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2010/1 Module Catalogue
Module Provider: Physics Short Name: PHM-IRP
Level: M Module Co-ordinator: BRADLEY DA Prof (Physics)
Number of credits: 15 Number of ECTS credits: 7.5
Module Availability

Spring Semester




Assessment Pattern

Unit(s) of Assessment



Weighting Towards Module Mark (%)


Closed book examination



100 %



Part-time Students:



Same as for full time students



Qualifying Condition(s) 



This module is assessed in Paper III which will consist of 6 questions. Students answer 4 questions from the 6. Full marks for a question will be equivalent to 25 % of the total marks available in assessment of this module.
Module Overview
Ionising radiation is widely used for diagnostic and therapeutic purposes. The bulk of hospital physicists work with ionising radiation and hence the topic is fundamental for anyone entering the profession. An introduction is given to imaging systems: X-radiography, gamma cameras, X-ray computed tomography, single photon computer tomography (SPECT) and positron emission tomography (PET). An overview is given of radiotherapy techniques and the biological processes concomitant with this modality, together with discussion of isodose curves and variation with incident radiation energy. 
Module Aims
To achieve an understanding of medical X-ray and gamma ray imaging technology in terms of equipment components and their performance and to relate this to the needs of diagnostic medical imaging. To give the student a broad overview of the techniques used in-vivo and in-vitro nuclear medicine studies. To provide an overview of the use of radiopharmaceuticals in nuclear medicine. To establish a basic appreciation of the operational aspects of radiotherapy treatment units and accessories, the radiation beams available and their interaction with tissues, together with clinical implications. An appreciation of quality management, its aims and application to imaging and radiotherapy.  
Learning Outcomes

After completing this module, the student should be able to: 
Module Specific Skills:  

·         describe the physical principles and key technologies which determine the performance of medical X-ray imaging systems; 
·         describe the quality assurance cycle required for diagnostic X-ray and nuclear medicine equipment and to be familiar with test equipment commonly used for the most important measurements undertaken by physicists in an imaging department; 
·         describe the operation of treatment units and the radiation beams available together with their interactions in tissues and the clinical implications; 
·         describe details of the quality management system required in its application to radiotherapy facilities.  

Discipline Specific Skills:  

·            use this knowledge when taking up posts within the Health Service and other related fields.  

Personal and Key Skills:  

·            ability to use physics techniques in a multidisciplinary context;  

ability to evaluate the risks involved in a particular application.
Module Content

















Dr AJ Britten  














Prof. N.M. Spyrou























Dr I Badr



















Mr A Rust

























Dr M Masoomi/ DR J. Ballinger

























Dr AD Hall





















Dr J Ballinger







Prof A Nisbet



and relevant RSCH staff



X-ray Imaging and analysis



X-rays and diagnostic radiology; MTF and ROC Analysis 
The X-ray tube construction and operational needs.
X-ray scatter in diagnostic imaging and scatter reduction methods.



X-ray film, intensifying screens and film-screen imaging performance.



Non-film imaging:  Image intensifiers and video X-ray images.  Digital Subtraction Angiography. The production and use of digital medical X-ray images. Photostimulable phosphors and direct digital X-ray detectors.





Mathematical formulation of the imaging system; linear operator, principle of superposition, impulse response function, stationarity, line spread function, edge spread function, convolution integral, MTF.  Usefulness of MTF, modulation input and output, test objects, measure of  performance, cascade MTFs.  Perception of detail, visual acuity, resolution criteria.  Existence of observer, decision criteria, confidence thresholds, conditional probabilities, types of decision. Construction of the ROC curve and principle of ROC analysis.






Introduction to quality management systems.  The quality assurance or life cycle of x-ray equipment.  The role of the physicist, radiographer and engineer.  Types of x-ray equipment.  Radiation safety and performance measurements on diagnostic and fluoroscopic equipment.  Test equipment for the physicist.  Published protocols.  Measurement and significance of patient dose.  Radiation safety design of x-ray rooms.  Optimisation of patient exposure.





The NHS Breast Screening Programme - organisation, facts and figures.  Risk/benefit analysis in mammography.  The profile of quality assurance and the role of the physicist. Elements of the mammographic imaging system:  dedicated X-ray sets, films, intensifying screens and film processing systems.  Use of various anode and filter materials to tailor the X-ray spectrum to individual patients.  Effects of film processing on image quality and patient dose.  Stereotactic biopsy systems and special procedures.  Introduction to digital imaging modalities and their applications in mammography.





