Diagnostic and Nuclear Medical Physics Residency

Overview

The Diagnostic and Nuclear Medical Physics Residency at Cleveland Clinic aims to provide the highest quality training in all areas of imaging physics. The residency was first established in 2016 as a two-year training program in diagnostic medical physics. This two-year program was accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) in November 2017. In 2019, the program expanded to include an additional year of training in nuclear medicine. The combined three-year program has been accredited by CAMPEP since August 2020.

With a strong clinical focus, the program is designed based on the CAMPEP standards and the recommendations of the AAPM Report No. 249. Residents, under the supervision of board-certified medical physicists, perform the following training activities:

• Acceptance, annual, and post-repair testing of imaging equipment to ensure quality, safety, and regulatory compliance.
• Troubleshooting of image artifacts and other quality and safety incidents.
• Radiation dose tracking and protocol optimization.
• Accreditation data collection, site planning, site inspection, and equipment purchase.
• Patient/conceptus dose estimation, shielding calculation, and general health physics training.
• Shadowing of technologists and radiologists to understand how medical physics practice affects other healthcare providers.
• Attending and assisting in teaching conferences, quality assurance committee meetings and clinical/research seminars.
• Conducting research and presenting findings at local or national conferences.
• Teaching medical physics to other healthcare providers.

The residency training experience can be used to qualify for the certification examinations by the American Board of Radiology (ABR) in diagnostic and nuclear medical physics and the certification examination by the American Board of Science in Nuclear Medicine (ABSNM).

About Us

The Imaging Institute at Cleveland Clinic is one of the leading radiological academic centers in the world. It is also one of the busiest clinical departments in the country, performing more than 2.7 million examinations every year. Its Section of Medical Physics was officially founded in 1998 and currently consists of:

• 8 board-certified medical physicists (professional staff, rotation mentors).
• 1 quality physicist.
• 3 quality assurance technologists.
• 2 administrative staff.
• 2 system analysts.
• 3 residents.

The Section of Medical Physics and the Department of Nuclear Medicine provide medical physics service to the Cleveland Clinic Health System, including a main campus, 21 hospitals, 4 affiliated hospital, and 87 family health centers. Equipment available for resident training includes approximately:

• 104 CT scanners.
• 71 MR scanners.
• 98 mammography units.
• 188 ultrasound units.
• 86 angiographic or cardiac catheterization units.
• 601 general radiographic or general fluoroscopic units.
• 54 dental units.
• 167 primary display workstations.
• 13 Gamma cameras (10 SPECT, 3 SPECT/CT) and 3 PET/CT scanners.
• Various hot lab equipment.

In addition, residents participate in ACR accreditation testing for advanced imaging modalities such as CT, MR, mammography, gamma cameras, and PET.

One of the most cherished missions of Cleveland Clinic is “further education of those who serve”. Since its inception, the Section of Medical Physics has been enthusiastic in training the next generation of medical physicists. The enthusiasm of the section members to teach and to educate is the greatest incentive behind the launching of the residency program. This program benefits from the rich clinical and educational resources of Cleveland Clinic. It also benefits from its partnership with the recently formed Medical Physics Graduate Program at Case Western Reserve University as well as the clinic’s Radiology Residency and Radiation Oncology Physics Residency.

Program Faculty

Paul Johnson, PhD DABHP DABR
Program Director
Rotation mentor for radiation safety and nuclear medicine

Krishnendu Saha, PhD CHP DABSNM, DABMP
Associate Director (Nuclear)
Rotation mentor for nuclear medicine, radiation safety, and CT

Celalettin Topbas, PhD DABR
Associate Director (Diagnostic)
Rotation mentor for fluoroscopy and informatics

Xiang Li, PhD DABR 
Associate Director (Diagnostic)
Rotation mentor for radiography and CT

Mindy Bolger-Nahrstedt, MHA
Program Administrator  

Grant Fong, MS DABMP DABR
Rotation mentor for CT, MR and ultrasound

Katie Hulme, MS DABR
Rotation mentor for mammography, informatics, and radiography

Ashraf Morgan, PhD DABR
Rotation mentor for MR and ultrasound

Vivek Singh, PhD DABR
Rotation mentor for fluoroscopy

Eryn Doyle, MS
Quality physicist
Rotation mentor for radiography and mammography

Patrick Fisher, RT (R)(CT)(ARRT)
Quality assurance technologist

Vincent Kubicki, RT (R)(QM)
Quality assurance technologist

Bradley Powell, RT (R)(CT)
Quality assurance technologist

Contact Us

Joyce Hegedus
Education Coordinator
25900 Science Park Dr
Mailcode AC211
Beachwood, OH 44122
216.444.4517
hegeduj@ccf.org
 

Training

Clinical rotations

The nuclear component of the residency program is one year in duration, consisting of 5 rotations:

• Basic nuclear medicine physics.
• Hot lab.
• Gamma camera.
• PET.
• Nuclear medicine safety and dosimetry.

