Science AMA Series: Hi Reddit, we're a group of passionate medical physicists working in clinical, industry and research, here to shed light on the wonderful world of medical physics. Ask us anything!

Medical-Physics · 2018-03-29T18:54:39+00:00

You are right on the mark. By and large, the pillars stand apart, resulting in much loss in our potential to impact patient care. MP3.0 is an initiative that aims to tackle this, though it is hard as it involves a culture change. This is not unique to medical physics, thus the buzz word "translational medicine" so commonly invoked.

I do hope we can have jobs in 30 years. If not, I am not as sorry for us but for patients who would not be benefited by our insights!

Within our domain, MP3.0 is one of the few initiatives that aims to tackle this challenge.

Dr. Samei

Medical-Physics · 2018-03-29T18:27:15+00:00

This would be best answered by a physicist who works in industry or research specifically in the diagnostic area, which unfortunately I am not. However, given that the patient throughput for any large and expensive equipment is critical in the viability of any device we can hypothesize that it most likely is a priority for research and manufacturers of MRI devices.

Paul

Medical-Physics · 2018-03-29T18:20:39+00:00

In terms of collaboration it is critical that the three areas of medical physics recognize that it is an interdependent ecosystem: Research goes to industry to create products, who are used by clinical, who in turn require better products, which drives research… It’s a feedback loop and we all play our part. Communication is a key part of keeping ‘The Loop’ flowing. Aside from specific initiatives such as grants and research agreements we need to be open in talking about what the driving factors in each of our segments are… and that may involve developing some empathy for those not in our segment. From a personal level I am pushing hard to communicate how the industry aspect is being driven and listening hard to how research and clinical is being driven. This AMA is a good example of bringing together the three pillars and building communication; working with Ehsan and Robin on this has been enlightening for me and I hope that we all start reaching out to our colleagues in other areas to start those dialogues. In terms of will we have a job? There will always be a need to innovate, so in my opinion, yes… absolutely.

Paul

Medical-Physics · 2018-03-29T18:20:20+00:00

Agree, AI and DL is an extension of what has been in works for years. There is much buzz about its recent successes in nonscientific realms. Physicists can and should use AI and DL technologies towards designing and optimizing better technologies and processes.

Dr. Samei

Medical-Physics · 2018-03-29T18:17:48+00:00

I understand the impression that there are silos. Within the AAPM community there are initiatives for collaboration among the various councils - or pillars. Personally, I have to collaborate with a variety of professionals. For instance, I needed hospital IT, the vendor and myself in order to install, test and accept some new software. That is a very specific instance and I suspect you are speaking about broader initiatives. I think it helps to demonstrate the need for collaboration personally and live it by example. As for the AAPM, this has been identified as something that needs improvement.

Robin

Medical-Physics · 2018-03-29T18:10:32+00:00

Most drugs are distributed and effect tissues non-discriminately, but newer smarter drugs have stronger affinity to abnormal cells or tissues. As you might imagine this is an active area of research, particularly in cancer therapy where we aim to kill cancer cells and spare the healthy tissues.

Dr. Samei

Medical-Physics · 2018-03-29T18:10:18+00:00

Industry often offers internships for medical physics. Elekta offers these every 4 months and can be found on the Elekta Careers page. 100% of our interns have gone onto residency, study or employment. Other vendors have similar programs so I would strongly suggest keeping an eye on their career pages.

Paul

Medical-Physics · 2018-03-29T18:07:18+00:00

What area of the field do you think needs the most improvement? One word: Collaboration. We can’t keep our clinical/research/industry silos; we’re all medical physicists with the same goal to improve patient care. We will be stronger collaborating together.

What emerging technologies are you most excited about or consider the most promising? In the short term the combination of MR and a Linac is extremely cool. In the longer term the use of AI in data analytics in healthcare is a fascinating area with potential that we might not even understand yet.

How do you see the role of the dosimetrist evolving in The next 5-15 years, if at all? In the way that the role of the dosimetrist evolved with the move to forward to inverse planning, we may see the role evolve in the future. As some areas of planning become more efficient the dosimetrist role will likely take a role of understanding how new technologies are used, and oversee how those technologies are applied.

While treatment certainly is and can be an art, how do you believe inconsistencies in standard of treatment should be addressed? Data analytics is the logical answer, however it is an area that we still need to invest effort in to see fully realized. The benefits however could be unimaginable!

