International Day of Medical Physics Crossword Puzzle - 2017

Once again our department is organizing a few interesting activities for IDMP (see www.iomp.org for details).

Here is a harder crossword puzzle for this year... last year was too easy: this one will test the limits of medical physics knowledge (or perhaps your googlifying skills!).

If you're interested, I used this online tool to create the crossword which can neatly create a word or pdf of your puzzle. Enjoy!

My venture into Wikipedia

Backstory

Long ago when I was the Editor of the COMP InterACTIONS Newsletter I wrote an article about (among other things) Wikipedia (see here for the publication). Back in 2007, Wikipedia was still relatively new and there was good reason to be skeptical of the published content. Relevant excerpts from that article are reproduced below (with post notes and inserted links):

"...Out of curiosity, I typed in the words ‘Medical Physics’ in Wikipedia. After following a few links, I came across web pages that had the words ‘EDIT’ alongside each of the written texts. I clicked it and started to feel like a blind, thumbless plumber stumbling towards a CT with the gantry covers off (incompetent). After stopping myself from inflicting damage, I pondered: who are the contributors of these rather finely crafted words? 

After seeing some rather anonymous contributors, I noticed that characters by the names of ‘kungfuadam’ and ‘Bobo the Ninja’ appeared to be editing some of the pages. It turns out that Bobo is a self-proclaimed expert in chemistry who attends Rock Bridge High School in Missouri. I don’t know what kind of journals you are reading, but I haven’t cited or read many works from Bobo yet. [Post note: Bobo is gone! or has changed identities!] 

Some interesting facts about Wikipedia:
• Wikipedia is a free internet encyclopedia that anyone can edit
• There is a entry of ‘Wikipedia’ on Wikipedia
• According to a peer reviewed study published in Nature, Wikipedia is as reliable as an encyclopedia in the accuracy of information provided (something the traveling Britannica salesman failed to mention).

To me, Wikipedia is a shining example of how good -and bad- things can get when you mix science and everyday life. Theoretically, if you wait long enough, any falsehoods, or ‘graffiti’, would be replaced with a majority consensus opinion on the “correct” description. Interesting concept. I just hope those volunteers adding to the website are competent. Sounds like digital Darwinism. Stephen Colbert, a comedian/political satirist calls it “bringing democracy to knowledge”, which I found particularly funny, and scary. [Post note: Stephen Colbert performed a hilarious experiment with Wikipedia]"

Re-reading this didn't really change my opinion all that much, but I think it is fair to say that the growth and reliance on Wikipedia as a reference-tool has grown tremendously since 2007. That isn't to say that Wikipedia have no challenges. For a real mind-bender/meta-exercise, consider that there is a pretty good submission on the criticisms of Wikipedia on Wikipedia. In fact, Time magazine thinks it is in trouble. Surprisingly, they stated the following:

"The problem, most researchers and Wikipedia stewards seem to agree, is that the core community of Wikipedians are too hostile to newcomers, scaring them off with intractable guidelines and a general defensiveness. One detailed study from 2012 found that new editors often find that their first contributions to the site are quickly rejected by more experienced users, which directly correlates with a drop in the likelihood that they will continue to contribute to the site. "

I found this particularly worrisome after realizing that someone needed to create an entry for Jack Cunningham somewhere on the internet.

My venture

If you don't know Jack Cunningham, well... you can now read his profile on Wikipedia. My motivation for creating an entry was based on the few times I searched him through various search engines. Too frequently I'd be disappointed with the results. So I figured why not enter him into Wikipedia? It is citable and a probably a good thing to do. Plus I could add some of my medical physics competency into this massive digital-Darwin experiment.

The steps were quite easy. 

• Create a profile in Wikipedia
• Read what you need to do to create your first article
• Follow all the suggestions in that article
• And write it up in your draft-space!
• Get all your references lined up
• Write and edit.
• Edit some more
• Then submit it for review

I had some experience with HMTL coding so using mark-up language to create the article wasn't much of a challenge. There are a great number of helpful editing tools which can make referencing pretty simple.

For the record, my first submission was rejected due to poor references. Easy-peasy fix. The second revision took much longer to receive feedback, but when it came, I received a lot of great feedback from the community. Shortly thereafter it was published! I received a bunch of helpful suggestions such as inserting links to the profile (which I did through inserting a link on Harold John's wiki entry). 

Now that the page is created, anyone can edit it. And that kind of scares me a bit. Maybe Bobo The Ninja is hammering away at the page at this second (probably not). Now that I am an editor of a page, I can receive a message / flag if any changes are made. And I still have some more work to do (see the 'warnings' on the front page... that I will likely remove soon).

I have to say that the process was a lot easier than I expected. Even enough for me to consider submitting more articles or editing others. 

I'd love to hear your thoughts on this.

