McLaren J W (ed) Modern Trends in Diagnostic Radiology, 2nd and 3rd series Butterworth
Meschan I An Atlas of Normal Radiographic Anatomy, Saunders 1957
Faculty of Medicine
to present certificates of practice (at least two years, including one Year spent in a resident appointment in a general hospital).
(3) Before entering for the examination in Part II candidates are required to present certificates of experience as specified below. Candidates admitted ad eundem statum are required, in addition, to present certifi- cates of three months' approved experience in the Clinical Schools of this University.
PART 1 ANATOMY
The examination may include questions covering any aspect of human anatomy but with particular reference to the structures concerned with the spread of malignancy.
BOOKS Recommended for reference:
Frazer J E Anatomy of the Human Skeleton, 5th ed Churchill 1958
Gray's Anatomy, Descriptive and Applied, 32nd or subsequent ed Long- mans
or
Cunningham's Textbook of Anatomy, 10th or subsequent ed OUP
or
Lockhart R D Hamilton G F & Fyfe F W Anatomy of the Human body,
Faber 1959
Arey L B Developmental Anatomy, 6th or subsequent ed Saunders
or
Patten B M Human Embryology, 2nd or subsequent ed Blakiston Ham A W Histology, 6th ed Lippincott 1969
In addition, candidates are expected to keep themselves informed of
work appearing in periodical literature.
EXAMINATION One 3-hour written paper; oral examination.
BASIC RADIOTHERAPEUTIC PHYSICS
PRELIMINARY READING Candidates are advised to revise the topics of electricity, atomic structure and electromagnetic radiation as given in the syllabus for Physics (Medical Course) for the degrees of M.B., B.S.—
see p. 84 for details and prescribed textbooks.
SYLLABUS
1. X-ray Equipment—construction of x-ray tubes (superficial and deep therapy, contact and beryllium window); causes of x-ray tube failure;
circuits (self rectified with and without Inverse Suppressor; two valve rectification; Greinacher); cooling of x-ray tubes; tube voltage and current controls and meters; rectifiers (valve and solid state);
timers; monitors; filter interlocking devices; design and construction of treatment cones.
2. Absorption and Scattering of Radiation—photoelectric and recoil processes; unmodified scattering; pair production; positron annihila- tion; characteristic radiation; absorption of homogeneous radiation;
absorption coefficients; mass absorption coefficients; half-valve layer;
effective keV.
138
3. Production of Radiation—electron interactions; characteristic radia- tion; Brenstrahlung.
4. Radioactivity—natural and artificial; decay and half-life; isotope charts; modes of disintegration; production of isotopes; growth of activity; radioactive equilibrium; units of activity.
5. Spectra and Photon Energy Distribution—angular distribution of x-ray beams; energy distribution spectrum of x-ray beams; changes in spectrum with kilovoltage, tube current and filtration; relation be- tween photon energy and wave-length; energy distribution spectrum of x-rays from radioactive isotopes; typical spectrum of gamma rays from Cobalt-60 tele-therapy units.
6. Exposure—definition of and unit of electronic equilibrium standard chamber; air-wall material; thimble chambers; dosemeters; calibration
of dosemeters; monitors; measurement of high energy radiation.
7. Sealed Radioactive Sources—radium decay series; radioactive equi- librium; construction of, care of and testing of radium and radon containers; growth and decay of radon and decay products; con- struction of Strontium-90 applicators, Cobalt-60, Caesium-137 needles, tubes, etc., Tantalium-182 wires, intercomparison of sealed sources used for therapeutic purposes; isodose distributions; non- uniformly loaded containers; measurement of activity and/or output of sources.
8. Absorbed dose—definition of and unit of; relation between absorbed dose and exposure; dose quivalent; relative biological effectiveness.
9. High Energy Machines—linear accelerators; betatron; resonant trans- former; van den Graaf generator; teletherapy units (Cobalt-60 and Caesium-137); comparison of high energy machines.
10. Instrumentation for Isotopes—construction and use of Geiger and scintillation counters and associated auxiliary apparatus; statistics of counting, scalers and ratemeters; resolving time and loss of counts, etc., measurement of activity of radioactive samples.
11. Other methods of measurement of radiation—use of chemical dose- meters; photographic film; silver-activated phosphate glass; thermo- luminescent dosemeters; semiconductors, etc.
