Opening Statement

Medical physics research has contributed to advances in radiation oncology technology and has improved treatment quality and outcomes. Inventions including IMRT, intensity‐modulated proton therapy (IMPT), and rotational modulated radiation therapy, have brought fundamental changes to cancer therapy, making new and more effective treatments such as SBRT possible. It is reasonable to expect that physics research will remain an essential aspect of radiation oncology in the years to come.

Unlike basic science, therapeutic medical physics is an applied science based on actual clinical needs. Within radiation oncology, medical physicists can appreciate clinical needs, work with clinical instruments, and test the inventions on real patients in collaboration with clinicians. While algorithms and precursory technologies can be developed outside of radiation oncology, it is hard to imagine how clinical integration and testing can occur outside of the clinical environment. Similar to other types of research, success cannot be achieved without two essential elements: financial resources and institutional infrastructure. Both in my opinion are currently insufficient to sustain medical physics research.

In 2009, Fuller et al. reported that although radiation therapy is involved in the care of 60% cancer patients, only 0.3% of National Institutes of Health (NIH) funded PIs are in the field of radiation oncology, and 1.6% of NIH cancer grants are awarded to radiation oncology.1 Moreover, a small fraction (13%) of radiation oncology grants are held by medical physicists.2 In an absolute dollar amount, approximately $11M NIH grants (direct +indirect) are held by therapeutic medical physicists as of 2013. At the departmental level, there are only 13 radiation oncology departments with more than five NIH funded projects, many of which are held by radiobiologists, in comparison to 45 radiology departments with $1M or more annual NIH grants.3

On the institutional infrastructure side, there are equal, if not greater, challenges. The medical physicist career path is largely driven by clinical operations. On one hand, most therapy physicists are not under stress to secure extramural funding for research; on the other hand, their research most lack protected research time. With the overall graduate and postgraduate training being steered toward serving clinical needs, there is insufficient training for writing grants and papers. Most radiation oncology departments would not hire faculty who are board‐ineligible, even if they have a pertinent skill set for novel research. These disadvantages are compounded by the fact that start‐up packages are only rarely provided to medical physicists, while start‐up funds of $0.5–1 M or more are standard for biologists whom medical physicists must compete against.4

These barriers result in underprepared and undermotivated medical physicists, who in turn are less likely to secure extramural research funds, which further discourages individual radiation oncology departments to support research, creating a vicious circle. A recent AAPM working group showed a small but alarming decline in NIH grants secured by AAPM members in 2016 compared to the historical mean.5

Since it is unlikely to significantly increase extramural funding rates, the only way to stop this downward spiral is by encouraging more self‐sustaining research initiatives. In my opinion, a career path for pure academic medical physicists in radiation oncology is critical to achieve such a goal.