BC proposes new college for diagnostic and health professions

On December 9, 2016, the BC Ministry of Health issued a news release proposing a new college for diagnostic and health professionals. What does this have to do with Medical Physics? Read on.

Background

While "Health" is a Federal Ministry in Canada (and have 'Acts'), healthcare is administered and executed at the provincial level. This means that the bulk of health care legislation resides in provincial Acts and, subsequently, legal provisions for administering health care (insurance plans), funding for hospitals and other facilities, and administering and paying for services are through the province. In so doing, each province has a variety of healthcare-related Acts to follow through with these obligations, including a Health Professions Act that defines who can deliver healthcare services. 

Here is a simple search on CANLII on 'health professsions acts'. As you'll see, some provinces have a single Act and make changes when new 'professions' of import and need are defined, whereas other Acts are more complex. Often coupled with such Acts are reference to some type of body (organization, college, etc) that has an authority -independent of the government- to determine if an individual has the academic and/or clinical background to be a healthcare professional. Through legislation, the provincial government can empower an organization to regulate a profession. This simple framework exists for most professions in healthcare. 

But today's delivery of healthcare requires many different types of skills and knowledge sets, and often healthcare needs outpace the speed of legislation. This phase difference can result in medical errors. Take for example, a recent series of incidents related to pathologists in Canada. An inquiry into those errors suggested that more work needs to be done in establishing credentials, national standards, quality assurance procedures and processes, and accountability. Much of this can be accomplished through sound organizations which are firmly committed to patient safety. Such organizations may be empowered through legislation to be 'self-regulating' such that they, among other things, are 'gate-keepers' of the profession that can regulate entry into the profession. These colleges exist for many health professionals. Regulation, often through the mechanism of a college, helps define accountability, which is the bond of trust between healthcare professionals.

Medical Physicist as a Profession in Canada

At the time of writing this post, outside of Quebec, the phrase 'Medical Physicist' does not exist in any provincial legislation. And even within Quebec, the phrase 'Medical Physicist' is only used in the context of the Hospital Insurance Act and in reference to collective bargaining units (i.e., how they get paid). There are some important radiation safety documents published by provincial and federal agencies that specifically refer to a "Medical Physicist", often preceded by "qualified", and followed by "cerftied by [CCPM/ABR/etc]". 

At the Federal level, the most commonly cited example of the use of "Medical Physicist"  is Safety Code 35 : Safety Procedures for Installation, Use and Control of X-ray Equipment in Large Medical Radiological Facilities: 

"There must be a Medical Physicist or Radiation Safety Officer to act as an advisor on all radiation protection aspects during the initial stages of construction of the facility, installation of the equipment, and during subsequent operations. Medical physicists are health care professionals with specialized training in the medical applications of physics."
"The medical physicist /radiation safety officer must:

1. possess qualifications required by any applicable federal, provincial, or territorial regulations or statutes and be certified according to a recognized standard, such as for medical physicists, the Canadian College of Physicists in Medicine;"

and that individual must have achieved a measure of competency.

And at the provincial level, one example in the use of "Medical Physicist" is in BC's Diagnostic Accreditation Program (www.dap.org) which spells out who can perform acceptance testing and quality assurance on various diagnostic imaging technologies.

While such mentions are important for ensuring quality in patient care, the profession itself is not "protected". Traditionally, the profession of 'Medical Physicist', if only by name, is regulated by the 'employer'. While the situation in Canada does not render itself to misjudgements in hiring a 'qualified' Medical Physicist, a gap in regulating the profession exists, and as evidenced for Pathologists mistakes can happen.

I don't want to get into a detailed conversation over whether the profession of Medical Physicist should -or should not- be regulated in Canada. There is an excellent post in the COMP Point-CounterPoint (see April 2015, page 53) that discusses the pros and cons of this at length. The goal of this blog is to take a snapshot of the status today, particularly in BC.

Medical Physicist as a Profession in British Columbia

So where are we today? Since inception, the British Columbia Association of Medical Physicists (BCAMP) purposes are:

a) to represent the interests of medical physicists practising within British Columbia; 

b) to promote within British Columbia the recognition of the importance of certification by the Canadian College of Physicists in Medicine (CCPM) and to encourage eligible society members to become Members or Fellows of CCPM; 

c) to promote and encourage the development of scientific knowledge towards the applications of physics to medicine; 

d) to further the exchange and publication of scientific and technical information relating to the science and practice of medical physics; 

e) to promote educational opportunities in those disciplines which support the science and practice of medical physics; 

f) to assist in the development and protection of professional standards in the discipline of medical physics, and 

g) to link to the activities of other societies, associations or organizations, whether provincial, national 

Since 2012 there has been more rigour directed at including "Medical Physicist" within the BC "Health Professions Act" (it's a quick read... don't be scared!). As you'd guess, many professions are not included in this (rather old) legislation. In order to be included on this list, the Minister of Health needs to be convinced that the practice of that profession may involve risk of physical, mental or emotional harm to the health, safety or well-being of the public, particularly -in the case of Medical Physicists- in regard to technology, including instruments and materials, used by practitioners of the health profession. Within the Act, the Minister has the authority to determine if the public would benefit from regulating that profession. 