The diagnostic component of the residency program is two years in duration, consisting of 15 rotations through 8 modalities:

• Radiography.
• Fluoroscopy.
• Mammography.
• Informatics and display.
• CT.
• MRI.
• Ultrasound.
• Radiation safety and regulations.

The residents are exposed to most diagnostic modalities twice, once in their second year and once in their third year.

Download a sample training schedule.

The rotation mentors devote substantial time and efforts to training residents, as evident by the various elements of a clinical rotation:

• A resident’s initial experience with equipment testing in a given modality is always supervised by a rotation mentor (a board-certified physicist). The mentor not only introduces the testing procedures, but also explains and quizzes the resident on the rationale behind each test. They also discuss the related regulations and standards. Subsequent training in equipment testing is also provided mostly by rotation mentors with other experienced individuals (e.g., quality assurance technologists and senior residents) acting in a supplemental role.
• In most modalities, a resident progresses through four training levels: (1) observe and assist, (2) test under close supervision, (3) test with occasional assistance, and (4) test independently.
• For selected modalities (e.g., radiography, fluoroscopy, and ultrasound), equipment testing does not require the presence of a certified physicist. For such modalities, a resident will be issued a Certificate of Independence once they’re deemed qualified to test independently (Level 4). At this level, a resident is also the lead person to handle all the scheduling and communications. Several periods of Practice of Independence are built into the training schedule to allow a senior resident to practice working independently. In addition, there are frequent opportunities for a senior resident to lead the investigation of an image quality issue. Such opportunities develop key skills of critical thinking, problem-solving, and communication. They allow the residents to experience at firsthand how their knowledge and skills can make a difference in patient care.
• Residents with adequate teaching skills may also advance to Level 5, where they mentor a junior resident in the absence of a rotation mentor.
• The curriculum is designed to provide sufficient experience for a resident to obtain the following mammography credentials before graduation: (a) FDA requirements for 8 hours of initial training in digital breast tomosynthesis, (b) FDA and ACR requirements for stereotactic breast biopsy, and (c) Ohio Certified Radiation Expert (CRE) in mammography.
• On a weekly or biweekly basis, the rotation mentors have sit-down didactic sessions with the residents. Topics discussed include (a) the fundamental principles of the image modality, (b) practice-based skills (e.g., image artifact troubleshooting, structure shielding design, and patient dose calculation) and (3) special interest topics (e.g., radiation dose tracking, protocol optimization, and equipment purchasing). Residents are asked to complete an assignment or a reading list before each didactic session. During the session, the mentors quiz the residents frequently and ask them to teach mini-topics on a white board. This evaluates the residents’ understanding of the subject material and provides them with ample opportunities to practice oral presentation skills.
• To enhance the residents’ awareness of and responsiveness to the larger system of health care, mentors arrange for the residents to shadow (a) patient imaging procedures, (b) technologist quality control, (c) radiologist interpretation, and (d) internal and external audits and inspections.
• Training in each rotation also includes an oral presentation to the entire Section of Medical Physics. The rotation presentation is intended for a resident to delve deep into a particular clinical topic and for the group to learn from the resident’s oral report.

Download sample rotation presentation topics.

• Each rotation ends with two competency tests, an oral test in medical physics knowledge and a hands-on test in equipment testing skills. A separate assessment of professional behavior completes the evaluation package.
• Finally, a modality revisiting scheme is in place to allow a resident to revisit earlier rotations to keep their knowledge and skills fresh.

The above training elements ensure that the residents are progressively trained and rigorously evaluated in six core competency areas specified by the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME):

• Patient care and procedure skills.
• Medical knowledge.
• Practice-based learning and improvements.
• Interpersonal and communication skills.
• Professionalism.
• Systems-based practice.

In addition, a comprehensive orientation program is designed to provide training in safety, ethics/professionalism, leadership, and informatics.

At the resident’s request, mock oral exams, emulating the style of the ABR Part III exams, are provided at the end of the residency.

Research

As a clinically focused training program, our residency does not offer protected research time. It may not be suited for individuals with strong interest in academic research. However, applicants enjoying clinical research and troubleshooting in a clinical environment will find the training experience stimulating and rewarding.

At the beginning of their second year, a resident is provided with a list of potential projects, divided into two categories: research projects and practical quality improvement (PQI) projects. Research projects require more efforts, are longer-term, and are more likely to result in conference abstracts. PQI projects are short-term efforts that aim to address ongoing clinical needs. A resident should choose a single research project. In addition, he or she is welcome to take on any number of PQI projects provided that the resident’s clinical training is in good standing. Before making a final decision, the resident is strongly advised to discuss the projects of interest with the mentors to get more information about the projects as well as the mentor’s expectations and mentoring styles.

While collaboration with other trainees, such as graduate students and radiology fellows, is encouraged, the majority of the work on literature review, data collection, analysis, and presentation should be conducted by the resident. To ensure a productive effort, the resident is required to submit at least two conference abstracts in the three-year training period.

