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PURPOSE: We propose a novel compensator-based IMRT system designed to provide a simple, reliable, and cost-effective adjunct technology, with the goal of expanding global access to advanced radiotherapy techniques. The system would employ easily reusable tungsten bead compensators that operate independent of a gantry (e.g., mounted in a ring around the patient). Thereby the system can be retrofitted to existing linac and cobalt teletherapy units. This study explores the quality of treatment plans from the proposed system and the dependence on associated design parameters. METHODS: We considered (60)Co-based plans as the most challenging scenario for dosimetry and benchmarked them against clinical MLC-based plans delivered on a linac. Treatment planning was performed in the Pinnacle treatment planning system with commissioning based on Monte Carlo simulations of compensated beams. (60)Co-compensator IMRT plans were generated for five patients with head-and-neck cancer and five with gynecological cancer and compared to respective IMRT plans using a 6 MV linac beam with an MLC. The dependence of dosimetric endpoints on compensator resolution, thickness, position, and number of beams was assessed. Dosimetric accuracy was validated by Monte Carlo simulations of dose distribution in a water phantom from beams with the IMRT plan compensators. RESULTS: The (60)Co-compensator plans had on average equivalent PTV coverage and somewhat inferior OAR sparing compared to the 6 MV-MLC plans, but the differences in dosimetric endpoints were clinically acceptable. Calculated treatment times for head-and-neck plans were 7.6 ± 2.0 min vs 3.9 ± 0.8 min (6 MV-MLC vs (60)Co-compensator) and for gynecological plans were 8.7 ± 3.1 min vs 4.3 ± 0.4 min. Plan quality was insensitive to most design parameters over much of the ranges studied, with no degradation found when the compensator resolution was finer than 6 mm, maximum thickness at least 2 tenth-value-layers, and more than five beams were used. Source-to-compensator distances of 53 and 63 cm resulted in very similar plan quality. Monte Carlo simulations suggest no increase in surface dose for the geometries considered here. Simulated dosimetric validation tests had median gamma pass rates of 97.6% for criteria of 3% (global)/3 mm with a 10% threshold. CONCLUSIONS: The novel ring-compensator IMRT system can produce plans of comparable quality to standard 6 MV-MLC systems. Even when (60)Co beams are used the plan quality is acceptable and treatment times are substantially reduced. (60)Co-compensator IMRT plans are adequately modeled in an existing commercial treatment planning system. These results motivate further development of this low-cost adaptable technology with translation through clinical trials and deployment to expand the reach of IMRT in low- and middle-income countries.

INTRODUCTION: As radiotherapy moves towards intensity modulated arc therapy (arc‐IMRT), there is a need for electronic portal imaging(EPID) to move towards continuous acquisition (cine) mode for dosimetric verification purposes. However, as the EPID resolution and frame rate (fps) increase, so does the computational burden of image processing. We investigated the reliability of cine mode EPIDimaging in IMRT as a function of frame rate. METHODS: We acquired EPIDimages continuously while running an IMRT plan (6MV photons, 150MU, dose rate = 300MU/min) with frame rates ranging from 1–12 fps, as well as a single integrated mode image. Each cine dataset was then averaged to form a single image, which was compared with the integrated mode image by means of a pixel‐by‐pixel absolute value subtraction. RESULTS: Although a greater frame rate gave better agreement with the integrated mode image in all cases, the relative benefit diminished with increasing frame rate. In particular, for the IMRT plan delivered, there was little benefit of imaging faster than 6 fps, and virtually no benefit in increasing from 9 to 12 fps. In contrast, 12 fps produces twice the number of images as 6 fps which significantly increases the image processing and data storage burdens. CONCLUSION: Increasing frame rate in cine mode EPIDimaging may be beneficial in some cases, but there is likely a threshold level above which no relevant additional information is obtained. Further research to determine the ideal frame rate for any particular IMRT or arc‐IMRT plan is warranted.

