Hug a medical physicist today

On November 7, 2013

Early_xray

Coinciding with the birthday of Marie Curie, 7 November is the International Day of Medical Physics and a time to celebrate our medical physicists. So if there is one in your vicinity, give them a hug – they deserve it!

Medical physicists inhabit a diverse field. They work in hospitals, universities and in industry as service providers and researchers. The field was born and thrives on the back of curiosity driven research in basic physics, such as Roentgen’s discovery of X-rays in 1895 and the discovery of the positron in 1932 that was central to the development of positron emission tomography (PET) decades later.

Medical physics is central to the treatment of cancer with different types of radiation, from X-rays, protons and heavy ions to ultrasound, and medical imaging techniques ranging from basic X-ray exposures to advanced modalities like PET. Medical physicists also provide radiation protection services in hospitals and industry.

By its very nature, the field is interdisciplinary. Depending on their subfield, medical physicists may use radiobiology, anatomy and physiology, cancer biology and engineering in their daily work. And no medical physicist is an island: they typically work in teams that can include medics, radiation therapists, radiographers, nurses, engineers, technicians and biologists.

In hospitals, medical physicists ensure imaging and treatment services are delivered safely and to the highest standards. This might take the form of monitoring and managing instrumentation, commissioning new technologies that improve the diagnosis and treatment of patients and assisting in the standardisation of clinical trials that rely on physics-related technology for data.

In research and development, medical physicists develop new technology and improve upon existing ones – not only for patient use, but also for basic research that investigates the function of the human body and preclinical research that tests new pharmaceuticals. And as medicine evolves towards molecular-based imaging and therapy, input from physicists will be crucial.

But disappointingly, despite the important work they do, many of the general public don’t even know that medical physicists exist. I have memories of the blank looks I received during my time as a clinical medical physicist as I told people what I did for a living. “Physicists work in hospitals? Really?” was a common response. Maybe it’s the fact they work behind the scenes, or the fuzzy, interdisciplinary nature of the field that throws people – in fact, when I contacted several researchers for comments on their work for this blog, a common response was “Well, it depends what you mean by medical physics.” The field is closely related to and overlaps with biomedical engineering.

Aside from this identity problem, maybe medical physicists, whoever that might include, also aren’t so good at tooting their own horn. Or perhaps, delivering services such as cancer treatment or performing quality assurance on a CT scanner lack the glamour and therefore the exposure that astronomy or particle physics might receive.

In any case, today is all about celebrating these unsung heroes. I asked four medical physicists with very different roles about their work.

 

The clinical physicist

Nikki Caswell is the chief radiation oncology physicist at Launceston General Hospital in Tasmania, Australia. Her team of five physicists, her included, support the treatment of patients using three linear accelerators and a brachytherapy unit – where radioactive sources are inserted into the patient via needles or an applicator.

Nikki_linac_R2D2_crop

How will you be celebrating International Medical Physics Day?
I‘d like to say with a big ticker-tape parade down the high street or a telegram from the Queen, but reality it is a work day and I’m on the early start. We’ll probably have a morning tea in the department at a minimum, and maybe I’ll take the rest of the physics group out for lunch.

What’s a typical day of work for you?
There are routine jobs usually involving quality assurance on the treatment equipment that have to be done on a schedule. We also have duties as radiation safety officers for some patients, as well as teaching and training medical physics registrars and their medical counterparts in radiation oncology, and the commissioning and development of new techniques and systems keeps us on our toes.

But there is also a bunch of tasks that come up day to day that are unscheduled. For example, radiation therapists will ask us “Can you come and talk to this patient about their uranium glass collection?”, “Can we treat through a patient’s wound dressing?” or “Can you come and check the treatment setup and/or treatment plan for this patient?”

What are the best things about your job?
For me it is the patient contact. The fact that my job directly impacts on patient care and treatment is the best thing for me. Working in a multi-disciplinary team I find is also very rewarding. I think a lot of medical physicists would say getting to play with lots of great technology, but maybe I take that part for granted.

