued (the impact factor and H index)? How to develop an academic resume? How publish in radiation oncology, starting from a high-altitude bullet point to AI assisted redaction, selecting the best journal, and responding to fierce peer review? How to ensure the largest visibility of your publications through social media? How to apply for peer review grants? What are the rules and tips for excellence in scientific presentations. This lecture will end with each student selecting a topic for the seminar series (505.2).

505.2 Student led seminars and reports

During this week seminar series each student will present the final version of their research assignments. This includes a 60 mn student presentation, followed by questions from peer students (30 mn) and faculties (30 mn). A maximum of 4 presentations are planned each day corresponding to 8+ hours of work.

Students completing a Thesis Option master’s degree are expected to write a report, referred to as a thesis, on the results of an original investigation, in conjunction with a Master’s Advisory Committee. Length and style of the thesis vary by college/department. All these are filed with the Office of Graduate Studies. A Master’s Advisory Committee will be formed for each student. The Chair of the Committee must have research and graduate student advising experience. This Committee will assist the student in the formulation of the Thesis Proposal, and later advise the student in the execution of the research, the Thesis write-up, and help the student to prepare for the oral defense.

Students completing a Thesis Option master’s degree are expected to write a report, referred to as a thesis, on the results of an original investigation, in conjunction with a Master’s Advisory Committee. Length and style of the thesis vary by college/department. All these are filed with the Office of Graduate Studies. A Master’s Advisory Committee will be formed for each student. The Chair of the Committee must have research and graduate student advising experience. This Committee will assist the student in the formulation of the Thesis Proposal, and later advise the student in the execution of the research, the Thesis write-up, and help the student to prepare for the oral defense.