12. Radiation Protection—Background information; ICRP recommenda- tions on personnel dose, population dose, design of equipment, maximum permissible concentrations, medical examinations etc.;
design of departments; procedures for custody use and disposal of radioactive sources; nursing procedures; reduction of dose to patients and others.
13. Personnel Monitoring—use of pocket dosemeters, thermolumines- cent dosemeters, film badges; relative advantages and disadvan- tages; interpretation of results obtained.
EXAMINATION One 3-hour written paper.
PATHOLOGY
The examination in Pathology will test the candidate's knowledge of both general and systematic pathology, with emphasis on those fields which are relevant to the practice of Radiotherapy.
SYLLABUS
General Pathology: The structure of cells and connective tissue, and the effects of damage on them. The inflammatory reaction, mechanisms of im-
Faculty of Medicine
munity, hospital infections and anti-bacterial chemotherapy. Disorders of growth, precancerous conditions and carcinogensis, the classification, structure and spread of tumours. Reaction to haemorrhage, disturbances in body fluid and electrolyte balance. The red cell and mechanisms of anaemia; the white cells, bone marrow and spleen. Platelets and clotting factors, blood groups and blood transfusion.
Systematic Pathology: A sound general knowledge of the specific types of tumour occurring in the various organs of the body.
PRACTICAL WORK The candidate is advised to attend necropsy ex- aminations, and avail himself of the material becoming available in the Pathology Department of his Institution to assist him in his study of the gross and microscopic manifestations of representative disease processes and tumours. The candidate's knowledge of these aspects of pathology will be tested by a practical examination.
PRESCRIBED BOOKS
Walter J B & Israel M S General Pathology, 3rd ed Churchill 1970 Robbins S L Text Book of Pathology, 3rd ed Saunders 1967
Payling Wright G & Symmers W St C Systematic Pathology, 1st ed Longmans 1967
Willis R A Pathology of Tumours, 4th ed Butterworth 1968
EXAMINATION One 3-hour written paper; one 3-hour practical test;
viva voce examination.
PART II
The experience required of a candidate presenting for Part Il shall be- 1. A period of twelve months as a resident medical officer in a general
hospital with experience equivalent to four months as Resident Medical Officer to each of In=patient Medicine and Surgery.
2. Two years at a special hospital or clinic with full-time attendance
under the supervision of a senior practitioner or practitioners in Radiotherapy, or its equivalent. In assessing equivalence, all hos- pitals or departments recognized as Radiotherapeutic Clinical Schools by Australasian Universities shall have equivalent standing.
In the case of public hospitals or departments not so recognized, the faculty of Medicine will require from a candidate particular details of his experience, the acceptance of which will enable the candidate to proceed with the Diploma.
3. Evidence of having performed under the supervision of one or more consultants in Radiotherapy all the common procedures of the specialty. These procedures shall include the diagnostic and treat- ment techniques including the conduct of pre-operative, operative and post-operative procedures. Candidates are advised to confer with the Chairman of the Standing Committee for advice concerning the
current common procedures.
RADIOTHERAPY: APPLIED RADIOTHERAPEUTIC PHYSICS SYLLABUS
1. Calibration of x-ray equipment—measurement of free-air output, measurement of HVL, cone factors; test of inverse square law.
2. Tissue Dose—phantoms; back-scatter factor—variation with treat- ment area; HVL and depth of underlying tissue; depth dose curves—
variation with treatment area, source—skin distance, HVL and type of cone; tissue-air ratios; measurement of back-scatter factor and 140
percentage depth dose; calculation of back-scatter factor and per- centage depth dose for points off central axis; isodose curves; in- tegral dose; exit dose; use of bolus, etc., comparison of depth dose values with different radiation sources.
3. Correction for Body Inhomogeneities—spectral distributions of scat- tered radiation; variation of HVL with irridiated tissue; effects of bone, lung etc., on depth dose curves; dose within cavities in bone;
density of bone; effect of bone position in tissue on depth dose curves.
4. Beam Direction Devices—pin and arc; back pointer; protractor, etc.
5. Treatment Simulators—principles involved, comparison of radio- therapeutic and radiological equipment and techniques.
6. Treatment Techniques—cross fire; multiple field; rotation; grids;
wedges, etc.