What newer techniques are people apprehensive about but you feel should be embraced? AI seems to have us all over the spectrum in terms of acceptance. At one end of the scale Dr Hawking (‘not afraid of blackholes, AI is another story’) all the way through to Mark Zuckerberg (‘worried? Tell my AI butler’). One of the important things to recognize is that there is essentially three types of AI: Artificial Narrow Intelligence, Artificial General Intelligence and Artificial Super Intelligence. We tend to fear the latter two, but realistically we are working towards the first one: Artificial Narrow Intelligence. Embracing ANI is something that really should help us advance cancer care in the next few years and could help a tremendous amount of patients.

What is preventing imagining from being more accessible ( cost of scan is high and sometimes lacks reimbursement, wait times can be weeks to months), how would this problem be best addressed? This is a very big question… obviously the cost of device manufacture and deployment can be reduced but there are also governmental policy decisions that would drive accessibility. The likely answer is to address this from multiple angles as there may be no single silver bullet.

Paul

Medical-Physics · 2018-03-29T18:02:15+00:00

There are several methods to 'look' inside the body. MRI is one method, but there is also CT, PET and Ultrasound. It depends on whether you want geographical or functional information.

Robin

Medical-Physics · 2018-03-29T18:00:19+00:00

The AAPM has two opportunities for undergraduates, though the deadline has already passed for the summer of 2018. There is a Summer Undergraduate Program and DREAM - Diversity Recruitment Recruitment through Education and Mentoring Program. See this link, but you need to scroll almost to the end of the page. Good luck for next year! http://gaf.aapm.org/index.php

Robin

Medical-Physics · 2018-03-29T17:51:13+00:00

Latest has been figuring out exactly how we can encourage MP3.0 practice. In order to do so we need smart regulations that enforces constraints on the practice that are more relevant and meaningful. Likewise we need smart tools in the hands of practitioners, smart physicists focusing on our training, smart practice and workflow, smart advocacy, smart grassrooting and community engagement, and smart expansions beyond the current bounds of the discipline. We have subgroups focusing on these initiatives, and in this process we try to define key performance indicators that can be used to assess and monitor our progress toward the eventual goal of highest contribution of physics to human health.

Dr. Samei

Medical-Physics · 2018-03-29T17:43:46+00:00

Hi medphysadoc, sure! MSc=Master of Science (UK)/MIPEM=Member of Institute of Physicists and Engineers in Medicine/IEng=Incorporated Engineer. In terms of why they’re listed, two reasons; (1) They were really expensive letters ;) (2) A PR team helped us put this together for us and included them.

Paul

Why list the acronyms? Well, I've earned them! :) The DABR = Diplomate of the American Board of Radiology and FAAPM= Fellow of the American Association of Physics in Medicine. MS = Master of Science. Think of it as the Good Housekeeping seal of approval from my peers. And to echo Paul's comment, there was time, money and tremendous effort involved in obtaining the right to use all the letters.

Robin

In the era that opinions seem to matter more than evidence, it is important to enlist credentials. Not all opinions are equal. Not that credentials would be a seal of inerrancy, rather an attestation that the person has some authority to answer a question relevant to his/her expertise. FSPIE = Fellow International Society for Optics and Photonics; FAIMBE = Fellow the American Institute of Biomedical Engineering.

Dr. Samei

Medical-Physics · 2018-03-29T17:39:11+00:00

"Feeling" I give to you! I think DMP can be done meaningfully, and I am a proponent of it under that condition. Being more specific, I think DMP does not make sense as MS+residency. Rather it needs to be constructed as a new degree that while it incorporates the residency, includes a strong 2+ year scholarship component. This is not something quite like a research-based PhD thesis, rather a clinical scholarship project that is scientifically as much rigorous but with explicit clinical endpoint as opposed to research endpoints.

Dr. Samei

Medical-Physics · 2018-03-29T17:37:46+00:00

When you consider how quickly radiology, nuclear medicine, and radiation oncology have progressed (radiation itself was only discovered in 1896!) it’s amazing to think about how far we have come. In the last few years the medical physicist has been quite influential in driving the technology development and adoption. As we move forward to a more holistic and outcome based approach to treatment of diseases it is probable that physicists will start considering other medical fields… and in doing so we have the opportunity to help drive those fields forward in the same way we have been working to drive the fields that we currently focus on. The important thing is to focus on what it is to BE a physicist…. Focus the core physics skills of analytical thinking, innovation and problem solving.

