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Brachytherapy education for medical physicists is currently part of national, European (ESTRO-EFOMP), North American (e.g. AAPM) or Asian (e.g. India) core curricula for medical physics experts in radiotherapy. Although there are differences in the distribution of learning skills via internship or courses and the overall amount of training hours, brachytherapy education is an integral part of those regulations. An important issue is that in contrast to most external beam techniques, brachytherapy is not performed in every radiotherapy department. If performed there is a huge variation in centers regarding treatment approaches (from standard plans to image-based treatment planning) and treated sites (centers performing a huge variety of treatments versus centers focusing only on prostate or GYN). The trend towards centralization with less centers performing brachytherapy increases the problem of missing training sites. While in some countries the education of those residents working in centers without brachytherapy remains limited to courses, other countries support an internship for a limited time in other centers.

Future needs have to be defined in a strategic way. The status quo might result in a limited basic education for all medical physics experts, where only those at selected centers will reach an expert level in brachytherapy. However, these special skills might not be visible in certificates. The other option would be therefore to even reduce brachytherapy skills from the current curricula, while expanding it for dedicated extra certification.

In any case the needs also have to be defined according to the future requirements in brachytherapy. The basics of brachytherapy dosimetry and quality assurance are mandatory and have to be included with high priority. On the other hand, the required expertise for treatment planning is changing. There is an increasing focus on imaging (e.g. also special techniques as ultrasound and MRI) and image handling (registration and fusion of different modalities and for different time points). Treatment planning expertise has to include traditional forward planning approaches as well as inverse optimization and the correct definition of constraints (dose and volume, but also spatial dose and dose rate distribution). Training in automated planning and even more in QA for those techniques will become essential. Finally, brachytherapy is a highly interdisciplinary technique. Due to the close interaction of physicians, radiation technologists and medical physicists, often also together in an operating theater, brachytherapy physicists might need more insight into clinical issues – anatomy, implantation techniques, intraoperative imaging and definition of dose-response curves for prospective treatment planning. This close interaction is also visible in the course contents of the ESTRO School. In addition to an “Advanced Physics for Brachytherapy” course, there are several special courses on Comprehensive Brachytherapy, GYN, prostate and breast designed for a target group consisting of clinicians together with physicists. Similar courses, often focused to dedicated techniques (e.g. MRI based GYN Brachytherapy, prostate, breast or skin) are offered by radiotherapy vendors. Some of those have already a tradition of more than a decade.

Independent of the integration of brachytherapy in core curricula or the introduction of specialized brachytherapy physics education/certification the additional post-graduate courses have to remain an integral part for continuous education and training.