The medical physicist today
ESTRO physics committee chair Dr Núria Jornet reflects on the role of the medical physicist in radiation oncology and considers what could be done to harmonise the field’s reputation across Europe
ESTRO (the European SocieTy for Radiotherapy & Oncology) was founded in 1980 with the intention of establishing radiation oncology as a specialty independent from radiology and integrating it as a driving force within the broader field of multidisciplinary oncology. Today, as a 5,000-member strong non-profit and scientific organisation, its main objective is to ensure that every cancer patient in Europe has access to ‘state-of-the-art radiation therapy, as part of a multidisciplinary approach where treatment is individualised for the specific patient’s cancer, taking account of the patient’s personal circumstances’.
With this in mind, ESTRO works to promote innovation, research and scientific dissemination, which it does via a series of congresses, special meetings, educational courses and publications; develop and promote standards of education and practice in radiotherapy, clinical oncology and related subjects; and support radiation oncology professionals (medical physicists, radiobiologists and radiation therapists, etc.) in their daily practice.
Within this, the ESTRO physics committee is tasked with establishing a vision for the future of medical physics within radiation oncology in Europe, promoting the field via educational and professional development, advising and educating the public and health professionals on all radiation oncology physics-related matters, and promoting standards within the field. Speaking to PEN, committee chair Dr Núria Jornet discusses the group’s activities, the role of the medical physicist within radiation oncology today, and what could be done to harmonise the position and reputation of medical physicists across the continent.
How would you define the role of the medical physicist within the radiation oncology landscape in Europe today?
The medical physicist plays a key role within the radiation oncology landscape in Europe. Nobody would argue against the fact that a radiation oncology department needs a strong team of medical physicists in order to assure that treatments are safely delivered with a high quality. As far as research and development is concerned, European centres have a leading role and are driving forces at the global level to further improve radiotherapy techniques and technologies.
How far would you agree that medical physicists’ responsibilities have shifted away from their original clinical role?
That’s an interesting question. Looking back to my department, as in many departments in Europe, our clinical responsibilities have not changed that much since the first Cobalt Unit was installed. Our key responsibility is the safe implementation of new technology and techniques (in the 1960s it was the Cobalt Unit but nowadays may be an MRI-linac). In this aspect our scope has widened with the ever-increasing role of imaging in radiation oncology. We are responsible for guaranteeing that the planned treatment for each individual patient is the ‘optimal’ that can be achieved with the available technology and resources. We are responsible for ensuring that the machines used for treating patients operate the way they are supposed to. We are also responsible for ensuring that the machines deliver any single treatment as it was planned and approved by the radiation oncologist. An error in any of the tasks that I have described would lead to an accident that could result in severe damage to the patients, including death. So, medical physicists still have a relevant clinical role in radiation oncology.
In addition, more research-oriented medical physicists, as in the past, are substantially contributing in clinically relevant fields: look, for instance, to the advent of biological and functional imaging whose translation into the clinic is resulting in an improved characterisation of tumours and more personalised treatments that will hopefully result in better survival, less toxicity and a wiser use of resources. Isn’t this clinically relevant?
So, I would say that the clinical role comes together with the word ‘medical’ in front of ‘physicist’. In other words, our ‘clinical’ focus is what makes the difference between a ‘physicist’ and a ‘medical physicist’. And now, quoting the theme chosen by the International Organization for Medical Physics (IOMP) to celebrate the International Day of Medical Physics in 2015, ‘Better medical physics will result in better cancer care in radiation oncology’, and I would go a step further: ‘It will result in better cancer cure.’ And this applies for both more clinically oriented medical physicists and those more research oriented.
The past few decades have witnessed a physics-based revolution thanks to huge advances in medical imaging, but this has not perhaps been without its challenges – some EU member states have reported difficulties regarding the availability of appropriately qualified medical physicists. How far is this a problem in radiation oncology physics, and how would you like to see this problem addressed – is there a call here for greater funding or improved harmonisation between countries as to what a medical physicist is?
Yes, despite the efforts of the European Federation of Organisations for Medical Physics (EFOMP) towards the harmonisation of medical physics profession in Europe, the reality shows that the position and the reputation of medical physicists are highly variable across Europe. In 2011 the ESTRO physics committee and EFOMP published a Core Curricula for Medical Physics in Radiation Oncology in line with the Bologna Process. This curriculum should standardise the knowledge, skills and competences of medical physicists working in radiation oncology across European countries. However, it was felt that further education and training was needed to qualify as medical physics experts (MPE) able to act independently.
The training of medical physicists to become MPEs requires resources in terms of both equipment and faculty that may be difficult to find in all European countries. Although in many countries individual training programmes have been implemented based on a Euratom directive for the medical use of ionizing radiation in medicine, to our best knowledge, no systematic training programme for MPEs in radiation oncology as yet exists at a European level. Together with EFOMP, the ESTRO physics committee is now working on an educational project which will use both online and hands-on training. We think that this ambitious project will contribute substantially in the process of harmonisation of national qualifications across Europe, also facilitating mobility between European countries. In addition, we believe that this project will largely contribute to speeding up the road toward the standardisation of high-level safety and quality procedures across Europe. Obviously, the development and the sustainability of such a platform requires financial support.
