Journals Highlights
The Role of Medical Physicists in High-Quality Treatment Planning: An Interview with Mu-Han Lin, PhD, Minsun Kim, PhD, Dustin Jacqmin, PhD, and Lindsey Olsen, PhD
Authors of the PRO editorial, “Beyond Acceptable: The Vital Role of Medical Physicists in Ensuring High-Quality Treatment Plans,” discussed their paper with ASTROnews. The editorial can be found at https://www.practicalradonc.org/article/S1879-8500(23)00239-4/abstract.Please give a brief overview of your editorial. What are the major points you would like readers to know?
Treatment planning is a critical step in the radiotherapy process, helping to shape the quality of care for cancer patients. While there are guidelines for ensuring the safety and minimum quality of a treatment plan, achieving the highest quality to the extent feasible is not always straightforward. There is currently no standard for defining the optimal quality achievable for a given patient. Despite physicists conducting initial chart checks post-plan completion, the window for significant plan modifications is often limited unless a plan is deemed egregiously incorrect or unsafe.
The emergence of adaptive therapy and automated planning necessitates the urgency of attaining high quality plans within condensed timelines. This requires a deep understanding of physics principles in imaging, optimization, dose calculation and delivery robustness to effectively utilize advanced tools in clinical settings, which are often black boxes to users. While medical physicists are ideally positioned to conduct plan quality reviews and elevate plan quality, their varying levels of involvement in plan generation are influenced by institutional cultures and resource availability.
Our editorial aims to raise awareness about the critical importance of engaging in physics plan quality reviews to promptly identify and rectify deficiencies in treatment plans. We delve into the nuances of plan quality, stress its pivotal role, outline potential hurdles and propose viable solutions to facilitate more meaningful engagement from physicists. Targeting physicists, physicians, planners, therapists and radiation oncology trainees, our objective is to foster a collaborative, multidisciplinary environment that prioritizes a culture of excellence in quality assurance.
What prompted/inspired you to write this paper?
Our journey began in 2021, when the members of the AAPM Working Group on Treatment Planning embarked on a mission to enhance education around treatment planning at the request of the AAPM membership. During the discussion, it became clear that improving plan quality beyond merely acceptable levels is challenging in the modern era due to complex treatment planning technologies and the diverse responsibilities that medical physicists have in the clinic. This effort culminated in the coordination of our working group to develop a presentation on physics plan quality review, encompassing the fundamental principles and providing a range of real clinical examples of unacceptable to high-quality plans.
Our presentation at the 2022 AAPM Spring Clinical Meeting and Annual Meeting garnered significant positive feedback, leading to invitations to present at several local chapters in 2023. In an effort to gauge the effectiveness and common barriers to implementing physics plan quality review, we conducted a survey targeted primarily to physicists. The survey results highlighted that fostering a quality-driven environment hinges on the collaborative efforts of the entire team, including physicians, physicists, planners and therapists.
It was these insights that inspired us to write this editorial, with the aim of raising awareness about the importance of ensuring the highest feasible plan quality and highlighting the role of physicists in achieving this goal.
What has surprised you with regard to medical physicists’ involvement in high-quality treatment planning?
Our survey revealed several intriguing insights. First, despite treatment planning being a fundamental aspect of therapy physics residency programs, there’s a wide spectrum of planning involvement observed in clinical practice. Second, the level of physicists’ engagement in treatment plan generation varies significantly based on the prevailing work culture and available resources within each clinic. Third, despite these variations, we found that the barriers to adopting plan quality review in the planning process are remarkably consistent across clinics. The most common barriers consistently identified include lack of treatment planning education and resource constraints (both time and personnel).
Given these findings, we believe this editorial highlights the potential benefits for clinics considering the implementation of plan quality review. In fact, we’ve taken additional steps in 2024 by launching a lecture series titled “Treatment Plan Evaluation” with Rayos Contra Cancer. This series covers both general principles and site-specific plan quality review, aiming to disseminate this crucial knowledge to members of the radiation oncology team, particularly in limited-resource settings worldwide.
