Medical physics workforce: A global perspective

Strengthening education and training programmes for medical physics in Asia and the Pacific: the IAEA non-agreement technical cooperation (TC) regional RAS6088 project

This article documents the work conducted in implementing the IAEA non-agreement TC regional RAS6088 project "Strengthening Education and Training Programmes for Medical Physics". Necessary information on the project was collected from the project counterparts via emails for a period of one month, starting from 21st September 2023, and verified at the Final Regional Coordination Meeting in Bangkok, Thailand from 30th October 2023 to 3rd November 2023. Sixty-three participants were trained in 5 Regional Training Courses (RTCs), with 48%, 32% and 20% in radiation therapy, diagnostic radiology, and nuclear medicine, respectively. One RTC was successfully organised to introduce molecular biology as an academic module to participants. Three participating Member States, namely United Arab Emirates (UAE), Nepal and Afghanistan have initiated processes to start the postgraduate master medical physics education programmes by coursework, adopting the IAEA TCS56 Guidelines. UAE has succeeded in completing the process while Nepal and Afghanistan have yet to initiate the programme. The postgraduate master medical physics programmes by coursework were strengthened in Indonesia, Jordan, Malaysia, Pakistan, Syria, and Thailand, along with the national registration of medical physicists. In particular, Thailand has revised 6 postgraduate master medical physics programmes by coursework during the tenure of this project. Home Based Assignment and RTCs have resulted in two publications. In conclusion, the RAS6088 project was found to have achieved its planned outcomes despite challenges faced due to the COVID-19 pandemic. It is proposed that a follow up project be implemented to increase the number of Member States who are better prepared to improve medical physics education and training in the region.

Global status of medical physics human resource - The IOMP survey report

PURPOSE

Realizing the need for periodic surveys about global medical physics human resource, the International Organization for Medical Physics (IOMP) performed a third survey following the previous two (2015 and 2018). The objective was to collect information about the current numbers of medical physicists (MPs) in individual countries, about their MP training, and accreditation pathways.

METHODS

The survey was designed using Google Forms. Forms were distributed to national MP associations around the world. The data was collected during May-Nov 2022. MS Excel and SPSS software were used to perform descriptive statistics.

RESULTS

64 valid responses were received covering all continents. The largest numbers of MPs are in high income countries of Europe, Australia and North America, while the lowest numbers of MPs are seen in middle and low-income countries of Asia, Latin America and Africa. Among the respondents, 73% reported MP shortages in their countries. 69% reported the existence of an official MP training program which comprises university courses and in-service training. Furthermore, 85% of the respondents indicated the availability of MP university courses, primarily at the Master's degree level. Participation in research was between 10 and 30% of allocated work time for 42% and below 10% for 33% respondents.

CONCLUSIONS

There are new findings on number of MPs per million population in different countries, with some expressing adequacy in the total number of MPs, but the data breakdown indicates a shortage in diagnostic X-ray physicists. Future surveys should also investigate in more detail data on outsourcing, and involvement in research.

Diversity of medical dosimetry applicants and graduates

Diversity is a critical component in the advancement of human endeavor in science. Students who complete their education and training at diverse schools can serve patients from a wide range of ethnic backgrounds and promote cross-cultural competence. However, developing a diverse environment of professionals is a long-term effort which often takes generations to complete. Increasing awareness of underrepresented genders and/or minorities helps to establish goals for building a future of improved diversity. Specific to radiation oncology, professions such as medical physicists and radiation oncology physicians have reported underrepresented females and minorities. The problem is that there is a paucity of literature regarding diversity of medical dosimetry professionals. The professional organization does not track diversity data for those members currently working in the profession. Therefore, the purpose of this research was to present aggregate data demonstrating the diversity of medical dosimetry applicants and graduates. The methodology involved quantitative data collection from medical dosimetry program directors which answered the research question, what is the diversity of medical dosimetry applicants and graduates? In comparison to the U.S. population, there were less applicant and accepted students of Hispanic/Latino and African American ethnicities whereas the Asian population was higher. While the U.S. population data reveals 3% more females, there were 35% more female than male applicant and accepted students in this study. However, the results differ significantly from medical physics and radiation oncology physicians with only 30% female clinicians.

