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Medical physics has made considerable contributions to recent advances in radiation oncology. Medical physicists are key players in the clinical and scientific radiation oncology context due to their unique skill sets, flexibility, clinical involvement and intrinsic translational character. The continuing development and widespread adoption of "high-tech" radiotherapy has led to an increased need for medical physics involvement. More recently, our field is rapidly changing towards an era of "precision oncology". These changes have opened new challenges for the definition of the professional and scientific roles and responsibilities of medical physicists. In this paper, we have identified four grand challenges of medical physics in radiation oncology: (1) improving target volume definition, (2) adoption of artificial intelligence and automation, (3) development of predictive models of biological effects for precision medicine, and (4) need for leadership. New visions and suggestions to orientate medical physics to successfully face these new challenges are summarized. We foresee that the scientific and professional challenges of our times are pushing medical physicists to accelerate toward multidisciplinarity. Medical physicists are expected to innovatively drive interactions and collaborations with other specialists outside radiation oncology while the radiation physics core will remain central. Medical physicists will retain strong and pivotal roles in quality, safety and in managing ever more complex technologies. The new challenges will require medical physicists to continuously update skills and innovate education, adapt curricula to include new fields, reinforce multi-disciplinary attitude and spirit of innovation. These challenges require visionary and open leadership, which is able to merge established roles with the exciting new fields where medical physics should increasingly contribute.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines:• Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.• Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. Approved by AAPM Professional Council 3-31-2017 and Executive Committee 4-4-2017.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline (MPPG) represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiation requires specific training, skills, and techniques as described in each document. As the review of the previous version of AAPM Professional Policy (PP)-17 (Scope of Practice) progressed, the writing group focused on one of the main goals: to have this document accepted by regulatory and accrediting bodies. After much discussion, it was decided that this goal would be better served through a MPPG. To further advance this goal, the text was updated to reflect the rationale and processes by which the activities in the scope of practice were identified and categorized. Lastly, the AAPM Professional Council believes that this document has benefitted from public comment which is part of the MPPG process but not the AAPM Professional Policy approval process. The following terms are used in the AAPM's MPPGs: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

The purpose of this study was to quantify gender diversity in leadership positions within the field of medical physics, as well as within award categories and other recognitions by the American Association of Physicists in Medicine. The April 2019 PDF version of the AAPM membership directory was searched for all users self-reporting as holding a leadership position at their place of employment, those elected to leadership positions within the AAPM, those serving as chair of an AAPM council, and those listed as having received an award or other such recognition from AAPM (beginning in 1972 with the William D. Coolidge Award). Historical data for these categories were obtained from archived membership directories on the AAPM website. The AAPM website was also used to identify members who have served on the Medical Physics Editorial Board. The Commission on Accreditation of Medical Physics Education Programs (CAMPEP) website was used to identify the current directors of graduate and residency programs (as of July 2019). Because gender was not a reported field in any of these categories, gender was assigned by reviewing names and photographs. Percentage representation in these respects was compared to the overall percentage of women in the AAPM in 2019 (23.3%) and reported the number of women working as medical physicists globally (29.8%). Within the AAPM, the percentage of women reporting clinical leadership roles is 12.0% within the US, 13.6% in Canada, and 18.0% in all other countries combined. Women comprise only 7.5% of CAMPEP graduate program directors and 21.5% of residency program directors. The percentage of female presidents in AAPM is 8.1%. A woman has never served as Editor-in-Chief of Medical Physics, and the average for the past 10 yr for female board membership is 13.6%. With the exception of the John R. Cameron Young Investigators Symposium Award, the percentage of all female AAPM awardees is less than the percentage of women AAPM members. The lowest percentage of female representation within AAPM is among council chairs with only one woman having held a chair position out of 42 positions (2.4%) from 1970 to July 2019. Similar to the traditional discipline of physics, medical physics displays a clear gender disparity with regard to leadership positions, both within educational training programs and the AAPM. Further investigation into the demographics of the field and psychosocial factors affecting medical physicists may help to elucidate the origin of these disparities and inform strategies to address them.