Mu-Han Lin, PhD, serves as the Director of Adaptive Therapy at the University of Texas Southwestern Medical Center. Her research and clinical service focuses on the practical application of artificial intelligence to advance planning practices, alongside her exploration of X-ray/MR guided adaptive therapy techniques.
Minsun Kim, PhD, serves as the Clinical Physics Lead at the University of Washington Medical Center – Montlake. Her research focuses on clinical outcome-based treatment planning strategies and data-driven decision aid tools to improve patient care. Her clinical interests include treatment planning and stereotactic body radiotherapy.
Dustin Jacqmin, PhD, serves as the Director of Quality and Safety for the Department of Human Oncology at the University of Wisconsin – Madison. His research and clinical service focuses on promoting high quality patient care through data-driven patient safety initiatives and automation in radiation therapy treatment planning.
Lindsey Olsen PhD is a medical physicist at the University of Colorado Health in Colorado Springs. Her passion lies in helping to foster and promote high-quality cancer care for all patients through treatment planning education and exploration of novel, data-driven and automated treatment planning techniques.
Women in the Medical Physics Workforce: An Interview with
Jillian Rankin, BS
Ms. Rankin spoke with ASTROnews about the Red Journal paper, “Women in the Medical Physics Workforce: Insights from Membership Trends of the American Association of Physicists in Medicine, 1993 to 2023,” which can be found at https://www.redjournal.org/article/S0360-3016(24)00318-3/abstract.
What research question(s) did you explore in this paper?
The “Women in the Medical Physics Workforce” project allowed us to take a deep dive into the world of gender equity in the field. Prior studies had shown that women are underrepresented in medical physics, including in leadership roles, despite significant movement toward parity in the undergraduate and graduate student pipeline. We wanted to better understand why this was the case. Using American Association of Physicists in Medicine (AAPM) membership as a proxy for professional involvement in medical physics, we evaluated whether membership tenure differed between men and women, including when and at what age membership cessation occurred. We further stratified by highest degree to evaluate how differences in training influenced the membership trends that we observed.
Please describe the data you obtained and statistical methods you used.
Historic membership data from 1993-2003, including gender, age, highest degree, membership type, and years of active membership, were obtained from AAPM. To best represent the United States medical physics workforce, only full members practicing in the U.S. were included in the analysis. Stratifying by gender and highest degree type (PhD vs. Master’s), a Kaplan-Meier “survival” analysis was used to assess when, by both age and years of active membership, membership cessation occurred. We also specifically evaluated the distribution of age at membership cessation by gender.
What did you find through your analyses?
Shorter average membership durations were observed amongst women relative to men, and women were found to both start and end their memberships at earlier average ages than men. Additionally, a higher proportion of Master’s vs. PhD degree holders were observed amongst women, while the opposite trend was observed amongst men. Regardless of gender or degree, age at membership cessation followed an approximately bimodal distribution. While one peak occurred around retirement age, as might be expected, for both men and women another occurred around age 40. This suggests that, while broader societal factors (e.g., gender roles, child care responsibilities) may play a role in early membership cessation amongst women, additional factors within the field likely contribute to the continued disparity in representation.
What surprised you? Why?
Interestingly, unique membership trajectories were observed by gender-degree subgroup. Notably, despite the earlier average membership cessation amongst women than men, women with PhDs were found to have the greatest membership “survival”, meaning that, relative to any other gender-degree subgroup, a greater proportion of the original group of women with PhDs were still members after a given number of years. This suggests that there may exist unique challenges, motivations and experiences for different subsets of women within the field. Further work, especially qualitative analysis, will be necessary to better elucidate these differences. A member exit survey will be particularly important in developing a more complete understanding of the trends observed in this work.
Jillian Rankin is a second-year medical student at Emory University School of Medicine with a background in physics, mentorship and leadership equity in medicine.