Purpose: Total body irradiation (TBI) techniques aim to deliver a uniform radiationdose to a patient with an irregular body contour and a heterogeneous density distribution to within ±10% of the prescribed dose. In the current article, the authors present a novel, aperture modulated, translating bed TBI (AMTBI) technique that produces a high degree of dose uniformity throughout the entire patient. Methods: The radiation beam is dynamically shaped in two dimensions using a multileaf collimator(MLC). The irregular surface compensation algorithm in the Eclipse™ treatment planning system is used for fluence optimization, which is performed based on penetration depth and internal inhomogeneities. Two optimal fluence maps (AP and PA) are generated and beam apertures are created to deliver these optimal fluences. During treatment, the patient/phantom is translated on a motorized bed close to the floor (source to bed distance: 204.5 cm) under a stationary radiation beam with 0° gantry angle. The bed motion and dynamic beam apertures are synchronized. Results: The AMTBI technique produces a more homogeneous dose distribution than fixed open beam translating bed TBI. In phantom studies, the dose deviation along the midline is reduced from 10% to less than 5% of the prescribed dose in the longitudinal direction. Dose to the lung is reduced by more than 15% compared to the unshielded fixed open beam technique. At the lateral body edges, the dose received from the open beam technique was 20% higher than that prescribed at umbilicus midplane. With AMTBI the dose deviation in this same region is reduced to less than 3% of the prescribed dose. Validation of the technique was performed using thermoluminescent dosimeters in a Rando® phantom. Agreement between calculation and measurement was better than 3% in all cases. Conclusions: A novel, translating bed, aperture modulated TBI technique that employs dynamically shaped MLC defined beams is shown to improve dose uniformity in three dimensions. In comparison with the fixed open beam TBI technique, homogeneity of dose distribution is greatly improved.

Purpose: Incident learning systems encompass volumes, varieties, values, and velocities of underlying data elements consistent with the V’s of big data. Veracity, the 5th V however exists only if there is high inter-rater reliability (IRR) within the data elements. The purpose of this work was to assess IRR in the nationally deployed RO-ILS: Radiation Oncology-Incident Learning System (R) sponsored by the American Society for Radiation Oncology (ASTRO) and the American Association of Physicists in Medicine (AAPM). Methods: Ten incident reports covering a wide range of scenarios were created in standardized narrative and video formats and disseminated to 67 volunteers of multiple disciplines from 26 institutions along with two published narratives from the International Commission of Radiological Protection to assess IRR on a nationally representative level. The volunteers were instructed to independently enter the associated data elements in a test version of RO-ILS over a 3-week period. All responses were aggregated into a spreadsheet to assess IRR using free-marginal kappa metrics. Results: 48 volunteers from 21 institutions completed all reports in the study period. The average kappa score for all raters across all critical data elements was 0.659 [range 0.326–1.000]. Statistically significant differences (p

It has long been standard practice in radiation oncology to report internally when a patient’s treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non-punitive environment. There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include: • How to create a system that is easy for front line staff to access • How to motivate staff to report • How to promote the system as positive and educational and not punitive or demeaning • How to organize the team for reviewing and responding to reports • How to prioritize which reports to discuss in depth • How not to dismiss the rest • How to identify underlying causes • How to design corrective actions and implement change • How to develop useful statistics and analysis tools • How to coordinate a departmental system with a larger risk management system • How to do this without a dedicated quality manager Some speakers’ experience is with in-house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO-ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown. There will be ample time set aside for audience members to contribute to the discussion. Learning Objectives: 1. Learn how to promote the use of an incident learning system in a clinic. 2. Learn how to convert “event reporting” into “incident learning”. 3. See examples of practice changes that have come out of learning systems. 4. Learn how the RO-ILS system can be used as a primary internal learning system. 5. Learn how to create succinct, meaningful reports useful to outside readers. Gary Ezzell chairs the AAPM committee overseeing RO-ILS and has received an honorarium from ASTRO for working on the committee reviewing RO-ILS reports. Derek Brown is a director of TreatSafely.org . Brett Miller has previously received travel expenses and an honorarium from Varian. Phillip Beron has nothing to report.

