Why this course exists
Superficial radiation therapy is delivered in dermatology offices by clinicians who are excellent dermatologists and who were never taught radiation physics, radiobiology or radiation protection — because nothing in a dermatology training pathway teaches them. California recognises this by requiring a separate permit before a licensed practitioner may supervise and operate X-ray equipment, and by examining candidates on material their primary training did not cover.
Education is one of the four pillars of the Institute, and this is the most concrete form it takes: the people who will actually point a beam at a patient, taught properly, and tested.
The permit, and what this course is and is not
California’s Department of Public Health, Radiologic Health Branch (CDPH-RHB) issues the X-ray Supervisor and Operator Certificate/Permit, of which dermatology is one category. Applicants must hold a valid California healing-arts licence — Physician and Surgeon, Osteopathic Physician and Surgeon, Podiatrist, or Chiropractor — and must pass a CDPH-RHB approved examination. Permits renew on a two-year cycle and require approved continuing-education credit at renewal.
Read this part carefully. This course is preparation. It is not a permit, it does not issue a permit, and completing it does not oblige CDPH-RHB to grant you one. Requirements, fees, examination content and continuing-education rules are set by the State and change; the authoritative source is CDPH-RHB and no one else, including us. Verify current requirements with the Branch before relying on anything on this page.
How the course is built
Twelve lectures, each paired with two things that most short courses leave out:
- Measurement metrics — each module has defined learning objectives and an objective assessment against them, so a participant knows what they have actually mastered rather than what they have merely sat through. Scores are recorded per module, not just at the end.
- Practice examinations — question sets built to the format and scope of the CDPH-RHB examination, so the first time a candidate meets that style of question is not on the day it counts.
The metrics exist for the Institute’s benefit as well as the participant’s: a course that does not measure whether it taught anything is an assertion, not a program. Aggregate, de-identified module performance tells us which lectures are failing and need rewriting.
The twelve lectures
- 1. Radiation physics for the dermatology office. Production of X-rays, the orthovoltage and superficial energy range, beam quality, half-value layer, and why kilovoltage behaves differently from the megavoltage beams in a cancer centre.
- 2. Interaction of radiation with tissue. Photoelectric effect and Compton scatter, why the photoelectric effect dominates at superficial energies, and what that means for dose to bone and cartilage.
- 3. Dosimetry and units. Exposure, absorbed dose, equivalent and effective dose; output measurement, calibration, timer settings, and depth-dose curves.
- 4. Radiobiology I — cell survival and repair. DNA damage, repair kinetics, the linear-quadratic model, and the α/β ratio.
- 5. Radiobiology II — fractionation. Why dose is divided: sparing of late-responding normal tissue, the four Rs, and the basis of the schedules used in superficial practice.
- 6. Radiation protection and shielding. Time, distance and shielding; room design and barrier calculation; ALARA as an operating discipline rather than a slogan.
- 7. Occupational and public dose limits. Regulatory limits, personnel monitoring, dosimetry badges, the declared-pregnant-worker provisions, and record-keeping obligations.
- 8. Patient selection and lesion assessment. Which skin cancers are appropriate for superficial radiation, which are not, biopsy and margin considerations, and when to refer rather than treat.
- 9. Treatment planning and delivery in practice. Field selection, cones and cut-outs, bolus, shielding of eye and cartilage, image guidance, and setup reproducibility.
- 10. Acute and late effects. Expected skin reaction and its management, distinguishing normal reaction from complication, late effects on a multi-year horizon, and what patients must be told before consenting.
- 11. Quality assurance and equipment. Daily, monthly and annual QA; output constancy; interlocks and warning systems; malfunction reporting and when a unit must come out of service.
- 12. Regulation, documentation and the examination. California requirements, registration of equipment, records that must be kept, informed consent, and a structured review for the CDPH-RHB examination.
Who it is for
Licensed clinicians who intend to supervise or operate superficial X-ray equipment in a dermatology setting, and who hold — or are eligible for — a California healing-arts licence in one of the categories the Branch accepts. Radiation therapists, medical assistants and office staff working alongside a permitted supervisor benefit from modules 1–7 in particular.
The Institute teaches this course because a hub-and-spoke model only works if the spokes are trained. Extending specialist expertise into community clinics is worth nothing if the person at the console does not understand the beam.