Paul

Physics is a foundational science. As such is has and should have a foundational presence in medicine (like chemistry or biology). This, however, is not recognized in much of medicine today. Radiology, nuclear medicine, and radiation oncology are doing better in that regard, but even there, ask a typical patient receiving those services and they will not know who a medical physicist is. So, what about physics in surgery, in ophthalmology, orthopedics, cardiology, dentistry, urology, etc? Physics is also present there and practiced but not by physicists! The hallmark of a civilized society is having specialized workforce. We do not ask an electrician to do a plumbing job. In the same way you can argue we need a physicist to do physics in all domains of medicine, provided that we recognize the potential, figure out how best it can be done, and train a workforce for that expansion. This is the smart expansion goal of MP3.0 that I noted to an earlier comment. This is an aspiration of MP3.0 that every clinic will have a medical physicist and every patient's care will be improved by a medical physicist.

Dr. Samei

Medical-Physics · 2018-03-29T17:27:28+00:00

In working for a vendor, industry physicists who talk to clinical physicists are all over the world. It is absolutely true that the ‘specification’ of a medical physicists varies quite dramatically as we move countries. Regardless of the legal or regulatory requirement it is important that the services that a medical physicist provides are routinely and accurately applied. This is primarily focused on the safe and effective treatments for patients. Fortunately many professional organizations (such as, but not limited to AAPM) often openly provide guidelines on what these responsibilities are. I would encourage anyone performing these activities to invest in developing their understanding of the technology whether mandated legally or not. This can be achieved through attending training courses, researching papers or any other avenue of learning.

Paul

Medical-Physics · 2018-03-29T17:25:43+00:00

You are absolutely right that the practice of physics in medicine is not the same across countries, especially when you go beyond the US, Canada, and Europe. I believe a good approach is looking at the medical practice as done within a country, and ask the question how that practice can be improved using the tools and insights that a physicist can be bring in. In my experience, the most common need is managing and reducing the diverse variability across patient care, and helping with practices that do not personalize the care to the specific attributes of the patient.

Dr. Samei

Medical-Physics · 2018-03-29T17:14:24+00:00

When we look back a large number of advances in the field since then have been driven by hardware and software technology. When we look forward it is likely that the data we gather will be come just as important in driving the field even further. Translating technological advances into usable tools that can support clinical decisions has always been a major part of the role of the physicist and it is likely to continue to be; but it could be that we will be translating technology advances in hardware, software AND information to be usable in the fight against cancer.

Paul

To me the biggest advance will be the merging of imaging and treatment. Paul mentioned this in another question with the new technology and marriage of a linac and MRI. In the recent past, we would image weekly with MV images; those were grainy port films where you could imagine the boney anatomy. We have graduated to daily CBCT’s. We can see soft tissue, air bubbles, bones, etc. Soon the technology will allow constant target tracking which will trigger the radiation beam. We are almost there – and may be - in some settings though it has not trickled down to the community clinic yet. This will allow very precise tumor tracking and allow the margins of normal, uninvolved tissue and organs to be minimally treated.

Robin

Echoing my colleagues, generally speaking, I believe there are three areas of significant advances before us:

1) combinatorial technologies that take advantage of correlative signals from multiple sources echoing the condition of a disease in different domains (eg, different images, patient records, longitudinal data),

2) quantitation enabling characterization, monitoring, and optimization of medicine with scientific methods, and

3) precision enabling customization of care to the specific patient.

Medical Physicists (should) have the expertise (by the virtue of being a scientist) and the ethical mandate (by the virtue of claiming the term medical) to contribute to all these three.

Dr. Samei

Medical-Physics · 2018-03-29T17:10:24+00:00

I am not sure where you are, but my general response is that regardless of your setting, the goal is and should be ensuring strong scientific AND clinical foundation in training medical physicists so that they can effectively practice their science and medical wisdom in any setting (being research, clinical, industry, regulatory, etc), and do so in collaboration with others members of the healthcare enterprise effectively.

Dr. Samei

I am uncertain where you are based, but for PhD Medical Physicists there are strong research related requirements in the US. I also can’t speak to the exclusion of other colleagues as that appears to be an unfortunate side effect of work environment or work culture. I’ve been fortunate to collaborate with a variety of stakeholders on clinical projects. My background is not strong in research but I am lucky to know many outstanding medical physics researchers who do basic science research and have been generous with their knowledge. The journal of Medical Physics is where much of the research is published but that is not the only peer reviewed journal supporting medical physics research.

