The Board's Vision for the Future from the Spring Clinical Meeting of the Board

At the AAPM Board meeting on April 3, the Board addressed the future of the AAPM and medical physics, looking nominally 20 years ahead. To do this they addressed three questions, based on the suggestion of Paul B. Brown at the President's Symposium at the last Annual Meeting: What is the future we want, what are the impediments to achieving it, and what steps do we take right now to begin to bring about that future?

To start, on the evening of April 2, the Board broke into five groups to answer these questions. The groups' responses are shown at the end of this document. Photographs of the actual flipcharts are posted on the Board's website. We reconvened the next day, presented the work from the evening before and then made this consolidated list:

Visions of a Good Future

1. Looked for (or the person who is seen as knowledgeable, capable and wise)
2. Medical physicists as disruptors (or the ones who initiate and cause change))
3. Decision makers
4. Leaders in sciences
5. Quality (Very high quality of medical-physics practice)
6. Patient-facing
7. Patient communicators
8. Medical physics and AAPM more multidisciplinary (molecular biology, IT-data-comp sci, business, integrators-SI)
9. Jobs for all medical physicists
10. Know about low-dose radiation response
11. AAPM becomes Global
12. Enfranchising global members of the AAPM

I did reorder the lists to group common themes. For the visions of a good future, several themes stand out. The first is that medical physicists would be leaders and drivers in health care (items 1–4) and do so by accentuating quality, patient interaction (items 5–7) and broadening our profession (item 8). This would lead to a plentiful supply of jobs in medical physics. The future also entails understanding biological effects of low-dose radiation. The final two items reflect expanding the AAPM activities and influence globally.

Impediments

1. Risk-averse
2. Medical physics inertia
3. AAPM's inertia
4. Silos
5. Finance
6. Lack of evidence
7. Dogma
8. Monoculture
9. Lack of publicity
10. Ill-informed regulators
11. Transformation
12. Travel (?)

The impediments to reaching our desired future include medical physicists being risk-averse and having great inertia and that the AAPM also has considerable inertia. This makes it difficult to make progress. Medical physics and the AAPM suffer from silos and divides that also inhibit progress.

Financing our future also presents challenges. Some of the issues for radiotherapy physics include the potential for large reductions in reimbursements and research funding. Imaging physics has suffered from lack of clinical funding for a long time. Fortunately, research funding for imaging physics is obtainable at the present. The AAPM, while financially sound, is faced with rising fixed costs (I understand that does sound contradictory) and a mostly level income stream. We are also faced with a lack of evidence that proves the benefit of medical physics involvement in clinical care. Yes, we all know that is true, but we cannot point to a study that we can hand to administrators. We not only strongly believe that we do is extremely valuable to patients, but we tend to believe strongly most things about our field and that most things we believe are true. That makes it hard to change what we believe and do. And, we spend a lot of time talking with ourselves, which reinforces our dogmas.

Item 9 highlights a major impediment: the population at large do not know who we are, and administrators misunderstand us. We have not gotten our message out effectively.

In general, we, as a field, are not prepared to accept, first that major changes are coming to the field, second that those changes will have major effects on what we do, and finally, that if we do not take appropriate steps now the final results will be determined by others and likely be very different from what we would like.

What We Need to Do Now

1. Expose members to healthcare changes
2. Sponsor more events
3. Training that prepares for the future
4. Interactions with sister societies
5. Joint symposia with other disciplines
6. Joint symposia with international sister societies
7. AAPM seed funding
8. Seed funding to address disparities in health care globally
9. Funding internships
10. Aggressive fundraising
11. Marketing strategy and budget
12. Collaboration with organizations that recommend radiotherapy
13. Target aging populations
14. Entice bright minds
15. Chapters more involved in publicity
16. Make TED-Talk-like videos and podcasts (possibly based on slams)
17. Outreach to administration
18. International jobs
19. Administrative curricula for international
20. Work to have medical physics higher on web searches
21. Design of data system
22. Establish quality metrics
23. Address understanding of low-dose radiation
24. External reviews of strategic plan
25. Non-member physicists on the Board

From where we left off in the impediments, the first action in the list of what we need to do now is to expose the members of the AAPM to the forces at work that will be changing our practices in major ways. This would entail sponsoring more events dealing with our future. Training for medical physics, particularly in graduate programs, will need to change to prepare students to be more flexible to adapt to the future. We need to attract the smartest STEMM students into medical physics.

Relations with our sister societies will be important supporting medical physics in the future, including joint programs crossing disciplines.

Funding the future will be very important, of course. Some funding should be from AAPM seed grants for domestic and global projects and for internships. Providing this funding will require aggressive fundraising initiatives and a marketing strategy, and all of that will require a dedicated budget.

One major problem for medical physics is that we are not well known. We need to work with and educate the organizations that refer patients for radiotherapy as well as the potential patient population, particularly the elderly. The regional chapters could take a lead in spreading the word about medical physics, with help from the Public Information Committee. A collection of TED-like-talk videos could be useful. Hospital administrators are another group with whom we need to work. We also should work to improve our visibility in web searches.

