Medical physicist should be a planner in the treatment planning process

Abstract

In the United States, both medical physicists and medical dosimetrists play essential roles in radiotherapy. Since its inception, the profession of medical dosimetry has focused primarily on the creation of treatment plans and related clinical tasks. In contrast, the involvement of medical physicists in the treatment planning process has been more variable and continues to evolve as clinical practices and professional expectations shift. Traditionally, the most common model of collaboration between dosimetrists and physicists involves physicists serving as secondary reviewers, ensuring quality and safety after the dosimetrist has completed the initial treatment plan. However, with the increasing complexity of modern radiotherapy techniques, which demand greater precision, personalization, and interdisciplinary coordination, many institutions face growing challenges in recruiting experienced treatment planners capable of handling complex cases. The need for extensive on-the-job training, often provided by senior dosimetrists and occasionally by physicists, places additional strain on departments already affected by workforce shortages. This situation raises an important question: should medical physicists assume a more formalized role as treatment planners? This debate examines the proposition that clinical medical physicists should participate routinely in the treatment planning process, not merely as reviewers or technical advisors, but as active contributors working alongside dosimetrists and radiation oncologists. The faculty physicist arguing for the proposition is Dr. Dongxu Wang from Memorial Sloan Kettering Cancer Center, while the faculty physicist arguing against the proposition is Dr. Douglas Prah from the Medical College of Wisconsin.

Dongxu Wang, PhD, MBA, received his PhD in Medical Physics from the University of Wisconsin-Madison in 2011. After graduate school, he joined the University of Iowa Hospitals and Clinics as a faculty physicist. While at the University of Iowa, he studied part-time and received his master's degree in business administration (MBA) in 2019. He is now an Associate Attending Physicist at Memorial Sloan Kettering Cancer Center. Dr. Wang's earlier expertise and focus were in proton therapy and proton imaging. Lately he is active in advancing medical physics leadership and professionalism education using the case study method.

Douglas Prah, PhD, DABR, is a board-certified medical physicist, Associate Professor of Radiation Oncology, and the Director of Advanced Care & Technology at Froedtert & the Medical College of Wisconsin. He earned his PhD in Biophysics from the Medical College of Wisconsin and specializes in radiation beam modeling, treatment planning, and integrating advanced technologies into clinical workflows. Dr. Prah chairs the Service and Technology Implementation and Review Committee and oversees medical dosimetry services across the enterprise. He is also an APEx Surveyor and serves on the Practice Accreditation Subcommittee for the American Society for Radiation Oncology, where he supports national efforts to improve quality and safety in radiation oncology. Dr. Prah is committed to advancing the field through collaborative leadership, innovation, and education.

Dongxu Wang reports receiving an honorarium from Mevion Medical Systems, Inc., and a licensing fee payment from Ion Beam Applications, S.A.; neither is related to this work.