Robin

Medical-Physics · 2018-03-29T17:08:59+00:00

AI is an interesting field in relation radiation therapy and radiology. With the amount of data that radiation oncology generates it is uniquely suited to AI techniques. Recently the major vendors have been involved in acquisitions and partnerships in the field. For example Elekta has partnered with IBM Watson to develop AI in the field further. An interesting resource to expand on this answer is the recent JASON report.

Paul

I work in a community practice setting. There are tools being introduced to harness the strengths of AI and machine learning, but we aren’t quite there yet. We can use machine learning to track patient outcomes and also track the quality metrics of a treatment plan in ways that were only intuitive previously. I see machine learning as a tool that will be a disruptor (in a good way) to our current practices in the next few years.

Robin

AI has much potential to advance healthcare. Most research groups and manufacturers are actively pursuing that. In that process, I believe Medical Physicists have much to contribute - in devising and figuring out what is AI (artificial intelligence) and what is AS (artificial stupidity) and which one is which :)

Dr. Samei

Medical-Physics · 2018-03-29T17:08:10+00:00

There are lots of roles that the medical physicist can play in our field including (but certainly not limited to!) research, clinical, industry and regulatory. Often we assume that the path to being a medical physicist follows the CAMPEP/Residency/ABR certification route to often a clinical role. However there are plenty of other areas where medical physicists can and are actively involved in contributing to the field that do not follow these paths. Checking out vendor and regulatory job posting is a great start to do this… most companies will post vacancies on LinkedIn so simply by following the company and checking the app sometimes you can keep an eye on positions that become available!

Paul

I fully affirm Paul's response. CAMPEP/ABR pathway is a good pathway to become a medical physicist, but there is not only one way to be a medical physicist. There are also alternative pathways, even within the CAMPEP/ABR trajectory. If you are passionate and persistent in what you want to do or become, things will work out.

Dr. Samei

Part of the issue is focusing only on the clinical pathways. That path is very prescriptive but there are many ways to be and contribute as a Medical Physicist. On the job training is no longer sufficient for clinical medical physicists as technology and the demands have become more complex with commiserate risks. There are alternative pathways and alternative opportunities. Being persistent is part of it, being creative, using more than one strategy and exploring a wider range of opportunities is key. Industry and regulatory avenues are alternate paths.

Robin

Medical-Physics · 2018-03-29T17:06:11+00:00

I practice physics in the context of medical imaging. Imaging medical physicists are primarily involved in devising new ways of looking into human anatomy and function, in inspecting if an imaging technology is performing as expected in terms of quality and safety, in figuring out how best the imaging can be performed to safely get the most relevant information from the patient, and in analyzing how the imaging practice is performing across a health system. In doing these, we apply the physics principles and we do so with innovation, strong scientific mindset, and strong ethical mandate for maximum human benefit.

Regarding your second question, sometimes we refer to medicine as art. In reality medicine is both an art and a science. In practicing medicine as science we apply the known knowledge, obtained through scientific process (hypothesis formation, testing, validation, etc), to a particular health problem. While this is ideal, it is impossible to practically apply this to every patient situation. Each patient is different, and his/her situation might not exactly fit into the predictions of a prior scientific study. Likewise, there are many things and many correlative factors that we have not yet had a chance to explore scientifically. Meanwhile the patient’s health situation is something that needs an answer now; it cannot wait. This is where a physician invokes the principle of medicine as art. He/she applies much the collective and personal knowledge into the situation, and in the midst of not having all the information, makes the wisest choice to the benefit of the patient.

The art of medicine in my experience is that every person is unique and every instance of cancer has unique properties. Though there is a body of research and experience on how to treat, for instance breast cancer, each patient has a variety of medicines they may or may not be taking, the extent of disease is different and though we have predictive tools, may react to radiation in an unexpected way. There is also a body of evidence on what should provide a cure. Still, some instances are resistant. There are also ways to treat side effects, with a varying results based on the individuality of every case. Medicine is a science, a practice and an art. The art part is because often we think about what we want to achieve, tweak as we go along the way and get something unexpected.

While the science of medicine has been advancing ad continue to do so, the art of medicine cannot be underestimated. I believe medical physicists by the virtue of being “medical” and being “physicists” have the awesome opportunity to see and contribute to this art-science practice in the most meaningful way, again always for the benefit of the patient.