Nuclear Medicine



Types of radionuclides used in medicine and methods of production.  'In vivo' and sample measurement techniques.  Radionuclide imaging, design and QA of cameras and other imaging systems.  Gamma-ray emission tomography and positron tomography.  Dynamic studies.  Whole body counting.  Saturation analysis.  Clinical applications of radionuclide techniques, tumour localisation and uptake, organ function, absorption studies, metabolic investigations.  Comparison of radionuclide and other tests. Gamma probe;  design and clinical application.  Introduction to PET imaging.  PET instrumentation;  coincident events, scintillators, block detectors, 2D versus 3D, PET radioisotopes.  Clinical application of PET.





Radionuclides - review of decay modes and production methods.  Preparation of radiopharmaceuticals - Pharmacopoeial requirements.  Overview of radiopharmaceuticals - labelling methodologies.  Diagnostic radiopharmaceuticals - selection of radionuclide, localisation mechanisms, clinical applications, protein and peptide based radiopharmaceuticals



Therapeutic radiopharmaceuticals - selection of radionuclide, relevance of dosimetry studies, clinical applications



In vitro studies











Radiotherapy and Treatment Planning



Overview of role of radiotherapy and biological process.  Interaction of X-rays and electrons with body tissues.  Isodose curves and variation with incident radiation energy.  Clinical advantages of high energy X-radiations.



Production of X-radiation.  Operation of X-ray therapy units, cobalt-60 teletherapy units and linear accelerators. Features of modern linear accelerators including those for conformal and intensity modulated radiotherapy.  Sources of treatment errors and safety features in treatment units.  Acceptance and routine tests of treatment unit performance.  Quality Management Systems, ISO 9001 (2000) and quality assurance in radiotherapy.  To introduce quality management, its aims and its applications to radiotherapy.



External Beam Radiotherapy:  Factors affecting dose.  Treatment planning for kilovoltage, 60Co and linacs (high energy photons and electrons).  Planning techniques for single fields, two fields and multiple fields.  Beam modifiers such as wedges, compensators.  Planning techniques such as conformal radiotherapy and intensity modulated radiotherapy.  Examples will be given.  Brachytherapy:  Interstitial and intracavity, radionuclides and techniques used, high and low dose rate and after-loading procedures.  Four examples will be discussed in detail.






















































































































































Methods of Teaching/Learning
The module is taught by lecturers from both the Department of Physics and from hospitals.

This module is assessed in Paper 3 which will consist of 6 questions.  Students answer 4 questions from the 6.
Selected Texts/Journals