Science diplomacy in medical physics - an international perspective

Purpose

Science diplomacy in medical physics is a relatively young research field and translational practice that focuses on establishing international collaborations to address some of the questions biomedical professionals face globally. This paper aims to present an overview of science diplomacy in medical physics, from an international perspective, illustrating the ways collaborations within and across continents can lead to scientific and professional achievements that advance scientific growth and improve patients care.

Methods

Science diplomacy actions were sought that promote collaborations in medical physics across the continents, related to professional and scientific aspects alike.

Results

Several science diplomacy actions have been identified to promote education and training, to facilitate research and development, to effectively communicate science to the public, to enable equitable access of patients to healthcare and to focus on gender equity within the profession as well as healthcare provision. Scientific and professional organizations in the field of medical physics across all continents have adopted a number of efforts in their aims, many of them with great success, to promote science diplomacy and to foster international collaborations.

Conclusions

Professionals in medical physics can advance through international cooperation, by building strong communication across scientific communities, addressing rising demands, exchange scientific information and knowledge.

Status of cancer treatment by radiotherapy and requirement of radiation oncology medical physicists in Asia Oceania federation of organizations for medical physics region

Objective

Cancer is a major health problem worldwide including Asian-Pacific region. The region hosts over 4.5 billion people, over 60% of the world population and very divergent socioeconomically. The major cancers in the region in male include lung, stomach, liver, colorectal and esophagus and in female breast, lung, cervix, colorectal, and stomach. Over 60% of cancer patients need radiotherapy alone or in combination with surgery and/or chemotherapy, and therefore, radiotherapy is the main and essential modality of cancer treatment. Radiation oncology medical physicists play a pivotal role in efficient implementation of radiotherapy. This study was aimed to assess the status of cancer treatment by radiotherapy and the requirement of radiation oncology medical physicists in the region.

Materials and Methods

To access the status and requirement of radiotherapy machines, availability of radiation oncology physicists in the region of Asia Oceania Federation of Organizations for Medical Physics (AFOMP), we have carried out a survey by sending questioners to AFOMP National Medical Physics Organizations (NMO). We received response from 21 countries, 100% response, regarding availability of teletherapy units, number of medical physicists working in radiotherapy and related information. Using GLOBOCAN cancer incidence data and considering 62.5% of cancer patients need radiotherapy treatment and up to 500 cancer patients can be treated in a year on one teletherapy machine, the gap between the available and required teletherapy machine to treat all the cancer patients requiring radiotherapy is estimated. Further, we estimated the gap between radiotherapy medical physicists available and required as per International Atomic Energy Agency and European Society for Therapeutic Radiology and Oncology guidelines.

Results

It was observed that availability of teletherapy machines in AFOMP region is 0.21-14.0 teletherapy machine/million population and radiotherapy medical physicist are 0.82-2.43/teletherapy unit.

A First Look at Equity, Diversity, and Inclusion of Canadian Medical Physicists: Results From the 2021 COMP EDI Climate Survey

PURPOSE

In 2021, the Canadian Organization of Medical Physicists (COMP) conducted its first equity, diversity, and inclusion Climate Survey. The membership's experiences of inclusion, belonging, professional opportunities, discrimination, microaggressions, racism, and harassment in their professional lives are presented.

METHODS AND MATERIALS

The ethics-reviewed survey was distributed in English and French to full members of COMP. Participants responded to questions covering demographics and professional climate. Simple descriptive statistics were used to measure frequency of responses. Data pertaining to impressions on the climate within the profession were compared using nonparametric statistical tests.

