Adapting training for medical physicists to match future trends in radiation oncology

Radiation oncology is a field with constantly evolving technological developments, both with respect to planning and delivering treatment, and it is therefore essential to adapt the training in medical physics to these changes. Automation is increasingly being introduced into radiation oncology processes, and hence there is greater reliance on computing capability and power. We are learning how to better predict treatment outcomes and the risks of morbidity and treatment failures by modelling with available data we already have. In radiation oncology much of our ability to predict and measure outcomes is based on imaging and the quantitative information it can give us. However, the field is also diversifying and increasing in complexity and therefore we will also need leaders who have a vision to progress as effectively as possible, who are prepared in a constructive way with the other disciplines, learning how to cope with change and new knowledge whilst maintaining physics knowledge. Future training will need to consider how this can best be incorporated to ensure that the education of medical physicists in radiation oncology is most effective in this continually developing field [1–3], see footnote. Here we consider some of the topics which might need to be incorporated to optimally equip the next generation to be the most effective radiation oncology physicists of the future.

[1]  B. Gallego,et al.  Big Data Readiness in Radiation Oncology: An Efficient Approach for Relabeling Radiation Therapy Structures With Their TG-263 Standard Name in Real-World Data Sets , 2018, Advances in radiation oncology.

[2]  V. Feygelman,et al.  AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams. , 2015, Journal of applied clinical medical physics.

[3]  A Brahme,et al.  Solution of an integral equation encountered in rotation therapy. , 1982, Physics in medicine and biology.

[4]  M. Alber,et al.  Prospective Evaluation of a Tumor Control Probability Model Based on Dynamic 18F-FMISO PET for Head and Neck Cancer Radiotherapy , 2019, The Journal of Nuclear Medicine.

[5]  Xiaodong Wu,et al.  Comparative study with new accuracy metrics for target volume contouring in PET image guided radiation therapy. , 2012, IEEE transactions on medical imaging.

[6]  Stuart A. Taylor,et al.  Imaging biomarker roadmap for cancer studies , 2016, Nature Reviews Clinical Oncology.

[7]  Mechthild Krause,et al.  Radiation oncology in the era of precision medicine , 2016, Nature Reviews Cancer.

[8]  W. Oyen,et al.  FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0 , 2009, European Journal of Nuclear Medicine and Molecular Imaging.

[9]  Carlos E Cardenas,et al.  Advances in Auto-Segmentation. , 2019, Seminars in radiation oncology.

[10]  Hui Lin,et al.  Towards real-time respiratory motion prediction based on long short-term memory neural networks , 2019, Physics in medicine and biology.

[11]  M. Crumpton The role of leadership , 2015 .

[12]  E. Spezi,et al.  Head and neck target delineation using a novel PET automatic segmentation algorithm. , 2017, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[13]  R Jeraj,et al.  The physical basis and future of radiation therapy. , 2011, The British journal of radiology.

[14]  C. Fiorino,et al.  Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the dose-effect. , 2017, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[15]  Jan-Jakob Sonke,et al.  Tumor Trailing for Liver SBRT on the MR-Linac. , 2019, International journal of radiation oncology, biology, physics.

[16]  David A Jaffray,et al.  How Advances in Imaging Will Affect Precision Radiation Oncology. , 2018, International journal of radiation oncology, biology, physics.

[17]  Alex Lallement,et al.  Survey on deep learning for radiotherapy , 2018, Comput. Biol. Medicine.

[18]  V. Grégoire,et al.  Molecular Imaging-Guided Radiotherapy for the Treatment of Head-and-Neck Squamous Cell Carcinoma: Does it Fulfill the Promises? , 2018, Seminars in radiation oncology.

[19]  Alberto Torresin,et al.  The research versus clinical service role of medical physics. , 2015, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[20]  A. Lomax What will the medical physics of proton therapy look like 10 yr from now? A personal view. , 2018, Medical physics.

[21]  Steve B. Jiang,et al.  Three-Dimensional Dose Prediction for Lung IMRT Patients with Deep Neural Networks: Robust Learning from Heterogeneous Beam Configurations , 2018, ArXiv.

[22]  Eric S Paulson,et al.  Consensus opinion on MRI simulation for external beam radiation treatment planning. , 2016, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[23]  Karin Haustermans,et al.  Contouring of prostate tumors on multiparametric MRI: Evaluation of clinical delineations in a multicenter radiotherapy trial. , 2018, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[24]  Julian Malicki,et al.  Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control. , 2015, Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology.

[25]  Tobias Gauer,et al.  Intelligent 4D CT sequence scanning (i4DCT): Concept and performance evaluation. , 2019, Medical physics.

[26]  Paul Kinahan,et al.  The Use of Quantitative Imaging in Radiation Oncology: A Quantitative Imaging Network (QIN) Perspective. , 2018, International journal of radiation oncology, biology, physics.

[27]  F. Koetsveld,et al.  Feasibility and accuracy of quantitative imaging on a 1.5 T MR-linear accelerator. , 2019, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[28]  D. Yan,et al.  Tumor Voxel Dose-Response Matrix and Dose Prescription Function Derived Using 18F-FDG PET/CT Images for Adaptive Dose Painting by Number. , 2019, International journal of radiation oncology, biology, physics.

