RESUMO
PURPOSE: To present an overview of the status of Medical Physics practice in Mexico, promote the legal recognition of Medical Physics high-end training, and provide information that will potentially improve the Mexican healthcare system. METHODS: For the purpose of this research, the concept of "Medical Physics Professional/s" (MPP) is introduced to refer to any person/s executing the role of a clinical medical physicist (cMP) in whole or in part independent of academic profile, training or experience. A database of MPP in Mexico was built from official sources and personal communication with peers. Database records included the following fields: employer/s, specialty, academic profile, and annual income (when available). RESULTS: 133 centers in Mexico employ MPP, 49% of which are public institutions. 360 positions involving cMP roles were identified at the National Healthcare System (occupied by 283 MPP), 77% of which corresponded to radiation therapy. Public healthcare services hold 65% of the reported positions. Only 40% of MPP hold a graduate degree in Medical Physics, 46% of whom were located in the most densely populated region of Mexico. Of all MPP, 32% were women. CONCLUSIONS: This work allowed to clearly identify the current challenges of Medical Physics practice in Mexico, such as: insufficiency and uneven geographical distribution of qualified manpower, gender imparity, multishifting and wage gap. The products derived from this work could be used to guide the efforts to improve the Mexican healthcare system.
Assuntos
Medicina , Feminino , Humanos , México , Física , Recursos HumanosRESUMO
OBJECTIVE: To validate the radiosurgery-based arteriovenous malformation score (RBAS) as a predictor of outcome in patients with arteriovenous malformations (AVMs) treated with LINAC-based conformal radiosurgery. METHODS: We analysed 40 patients with a mean follow-up of 22 months. One patient (2.5%) pertained to Spetzler-Martin Grade I, 11 (27.5%) to Grade II, 19 (47.5%) to Grade III, eight (20%) to Grade IV and one (2.5%) to grade V. The mean RBAS was 2.0 (range: 0.76-5.56). The mean obliteration prediction index (OPI) and the Karlsson index (KI) were 0.74 (range: 0.2-2.86) and 109.48 (range: 3.0-350.7) respectively. Outcomes were analysed according to the OPI, KI and RBAS. RESULTS: We analysed different cutoff points in the RBAS and found a significant difference to predict the outcome in four scores: 1.2, 1.6, 1.7 and 1.8. In the group with RBAS < or = 1.8, 13 (68%) had an excellent outcome and six (33%) did not, while with RBAS>1.8, seven (32%) had an excellent outcome and 14 (67%) did not (p = 0.02). We did not find any correlation between Spetzler-Martin grading scale or OPI and outcome (p = 0.7 and p = 0.3 respectively). The KI predicted the excellent outcome in 8/9 patients (89%) with KI < or = 27 and in 12/31 patients (39%) with KI>27 (p = 0.08). CONCLUSION: The RBAS seems to be a good predictor of outcome in patients with AVMs treated with LINAC-based conformal radiosurgery as in patients treated with Gamma Knife. It remains only to find the best cutoff point based on a larger series and longer follow-up.