Purpose: To develop and test clear illustrated instructions for training of monthly mechanical QA of medical linear accelerators. Methods: Illustrated instructions were created for monthly mechanical QA with tolerance tabulated, and underwent several steps of review and refinement. Testers with zero QA experience were then recruited from our radiotherapy department (1 student, 2 computational scientists and 8 dosimetrists). The following parameters were progressively de-calibrated on a Varian C-series linac: Group A = gantry angle, ceiling laser position, X1 jaw position, couch longitudinal position, physical graticule position (5 testers); Group B = Group A + wall laser position, couch lateral and vertical position, collimator angle (3 testers); Group C = Group B + couch angle, wall laser angle, and optical distance indicator (3 testers). Testers were taught how to use the linac, and then used the instructions to try to identify these errors. A physicist observed each session, giving support on machine operation, as necessary. The instructions were further tested with groups of therapists, graduate students and physics residents at multiple institutions. We have also changed the language of the instructions to simulate using the instructions with non-English speakers. Results: Testers were able to follow the instructions. They determined gantry, collimator and couch angle errors within 0.4, 0.3, and 0.9degrees of the actual changed values, respectively. Laser positions were determined within 1mm, and jaw positions within 2mm. Couch position errors were determined within 2 and 3mm for lateral/longitudinal and vertical errors, respectively. Accessory positioning errors were determined within 1mm. ODI errors were determined within 2mm when comparing with distance sticks, and 6mm when using blocks, indicating that distance sticks should be the preferred approach for inexperienced staff. Conclusion: Inexperienced users were able to follow these instructions, and catch errors within the criteria suggested by AAPM TG142 for linacs used for IMRT.

Purpose: The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy. Methods: The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1-month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place in Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time. Results: We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross-disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource-limited settings – one of which is currently being pursued in collaboration with a vendor. Conclusion: The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially conscious and equip them with the clinical and problem solving skills required to deliver effective treatments in resource limited settings?

Purpose: The Equipment Donation Sub-Committee has developed a new, formalized process for both donating and requesting donated equipment. The purpose of the framework is to increase the likelihood that available, working-order equipment is put to good use at functional, deserving clinics. Methods: A consensus approach was used to develop a fresh approach to equipment donation and requesting equipment for donation. The committee developed specific forms for people who wish to donate equipment and for those who are seeking specific donated equipment. The forms include a summary of the equipment as well as questions designed to inform the committee with respect to the condition of the equipment, the resources of the clinic that is requesting equipment, the specific need for requested equipment, whether or not additional components or software are required for its proper functioning, and ancillary considerations such as regulatory and import rules that may affect the donation. Following submission of the forms the equipment, or request, are entered into a database, reviewed by the committee, and compatibility matches are proposed. Results: This is the first time a formalized, consensus-based approach has been used by the Equipment Donation Sub-Committee. Forms are available on the aapm.org website and should be emailed to equipment.donation@aapm.org. The first applications using this new process will be summarized and discussed. Conclusion: We anticipate this process will facilitate and expedite the process of equipment donation and will serve as a tool for assessing and improving the program.