[29]  M. V. van Herk,et al.  Quantitative evaluation of 4D Cone beam CT scans with reduced scan time in lung cancer patients , 2019, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[30]  Jan-Jakob Sonke,et al.  Adaptive Radiotherapy for Anatomical Changes. , 2019, Seminars in radiation oncology.

[31]  Kuo Men,et al.  Automatic segmentation of the clinical target volume and organs at risk in the planning CT for rectal cancer using deep dilated convolutional neural networks , 2017, Medical physics.

[32]  Ludvig Paul Muren,et al.  Prediction of rectum and bladder morbidity following radiotherapy of prostate cancer based on motion-inclusive dose distributions. , 2013, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[33]  Ronald Boellaard,et al.  18F-FDG PET image biomarkers improve prediction of late radiation-induced xerostomia. , 2017, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[34]  Eric C Ford,et al.  Deep learning for patient‐specific quality assurance: Identifying errors in radiotherapy delivery by radiomic analysis of gamma images with convolutional neural networks , 2019, Medical physics.

[35]  Daniel Cremers,et al.  Radiomics in radiooncology - Challenging the medical physicist. , 2018, Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics.

[36]  Arvind Rao,et al.  Performance/outcomes data and physician process challenges for practical big data efforts in radiation oncology. , 2018, Medical physics.

[37]  F. Milano,et al.  Guidelines for education and training of medical physicists in radiotherapy. Recommendations from an ESTRO/EFOMP working group. , 2004, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[38]  Yong Fan,et al.  A deep learning model for predicting xerostomia due to radiotherapy for head-and-neck squamous cell carcinoma in the RTOG 0522 clinical trial. , 2019, International journal of radiation oncology, biology, physics.

[39]  Fang Liu,et al.  MR‐based treatment planning in radiation therapy using a deep learning approach , 2019, Journal of applied clinical medical physics.

[40]  Indra J. Das,et al.  AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations — Megavoltage Photon and Electron Beams , 2015, Journal of applied clinical medical physics.

[41]  C. Fiorino,et al.  Multi-variable models of large International Prostate Symptom Score worsening at the end of therapy in prostate cancer radiotherapy. , 2016, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[42]  Carlo Cavedon,et al.  Texture analysis of 3D dose distributions for predictive modelling of toxicity rates in radiotherapy. , 2018, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[43]  I. Lax,et al.  Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. , 1994, Acta oncologica.

[44]  Berkman Sahiner,et al.  Deep learning in medical imaging and radiation therapy. , 2018, Medical physics.

[45]  A. Zietman Particle Therapy at the "Tipping Point": An Introduction to the Red Journal's Special Edition. , 2016, International journal of radiation oncology, biology, physics.

[46]  Ulrike Schick,et al.  Normal tissue complication probability (NTCP) modelling using spatial dose metrics and machine learning methods for severe acute oral mucositis resulting from head and neck radiotherapy. , 2016, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[47]  Roberto Orecchia,et al.  Current concepts on imaging in radiotherapy , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[48]  R Mohan,et al.  Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation. , 1996, International journal of radiation oncology, biology, physics.

[49]  N. Schwenzer,et al.  Assessment of image quality of a radiotherapy-specific hardware solution for PET/MRI in head and neck cancer patients , 2018, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[50]  Daniela Thorwarth,et al.  Quantitative Imaging for Radiation Oncology. , 2018, International journal of radiation oncology, biology, physics.

[51]  A. Brahme,et al.  Optimization of stationary and moving beam radiation therapy techniques. , 1988, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[52]  Joseph O Deasy,et al.  Spatial rectal dose/volume metrics predict patient-reported gastro-intestinal symptoms after radiotherapy for prostate cancer , 2017, Acta oncologica.

[53]  B. Stemkens,et al.  Towards fast online intrafraction replanning for free-breathing stereotactic body radiation therapy with the MR-linac , 2017, Physics in medicine and biology.

[54]  H. Lyng,et al.  Combined MR Imaging of Oxygen Consumption and Supply Reveals Tumor Hypoxia and Aggressiveness in Prostate Cancer Patients. , 2018, Cancer research.

[55]  S Leibfarth,et al.  Automatic delineation of tumor volumes by co-segmentation of combined PET/MR data , 2015, Physics in medicine and biology.

[56]  B. Heijmen,et al.  Automation in intensity modulated radiotherapy treatment planning-a review of recent innovations. , 2018, The British journal of radiology.

[57]  Daniela Thorwarth,et al.  Integration der FDG-PET/CT-Bildgebung in die Planung der externen Strahlentherapie – Technische Aspekte und Empfehlungen zur methodischen Annäherung , 2012 .

[58]  J. Deasy,et al.  A case-control study using motion-inclusive spatial dose-volume metrics to account for genito-urinary toxicity following high-precision radiotherapy for prostate cancer☆ , 2018, Physics and imaging in radiation oncology.

[59]  Radhe Mohan,et al.  Empowering Intensity Modulated Proton Therapy Through Physics and Technology: An Overview. , 2017, International journal of radiation oncology, biology, physics.

[60]  Rob H N Tijssen,et al.  MRI commissioning of 1.5T MR-linac systems - a multi-institutional study. , 2019, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[61]  M F Fast,et al.  MRI-guided mid-position liver radiotherapy: Validation of image processing and registration steps. , 2019, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[62]  Radhe Mohan,et al.  Report of the AAPM TG-256 on the relative biological effectiveness of proton beams in radiation therapy. , 2019, Medical physics.