In the field of radiation oncology, the clinical role of the physicist was greatly enhanced by the advent of Co-60 γ-ray and megavoltage (1–25 MV) X-ray beams in the latter part of the last century. Such beams require much greater attention to dosimetry and computation in treatment planning, because visible indicators of treatment progress are eliminated.

In training
In training

Over the past 30 years the advent of computer-generated images in existing and emerging imaging technologies has separated the task of data acquisition from that of image generation and display. This separation creates an essential role for physicists in assuring that any abnormalities in the images are expressions of pathological conditions in the patient and not artefacts introduced by the imaging process.

The complexity of both medical imaging and radiation oncology has increased dramatically over the past three decades, raising the importance and the clinical role of medical physicists to even greater heights. This elevated stature has inevitably been accompanied by an increased demand for accountability of medical physicists to their peers, clinical colleagues and, most significantly, the public.

Accountability calls for medical physicists to examine the existing standards for education and training in the discipline and to demand credentials of physicists entering the clinical practice of medical physics. Certification and periodic recertification of practising physicists is required to ensure that their level of knowledge and competence is sufficient to participate in patient care. Education and training programmes should be accredited to verify that agreed standards are being met. Finally, all of these activities must be transparent to other professions and to the public.

Talking training

In January 2006 the American Association of Physicists in Medicine (AAPM) hosted a three-day summit to examine the challenges of medical physics education and training, and the growing demands for quality and accountability in these endeavours. The first day of this event focused on the physics education of radiologists, while the third day addressed the physics education of radiation oncologists.

The second day of the summit was devoted to an analysis of the education and training of physicists in medical physics. Several recommendations evolved from this discussion, and these were described in an article published recently in Medical Physics.1 Similar recommendations resulting from the first and third days' discussions have been, or will be, published.2, 3, 4

The overwhelming conclusion of the second day's discussion was that the process of educating and training medical physicists in the US (and presumably in many, or most, other countries) does not measure up to the accountability standards already in place for physicians and many other health-care professionals.

Currently, major disconnects exist among graduate programmes for educating medical physicists, residency programmes for the clinical training of physicists, the accreditation of these programmes (and, some time in the future, an alternative accredited pathway into the field for physicists who don't complete an accredited graduate or residency programme), the certification of medical physicists, and their periodic recertification through the maintenance-of-certification process.

The various organizations involved in these activities share the common objective of assuring the competent and safe practice of medical physics in the clinical arena. However, communication among them is less than ideal. In the recommendations emanating from the AAPM summit, improving communication among these organizations – to enhance medical physics education, training and assurance of competence – was a common theme.

One of the recommendations arising from the summit was the development of web-based educational modules relevant to the education of medical physicists, radiologists and radiation oncologists. These would be accessible on an as-needed basis when a particular knowledge set was desired (i.e. at the "teachable moment") and would focus principally on clinical applications of physics in medical imaging and radiation oncology.

Web-based modules are viewed as supplements to, not replacements for, productive discourse between a student and teacher or mentor. They could prove important, not only in well endowed medical physics education and residency programmes but also in those that are less structured. This type of scheme could be especially valuable in developing countries, where medical physicists are needed but education and training resources are limited.

Prime potential

Never have the opportunities been greater for medical physicists to contribute to the wellbeing of patients around the world. The growth of new technologies and their export into the world market demands the emergence of leading individuals who understand the potential contributions that these technologies can make to patient care, and how their cost-effectiveness compares with alternative ways to improve patients' health.

Medical physicists can be among these leaders, but they must be well educated and able to demonstrate knowledge and clinical acumen through pathways such as accreditation and certification, where such mechanisms exist, and by other means where they are absent.

In several developed and developing countries, medical physicists are attempting to create an organizational structure to share knowledge and experiences. Such a framework could identify ways to improve the education and training of medical physicists and help to increase their numbers in order to address existing and emerging clinical needs.

The International Organization for Medical Physics (IOMP) is assisting in this development – a function that may be its single most important activity – but it is handicapped by limited resources. Efforts (and funds) should be increased to enable the IOMP to provide assistance to those countries in which an organizational framework for medical physics is emerging.

It is an exciting and challenging time for medical physicists around the world, with virtually unlimited opportunities to contribute to improving the health and wellbeing of patients. These opportunities are accompanied by the challenges of assuring the quality education and training of physicists entering the discipline, as well as documenting the continued knowledge and competence of those practising in the field.

Meeting these challenges requires medical physicists to accept the reality that they must be accountable to their peers, clinical colleagues and the public for the integrity of their profession. Such accountability demands that we all work together to improve the quality of the services that we provide for our colleagues and for the patients in our institutions.