And the most challenging aspects?
Competing interests. All the employees in our department are here to do the best by our patients, but at times it may not be clear to the other professions why the medical physicist is spending time ensuring that things are correct to the nth degree. Conversely, it is challenging to train medical physicists to see the big picture and think in terms of clinical significance, as frequently their backgrounds are mainstream physics.

Would you recommend the career to a physics graduate?
The simple answer is yes. It is not for everyone – if you are super keen on theoretical physics then clinical medical physics might be a bit too applied and hands-on for you. There are however opportunities in medical physics outside or running parallel to the clinical setting including research and academia. If you are looking for a career with a well-defined training program*, in which you can use science to make a difference in people’s lives then clinical medical physics could be for you.

* Structured training programs are available in many countries including Australia, New Zealand, UK, US and Canada.

Do people you meet tend to know what a medical physicist is?
No! Most definitely not. People usually ask “Where do you work,” and when I respond “At the hospital,” they immediately reply “Oh you’re a nurse”, stereotypical I guess because I am female.  When I say “No, I’m a medical physicist” that usually ends the conversation right there and then.  Others will ask me to explain, which I find a bit challenging. A lot of people like to joke that I must glow in the dark once they hear that I work with radiation. Many people assume that the work is dangerous and depressing, but I assure them that we are here to keep things safe and doing a job that helps people is not depressing.

 

The MRI researcher

Gavin Merrifield is a PhD candidate in magnetic resonance imaging (MRI) specialising in brain imaging at the University of Edinburgh as part of SINAPSE, a network of medical imaging researchers across Scotland.

Created with GIMP

What are your plans for celebrating International Medical Physics Day next week?
Honestly, that there is such a day is news to me! But now that I know about it, I suspect there will be cake involved.

Tell me about your research.
I use MRI for biomedical research in animal subjects. I’m just finishing a project on a particular technique called functional MRI. This is a technique which is used in a huge range of research from understanding the basic workings of the brain right through to testing new therapeutic drugs for patients. It’s a complicated technique with many temperamental steps along the way and I am looking at whether the very first steps are reliable enough to be as useful as we (currently) think they are. I also have a few other studies on the side where I am using MRI to investigate the cardiac performance of more unusual species such as spiders and zebrafish.

What do you love most about your research in medical physics?
There’s a huge range of problems that can be tackled with medical physics which is always exciting. Medical Physics is also ultimately geared towards improving human (and animal) health, which is a very worthwhile goal to be striving for. I’ve worked with chemists, biologists and clinicians as well as other physicists over the years. That sort of very interdisciplinary activity is rare to find in a straight physics career and can be very refreshing as there is much that can be learned from working with people coming at the same problem from multiple angles.

And what are the most challenging aspects?
I think a scientist should always be mindful of the ethical and social aspects of their research and being involved in biomedical research puts you right on the edge of many conundrums a pure physicist is unlikely to face. For example, in today’s biomedical research environment everything from stem cells to genetic engineering to the use of animals in scientific research will inevitably come up. These all need to be properly considered in advance by any individual who participates in research involving them.

What made you want to become a researcher in medical physics?
I don’t think I had a deliberate aim to be a medical physicist – in fact I managed to avoid all the medical physics modules on my undergrad degree by studying astrophysics instead! But there was an opportunity to get involved several years ago that I took and it has been a fantastic experience ever since.

Would you recommend medical physics to new graduates in physics?
Definitely. It is an exciting time in the medical world as we begin to make great strides in new areas such as regenerative medicine and start to get to grip with using genomics to aid health. Medical physics will be at the cutting edge of these techniques through the continuing development of old and new imaging and data analysis techniques, novel interventional therapies and helping to unravel the biomechanics of the human body from the level of DNA up to the whole person.