This presentation takes a broad view of the meaning of quality in radiation therapy, with a focus on the role of the physicist in the pursuit of quality. The strategic approaches to the pursuit of total quality in radiation therapy draw from the fields of philosophy, industrial engineering, behavioral science, mathematical biology, and neuroscience. The first presentation covers the following strategies... • Tools, not rules _ The added cost of the tools of today is justified through efficiencies that can be gained. • Delegate _ Delegation of QA tasks increases the value of both the physicist and the delegate employees. • The Situational Leadership model is presented as a guide to effective delegation. Processes design and improvement QC of equipment performance is not enough if people are not following effective processes • Create a culture of Total Quality Management Provide leadership and get started with Root Cause Analysis. • Experience Design _ The experience of the patient should be included in measures of quality • The Opportunity, Influence, Impact cycle _ You need opportunities for awareness and influence. • Customer and supplier feedback _ Equipment suppliers should be included in your quality improvement system. • Organizational strategies _ It is important to have the right reporting relationship between the physicist and management, and the physicist and dosimetrists. • Influencing staff without direct authority using the Systems Theory model. • Medical physicist archetypes from 20th Twentieth century American mythology _ Be the town marshal, not the Lone Ranger. The second presentation introduces more advanced strategies for quality improvement, including... • Implementing an incident and near_miss reporting system. • Those who cannot remember the past are condemned to repeat it. CG. Santayanaj • Implementation of an Incident Learning System is a daunting task, but there is tremendous value in even sub_optimal implementations. • Incident learning systems on a shoe_string budget accessible strategies for implementation and monitoring. • An abbreviated Failure Modes and Effects Analysis. • When change is upon us, the FMEA provides a fast, inexpensive, and effective means of getting all the clinical players on the same page for a harmonized clinical practice. • Finding potential problems before they occur in the clinic. • Developing an efficient QA process. Learning Objectives: 1. Define the broad meaning of quality in the context of Total Quality Management, and the application of it in radiation therapy. 2. Describe the role of the physicist in the assurance of quality in radiation therapy. 3. Demonstrate an understanding of 10 strategies for achieving quality. 4. Demonstrate understanding of the formation and persistence of organizational culture. 5. Demonstrate understanding of basic principles of Total Quality Management. 6. Describe the steps of Root Cause Analysis. 7. Describe how to implement an error and near‐miss reporting system. 8. Describe the performance of an abbreviated Failure Modes and Effects Analysis. 9. Demonstrate understanding of the application of experience design to health care. 10. Describe how to influence staff without direct authority using the Systems Theory model.

Purpose: As radiotherapy (RT) increases in complexity, so does motivation for in vivo dosimetry (IVD), which may detect errors such as: setup, beam shaping and dose delivered. We have recently developed an easy-toimplement method for two-dimensional IVD based on images taken with the electronic portal imaging device (EPID) in cine mode during treatment. The purpose of this work is to characterize its sensitivity to possible RT delivery errors. Methods: We introduced a series of modifications to a simple RT field (10×10, 100MU, 300RR, 20cm homogeneous phantom) to simulate errors. These modifications included multi-leaf collimator (MLC) position, number of MUs, and collimator angle. We quantified the sensitivity to inhomogeneities by inserting variable amounts of solid lung and bone. Finally we delivered realistic fields to an anthropomorphic phantom to estimate sensitivity to gantry angle and setup errors. Results: Our EPIDIVD is sensitive to MLC positioning errors of 1mm and 3mm in the closed and open directions respectively, and to 3% MU variations. Sensitivity to collimator angle depends on field shape irregularity; in the case of a 10x10 field, we are sensitive to errors of 0.8°. The sensitivity to inhomogeneities is limited by the nature of MV imaging: approximately 1% signal change is noted when switching 5cm of water to equal amounts of bone or lung. This suggests that the EPID-IVD is likely not sensitive to small setup or gantry angle errors, as confirmed by anthropomorphic tests. Conclusion: We have characterized a simple method of 2D dose reconstruction at isocenter depth inside the patient, which is sensitive to possible RT delivery errors. This method may be useful as a secondary safety check, to prevent large errors from being carried on to following fractions, and to record delivered dose. By using readily available hardware, it is easily implemented and may prove especially useful in centers with limited resources.

Purpose: Current training and education delivery models have limitations which result in gaps in clinical proficiency with equipment, procedures, and techniques. Educational and training opportunities offered by vendors and professional societies are by their nature not available at point of need or for the life of clinical systems. The objective of this work is to leverage modern communications technology to provide peer-to-peer training and education for radiotherapy professionals, in the clinic and on demand, as they undertake their clinical duties. Methods: We have developed a free of charge web site (https://i.treatsafely.org) using the Google App Engine and datastore (NDB, GQL), Python with AJAX-RPC, and Javascript. The site is a radiotherapy-specific hosting service to which user-created videos illustrating clinical or physics processes and other relevant educational material can be uploaded. Efficient navigation to the material of interest is provided through several RT specific search tools and videos can be scored by users, thus providing comprehensive peer review of the site content. The site also supports multilingual narration\translation of videos, a quiz function for competence assessment and a library function allowing groups or institutions to define their standard operating procedures based on the video content. Results: The website went live in August 2013 and currently has over 680 registered users from 55 countries; 27.2% from the United States, 9.8% from India, 8.3% from the United Kingdom, 7.3% from Brazil, and 47.5% from other countries. The users include physicists (57.4%), Oncologists (12.5%), therapists (8.2%) and dosimetrists (4.8%). There are 75 videos to date including English, Portuguese, Mandarin, and Thai. Conclusion: Based on the initial acceptance of the site, we conclude that this open access web-based peer-to-peer tool is fulfilling an important need in radiotherapy training and education. Site functionality should expand in the future to include document sharing and continuing education credits.

