MEDICAL PHYSICS INTERNATIONAL Journal (Rejected May 2020)
A DIFFERENT PERSPECTIVE ON MEDICAL PHYSICS EDUCATION
AND TRAINING IN ALGERIA
H. Zaidi1 and A. Brihmat2
1
Geneva University Hospital, Division of Nuclear Medicine & Molecular Imaging, Geneva, Switzerland
2
Service de Radiothérapie, Centre de Lutte Contre le Cancer, Annaba, Algeria
Abstract— We should not let our past dictate our future but
shaping our future should be based on thorough
understanding of our past. Medical physicists should not only
keep complaining about the lack of support, equipment and
educational programs. They should also develop critical
thinking skills to learn from their mistakes and build bridges
to the future of their discipline.
Keywords— Medical physics, Algeria, education and training.
I. INTRODUCTION
During the 1999 Forum held in Crans-Montana,
Switzerland, the former President of Algeria, the one whose
fate merges with the history of his country, launched after
coming to power in a very provocative declaration: “I am
the whole of Algeria, I am the embodiment of the Algerian
people.” This is politics. Scientists would find it strange that
even the most famous medical physicist claims that he is the
illustration of medical physics in his own country.
Therefore, it’s with great humility that we are providing
herein our views of the history of this discipline in Algeria
and highlight the major challenges facing its further
development, particularly issues related to education and
training of medical physicists in view of the lack of a
medical physics society. The ideas and thoughts expressed
herein complement those provided in a recent report [1],
which unfortunately didn’t reference previous articles
addressing the same topic [2, 3]. In this brief
communication, we briefly review the history of medical
physics and provide a critical appraisal of the current
situation in Algeria.
II. BRIEF HISTORY OF MEDICAL PHYSICS IN ALGERIA
While it’s true that medical physics activities started as
early as 1959, it’s only towards the end of the 1980s that the
Algerian government realized that the radiotherapy
treatment of cancer patients had become an important
source of transfers for care abroad. To reduce or even
eliminate this economic burden, they initiated a project
culminating with the creation of regional cancer centres in
Algiers (CPMC), Blida (Frantz Fanon) and Constantine
(CHU Benbadis). The national Atomic Energy authority
( ommissariat l’ nergie tomi ue - COMENA), a key
partner in this initiative, was responsible for monitoring the
construction of the centers (bunkers), the acquisition of
1
equipment, and the training of medical physicists and other
staff to enable the operation of these facilities in good
conditions. From 2007, the Algerian government began to
modernize existing radiotherapy equipment and build new
centers by introducing modern imaging-based radiotherapy.
The transition from 2D to 3D (or even 4D) radiotherapy
treatment planning represented a greater challenge than in
the 1990s and required more intensive training of physicists,
radiation oncologists and technologists.
It is within the framework of the recommendations of the
"International Study Days for the Optimization of
Radiotherapy Treatments" organized jointly by the
COMENA and the Ministry of Population and Hospital
Reform that the latter established, despite the lack of
support from the former, a training program on
conformational radiotherapy for one year, at the rate of 12
sessions lasting 5 full days per month, for 30 radiotherapy
radiation oncologists from different corners of the country.
This training was unfortunately interrupted in its second
edition in June 2011 for the above-mentioned reasons. From
2013, a solemn commitment at the highest level of the state
made fighting against cancer a national priority. A Cancer
Plan was born, and 2 years later, a comprehensive report
was published [4]. Curiously, medical physicists were not
consulted or involved among the long list of contributors
and participants. Steering committees for the cancer plan
were created starting from 2016 and few medical physicists
were involved in the radiotherapy group under the
leadership of a radiation oncologist.