Do you encounter any funny misconceptions of what you do – do you think people understand what a medical physicist is?
Yes, but then I often have trouble myself explaining what exactly it is I do myself. Sometimes I’m a brain scientist, other times an MRI physicist… occasionally even a biologist! Medical physics covers such a broad range of topics and we are often behind the scenes that from a patient point of view it can be difficult to understand what we are and do. It’s a bit like quantum theory, somewhat mysterious and ethereal, but vital to how things work.

 

The radiation protection physicist

Fergus Dunn is a technical officer at Integrated Radiological Services (IRS) Ltd in Liverpool in the UK who is training as a clinical scientist and radiation protection advisor (RPA). The company provides radiation protection services to hospitals, veterinary practises, dentists and industrial clients in the UK and overseas, ensuring the exposure of patients and workers to ionising radiation is minimised. (Follow Dunn on Twitter here.)

How will you be celebrating International Medical Physics Day?
I will be taking over the IRS twitter account to answer any questions anyone has about what we do as medical physicists or as a company. Using social media will also enable us to see what others are doing around the world.

What’s a typical day of work for you?

The majority of my work involves the routine quality assurance of radiation-producing medical equipment. I also carry out large scale patient dose audits, using techniques developed through research, and help to develop systems of work and commercial products.

IRS acts as an RPA body, so in addition to our regular work in hospitals we have a number of industrial users of radiation that we provide advice and service for. This can be anything from radon gas monitoring in water pumping stations, to radioactive sources used to measure the quality of wood in a saw mill, to the use of nuclear density gauges in the tunnelling and construction industries.

What are the best things about your job?
Our work is very diverse and even the routine jobs are always different in some way.

And the most challenging aspects?
Time management is crucial and we have to very carefully make a balance between gathering enough data to make an assessment of equipment performance and getting the equipment back into clinical use as soon as possible.

Why do we need medical physicists like you?
In our main field of diagnostic radiology and radiation protection, my colleagues and I make sure radiation-producing equipment operates safely and is examined frequently to ensure it is operating effectively. In many respects these are “background” services that radiation workers, members of the public and patients see less frequently. But it’s not just about the equipment, we also train the people working with radiation, as well as working with them on new services or better use of their data systems to ensure optimisation of doses across different department and modalities.

What made you want to use your medical physics expertise in a commercial environment? 
I liked the idea of being able to contribute to the knowledge already at IRS by bringing skills and ideas that could be used to improve and expand on services offered. Even though I am only at the start of my career I have been involved with a number of projects that will be marketed in the near future, colleagues in healthcare and academia may not have this opportunity until much later in their career.

Do you encounter any misconceptions of what you do?
When I tell people my profession they don’t instantly know what I do. After explaining some of my job role I often get asked, “So you fix the equipment if it’s broken then?” I wouldn’t know where to start fixing an X-ray unit or an MRI scanner as they are all such complex, individual machines and I’m happy to leave that to the engineers!

We also often get asked if we glow in the dark and a colleague has been asked if he has to wear lead underpants.

The medical physicist in product development

Armin Langenegger is a radiation oncology medical physicist with over three decades of experience. Once a clinical physicist working in hospitals, he now works for ViewRay. The company has developed the first commercially available combined MRI scanner and radiation therapy system that will enable tumours – that move during treatment with bodily functions like breathing – to be tracked by the treatment beam in real-time. Langenegger is a senior product manager responsible for implementing new features and improvements into the new system. His duties also include acceptance and commissioning testing on the new treatment systems when they are installed in hospitals.

How will you be celebrating International Medical Physics Day?
By remembering why I am doing this. We have all lost family and loved ones to this insidious disease of cancer, so I will most likely be working.

How are you using your medical physics expertise in your job?
During acceptance testing, my clinical experience is vital, as the testing needs to be geared to the way the ViewRay system will be used in the clinic. Understanding workflow is crucial and this changes from clinic to clinic. The system has to be flexible and robust enough to meet these demands. I use physics every day in the job from creating test protocols to running tests and gathering data. The thing I like best is that every day is different and new challenges keep me young.