Purpose: Various causal taxonomies have been developed for healthcare incidents and for radiation therapy in particular. The causal analysis of incidents leads to corrective actions which can also be organized into a taxonomy. Such a corrective action classification system would provide information about the situational context, the action type, and the leverage of the action in order to detect patterns in the corrective actions frequently employed in radiation therapy. It would also provide practical guidance to the radiation therapy community for determining the appropriateness and potential effectiveness of proposed corrective actions. Materials: A review of causal analysis reports and corrective action plans was conducted using the following sources: US NRC medical event reports, IAEA reports, ROSIS submissions, US Veterans Health Administration reports, and singleincident report sources. The corrective actions presented in the published sources were then mapped onto four corrective action taxonomy prototypes: role-based, safety-context-based, responsibility-based, and hierarchy of hazard control. The resulting corrective action taxonomy was then validated through use of the published sources. Results: The responsibility-based taxonomy and hierarchy of hazard taxonomy provided more intuitive and sensible categories than the role-based taxonomy or the safety-context taxonomy. The most frequent corrective actions were added safety barriers, training, process standardization, and development of a quality improvement program where one was lacking. Conclusion: Published corrective action statements in radiation therapy emphasize what to do more so than whom the recipient is or which process step is affected. The hierarchy of hazard taxonomy provides a suitable framework for radiation therapy and has the advantage of providing insight into the likelihood that a particular corrective action will mitigate the recurrence of the error it was meant to correct. This information would be useful to medical center administration, safety personnel, and regulators who must assess the projected efficacy of corrective actions. Derek Brown is a director of TreatSafely, LLC.

Purpose: To develop an on‐line questionnaire‐based tool for documenting, benchmarking and improving quality and safety in radiotherapy clinics. Methods: The Safety Profile Assessment (SPA) Tool, a project of the AAPM Work Group on Prevention of Errors, was built principally on four foundations: validated survey tools from the Agency for Healthcare Research and Quality; a published review of safety recommendations in seven recent authoritative documents; an AAPM white paper on incident learning; and the requirements for accreditation of radiation oncology practices within the ACR/ASTRO system as of 2011. The authors performed several iterations of the SPA prototype before further refinement at a workshop with detailed input from representatives of ASTRO, AAMD, ASRT and SROA for content validity. SPA was subsequently released to 32 centers for pilot testing. Results: SPA consists of 92 statements divided into four major sections: 1) Institutional Culture, 2) Quality Management, 3) Managing Change and Innovation and 4) Clinical Performance. The assessor identifies compliance with each statement on a five‐point Likert scale and can also add free text. Output options are pie charts giving an overall visual impression of the safety profile of a radiotherapy department and bar graphs allowing benchmarking against all radiotherapy contributors to the SPA database. Additionally SPA supports a Quality/Safety Improvement Tracking Log and links to relevant literature. In pilot testing, SPA required on average 1.3 hours to complete. Pilot test participants ranked SPA highly for ease of use and utility for improving safety. Pilot participants further noted that completing the SPA as a group improves efficiency and completion and also facilitates interaction of clinical staff. Conclusion: SPA distills advice and experience from a variety of authoritative sources into a convenient, logically configured, on‐line resource, which has received overwhelmingly positive reviews during pilot testing. SPA is now being configured for on‐line distribution through the AAPM website. The project was funded by the AAPM through the budget allocated to the Working Group on the Prevention of Errors.

