Rationale and Objects
We describe a new web-based physics course for radiology residents preparing for the Exam of the Future (EOF).
Materials and Methods
A course was developed with a total of 12 web-based modules. Six modules were focused on “imaging” and six on “radiation.” A module was subdivided into nine short “nuggets.” Traditional lectures were replaced by modules using prerecorded lectures (Tegrity) to a secure website (WebCT). Each module was accompanied by three quizzes, each consisting of ten questions designed to reinforce covered materials. All online modules were accompanied by a noon conference that employed an Audience Response System (Turning Point). Seventeen first-year residents over 2 consecutive years beginning in July 2010 took this new course, and participated in an anonymous online follow-up survey (Survey Monkey).
Results
The recorded 12 modules had an overall average duration of 72 ± 19 minutes. Ten of 17 residents expressed a preference of 15 minutes for nugget duration. Highest personal assessment scores of each resident’s understanding were obtained in human radiation risks and radiation protection. Residents considered supplemental noon conferences to be important for learning radiological physics. Satisfaction level was largely positive, with five residents highly satisfied, nine residents somewhat satisfied, two residents neutral, and only one resident somewhat dissatisfied.
Conclusions
Our Foundations of Radiological Physics course was well received and served as the springboard for mastering x-ray–based imaging modalities of radiography, mammography, fluoroscopy, interventional radiology, and computed tomography.
The chairman of Radiology at the Medical College of Georgia, Dr. James Rawson, has defined a radiologist as a physician who manages the electromagnetic spectrum and ultrasound wave spectrum for the benefit of the patient . To perform this role, a radiologist must undergo formal training in radiological physics. Competency in this aspect of radiological imaging also needs to be assessed when radiology residents are examined by the American Board of Radiology (ABR). The advent of time-limited ABR certification, and the introduction of a Maintenance of Certification system of continual assessment of radiologists, implies that understanding of radiological physics is likely to become increasingly important for the practice of medical imaging.
In the past decade or so, radiology residents have generally taken an ABR written physics examination at the beginning of their second or third year of residency, a written diagnostic examination at the beginning of their third or fourth year of residency, and an oral examination at the end of a 4-year residency. Radiology residents who commenced their training in 2010, however, will now take a computer-based core examination after 36 months of residency, and a computer-based qualifying examination 15 months after the completion of their 4 years of resident training . Radiological physics will no longer constitute a separate examination, but will be integrated into the core examination, and important physics aspects of medical imaging are expected in the qualifying examination as well as in future examinations as part of the Maintenance of Certification process. By this means, radiological physics is expected to become more clinically focused and address important topics on dose and image quality that all practicing radiologists are expected to understand. Of particular importance is the fact that a passing score in radiological physics and safety sections will still be required for a resident to pass the ABR core examination.
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Materials and methods
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Course Content
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Table 1
Modules, Parts, and Nuggets of Part I of Foundations (ie, Imaging)
Module Title (Number of Nuggets) Part Nugget Titles 1. Matter & Radiation Laws of Physics Forces; Energy & Power; Electricity Matter (Atoms) Atoms; Binding Energies; Electron Densities Electromagnetic Radiation Waves; Photons; Reducing Exposures 2. X-ray Production Physics & Techniques kV & mAs; X-ray Production; Clinical Techniques Quantity & Quality Air Kerma; X-ray Quantity & kV/mAs; X-ray Quality (Half Value Layers) X-ray Hardware X-ray Generators; X-ray Tube Design; X-ray Tube Heating 3. X-ray Interactions Interaction Physics Coherent Effect; Photoelectric Effect; Compton Effect X-ray Attenuation Quantifying Attenuation; Attenuation Coefficients; Heel Effect & Beam Hardening Ionization Ions; Ionizing Radiations; Linear Energy Transfer (LET) 4. Image Creation Scatter Removal Scatter Characteristics; Grid Design; Grid Performance X-ray Detectors Solid State; Gas Detection & Scintillators; Photostimulable Phosphors & Photoconductors Screen-Film Film Characteristics; Screen Properties; Screen-film Performance 5. Medical Images Digital Images Bits & Bytes; Digital Image Data; Matrix Size & Bit Depth Image Processing Processing Basics; Standard Image Processing; Advanced Processing Techniques PACS PACS; Workstations 6. Image Quality Contrast & Mottle Image Contrast; Image Mottle; Contrast to Noise Ratio (CNR) Spatial Resolution Defining Resolution; What Affects Resolution; Line Spread Function & Modulation Transfer Function; Nyquist Frequency ROC Analysis Test Statistics; Receiver Operating Characteristic (ROC); Area Under the Curve (AUC)
