medical physics in Mexico

Transcription

1 Professional and academic issues of medical physics in Mexico María-Ester Brandan María a del Carmen Franco-Cabrera SWAAPM FMOFM Joint Meeting Querétaro, March 2007

2 OUTLINE Mexican Federation of Organizations for Medical Physics (FMOFM) Brief background and organization Professional issues The situation of Radiotherapy and Nuclear Medicine The situation of Diagnostic Imaging Academic issues Education Research

3 FMOFM First discussion during SWAAPM in Puerto Vallarta, 2000 Legally constituted in 2003 Mission Statement FMOFM is a civil association dedicated to develop, promote, and dignify the practice of Medical Physics, congregating related professional and academic societies, and representing them national and internationally.

4 FMOFM First discussion during SWAAPM in Puerto Vallarta, 2000 Legally constituted in 2003

5 STRUCTURE AMFM SMF SOFIMED NL Government Board Decisions Representation Board of Directors Execution of tasks

6 STRUCTURE AMFM SMF SOFIMED NL Government Board Decisions Representation Board of Directors Execution of tasks

7 Professional issues: Radiotherapy Brief historic notes 1960 s: First hospital physicist positions in Radiotherapy. Next three decades: Wide variety of status, from technologist to specialist, influenced by the medical staff background. Regulatory requirements evolved.

8 Professional issues: Radiotherapy Brief historic notes Last 15 years Growing number of facilities Growing technology level in Radiotherapy, Nuclear Medicine, and Diagnostic Imaging Pressure from regulators to meet national laws and international standards. Radiotherapy and Nuclear Medicine practice is regulated by Comisión Nacional de Seguridad Nuclear y Salvaguardias (CNSNS) since 1988.

9 Professional issues: Radiotherapy 140 Total RT (157): 58 brachy 51 Cobalt, 38 linac facilities, Public ortho Total Private MN (128) Orthovoltage 3 7 Orthovoltage Co Cobalt-60 Number of Licensed Facilities in Mexico Linacs Linear Accelerators (110 million) hab. Gamma Knife 2 0 Gamma Knife Brachytherapy HDR Brachytherap Brachytherap y HDR y LDR 10 Intraocular Brachy Private Public Brachytherapy LDR Intraocular Brachytherapy Oftalmology 28 5 Oftalmology In addition: 17 ongoing construction licenses, 6 for linacs. Nuclear Medicine Nuclear Medicine Source: Comisión Nacional de Seguridad Nuclear y Salvaguardias. February 2007

10 Professional issues: Radiotherapy Authorized Medical Physicist Required in Radiotherapy Not required in Nuclear Medicine Authorizations evaluated and issued by CNSNS.

11 Professional issues: Radiotherapy Authorized Medical Physicist Recognized training options today Clinical rotation in a Radiotherapy facility under supervision of senior physicists (typically 1 year). Available today at 3 major public institutions (not exclusively): Hospital General de México, Centro Médico Nacional, Instituto Nacional de Cancerología. No standardized application, curricula or evaluation process. Specific requirements to recognize the training are established at the discretion of the regulatory commission. Graduate degree in Medical Physics Clinical experience may be required at the discretion of the regulatory commission.

12 Professional issues Authorized Medical Physicist Radiation safety regulators in Radiotherapy have undertaken the task to evaluate the credentials of clinical Medical Physicists. We are well aware that this is our right and responsibility as a professional community. The creation of a certification process appropriate to the Mexican circumstance is urgent.

13 Professional issues: Radiotherapy Academic degrees and experience of the clinical full members affiliated to the FMOFM societies AMFM SOFIMED DFM TOTAL Full members (clinical) 59 % Ph.D 12% 4% 0% 7% % MSc 31% 22% 100% 39% %BSc 57% 74% 0% 54% AMFM SOFIMED DFM TOTAL Full members (clinical) 59 Years of experience Percentage >20 17% 7% 10% 12% 15 to 20 36% 7% 0% 17% 10 to 15 27% 41% 0% 29% 5 to 10 16% 26% 0% 19% <5 4% 19% 90% 25%

14 Professional issues: Radiotherapy Other concerns The pressure from regulators is more noticed and felt by employers than the pressure by the introduction of new technologies in the medical practice. Null to scarce planning and support for the continuing education of clinical physicists. Resistance to allot appropriate budget for dosimetry and QC equipment required. Underused technology due to insufficient physics equipment and training. Disproportion between clinical physicist s salary and growing responsibilities.