The roles of physicists in medical imaging have expanded over the years, from the study of imaging systems (sources and detectors) and dose to the assessment of image quality and perception, the development of image processing techniques, and the development of image analysis methods to assist in detection and diagnosis. The latter is a natural extension of medical physicists' goals in developing imaging techniques to help physicians acquire diagnostic information and improve clinical decisions. Studies indicate that radiologists do not detect all abnormalities on images that are visible on retrospective review, and they do not always correctly characterize abnormalities that are found. Since the 1950s, the potential use of computers had been considered for analysis of radiographic abnormalities. In the mid-1980s, however, medical physicists and radiologists began major research efforts for computer-aided detection or computer-aided diagnosis (CAD), that is, using the computer output as an aid to radiologists-as opposed to a completely automatic computer interpretation-focusing initially on methods for the detection of lesions on chest radiographs and mammograms. Since then, extensive investigations of computerized image analysis for detection or diagnosis of abnormalities in a variety of 2D and 3D medical images have been conducted. The growth of CAD over the past 20 years has been tremendous-from the early days of time-consuming film digitization and CPU-intensive computations on a limited number of cases to its current status in which developed CAD approaches are evaluated rigorously on large clinically relevant databases. CAD research by medical physicists includes many aspects-collecting relevant normal and pathological cases; developing computer algorithms appropriate for the medical interpretation task including those for segmentation, feature extraction, and classifier design; developing methodology for assessing CAD performance; validating the algorithms using appropriate cases to measure performance and robustness; conducting observer studies with which to evaluate radiologists in the diagnostic task without and with the use of the computer aid; and ultimately assessing performance with a clinical trial. Medical physicists also have an important role in quantitative imaging, by validating the quantitative integrity of scanners and developing imaging techniques, and image analysis tools that extract quantitative data in a more accurate and automated fashion. As imaging systems become more complex and the need for better quantitative information from images grows, the future includes the combined research efforts from physicists working in CAD with those working on quantitative imaging systems to readily yield information on morphology, function, molecular structure, and more-from animal imaging research to clinical patient care. A historical review of CAD and a discussion of challenges for the future are presented here, along with the extension to quantitative image analysis.

The Geant4 Monte Carlo radiation transport toolkit provides the basic services and infrastructure required for the development of flexible simulation frameworks and applications, which have found generalized use in high energy physics, nuclear physics, astrophysics, and medical physics research. Object-oriented design provides the possibility to implement or modify any physics process in Geant4 without changing other parts of the code. This feature makes Geant4 open to extension of its physics modeling capabilities and to the implementation of alternative physics models. In this paper, the development of a simulation platform for performance studies and detector optimization of the Clear-PEM scanner, a high-performance positron emission mammography prototype, and the implementation of precise low energy bremsstrahlung angular generators for the Geant4 LowE category are described.

This paper reviews the ecosystem of GATE, an open-source Monte Carlo toolkit for medical physics. Based on the shoulders of Geant4, the principal modules (geometry, physics, scorers) are described with brief descriptions of some key concepts (Volume, Actors, Digitizer). The main source code repositories are detailed together with the automated compilation and tests processes (Continuous Integration). We then described how the OpenGATE collaboration managed the collaborative development of about one hundred developers during almost 20 years. The impact of GATE on medical physics and cancer research is then summarized, and examples of a few key applications are given. Finally, future development perspectives are indicated.

We present a series of achievements associated with Geant4-based applications in medical physics and, in particular, in radiotherapy (external beams and brachytherapy), protontherapy, PEM, PET, MRT, metabolic therapy, IORT; projects in microdosimetry and radiobiology are beginning. The Geant4 CT-interface allows to reproduce realistically the patient anatomy, the integration to the GRID allows to run the applications sharing distributed computing resources. The Geant4 Medical Physics Group has born from the collaboration of Geant4 with several research and medical physics institutes in Europe.

Journal Article Essentials of Biological and Medical Physics Get access Essentials of Biological and Medical Physics. By Ralph W. Stacy, Ph.D., Associate Professor Laboratory of Biophysics, Dept. of Physiology, Ohio State University; David T. Williams, Ph.D., Physicist, Battelle Memorial Institute, Columbus, Ohio; Ralph E. Wor den, M.D., Associate Professor Physical Medicine and Rehabilitation, College of Medicine, Ohio State University; Rex O. McMorris, M.D., Associate Professor and Chairman of Dept. of Physical Medicine and Rehabilitation, University of Louisville Medical School. First Edition. Cloth. Price $8.50. Pp. 586; illus. McGraw-Hill Book Co., New York, 1955. Physical Therapy, Volume 35, Issue 12, 1 December 1955, Pages 752–753, https://doi.org/10.1093/ptj/35.12.752b Published: 01 December 1955

GEANT4 (GEometry ANd Tracking 4) is an object-oriented Monte Carlo simulation toolkit that has been developed by a worldwide collaboration of scientists. It simulates the passage of particles through matter. In order to validate GEANT4 for medical physics applications, different simulations are conducted. The results are compared to published results based on three Monte Carlo codes widely used in medical physics: MCNP, EGS4, and EGSnrc. When possible, the simulation results are also compared to experimental data. Different geometries are tested (multilayer and homogeneous phantoms), different sources considered (point-source and broad parallel beam), and different primary particles simulated (photons and electrons) at different energies. For the heterogeneous media, there are notable differences between the Monte Carlo codes reaching up to over 5% in relative difference. For the monoenergetic electrons in a homogeneous medium, the difference between GEANT4 and the experimental measurements is similar to the difference between EGSnrc and the experimental measurements; for the depth-dose curves, the difference expressed as a fraction of the peak dose is always smaller than 4%. We conclude that GEANT4 is a promising Monte Carlo simulation toolkit for low-energy medical applications.

