Each year roughly 1 million cancer patients make 24 million radiation therapy visits to nearly 2,000 hospitals, oncology clinics and community cancer centers nationwide. The numbers aren't surprising: The need for radiation therapy is increasing as baby boomers are more frequently diagnosed with cancer.

Unfortunately, the medical dosimetrist workforce is already inadequate to meet the needs of the radiation oncology community, according to a 2002 survey of the Workforce Committee of the American Society for Therapeutic Radiology and Oncology. Approximately 700 additional medical dosimetrists are needed nationwidea 35 percent increase over the present workforce. Additionally, treatment planning technology has become vastly more complex, and to keep pace, the level and quality of dosimetrist training must improve.

Further complicating this issue is the scarcity of medical dosimetry educational programs. Approximately 80 percent of certified medical dosimetrists are radiation therapists who obtain on-the-job training, according to the American Association of Medical Dosimetrists (AAMD). Most of the remaining 20 percent are graduates of formal medical dosimetry educational programs or those educated in other areas (nonradiation therapists) who also may be trained on the job. Historically, the educational programs contribute 25 to 30 individuals to the workforce annually. Exam statistics from the Medical Dosimetrist Certification Board (MDCB) reveal a pass rate of approximately 50 percent, whereas graduates of formal dosimetry programs demonstrate an 80 percent pass rate.

The workforce shortage and need for improved medical dosimetry education prompted the University of Wisconsin-La Crosse (UW-L) to survey Midwestern radiation therapists about their interest in medical dosimetry, desire to attend a formal educational program and ability to relocate, as well as the distance education possibilities. The results demonstrated a market of potential students who couldn't relocate to attend one of the few formal educational programs. This clearly defined need initiated an effort to design a distance learning medical dosimetry educational program with the Stanford (Calif.) University School of Medicine Dosimetry Training Tool (DTT) project, launched in July 2002. The project's purpose is not to create an online training program, but rather to develop a set of Web-based training tools for use by multiple training programs, large and small, throughout the country. Content for the tools, which is rendered into files that can be integrated into a computerized training program, is being contributed by a national network of medical physicists and dosimetrists.

The program's curriculum requires three semesters of distance online courses taken with a clinical internship at an affiliated site. The online courses consist of Stanford's Web-based DTT and UW-L's Desire to Learn online courses.

Funded through the National Cancer Institute (NCI) Cancer Education Grant Program, the DTT consists of 25 course modules that include didactic instructional material, learning exercises and quizzes to help train medical dosimetrists enrolled in a formal educational program. Content for the Web-based training tools, designed by medical physicists and dosimetrists for large and small training programs, is rendered into files that can be integrated into a computerized training program. Arthur Boyer, PhD, professor of radiation oncology and radiation physics at Stanford, is the project director of the NCI grant and is overseeing the development of the Web-based modules.

As the nation's first online dosimetry offering, the UW-L Medical Dosimetry Program features an online didactic curriculum delivered through its Desire to Learn Web platform. The UW-L program also uses the DTT for a didactic curriculum, as it's a beta site for the NCI-funded project. UW-L offers two enrollment options: Track One is a formal program designed to follow the AAMD guidelines and to seek accreditation by the Joint Review Committee on Education in Radiologic Technology, and Track Two is a nonformal program designed to aid on-the-job dosimetrist training with structured didactic curriculum for MDCB exam preparation.

Graduates of the UW-L distance learning programs should begin to help reduce the dosimetrist shortage in about two years. At that time, graduates should be eligible for the MDCB examination. Last year, the MDCB examined 407 candidates, but the pass rate remained about 50 percent. But the good news is that distance learning efforts are expected to increase the number of exam candidates and boost the pass rate. If these goals are attained, the radiation oncology component of health care will have improved significantly.

Nishele Lenards, BS, CMD, is the dosimetry program director at the University of Wisconsin-La Crosse and the membership secretary for the American Association of Medical Dosimetrists.