The Coalition College of Diagnostic and Health Professions

Of notable omission as a Health Care Profession are Medical Radiation Technologists. For a decades' long effort, the BCAMRT has been working towards creating a regulated college. During that time, other organizations, such as the BC Society of Laboratory Science (www.bcsls.net), have equally been working towards this goal. Rather than introducing professions into the Act one-at-a-time (and ensuring there was proper framework for a regulatory college if needed) the Ministry of Health opted for a different approach. Basically, the steps for any profession could follow a standardized trajectory:

1. Determine the type of profession it is. This might mean looking at the specifics of the qualifications  (education and training) of the profession.
2. Determine if the profession fits within the context of the Health Professions Act. 
3. Spell out what specific restricted activities *to the patient* the professional undertakes. Note, we're not talking about activities like QA'ing a machine, but rather those activities done to the patient, that only health professionals should do.

Of notable importance is that, given 3, it becomes pretty obvious that many professions may share restricted activities. 

With the government's blessing, various organizations have embarked on pursuing an 'Umbrella' College for 'Diagnostic and Health Professions'. 

So, now getting back to that news release, it mentions that the Ministry of Health is:

"...proposing to establish a new college of diagnostic and therapeutic health professions to enhance patient safety and quality of care in British Columbia. 

The new college would initially oversee four types of health-care professionals: respiratory therapists, radiation therapists, clinical perfusionists and medical laboratory technologists."

While eleven professions were examined by the Ministry (including Medical Physicists), these four were chosen for the first 'phase' of professions which would be self-regulating through a Coalition College. Thereafter,  

"Once the new college has been substantially implemented, the ministry will continue its work on regulatory options for a number of other diagnostic and therapeutic health-care occupations, including nuclear medicine technologists, medical radiography technologists, magnetic resonance imaging technologists, medical laboratory assistants, cardiology technologists, diagnostic medical sonographers and medical physicists."* 

*bolded by author

Medical Physicists as a Regulated Profession in BC

Clearly our allied health professionals value the work Medical Physicists undertake: no better example of this is through the Canadian Partnership for Quality Radiotherapy (www.cpqr.ca), where Medical Physicists play leadership roles in creating the gamut of technical guidance documents. The fact that Medical Physicists are explicitly mentioned in important provincial and federal documents is important in itself; however, fundamentally, the profession is not legally recognized in any province. The very fact that Medical Physicists have been brought to the attention of law-makers is important. 

Similar processes are unfolding throughout Canada, where provincial legislators are beginning to understand what Medical Physicists do. 

Medical Physicists are health professionals responsible for assuring the safe and effective delivery of radiation to achieve a diagnostic or therapeutic result by overseeing and managing technical aspects of the use of radiation in medical applications; implementing and overseeing quality assurance programs for accurate patient dosimetry and quality imaging; and, assuring compliance with relevant legislation and regulations.

Defining the profession in provincial jurisdictions is still going to take some time. But we are one step closer.

International Day of Medical Physics Crossword

Our department is organizing a few interesting activities for IDMP (see www.iomp.org for details). We decided to have a site-wide contest for our department where, upon completion of a crossword puzzle, staff can enter their name into a raffle for some prizes (gift cards, and a Medical Physicists is even making a tartane).

If you're interested, I used this online tool to create the crossword which can neatly create a word or pdf of your puzzle. Here is the file I created in both word and html format if you want to edit it directly. Enjoy!

International Day of Medical Physics

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Across 3. Our Assistant's first name (Medical Physics Reception) 5. The kind of "water" physicists use (Physics Lab) 6. "Internal" therapy 11. Newest member of Electronics Team 12. There is no other nation like ... 14. Name of our humanoid phantom (Physics Lab) 15. Let there be charge! 17. Name of our treatment planning software (or when the sun/moon overlap) 18. City where Cobalt-60 was invented 19. Model name of our centre's linear accelerators 21. Number of Medical Physicists with the Order of Canada 22. Not a torture chamber, an ... chamber

Down 1. 'assurance' or 'control' 2. Her birthday was today! 4. Name of RT information and treatment system 6. Last name of a UVIC Medical Physics Faculty 7. A "linac" is a linear ... 8. Some of our prostate brachytherapy patients become this 9. Let there be light! 10. First name of our (and Provincial) Professional Practice Physics Leader 13. They 'live' in room S1618 (hint: not undergrads) 16. What Medical Physicists are good at measuring 20. A Physics Assistant's first name (Physics Lab)