UI/ISEP-AAPM/ACOMP

Imaging Physics Course 2018

Hall B101 FMIPA UI Depok, West Java, Indonesia
October 4 – 7, 2018

The four-day UI/AAPM-ISEP/ACOMP Imaging Physics Course 2018, with the aim of assisting diagnostic medical physicists in South-East Asia—in particular Indonesia—to improve their skills in playing their roles in radiation medicine, was held at Hall B101, Faculty of Mathematics and Natural Sciences (FMIPA), Kampus UI – Depok, University of Indonesia, West Java, Indonesia on October 4–7, 2018. This imaging physics course (IPC) 2018 was organized by the Department of Physics (through the Medical Physics and Biophysics Division), Faculty of Mathematics and Natural Sciences, University of Indonesia in collaboration with the International Scientific Exchange Program (ISEP) of American Association of Physicists in Medicine (AAPM), and International Organization for Medical Physics (IOMP). The organizers for this imaging physics course were Cheng Saw, PhD, FAAPM serving as the Program Director on behalf of ISEP/AAPM and Supriyanto Pawiro, PhD as the Host Director on behalf of the Department of Physics, University of Indonesia.

The trend in the use of medical diagnostic x-ray has been increasing worldwide. As of 2017, the Nuclear Energy Regulatory Agency had issued more than 7000 licenses for medical diagnostic x-ray devices in Indonesia, and the number of new license applications is anticipated to increase rapidly. While the public is the beneficiary of the increased access to better healthcare, stakeholders like the natural authorities, clinicians, technicians, and scientists are subjected to stress in which their roles and significance are being tested.

While the recent economic conditions in Indonesia are favorable, they have led to the rapid acquisition of digital imaging technology. This transition to the digital era placed an enormous burden on the medical physicists to gain not only experience but also a deep understanding of the scientific background of the procedures as well as the clinical consequences they bring. The ease, comfort, and practically of digital medical x-ray imaging are unchallenged, however the stakeholders have to adapt to the transition with new ways of dealing with image formation, storage of images in the clouds, networks, and the operation and use of digital printers. The use of film to capture x-ray images, once the most dominant and important process in the diagnostic imaging department, is now obsolete. The transition is so vivid that what was used yesterday seems no longer valid today. While many are happy to embrace this digital revolution, the scientists and medical physicists are experiencing a rather different ambience—a great challenge indeed. Developing nations like Indonesia are allowing digital imaging systems to gain popularity with such an abrupt scale that medical physicists need to adapt quickly in order to keep themselves updated.

Different physical characteristics of imaging systems from manufacturers present challenges with overwhelming tasks to the medical physicists. Diagnostic medical physicists whose primary duties are to ensure the quality and safety of any device are now tasked with dealing with new and different and complex varied digital algorithms of images. The different breadth of physical characteristics and dose-response curves requires special attention of medical physicists. With the abundance of digital imaging systems due to their popularity, the digital planar x-ray imaging systems with computed radiography and digital flat-panel image receptors deserve attention to ensure that adequate, diagnostic-quality images are produced with minimum radiation dose to the patients that is being optimized.

There are more complexities that follow with other modalities employing digital technologies. CT scanners are now dominated by multi-detector configurations allowing wide-beam scanning to be used— one that requires special attention in radiation dosimetry. Breast imaging is now getting popular with tomosynthesis volume imaging, presenting challenges to the medical physicists regarding dosimetry and quality control methods. In angiography, volumetric imaging known as three-dimensional rotational angiography has left medical physicists struggling with novel dosimetry methods and image quality evaluation. Hybrid imaging systems with radiotherapy and nuclear medicine applications are getting far more common as the walls between medical physics sub-specialties begin to collapse. In short, this transition to digital age genuinely requires deep understanding in the physical characteristics on the recent technologies to enable medical physicists to master the situation and secure their significance.