7. Use of Sealed Radioactive Sources-specific gamma-ray emission;
clinical applications using sealed sources-Paterson Parker rules;
Manchester techniques; Sievert integrals; radiographic control of implants; dosage with gamma-ray emitters other than radium and radon; integral dose; dosage using beta-ray applicators.
8. Clinical Uses of Unsealed Radioactive Isotopes—diagnostic pro- cedures with isotopes; isotope scanning; dosimetry of the internally administered isotopes; dose administered from diagnostic pro- cedures; therapeutic treatments with unsealed sources; integral dose.
9. Electron Dosimetry—sources of electron beams; measurement of in- tensity of absorbed dose; dose distribution in tissue.
10. Neutron Dosimetry—sources of neutron beams; relationship between neutron energy and biological response; dosemeters for measure- ment of neutron dose; dose distribution in tissue.
11. Inaccuracies Arising in Dosimetry-use of incorrect settings, factors and tables; variation of line voltage and frequencies; incorrect loca- tion and size of tumours; incorrect beam alignment, faulty cones;
variation of spectra of beam in tissue; variation of absorbed dose with densities of tissue; biological response effects; incorrect place- ment of radioactive sources etc.
12. Radiation Protection—revision of section in Part I and practical ap- plication in radiotherapeutic practice.
PRACTICAL WORK Candidates are advised to arrange attendances at equipment calibration sessions, treatment planning departments, isotope scanning and isotope treatment sessions, and physics departments to experience at first hand the applications of radiotherapeutic physics in their own and allied hospitals and clinics.
BOOKS Prescribed textbook for Parts I and II:
Johns H E The Physics of Radiology, 2nd ed Thomas 1964 Recommended for reference:
Wagner H N Principles of Nuclear Medicine, Saunders 1968
Recommendations of the International Commission on Radiological Pro- tection ICRP Publications 2, 3, 4, 5, 9, Pergamon Press
Revised Radiation Protection Standards NH & MRC, 1967
Code of Practice for the Control and Safe Handling of Seated Radio- active Sources Used in Radiation Therapy (other than Teletherapy), NH & MRC 1962. Special Report Series No. 11
Code of Practice for Nursing Staff Exposed to Ionizing Radiations from Radioactive Substances NH & MRC 1965
Safe Handling of Corpses Containing Radioactive Substances, NH &
MRC 1966
Notes on Medical Procedure for Radiation Accidents and Radioactive Contamination, NH & MRC 1968
(Publications of NH & MRC are available on request, free of charge from the Commonwealth X-ray and Radium Laboratory, 30 Lonsdale Street, Melbourne 3000.)
EXAMINATION Sections of the Radiotherapy written paper and part of the oral examinations will cover this subject.
RADIOTHERAPY
The candidate will be expected to possess a sound knowledge of patho- logical, medical and surgical aspects of all conditions for which any form of radiation therapy is a recognized treatment. In addition, detailed knowledge of all technical procedures in Radiotherapy will be required, together with an understanding of the general principles of radiation bio- logy. The candidate should be able to carry out the prescription, planning and calculating of treatment, and should be able to demonstrate the physi- cal principles involved. He should be familiar with the detailed organiza- tion of a radiotherapeutic department.
BOOKS Recomended for reference:
Cade S S Malignant Disease and Its Treatment by Radium, Wright 1952 McKee & Cipollaro X-rays and Radium in The Treatment of Diseases of
The Skin, Lea & Febiger 1947
Paterson Treatment of Malignant Disease by Radium and X-rays, Arnold Meredith Radium Dosage, the Manchester System, Livingstone
Carling, Windeyer & Smithers British Practice in Radio Therapy, Butter- worth 1955
Beirwalters W H Johnson P C & Solari A J Clinical Use of Radioiso- topes, Saunders 1957
Mitchell J S Studies in Radiotherapeutics, Blackwell 1960
A knowledge of appropriate matter in current periodicals in the English language will be expected.
EXAMINATION One 3-hour written paper in Radiotherapy—Clinical. One 3-hour written paper in Radiotherapy—Radiation Biology, applied Radio- therapeutic Physics, and Radiation Protection and clinical and oral examinations.