Table 2
Modules, Parts, and Nuggets of Part II of Foundations (ie, Radiation)
Module Title (Number of Nuggets) Part Nugget Titles 1. Radiation Dosimetry Incident Radiation Air Kerma (AK); Patient AK; Kerma Area Product (KAP) Absorbed Doses Gray; Skin Doses; Organ Doses Biological Doses Equivalent Dose (H) & Effective Dose (E); E in Radiography and Fluoroscopy; E in IR, CT, and NM 2. Radiation Biology Cells & Radiation Energy Deposition; Radiation Effect in Cells; Cell Cycle and Radiation Cell Survival Curves Cell Survival Curves; Radiation Modifying factors; Linear Energy Transfer & Relative Biological Effectiveness Radiation Lethality Hematopoietic Syndrome; Gastrointestinal & Central Nervous System Syndromes; Medical Aspects of High Dose Exposures 3. Radiation Risks Deterministic Risks Deterministic Effects; Skin Effects; Non-Skin Effects Cancer Risks Stochastic Effects; Cancer Epidemiology; Cancer Risk Models; Cancer Risks (Quantitative) Embryo, Fetal & Genetic Risks Genetic Risks; Embryo and Fetal (Deterministic); Fetal (Cancer) 4.Protecting Workers Measuring Radiation Thermoluminescence Dosimetry & Optically Stimulated Luminescence; Ionization Chambers & Geiger Mueller Detectors; Pocket Dosimeters Regulatory Scientific Organizations; Regulatory Bodies; Regulatory Dose Limits Practical Protection Protection Basics; Time & Distance & Shielding; Room Shielding 5.Population Doses Natural Background Ubiquitous Natural Background; Domestic Radon; Elevated Background Regions Medical Doses Radiography, Fluoroscopy, and IR; CT & NM; US Medical Per Capita Doses Miscellaneous Exposures Occupational Exposures; Consumer Products 6.Protecting Patients Benefits & Risks Patient Risks; Protection Policy; Imaging Benefits vs Radiation Risks ALARA ∗ Radiography; Fluoroscopy; Computed Tomography Pregnant Patients Embryo & Fetal Doses; Pregnant Patient Policy; Post Irradiation Issues
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Course Presentation
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Course Evaluation
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Results
Nugget Duration
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Online Quizzes
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Course Evaluation
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Table 3
Residents’ Personal Assessment of Their Own Understanding of Each Topic (Seventeen Respondents in Each of the Six Topics Listed)
Topic Poor Below Average Satisfactory Very Good Excellent Average Score X-rays (Production & Interactions) 0 4 9 3 1 2.6 Image Creation (Screen-film) 0 4 9 3 1 2.6 Image Quality & Characteristics 0 2 10 4 1 3.0 Radiation Dosimetry 0 3 9 4 1 2.8 Human Radiation Risks 0 0 8 7 2 3.7 Radiation Protection 0 0 5 9 3 3.9
Table 4
Residents’ Assessment of the Presentation Mode (Tegrity + WebCT)
Question 1 2 3 4 5 Mean I prefer being taught with online “nuggets” compared to a traditional lecture format. 1 4 3 5 4 3.4 An online nugget based course is more efficient than a traditional lecture format. 2 3 2 6 4 3.4 An online nugget course is more engaging/interactive that a traditional lecture format. 1 5 3 5 3 3.2 The inability to ask questions when watching online modules is a major problem. 0 8 3 4 1 2.9 A major benefit of online nuggets is that I can work at my own pace. 1 0 1 7 8 4.2 Online quizzes are helpful as these enable me assess my understanding of the topic. 1 1 1 10 4 3.9 I prefer going online at my convenience, as opposed to having fixed lecture times. 1 3 3 5 5 3.6
1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree.
Seventeen respondents in each of the seven questions listed except only 16 on the fourth question.
Table 5
Residents’ Assessment of the Supplemental Lectures Employing an Audience Response System (Turning Point)
Question 1 2 3 4 5 Mean Review sessions with an instructor to complement online nuggets are important. 0 0 1 9 7 4.4 Review sessions provide an opportunity to clarify areas of confusion. 0 0 2 8 7 4.3 Use of an (anonymous) audience response system is beneficial. 0 0 3 6 8 4.3 Use of interactive question/answers during reviews sessions is important. 0 0 2 9 5 4.2
1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree.
Seventeen respondents in each of the seven questions listed except only 16 on the fourth question.
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Discussion
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Conclusions
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Acknowledgments
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