Purpose: Total body irradiation (TBI) techniques aim to deliver a uniform and accurate radiation dose to the entire anatomy of the patient. Given irregular patient shapes and internal inhomogeneities achieving a dose homogeneity within ±10 % of the prescribed dose represents a non trivial challenge. We propose a novel TBI technique which is capable of delivering a more uniform dose to the entire patient than conventional TBI techniques. Methods: Radiological depth calculations are performed along divergent ray lines through transverse CT slices of an anthropomorphic Rando® phantom. The radiological depths take into account both body contour variation and internal inhomogeneities. Based on the calculated radiological depths, multiple beam apertures can be generated using dynamic multileaf collimation (DMLC). To account for the scatter contribution, scatter kernels are derived using the concept of the scatter maximum ratios (SMR). Based on the scatter calculation the calculated beam apertures are modified. For dose calculation purposes the individual MLC files are imported into the Eclipse™ treatment planning system. However for treatment delivery, a single MLC file with multiple control points is generated and delivered while the phantom is translated on a motorized bed close to the floor through a stationary radiation beam with 0° gantry angle. Results: In comparison to fixed open beam translating bed TBI the dose deviation along the midline was reduced from ±8% to less than ±4% of the prescribed dose with this new technique. Lungdose was reduced by more than 15%. Agreement between calculated and measured doses was better than 3% in Rando®. Conclusions: A novel, aperture modulated translating bed TBI technique that employs dynamically shaped MLC defined beams has been developed for improving dose uniformity in three dimensions. In comparison with the open fixed beam TBI technique, the dose distribution homogeneity is greatly improved.

First do no harm. Prominent newspapers and other reports over the last several years have reminded us of this maxim. To make the patient's journey through radiation therapy safer requires all disciplines to develop an awareness of what can go wrong and why, develop practical skills in common error management techniques and consider what additional patient safety measures can realistically be implemented. This year's Education Council Symposium addresses the role of the medical physicist in patient safety education, with lectures on three distinct topics: Establishing a culture of safety through education: The medical physicist plays a vital role in being informed about and disseminating key safetyinformation in the use of radiation in medicine. The education and technical knowledge of the medical physicist positions him/her to understand, evaluate and address safety concerns and risks from a procedure standpoint. This point of view is used to establish mechanisms to provide specific periodic, and general ongoing education to clinical staff to prevent patient harm. The same knowledge base also allows the medical physicist to explain the risks and safety measures of the complex procedures to patients undergoing treatment and to lay persons outside of the clinic. Inclusion of patient safety into didactics and clinical training of medical physicists: In Calgary, Canada, a patient safety training course was designed to address all these issues for a multidisciplinary audience, but focusing on medical physicists who contributed to some of the most catastrophic incidents reported. Error management is a very practical activity. In recognition ofthat observation almost half of the 14 hour course is devoted to skill development through mentored practical exercises. The course starts with a review of the IAEA slide set describing 5 recent well known incidents in radiation therapy. This slide set forms the basis for several exercises. This is followed by a discussion of human factors and the power distance index — topics quite unfamiliar to the medical physicist. Subsequent sessions provide overviews of recent activities in patient safety encompassing incident learning and recommended preventative measures. Two‐hour sessions are devoted to each of the key analysis techniques: root cause analysis, failure modes and effects analysis and fault tree analysis. The messages in the didactic part of each session are reinforced and skills developed during structured exercises. The course has been generally well received by the participants and may serve as a useful model for graduate and residency medical physics education. Training individuals to use voluntary reporting systems: Development of event reporting systems has been a significant point of recent discussions and national and international activities. Such systems should ideally be implemented along with organizational training efforts and should be a part of a broader process improvement program. Event reporting systems are just tools which work best within an organization with healthy safety and reporting cultures. Without healthy safety and reporting cultures even the best designed event reporting systems ultimately result in poor outcomes and may even become a source of organizational frustrations and problems. When event reporting systems are placed in such a healthy environment, where safety culture is supported and valued from the highest levels of management down through all employees, these systems can be great learning and organizational diagnostics tools. Development of such an environment requires understanding and acceptance of event reporting principles and culture by everyone in an organization. Learning Objectives: 1. The role of the medical physicist in establishing a culture of safety through education 2. Review a template training course for patient safety within didactics and clinical training 3. Preparing individuals to utilize voluntary reporting systems