Monte Carlo techniques have become ubiquitous in medical physics over the last 50 years with a doubling of papers on the subject every 5 years between the first PMB paper in 1967 and 2000 when the numbers levelled off. While recognizing the many other roles that Monte Carlo techniques have played in medical physics, this review emphasizes techniques for electron-photon transport simulations. The broad range of codes available is mentioned but there is special emphasis on the EGS4/EGSnrc code system which the author has helped develop for 25 years. The importance of the 1987 Erice Summer School on Monte Carlo techniques is highlighted. As an illustrative example of the role Monte Carlo techniques have played, the history of the correction for wall attenuation and scatter in an ion chamber is presented as it demonstrates the interplay between a specific problem and the development of tools to solve the problem which in turn leads to applications in other areas.

The graphics processing unit (GPU) has emerged as a competitive platform for computing massively parallel problems. Many computing applications in medical physics can be formulated as data-parallel tasks that exploit the capabilities of the GPU for reducing processing times. The authors review the basic principles of GPU computing as well as the main performance optimization techniques, and survey existing applications in three areas of medical physics, namely image reconstruction, dose calculation and treatment plan optimization, and image processing.

The purpose of this technical report is to make available an up-to-date source of attenuation coefficient data to the medical physics community, and to compare these data with other more familiar sources. Data files from Lawrence Livermore National Laboratory (in Livermore, CA) were truncated to match the needs of the medical physics community, and an interpolation routine was written to calculate a continuous set of cross sections spanning energies from 1 keV to 50 MeV. Coefficient data are available for elements Z = 1 through Z = 100. Values for mass attenuation coefficients, mass-energy-transfer coefficients, and mass-energy absorption coefficients are produced by a single computer subroutine. In addition to total interaction cross sections, the cross sections for photoelectric, Rayleigh, Compton, pair, and some triplet interactions are also produced by this single program. The coefficients were compared to the 1970 data of Storm and Israel over the energy interval from 1 to 1000 keV; for elements 10, 20, 30, 40, 50, 60, 70, and 80, the average positive difference between the Storm and Israel coefficients and the coefficients reported here are 1.4%, 2.7%, and 2.6%, for the mass attenuation, mass energy-transfer, and mass-energy absorption coefficients, respectively. The 1969 data compilation of mass attenuation coefficients from McMaster et al. were also compared with the newer LLNL data. Over the energy region from 10 keV to 1000 keV, and from elements Z = 1 to Z = 82 (inclusive), the overall average difference was 1.53% (sigma = 0.85%). While the overall average difference was small, there was larger variation (> 5%) between cross sections for some elements. In addition to coefficient data, other useful data such as the density, atomic weight, K, L1, L2, L3, M, and N edges, and numerous characteristic emission energies are output by the program, depending on a single input variable. The computer source code, written in C, can be accessed and downloaded from the World Wide Web at: http:@www.aip.org/epaps/epaps.html [E-MPHSA-23-1977].

As one of the most popular approaches in artificial intelligence, deep learning (DL) has attracted a lot of attention in the medical physics field over the past few years. The goals of this topical review article are twofold. First, we will provide an overview of the method to medical physics researchers interested in DL to help them start the endeavor. Second, we will give in-depth discussions on the DL technology to make researchers aware of its potential challenges and possible solutions. As such, we divide the article into two major parts. The first part introduces general concepts and principles of DL and summarizes major research resources, such as computational tools and databases. The second part discusses challenges faced by DL, present available methods to mitigate some of these challenges, as well as our recommendations.

The integration of magnetic resonance imaging (MRI) for guidance in external beam radiotherapy has faced significant research and development efforts in recent years. The current availability of linear accelerators with an embedded MRI unit, providing volumetric imaging at excellent soft tissue contrast, is expected to provide novel possibilities in the implementation of image-guided adaptive radiotherapy (IGART) protocols. This study reviews open medical physics issues in MR-guided radiotherapy (MRgRT) implementation, with a focus on current approaches and on the potential for innovation in IGART.Daily imaging in MRgRT provides the ability to visualize the static anatomy, to capture internal tumor motion and to extract quantitative image features for treatment verification and monitoring. Those capabilities enable the use of treatment adaptation, with potential benefits in terms of personalized medicine. The use of online MRI requires dedicated efforts to perform accurate dose measurements and calculations, due to the presence of magnetic fields. Likewise, MRgRT requires dedicated quality assurance (QA) protocols for safe clinical implementation.Reaction to anatomical changes in MRgRT, as visualized on daily images, demands for treatment adaptation concepts, with stringent requirements in terms of fast and accurate validation before the treatment fraction can be delivered. This entails specific challenges in terms of treatment workflow optimization, QA, and verification of the expected delivered dose while the patient is in treatment position. Those challenges require specialized medical physics developments towards the aim of fully exploiting MRI capabilities. Conversely, the use of MRgRT allows for higher confidence in tumor targeting and organs-at-risk (OAR) sparing.The systematic use of MRgRT brings the possibility of leveraging IGART methods for the optimization of tumor targeting and quantitative treatment verification. Although several challenges exist, the intrinsic benefits of MRgRT will provide a deeper understanding of dose delivery effects on an individual basis, with the potential for further treatment personalization.