METHODS: A structured questionnaire was mailed in 2008, 2011 and 2014 to senior medical physicists representing 23 countries. The questionnaire covers 7 themes: education and training including certification; staffing; typical tasks; professional organisations; resources; research and teaching; job satisfaction.
RESULTS: Across all surveys the response rate was >85% with the replies representing practice affecting more than half of the world's population. The expectation of ROMP qualifications (MSc and between 1 and 3years of clinical experience) has not changed much over the years. However, compared to 2008, the number of medical physicists in many countries has doubled. Formal professional certification is only available in a small number of countries. The number of experienced ROMPs is small in particular in low and middle income countries. The increase in staff numbers from 2008 to 2014 is matched by a similar increase in the number of treatment units which is accompanied by an increase in treatment complexity. Many ROMPs are required to work overtime and not many find time for research. Resource availability has only improved marginally and ROMPs still feel generally overworked, but professional recognition, while varying widely, appears to be improving slowly.
CONCLUSION: While number of physicists and complexity of treatment techniques and technologies have increased significantly, ROMP practice remains essentially unchanged over the last 6years in the Asia Pacific Region.
AIM: To study factors associated with nonalcoholic steatohepatitis (NASH) and advanced fibrosis, and medical treatment of biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients.
METHODS: Retrospective study of biopsy-proven NAFLD patients from centres in the GO ASIA Workgroup. Independent factors associated with NASH and with advanced fibrosis on binary logistic regression analyses in a training cohort were used for the development of their corresponding risk score, which were validated in a validation cohort.
RESULTS: We included 1008 patients from nine centres across eight countries (NASH 62.9%, advanced fibrosis 17.2%). Independent predictors of NASH were body mass index ≥30 kg/m2 , diabetes mellitus, dyslipidaemia, alanine aminotransferase ≥88 U/L and aspartate aminotransferase ≥38 U/L, constituting the Asia Pacific NASH risk score. A high score has a positive predictive value of 80%-83% for NASH. Independent predictors of advanced fibrosis were age ≥55 years, diabetes mellitus and platelet count <150 × 109 /L, constituting the Asia-Pacific NAFLD advanced fibrosis risk score. A low score has a negative predictive value of 95%-96% for advanced fibrosis. Only 1.7% of patients were referred for structured lifestyle program, 4.2% were on vitamin E, and 2.4% were on pioglitazone.
CONCLUSIONS: More severe liver disease can be suspected or ruled out based on factors identified in this study. Utilisation of structured lifestyle program, vitamin E and pioglitazone was limited despite this being a cohort of biopsy-proven NAFLD patients with majority of patients having NASH.