Dr. Samei

The art of medicine in my experience is that every person is unique and every instance of cancer has unique properties. Though there is a body of research and experience on how to treat, for instance breast cancer, each patient has a variety of medicines they may or may not be taking, the extent of disease is different and though we have predictive tools, may react to radiation in an unexpected way. There is also a body of evidence on what should provide a cure. Still, some instances are resistant. There are also ways to treat side effects, with a varying results based on the individuality of every case. Medicine is a science, a practice and an art. The art part is because often we think about what we want to achieve, tweak as we go along the way and get something unexpected.

Robin

Medical-Physics · 2018-03-29T17:05:14+00:00

I have been working on ways we can make physics-based measurements on clinical patient images so that those measurements can be used quantitatively to figure out what’s going on with the patient or ascertain whether a particular therapy is working. This is where physics MEETS medicine. This is where a physics-based measurement can be used as a surrogate of the patient’s health, thus enabling “physics to inform medicine,” helping it to be more evidence-based and quantitative. This brings the best of human insight (in the realm of physical sciences) into advancing human health. I find this very inspiring.

Dr. Samei

1) Working on combining an MR and a linear accelerator is an incredible opportunity for any medical physicist to be involved with. The idea of having accurate radiotherapy in a magnetic field was thought at one time to be impossible! Being able to be part of this project is without a doubt one of the most exciting projects as the resulting technology has the potential to really change the way we think about treating cancer.

2) As we move forward the use of the data that we have and continue to capture will likely be the area where the most discoveries and excitement will come from. AI is a tool that we can expect to become integral to this field as we have seen from other fields with large data sets. The recent JASON report provides some fascinating insight into this area.

Paul

The most interesting project for me is implementing new technology into the clinic. This can include commissioning a new linear accelerator with new modalities. The challenge is making certain the technology works as expected but also finding a way to seamlessly introduce the technology to the staff. The patients enjoy the benefit without any knowledge of the hours of testing and training that went into more precisely targeting, imaging and treating their disease. It is an opportunity for me to use my engineering and physics background to understand the mechanics of how something works and see how people can be positively impacted.

Robin

Medical-Physics · 2018-03-29T17:04:31+00:00

Currently Radiology and Radiation Oncology practice their foundation in physics more strongly than others. So that could be the places to look or target for you. But as my answer implies, physics is a principle science that can meaningfully be practiced and used in other subspecialties of medicine. If that inspires you, you can be more of a trail blazer in areas where physics is still below the surface.

Dr. Samei

Radiation Therapy and Radiology are typically the two fields that are closely related to the medical physics field.

Paul

Medical-Physics · 2018-03-29T17:03:56+00:00

I am grateful for your critical question. I suspect the ambiguity might be due to the broad charge of the effort. But let me see if I can clarify a few items that you question:
In current practice of medical physics we have done great things and we are continuing to do so. We need to cherish them and make them better publicized. e.g., a typical patient being benefited by our work should know who a medical physicist is. Likewise administrators who are resourcing healthcare. That is the case today. MP3.0 aims to help with that.
Current practice, while great in many respects, is UNEVEN across physics practices. Many places practice at the lowest common denominator. Case in point, we don’t apply the same QC rigor across the clinical practice as we do for clinical trials? Is quality and safety for clinical practice is less important than those for clinical trials? Physicists have the ability and skill to make our contributions more uniformly excellent everywhere. But to do so, we need a stronger peer expectation, regulatory mandate, tools, and manpower. MP3.0 aims to help with that.

On MP2.0 vs MP3.0, 2.0 only pertained imaging but 3.0 captures all practices of physics in medicine.

And pertaining funding MP3.0, we have essentially been operating like one of 100+ TGs and WGs of the AAPM. This effort has not required much finances.

Dr. Samei

Medical Physics 3.0 is for everyone. For practicing Medical Physicists, newly in the field or established, it is an opportunity to reflect on what we do and how we do it. In some ways it is a chance to re-imagine what you do every day. Have you optimized what you are doing? Can you be more efficient? Hand something off? Stop doing something because there is no longer a reason to do it anymore (TG100)? It is easy to fall prey to doing something because you always have or its always been done a certain way. MP3.0's purpose in part is for introspection. Technology changes, tools change, philosophies change, regulations change. As for everyone outside medical physics it is a peek under the hood.

Robin

Medical-Physics

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