The international arena will become increasingly important in the future. We should address international jobs and develop curricula for radiological administrators that stress the importance of medical physics.

Items 21 through 23 address important fields for medical physics. The last two recommendations deal with the organization of the AAPM.

Summary

The Board retreat gave just enough time to produce the materials summarized here. We still have to go through the Appendix to incorporate any ideas that did not make it into the joint list. From all of this, we need to make an action plan, sending the suggested actions to the appropriate committees to evaluate and possibly develop concrete proposals for those steps considered worth pursuing.

Appendix: The preliminary lists compiled by the five groups.
Each group is identified by a color.
Analysis
Value = (Outcomes + Patient Experience) / Costs

Visions of a Good Future

1. Very similar to today but doing way cooler stuff
2. Radiation will be a sensitizer
3. Radiation oncology and imaging will merge
4. There will not be any machine commissioning
5. AI will help patient care
6. Mathematics and statistics will become part of cancer care through radiomics and outcomes
7. Radiomics and genomics will become part of cancer management
8. No conventional simulators
9. Real-time treatment planning
10. Treating in space
11. Gene therapy
12. Personalized medicine
13. CMS(??)
14. Less government and politicians involved with us
15. AAPM → Global Association of Physicists in Medicine
16. 2035 AAPM must become the leading society to produce leaders to manage data, personnel, money, technology and outcomes in the diagnosis and therapy of disease
17. Physicists become the prime leaders in interpreting complex systems as medicine becomes more molecular and data driven
18. Physicists with more than 30% engagement rate
19. Functional governance
20. Leaders in collecting and using databases in medicine to make machine learning and AI choices (No data left behind)
21. AAPM savvy enough and big enough so that we are able to define ourselves and our own agenda and not be the RSNA's little bro
22. 2035 → AAPM membership > 25k and AAPM defining standard of care in medical physics
23. A report card on every patient treated with radiotherapy (how well the prescription was filled)
24. On treatment weekly physics report to augment physician's OTV
25. Every clinic is a smart clinic leveraging technology such as AI and advanced analytics
26. All data are structures based on common data elements and consensus taxonomy
27. Instant walk-in therapy at CVS, fully QA'd by physicists
28. More MR linacs
29. AAPM premier organization for medical computing
30. AAPM will be the champion of spreading the good news of hormesis
31. More visibility in health care – Med Phys 3.0
32. Contribute beyond physical dosimetry (informatics, biophysics, biology, outcomes, molecular imaging, etc.)
33. Eliminate all QA measurements
34. National Repository of all treatment plans along with all the images, contours and doses delivered.
35. Image → plan → treat in 1 hour at 300 Gy/s is the norm
36. All treatments 1 to 5 fractions

Impediments

1. We are risk averse
2. Greater membership among other societies
3. Professional competition for leadership, risk and credit
4. Limitation on funding
5. Time allotment (to 24 hours per day)
6. We are currently well paid and change is a threat
7. Status of physicists among colleagues
8. The number of radiation oncologists and how they interact with physicists
9. Insurance companies are *#IL
10. Physicists play the second fiddle in the healthcare hierarchy
11. Lack of leadership skills
12. PMI/PII challenges in creating big data
13. Lack of resources
14. Perception in C-suite that medical physicists are an expense, not a revenue source
15. Narrow focus as a profession on what we do now
16. Regulatory burden
17. Greed for money
18. Divide between imaging and therapy
19. Information in many places
20. Relation of treatment plans to outcomes
21. Public doesn't know what a medical physicist does

What We Need to Do Now

1. Integrate disciplines and sciences (Computations science, biology, nanotechnology, data science
2. Become an international leader (in the above)
3. Think outside the box
4. Adoptions of best practices
5. Fill the training gaps
6. Training in soft skills such as dealing with administrators
7. Leverage physicists' perspective to improve value throughout continuum of care
8. Rejection of LNT
9. Focus on other aspects of imaging
10. Work to modernize regulations
11. New approaches to therapy
12. Advocate for clinical trials that include radiotherapy
13. Highlight and market precision radiotherapy and the science behind it
14. Changes to payment models
15. Management and oversight of technical application to humans (BME)
16. Data management (Organize, Analyze, Distribute)
17. Do something different
18. All QA programmed and sent automatically at a minimum
19. Automate (Image review, metrics, segmentations)
20. Develop advanced phantoms with intrinsic dosimeters, robotic arms, sophisticated feed-back loops for imaging calibration and output measurements
21. Use FMEA to test what matters
22. Do more than level 1 equipment performance evaluations
23. Advanced on-line analysis with advanced analytics
24. Physicists to become technical administrators (Med Phys 3.0)
25. Become active in population health, such as opportunistic screening and healthy aging
26. International Outreach (such international services as Automated distance support, chart checks, dosimetry, treatment planning) supported through interoperability