III. EDUCATION AND TRAINING IN MEDICAL PHYSICS
In 1988, the COMENA organized, on an exceptional
basis, a national competition for entry to a specialized
postgraduate training (Diplome de Postgraduation
Spécialisé) in Medical Physics. Two years later, 6 students
presented their dissertations on various themes linked to
external beam radiotherapy, brachytherapy and nuclear
medicine. Four of them were seconded to the “Centre Anti
Cancer” based in Constantine and two in Blida, which they
considered to be their natural home. These physicists
created, from scratch, and for the 1st time in Algeria,
Medical Physics units within University hospitals. This was
followed by a second program where ten medical physicists
were trained to graduate with a Magister (Master of
Science) degree. Some colleagues claimed for years that
they were coordinating and supervising, from COMENA,
 MEDICAL PHYSICS INTERNATIONAL Journal (Rejected May 2020)
medical physics activities in Algeria. This cannot be true at
least in Constantine or Blida and with a lot of doubt at the
CPMC (Algiers) where medical physics support was
provided by a pharmacist for several years. In 1994, a group
of medical physicists created the “ lgerian ssociation of
Medical Physicisits”. Unfortunately, this effort didn’t
survive as it was difficult to fulfil the legal requirements to
get approval from the authorities especially that the lead
person left the country. Surprisingly, some medical
physicists didn’t support this initiative. Later, other post-
graduate training programs in few universities, led by
faculty having background in nuclear or theoretical physics,
were launched sporadically in Constantine, Algiers, Blida,
Oran, Setif, Jijel, Tlemcen, with very little or no clinical
training. The absence of qualified medical physicists
involved in most of these programs had a negative impact
on the quality of education and training provided to young
medical physicists. The lack of clinical residency is another
major concern, keeping in mind that a number of these
physicists were immediately hired to provide clinical
support in the above mentioned national cancer centres. It
was only, following the strong involvement of senior
medical physicists in some programs (e.g. in Constantine)
that acceptable classes and practical sessions in radiotherapy
and in nuclear medicine were put in place. The IAEA
bilateral cooperation projects, mainly led by COMENA in
Algiers, did not reach the expected level of success owing to
questionable vision of the modern evolution of radiation
oncology technology, if not worse, leading to installation of
Cobalt-60 units even in 2010.
IV. REGULATION OF MEDICAL PHYSICS
As early as 2005, a legal document came into sight, in
which it was mentioned that "a specialist in radiation
physics” must be assigned to any radiotherapy unit. The
same document also mentioned that radiology and nuclear
medicine departments should seek, when necessary, the
services of "a specialist in radiation physics” without
providing any details on the duties, duration of part-time
involvement as well as the required skills/training, etc [5].
In 2010, an influential radiation oncologist managed to
validate the first statute of the medical physicist in the
country, without any prior consultation with medical
physicists in place since more than 20 years and in total
disrespect for the country's regulatory body (COMENA)
[6]. This statute was considered catastrophic by virtually all
active medical physicists. Attempts to modify this status
made within the framework of the 2015-2019 Cancer Plan
monitoring committee, based on the scheme proposed by
the IAEA, were unfortunately unsuccessful. The perception
of a qualified physicist in clinical practice is specified in the
IAEA recommendations [7], yet it’s completely absent in
the 2010 statute. It’s worth mentioning that recertification or
what the AAPM and other professional societies call
"maintenance of certification" is a prerequisite that needs to
be satisfied. With the opening of new anti-cancer centers,
recruitment of “biomedical engineers” having no
competence in the field of medical physics to occupy the
positions of physicists became common practice following
the award of an "equivalence" delivered by the authorities.
The lack of a national medical physics society in the
country is a serious concern that needs to be addressed.
V. CONCLUSIONS
A new, more attractive statute for the medical physicist
considering the aspirations of physicists should be
elaborated in collaboration with the national regulatory
body. The establishment of a medical physics society to
promote this discipline is in our opinion critical.
Coordination between universities and hospitals with the
involvement of active clinical physicists that can offer
training programs to provide adequate qualifications to
young medical physicists is a necessity. Clinical centres
having sufficiently qualified physicists to provide validated
clinical residency programs could then be established. It is
suggested that the training of young medical physicists
should be performed in a single site (COMENA) jointly
with the Ministry of Health, Population and Hospital
Reform to enable providing adequate training to medical
physicists within a clinical environment according to the
recommendations of the IAEA [7].
ACKNOWLEDGMENT
The authors would like to thank all their colleagues who
contributed in a way or another to the development of
medical physics in Algeria.
REFERENCES
1. Toutaoui A, Khelassi-Toutaoui N, Brahimi Z. Medical Physics
Education and training in Algeria. Med Phys Int. 2019;7:284-5.
2. Zaidi H. Reflections on International collaboration in medical physics.
Phys Med. 1997;XIII:417-9.
3. Zaidi H. Medical physics in developing countries: looking for a better
world. Biomed Imaging Interv J. 2008;4:e29.
4. INSP. Plan Cancer 2014-2019. Available at
http://www.insp.dz/images/PDF/Plan%20National%20Cancer%20201
5-2019.pdf.
5. JOURNAL OFFICIEL DE LA REPUBLIQUE ALGERIENNE. N° 27
du 13 avril 2005.
6. JOURNAL OFFICIEL DE LA REPUBLIQUE ALGERIENNE. N° 43
du 14 juillet 2010.
7. IAEA. Roles and responsibilities, and education and training
requirements for clinically qualified medical physicists. . Vienna,
Austria: International Atomic Energy Agency; 2013.
Contacts of the corresponding author:
Author: Habib Zaidi
Institute: Geneva University Hospital
Street: Division of Nuclear Medicine & Molecular Imaging
City: Geneva, Country: Switzerland
Email: habib.zaidi@hcuge.ch