With the above narrative from the local committee, the requests for medical physicists and their expertise were overwhelming. There is currently a shortage of medical physicists in Indonesia that will continue into the near future. The current concern is the lack of knowledge of the new technology and how to perform quality assurance and quality control on the vast number of existing imaging systems in Indonesia. The focus of the imaging physics course was on the recent technology and developments of digital medical imaging and its physical principles. The roles of digital imaging physics in diagnostic and interventional radiology, radiation oncology, and nuclear medicine was highlighted. The discussion sessions included clinical perspectives needed to emphasize the need of principles and practical knowledge in these areas (a) digital radiology systems, (b) modern mammography, (c) computed tomography dosimetry, (d) interventional radiology principles and optimization, (e) hybrid imaging systems, and (f) imaging in radiation oncology.

The faculty members from AAPM participating in this imaging physics course were Cheng B Saw, PhD from Northeast Radiation Oncology Centers, PA, Frank Dong, PhD from Cleveland Clinic, OH, Tinsu Pan, PhD from MD Anderson Cancer Center, TX, and Douglas Pfeiffer, MS from Boulder Community Health, CO. Prof Kwan Hoong Ng from University of Malaya with expertise in imaging physics also participated in this imaging physics course. Dr. Saw's expertise is in radiation therapy, and he gave presentations on the integration of imaging into treatment planning, image quality and quality assurance for imaging systems used in radiotherapy, and description of various imaging systems used for image-guided radiation therapy (IGRT). Dr. Frank Dong presented image quality and quality control in advanced technologies in CT, dose and image quality optimization in CT, and clinical responsibilities of medical physicists in CT. Dr. Tinsu Pan covered innovations in nuclear imaging, advanced image analysis methods in nuclear medicine, and hybrid imaging systems. Mr. Doug Pfeiffer covered physical and technical principles of interventional imaging, advanced techniques in interventional radiology, image quality assessment, dosimetry, and quality control in mammography, and clinical responsibilities of medical physicists in interventional imaging and mammography. Dr. Ng presented physical principles of planar digital imaging systems, clinical responsibilities of medical physicists in the use of CR and DR, and physical and technical principles of advanced mammography. Local faculty members for this imaging physics course included Gregorius Prajogi, MD, Cipto Mangunkusumo Hospital, Jakarta – radiotherapy, Hussein Kartamihardja, MD, Padjajaran University, Bandung Kardinah, MD, Dharmais National Cancer Center, Jakarta – diagnostic imaging, Sunarya Soerianata, MD, Harapan Kita National Cardiovascular Center, Jakarta – interventional cardiology, Choirul Anam, PhD, Diponegoro University, Semarang – CT, Lukmanda Lubis, MS, Universitas Indonesia, Depok – imaging, Ika Bayuadi, MS, LFMB UI, Depok – imaging. The physicians presented their clinical perspectives and concerns in their medical sub-specialties entering the digital era. Dr. Anam presented the advanced dosimetry methods in CT. Mr. Lubis presented dose and image quality optimization in interventional radiology and cardiology. Mr. Bayuadi discussed quality control and dosimetry in CR and DR.

The opening ceremony for this imaging physics course 2018 commenced on October 4, 2018 with the welcoming address delivered by Dr.rer.nat Agus Salam Chairman of the Department of Physics, Faculty of Mathematics and Natural Sciences, University of Indonesia, Depok, Indonesia. This was followed with the message from Cheng Saw, PhD. Dr. Saw thanked the participants for attending this course. Without their support and participation, this course would not be possible. Dr. Saw also thanked the Host Director, Dr. Supriyanto Pawiro for undertaking this project and conducting the course. Dr. Saw also thanked the faculty for traveling long distances to volunteer their efforts and times to participate in the project.

There were 180 registered participants with representatives from Philippines, Malaysia, and Vietnam. With the inclusion of the staff who was primarily students, there were over 200 attendees for this imaging physics course.

On behalf of the ISEP/AAPM, the Program Director, Dr. Cheng Saw wishes to thank the Host Director, Dr. Supriyanto Pawiro of University of Indonesia to undertake this project and the hospitality of his staff extended to the AAPM members in Indonesia. The Host Directors also wish to thank the AAPM members for their willingness to travel to Indonesia to participate in this educational project.