 (i) Essential Reading 
Radiation Oncology Physics. Ed. E.B. Podgorsak, IAEA, 2005 
Linear Accelerators for Radiotherapy, Greene D, Adam Hilger (Medical Physics Handbook 17) 1986, 
Physics of Electron Beam Therapy, Klevenhagen SCB, Adam Hilger (Medical Physics Handbook 13) 1985, 
Medical Electron Accelerators, Karzmark CJ, Nunan CS & Tanabe E, McGraw Hill (1993), 
Radiotherapy Physics (in practice), Williams JR & Thwaites DI. Oxford Medical Publications (1993), 
The Physics of Three-Dimensional Radiation Therapy, Webb, S, IoP Publishing Ltd;., Bristol (1993) 
The Physics of Radiation Therapy, Khan FM, Williams and Wilkins, 3rd Edn, 2003 
Physical Aspects of Brachytherapy, Godden TJ, Adam Hilger 1988    
The Essential Physics of Medical Imaging, Ed J T Bushberg, Williams & Wilkins, 1994 
The Physics of Medical Imaging, Ed S Webb, IoPP, 2002 
Medical Radiation Detectors, Editor N F Kember, IoPP, 1994 
Physics for Radiologists. Dendy & Heaton, Taylor & Francis; 2nd Edn, 1999 
Christensens Diagnostic Radiology, Lippincott Williams & Wilkins; 4th Edn, 1990 
Textbook of Radiopharmacy: Theory & Practice. 3rd Edn, CB Sampson, Gordon & Breach, 1999
Basic Science of Nuclear Medicine, Parker, Smith & Taylor, Churchill/Livingstone, 1984 
extbook of Nuclear Medicine, Vol I: Basic Science, Vol II: Clinical Applications, Harbert & Da Rocha, Lea & Febiger, 1984          
Practical Nuclear Medicine, Sharp, Gemmell & Smith. OUP 2nd Edn, 1998 
Physics in Nuclear Medicine, Cherry, Sorenson, Phelps. Saunders, 3rd Edn, 2003   
Medical Electron Accelerators, Karzmark CJ, Nunan CS & Tanabe E, McGraw Hill (1993), 
The Physics of 3D Radiation Therapy, Webb, S, IoPP, 1993 
Radiotherapy Physics in Practice, Ed: Williams & Thwaites, Oxford Medical Pub 2nd Edn, 2000 
Practical Radiotherapy Planning, Dobbs J, Barratt A and Ash D, Edward Arnold 3rd Edn, 1999 
The Physics of Conformal Radiotherapy, Webb S, IoPP,1997 
Intensity Modulated Radiation Therapy, Webb, S, Institute of Physics Publishing Ltd. (2001) 
Contemporary IMRT, Webb S, IoPP, 2005 
(ii) Supplementary Reading 
Guidance on the establishment and use of Diagnostic Reference Levels for Medical X-ray Examinations. IPEM Report 88, 2004. 
IPEM, College of Radiographers and the NRPB, 2005. Recommended Standards for Routine Performance Testing of Diagnostic X-ray Imaging Systems. IPEM Report 91 
IPEM, 1996-8. Measurement of the Performance Characteristics of Diagnostic X-ray Systems used in Medicine. Report 32  (2nd Edn). Part I: X-ray tubes and generators; Part II: X-ray image intensifier television systems; Part IV: X-ray intensifying screens, films, processors and automatic exposure control systems; Part V: Conventional tomographic equipment; Part VI: X-ray image intensifier fluorography systems. 
Screen Film Mammography. G T Barnes & G D Frey. Medical Physics Publishing 
Film Processing in Medical Imaging A G Haus.  Medical Physics Publishing 
Review of computerised radiography systems in the NHS. NHS BSP Equip. Rep. 0501, 2005 
A cost comparison of full-field digital mammography with film-screen mammography in breast cancer screening.  NHS BSP Equipment Report 0403, 2004 
QA Guideline for Medical Physics Services NHS BSP Pub 33, 2nd Edn, 2005 
Review of Radiation Risk in Breast Screening.  NHS BSP Pub 54, 2003 
Computer Aided Detection in Mammography.  NHS BSP Pub 48, 2001 
Performance of Mammographic Equipment in the Breast Screening Programme in 2000/2001. NHS BSP Pub 56, 2003 
IPEM Rep. 89. The Commissioning & Routine Testing of Mammographic X-ray Systems, 2005 
Screening for breast cancer in :  Past & future. NHS BSP Pub 61, 2006 
Consolidated Guidance on Standards for the NHS Breast Screening Programme NHS BSP Pub 60, 2005 
European Standard EN ISO 9001, European Committee for Standardisation, Brussels , 2000 
ICRU Report 50, Prescribing, Recording and Reporting Photon Beam Therapy, 1993 
ICRU Report 62, Supplement to Report 50, 1999 
BJR Suppl. 25, Central Axis Depth Dose Data for use in Radiotherapy, BIR, 1996 
Imaging in Biological Research, Part A (Methods in Enzymology, Volume 385) ISBN: 0-12-182790-9 
Imaging in Biological Research, Part B (Methods in Enzymology, Volume 386) ISBN: 0-12-182791-7 
P. Michael Conn (Series Volume Editor) Publisher: Academic Press Publication Date: 10 July 2004 
A variety of review articles covering the field are available in the scientific literature, including: Molecular Imaging Perspectives, J R Soc Interface, 2005 (published online) Paul J Cassidy and George K Radda 
Intensity-Modulated Radiotherapy:  Current Status and Issues of Interest. Int. J. Radiation Oncology Biol. Phys., SI No. 4, 880-914 (2001) 
European Standard EN ISO 9001 (2000), European Committee for Standardisation, Brussels (2000)




Last Updated

9 January 2009