视频课程之配套课件第1讲上-big picture

1、北美医学物理师义讲团第一讲：Big Picture, 治病流程，课程内在联系一国际医学物理界(IOMP)二医疗行业(non-profit)三癌症管理(Cancer Management)四治病流程五课程科目内在联系一国际医学物理界UN IAEA Department of Nuclear Sciences and Applications Division of Human Health Dosimetry and Medical Radiation Physics Section. (Free hand book from Dr. Ervin Podgorsak).International

2、 Organization for Medical Physics (IOMP) 1963, Canada, Sweden, UK, USA, etc 80 national organizations. 18,500 medical physicists.AFOMP 亚太 16 countries. EFOMP 欧洲 38 countries. SEAFOMP 东南亚 7 countries.ALFIM 拉美 13 countries. AAPM 美国 (7000 members). COMP 加拿大 (500 members)中东、非洲Journals & Meetings:Medical

3、 Physics journal AAPM, CCPM, COMP, IOMP.Physics in Medicine and Biology IOP, IPEM Physica Medica EuropeAAPM 年会，COMP 年会，每四年合开一次年会。Canada/US = 11%人口，23%论文AAPM Awards:- Farrington Daniels Award: 64% Canadian (ttl: 36)- Sylvia Sorkin Greenfield Award: 30% Canadian (ttl: 28)- Colidge Award: 12% Canadian

4、(ttl: 39)4) Education, Training, Certification (Career Path).B.Sc in Physics M.Sc. and/or Ph.D. in medical physics (CAMPEP) Residency (CAMPEP) Certificate Exam (DABR, MCCPM opens to world), or FAAPM, FCCPM MOC (maintenance of certification).CAMPEP accredited M.Sc. 28% in Canada, Residency 20% in Can

5、ada.5) IMPCB: International Medical Physics Certification Board (2010). The objectives and purposes are:To define minimum professional standards and improve the practice ofto establish the infrastructure, requirements and assessment procedures for the accreditation of medical physics certification p

6、rograms to establish the infrastructure, requirements and examination procedures for the certification of medical physicists to establish a continuing education and professional development system for certified medical physicists二医疗行业(non-profit)HCA (Hospital Corporation of America) is an American f

7、or-profit operator of health care facilities, the largest in the world.It manages 162 hospitals and 113 freestanding surgery centers in US and UK. (204,000 employees, Revenue:$33 billions).Compared to Fortune 500: Microsoft $78 billions2) US renowned hospitalsEast: UCLA/UCSF, Stanford UNorth: Mayo C

8、linic, Cleveland clinic, UPMCWest: Harvard U, John Hopkins U, Duke U, Memorial Sloan, U of WashingtonSouth: MD Anderson.3) US has most private hospitals in the world.2013 US has 5686 hospitals, private not-for-profit 60%, government 21%, private for-profit 19%. (from )Japan, Taiwan similar to US.Hon

9、g Kong, Singapore, Canada: government 70%.4) Not-for-profit is the mainstream in healthcare.一个健康的人可以有一百个愿望一个生病的人只有一个愿望！专心做事，好好做人三癌症管理(Cancer Management)1) Management(team work!)112 type of cancers, per NIH, NCI. (PDQ database for patients and professionals) /cancertopics/pdq/adulttreatmentExamples:L

10、ung SCLC (8 tx options):- LS-SCLC: 1) chemo&RT, may RT to whole brain. 2) chemo. 3) surgery+chemo. 4) surgery+(chemo&RT).- ES-SCLC: 4+Lung NSCLC (45+ tx options):- stage 0: 3+.Stage I: 5+.Stage II: 5+.Stage IIIA: 5+4+5+5.Stage IIIB: 6+.Stage IV: 7+.Breast: chemo + surgery + RT, etc.Prostate: no trea

11、tment, observe, or treat with RT or PSI + hormonal.Rectum: RT before surgery, etc.types of treatment治愈：Curative姑息：palliative.辅助：adjuvant/adjunct/adjunctive (to suppress like treating chronic disease)8000+ clinical trials (with NCI).“瞎猫碰死老鼠”：- biology of cancer and radiobiology lagging behind practic

12、es, need 10+ yrs to mature.Results or reports from 19,000 trials since 1970s.4) Effective TreatmentSurgery 50%, RT 40%, chemo 10%.Cancer is caused by 12 gene mutations. (human: 2 / day!)- Possibility of one gene mutation connected to next:If 1/2, Prob.=(212)/2/365 = 5.6 yrs.If 1/3, Prob.= 728 yrs.-

13、Surgery and RT remove or destroy all cancer cells, chemo acts on 1-2 gene mutations. (chemo 鸡尾酒疗法)四治病流程DiagnosisWrong cancer diagnosis in US: 6%- False negative and false positive. (有病说没病，没病说有病)- pathologist in China? 30%?Where patients from?- Diagnosed: from symptoms.- Screening: e.g. mamography, PSA, lung, etc. depends on age, sex, risk factors, diagnostic testing, etc.cancer is 老年病, incidence increase exponentially.now 1/4 cancer in life, future 1/2 cancer in life!- Found by chance: when doing other tests or examinations.放疗中心角色分工RO: contour orien