What are the best things about your job?
The best and most satisfying aspect is the ability to make a change and to see that change being successfully used in the clinic. I am and was an early adopter of technology as I am a firm believer in using technology to improve the lives of patients.

And the most challenging aspects?
The most challenging aspects is the work load and there is a lot of travel.

What made you want to use your medical physics expertise in a commercial environment?
Commercial development is giving me the opportunity to bring to market products that I would love to use in the health service arena. Understanding what a customer wants and needs based on my clinical experience is vital.

In your opinion, what are the most exciting developments in your field at the moment?
That would be the start of real time guidance for radiation treatment – that is, being able to actually see tumours move for the first time ever and actually treat them when they are in the correct position instead of approximating using surrogates or guess work for its location, as we tend to do now. This will lead, in my opinion, to improved outcomes for patients and fewer complications.

Would you recommend medical physics as a career to a physics graduate?
I think we are still a long way from finding a cure for cancer, although great strides have already been made. The market for medical physicists in radiation physics is certainly far from saturated and is a rewarding career.

When you tell people you’re a medical physicist, do they know what you mean?
The word physicist scares a lot of people because they do not know what it is. The word is slowly getting out there, when you explain what medical physics is, but when you mention radiation, people go all strange, because of the misconceptions about it. No one understands it and because I work with it, they tend to look at you funny and don’t know what to say. Sometimes I think they are waiting for a spontaneous mutation to suddenly appear and seemed perplexed that I am somewhat normal.

 

You can read about the history and important role medical physicists play in medicine in this (paywalled) Lancet special series from last year. You can also read about the evolving role of medical physicists in radiation oncology here.

Images:

  1. Experimenters taking an X-ray with early equipment in 1896. Credit: William J. Morton
  2. Checking the alignment of patient positioning lasers on a linear accelerator. Credit: Chris Low
  3.  MR image showing a longitudinal section of a rat’s head and neck, acquired with a 7 Tesla small animal system. Credit: Edinburgh Preclinical Imaging, University of Edinburgh

About Jude Dineley

Jude Dineley is a medical physicist turned freelance science writer based in Sydney, Australia. She did her PhD in Doppler ultrasound imaging at the University of Edinburgh and has worked in clinical radiation oncology physics in the UK, Ireland and Australia, latterly as a senior physicist at Royal North Shore Hospital in Sydney. She writes about a range of subjects, from physics, and issues affecting physicists, through to wildlife and rock art. She has written for Physics World, medicalphysicsweb, COSMOS magazine and Australian Geographic and also blogs for RiAus, the Royal Institution of Australia.

7 Responses to Hug a medical physicist today

  1. Wonderful stuff1 I worked for a very short time with the medical pysics research group at St Thomas Hospital, London. The work was interesting, the personnel were wonderful and the food in the canteen was…sorry I drifted off there!
    My time there was far too short

  2. Great article. It really gives a flavour of what it is like to be a medical physicist. There is so much we can do to make space-age technology available to the public so that as many patients as possible can benefit from safe and high quality medical systems which are delivered as efficiently as possible. We’ll all be patients one day so we’re really doing it for everyone – we want the best to be available to all.

  3. Thanks Jude for a great article. I’m a medical physicist and it’s great to see our little-known profession getting some recognition. Marie Curie has always been a hero for me, and I’m very happy that her birthday was chosen as the World Day of Medical Physics. I celebrated the day with colleagues at the Engineering and Physical Sciences in Medicine Conference in Perth, Australia.

  4. Thanks for the comments, guys. I hope you enjoyed the day! Writing this blog reinforced to me the sheer diversity of the field, from hands on clinical work to research that simulates diagnostics and therapy across a range of medical applications.

  5. This article helped me to draw a pretty future for medical physicist. Please, If you can tell us more about the training programs that are available in some countries.

    Thank you Jude.