By engaging in research and PQI projects, the resident is exposed to the entire process of:

• Recognizing patient care challenges that can be addressed by scientific studies,
• Applying scientific methodology to solve problems, and
• Communicating scientific ideas through writing and speaking in a public forum.

Download sample research presentations the residents have given at professional conferences.

Conferences

Residents participate in teaching conferences, quality assurance committee meetings, clinical/research seminars, and journal clubs. A list of required and recommended activities can be found below:

• Download information about Conference Participation.

By participating in these activities, the residents:

• Broaden their knowledge about the fields of radiology and medical physics.
• Interact with caregivers in related disciplines.
• Enhance their communication skills.
• Develop a habit of life-long learning.

Teaching

Residents are highly encouraged to teach, especially during their second and third years of training. Examples of resident teaching activities include

• Teaching 2-3 physics lectures to the radiology residents.
• Assisting program faculty in teaching hands-on labs to the radiology residents.
• Providing fluoroscopy hands-on training to physician fellows and residents.
• Providing radiation safety training to technologists and nurses.
• Offering in-service training to technologists during the transition to ACR digital mammography QC manual.

Program completion requirements

The residents receive a Certificate of Completion subject to the following requirements:

• Meeting all behavior expectations.
• Satisfactory completion of orientation requirements, as documented in the orientation summary report signed by the program director.
• Satisfactory completion of clinical rotations as documented in the rotation completion records signed by the supervising physicists and the program director.
• Completion of the annual RAPHEX exams.
• Meeting MQSA initial qualification for medical physicists.
• Completion and submission of all evaluation forms, including evaluations of individual rotations and evaluation of the residency program as a whole.
• Meeting the requirements for conference attendance.
• Satisfactory completion of the chosen research project with at least 2 abstracts submitted to local or national conferences during the three-year training period.

Resident Life & Benefits

Salary & benefits

Medical physic residents are Cleveland Clinic employees and eligible for all the employee benefits:

• Salary:  $58,400.
• Health insurance: Cleveland Clinic Employee Health Plan.
• Paid time off: 28 days per year (including 6 designated holidays).
• Office space: Each resident has an individual cubicle with standard office support, including a desk phone, an email account, a Cleveland Clinic laptop with a docking station, internet access, and a shared color printer/copier. The residents' office space is also a short walk to a well-equipment gym.

Commute

Cleveland Clinic has locations in Cleveland, Florida, Nevada, Toronto, Abu Dhabi, and London. At this time, resident training is only offered at the Cleveland facilities. The majority of these facilities are located within 45 minutes of the resident office in Beachwood, Ohio. Senior residents, if interested, may have the opportunity to travel to Florida once or twice to provide clinical physics support.

City of Cleveland

Cleveland often takes its visitors by surprise because it offers all the activities and amenities of a big city while maintaining the affordability and convenience of a smaller city. There is something for everyone, from sports and parks to theatre and fine dining.

Cleveland is home to the second largest theatre district in the country. Playhouse Square is alive with first run Broadway shows and musical talent. Before or after the show there are countless award winning restaurants from which to choose. Michael Symon and Zack Bruell are just a few who have made Cleveland home for their culinary talent. University Circle is full of culture with world-renowned museums, including the Cleveland Museum of Art and the Western Reserve Historical Society. It is also home to the amazing Cleveland Orchestra that performs in the recently refurbished Severance Hall which is known as one of America’s most beautiful concert halls.

If you are an outdoor enthusiast, the Cleveland Metroparks offer scenic areas to hike, cycle, boat, fish, golf, and explore. Enjoy Edgewater Park where you can swim or enjoy a beautiful sunset over Lake Erie. The Cleveland Metropark Zoo is also a part of this eighteen park system.

With all this, the cost of living in Cleveland is dramatically cheaper than in most major cities. In short, Cleveland is a great place to live, work and play!

• For more information, check out this webpage about Life in Cleveland.

Statistics

Admission Statistics

Post-residency statistics

Destination of graduates

Apply

To be considered for admission into the residency program, applicants must be enrolled in or have graduated from a CAMPEP-accredited graduate or certificate program with either a MS or a PhD degree. Completion of degree requirements will be expected before the start date of the residency. Qualified individuals must be able to lift up to 50 lb. of equipment and feel comfortable driving to various training sites (mostly within 45 minutes of driving distance). 

Starting in 2023, our program no longer participates in the Medical Physics Match program. Residency openings will be posted in the AAPM Blue Book in the fall. Interested applicants should submit their applications to the Cleveland Clinic Human Resources website directly. 

Applicants will be notified by email as to their status (e.g., selected for interview, wait listed or removed from consideration).

The residency commences at the beginning of July. Interested applicants should submit:

• Curriculum Vitae
• Statement of personal interests and goals
• Three letters of recommendation
• Official transcripts of all undergraduate and graduate studies