15 Professional issues: Radiotherapy Salary Survey (early 2006) Limited statistics, but illustrative results (49 responses among members of the Federation). Large gap between salary for medical physicists and physicians. Range of medical physicist salary: from US $6,000 to $24,000 per year (39 / 49 answers). 6 / 49 answers refer payment above $36,000 a year. A large majority of clinical medical physicists have, at least, two jobs.

16 Professional issues: Diagnostic Imaging Diagnostic Imaging Large number of facilities 1999 census: 3510 establishments, 6663 x-ray units: 76% radiography, 15% fluoroscopy, 5% mammography, 4% CT. Regulations (1997, revised 2006) apply to radiographic facilities, personnel, equipment. No regulations or quality standards for sonography, MRI, or diagnostic Nuclear Medicine.

17 Professional issues: Diagnostic Imaging Diagnostic Imaging Regulations do not specify the role of a Medical Physicist, but define a Specialized Radiation Safety Consultant that must be authorized by the Health Secretary and is responsible for acceptance testing, QC, and radiation safety surveys ordered. GREAT NEED for qualified professionals in QC and radiation safety. Large number of neglected imaging equipment in suburban and rural regions. Difficult job and business market. About 5% of the professional associates in the Federation have activities in Diagnostic Imaging, very few on a full time basis. High technology imaging equipment (public and private) slowly undertaken by medical physicists from graduate programs.

18 Academic issues: Education Two graduate programs Since 1996, the University of the State of Mexico (UAEM), Toluca, offers M.Sc. and Ph.D. in Medical Physics. Areas: RT, NM, DI, dosimetry and radiobiology Graduates: 23 M.Sc., 5 Ph.D. (2 in the last year) Regular students: 13 (M), 5 (D) 57% (16) of graduates in clinical jobs, 43% (12) in research activities Accredited by Conacyt until 2006

19 Academic issues: Education Since 1997, the National University of Mexico, (UNAM), Mexico City, offers M.Sc. in Medical Physics. Core education in RT and DI, and thesis areas: RT, DI, MRI and fmr, lithotripsy, optics and lasers, biological effects of radiation, optics and lasers, etc. Graduates: 33 M. Sc. (9 in the last year) Regular students: 18 48% (16) of graduates in clinical RT and NM, 15% (5) in clinical MRI and fmr, 6% (2) in related activities, and 21% (7) do or did a Ph.D. (Medical Physics) abroad or in Mexico (Physics). Accredited by Conacyt (High level) since 2000, until 2010.

20 Academic issues: Research Research activities Since 1996, the graduate programs have served as catalysts for research projects Institutions UNAM, Mexico City, (RT, DI, MRI, fmr, optics, lithotripsy, mathematical models in biology, image processing ) 60% Universidad de Guanajuato, León, (biomagnetism) 25% Instituto Politécnico Nacional, Cinvestav, UAM-Iztapalapa, ININ, and others.

21 Academic issues: Research The 9 Mexican symposia on Medical Physics Since March 1997, it is the academic event of the Medical Physics Division of the Mexican Physics Society It has taken place in Mexico City (4 times, Cinvestav and UNAM), twice in León- Guanajuato, Mérida- Yucatán, Juriquilla- Querétaro, Guadalajara, and next year in Monterrey. Sci presentations

22 Academic issues: Research The9th MexicanSymposiumon Medical Physics, March 2006 Since March 1997, it is the academic event of the Medical Physics Division of the Mexican Physics Society It has taken place in Mexico City (Cinvestav and UNAM, 4 times), Mérida-Yucatán, León- Guanajuato twice, Juriquilla- Querétaro, Guadalajara, and next year in Monterrey. Sci presentations

23 Joint issues This meeting: First FMOFM activity 97 registered attendants from Mexico 34 clinical, 63 academic affiliations 8 AMFM, 9 SOFIMED, 20 DFM (60 non - FMOFM) 49 posters from Mexico 16 RT, 10 DI, 18 General Medical Physics, 5 Education/ Societies 6 invited talks, 5 oral contributed papers, 2 YIS, from Mexico

24 Final comments During the last years, medical physics in Mexico has shown an accelerated growth, due to Need of qualified professionals in the clinical field Creation of graduate educational programs Promotion of scientific research However, as the rest of Latinamerican countries, Mexico still suffers a severe shortage of clinical medical physicists, as well as urgent need for better education and training of those in the job. The challenges that we face require an organized effort from our professional and academic community through the Federation. The Medical Physics community realizes its due responsibility to create a certification process that considers the means to develop, evaluate, and certify the knowledge and competence level of clinical medical physicists.

25 Acknowledgements Special thanks for the input and contributions from: Aurora Aldana Herrera Georgina Benites Villalobos David Espejo Villalobos Eleni Mitsoura Verónica Vélez Donis