How is the ESTRO physics committee involved in the application, research and training of medical physicists in radiotherapy?
The ESTRO physics committee strategy is based on ESTRO’s vision, which states: “Every patient in Europe will have access to state-of-the-art radiation therapy. His/her treatment will be individualised, safe and will take into account patient circumstances.”
To accomplish this vision the physics committee is active in different fields. In the education arena the physics committee – in synergy with the ESTRO education council – proposes courses aimed mainly at medical physicists but also takes a leading role in multidisciplinary courses. We strongly believe that the approach to making a difference in cancer cure is multidisciplinary; therefore, physicists entering into this field have to be trained from the start in a multidisciplinary setting. Teams that include medical physicists are often more effective at identifying better treatment techniques, research approaches and methods to improve quality and safety. The ESTRO school covers 40 course topics that are organised on a biennial basis: four of them target only physicists and 18 target a multidisciplinary audience. Moreover, each year, before the annual ESTRO meeting, the physics committee organises one or two one-day pre-meeting courses on a radiation oncology physics topic: for instance, last year a course on multidimensional radiation detectors was organised in Turin, Italy.
Concerning research, a major task is to facilitate the dissemination of the scientific activities by directly acting in the preparation of the scientific programme of the annual ESTRO meeting: a two-day full track is dedicated to physics and other contributions are organised for several multidisciplinary sessions. Last year in Torino the number of abstract submissions by medical physicists was 904 out of 2,148. ESTRO has also just launched three open access journals, one of them focusing on physics and imaging (Physics and Imaging in Radiation Oncology). We expect that this journal will attract a larger number of medical physicists and, together with Radiotherapy and Oncology, be a reference for high quality physics in radiation oncology and imaging science.
The scientific production of medical physicists in Europe, although high, is heterogeneously distributed. We feel there is room for improvement and we want to expand the scientific role of medical physicists in radiation oncology across all European countries. In order to contribute to this challenging objective, we recently created a task group to plan actions to stimulate research activities within our field in Europe, as recently reported in an editorial written by this group and published in Radiotherapy and Oncology. The ESTRO medical physics master class course, organised every two years, is among these initiatives. Importantly, we are also working on creating platforms to facilitate scientific supranational networks; along this line we have organised a workshop on dosimetry audits, which will be held in Brussels, Belgium, at the beginning of 2017.
Finally, the physics committee feels that the ESTRO medical physics community should be more active in developing guidelines for the fast and safe uptake of new technologies and innovative solutions working closer with industry. We are aware national initiatives exist in this field, but we think that ESTRO is in a perfect position for facilitating the integration of these different groups to elaborate European guidelines. This is for sure within our strategy plans.
How else does the ESTRO physics committee contribute to ensuring the recognition and optimisation of medical physics within radiation oncology in Europe?
I would say that there are, at least, two levels of recognition: first, the recognition of the medical physics role within the field of radiation oncology itself; and, second, the recognition as a health profession. The ESTRO physics committee is mainly involved with the first through high level scientific contributions to the annual ESTRO meetings, participation in research networks and projects, involvement in the scientific strategies and initiatives of the society, and by maintaining a strong presence in the ESTRO courses. Regarding the second, the ESTRO physics committee lobbies with EFOMP and IOMP to influence European policy makers to continuously improve the reputation and the recognition of MPEs in all European countries.
How do you envisage the future of medical physics within radiation oncology in Europe?
Medical physicists have had and still have a pivotal role in the development and safe implementation of new technologies and techniques in radiation oncology, not only regarding the treatment itself but also in many emerging fields of research and clinical service, e.g. the individualisation of treatments through adaptive radiotherapy, the use of quantitative imaging for predicting response and toxicity (radiomic), the optimisation, validation and implementation of functional imaging, the spread of proton facilities and of MRI-linacs, the use of advanced methods for handling big data to develop and validate predictive models in the actual personalised medicine scenario, the development of preclinical facilities for animal experiments, the need of a better modelling tumour kinetic, the growing need for physics skills in controlled clinical trials, and many others.
However, in order to continuously grow as a well-recognised scientific and professional community, we need to enhance our visibility in the professional and public media as well as increase our natural ‘translationality’ by better exploiting our ‘central’ position between the clinic, technology development and science. In this sense, we need to be more proactive in the oncology arena, also leaving our comfort areas and delegating standardised procedures; we are clearly expected to contribute more, thanks to our position and our specific and high-level scientific attitude, to the advancement of cancer cure over the next years.
Dr Núria Jornet
Chair
ESTRO Physics Committee
www.estro.org/
This article first appeared in issue 20 of Pan European Networks: Science and Technology, available here.