RESULTS

The survey was distributed to 649 eligible members; 243 (37%) responded, and 214 (33%) provided full response sets. From the full response sets, findings showed that in general, age, highest academic degree, and racial and ethnic distribution trends of medical physicists were comparable with previously collected data and/or the Canadian population. The experiences of respondents relating to harassment in the workplace and perception of climate are reported and provide a useful benchmark for future assessments of interventions or training programs. In the workplace, fewer women (58%) reported having professional opportunities compared with men (70%). The survey also found that 17% of respondents (most of whom were women) directly or indirectly experienced sexual harassment in the workplace within the past 5 years. Finding that 23% of survey respondents identified as having a disability is a valuable reminder that accommodations in the workplace are necessary for more than 1 in every 5 medical physicists working in clinics.

CONCLUSIONS

This study provided insight into the diversity and experiences of medical physicists in Canada. The majority of respondents had positive perceptions about their professional environment. However, equity-lacking groups were identified, such as women, underrepresented minorities, Indigenous peoples, and people with visible and invisible disabilities.

Cancer in sub-Saharan Africa: a Lancet Oncology Commission

In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.

Women in Medical Physics and Biomedical Engineering: past, present and future

Women in Medical Physics and Biomedical Engineering (WiMPBME) is a Task Group established in 2014 under the International Union of Physical and Engineering Scientists in Medicine (IUPESM). The group’s main role is to identify, develop, implement, and coordinate various tasks and projects related to women’s needs and roles in medical physics and biomedical engineering around the world.

The current paper summarizes the past, present and future goals and activities undertaken or planned by the Task group in order to motivate, nurture and support women in medical physics and biomedical engineering throughout their professional careers. In addition, the article includes the historical pathway followed by various women’s groups and subcommittees from 2004 up to the present day and depicts future aims to further these professions in a gender-balanced manner.

Medical physics services in radiology and nuclear medicine in Africa: challenges and opportunities identified through workforce and infrastructure surveys

The International Atomic Energy Agency (IAEA) developed a staffing model to estimate the number of clinically qualified medical physicists (CQMP) that are required in an imaging facility, including diagnostic radiology and nuclear medicine. For the first time this staffing model was applied on a large scale across Africa. Within the framework of the IAEA African Regional Agreement (AFRA) Technical Cooperation (TC) project RAF6/053 entitled “Enhancing Capacity Building of Medical Physics to Improve Safety and Effectiveness of Medical Imaging (AFRA)”, a survey based on the IAEA staffing model was used to investigate the current CQMP workforce needs in imaging and radionuclide therapy in Africa in order to establish a baseline, identify gaps and suggest steps for improvement. The survey was open for five months, after which data verification was performed. 82 responses were received from 21 countries, including data from 97 diagnostic radiology and 40 nuclear medicine departments, as well as 75 interventional radiology departments and/or catheterization laboratories. Only 26·8% of centres employed an adequate number of CQMPs. The staffing model indicated that 134·3 CQMPs were required for these centres, but only 63 are currently employed in medical imaging and/or nuclear medicine at these centres. At least 11 countries do not have a single institution with an adequate number of CQMPs. Data analysis indicated that the number of radiology and nuclear medicine CQMPs is largely inadequate, at least by a factor of 20 in almost all countries in the region.

Collaborative networking and support for medical physics development in low and middle income (LMI) countries

Medical physics is one of the key aspects of contemporary medicine, primarily focused on the safe and effective use of medical imaging and radiotherapy equipment. The number of medical physicists and their activities are directly related to the national/regional healthcare provision. The distribution of the medical physics workforce however is still very uneven-more than 70% of all medical physicists are in North America and Europe, serving the healthcare provision of about 1 billion people. The remaining 30% of medical physicists serve the healthcare provision of the rest of the world-serving about 6.5 billion people. A number of activities were taken by various teams and organisations to address this issue. The increase of quality of healthcare and the effectiveness of medical technology usage, lie in adequate education and training for medical physicists and engineers, who are the front-liners when it comes to dealing with technology in healthcare. To help LMI countries professional growth in the field of medical physics and technology, we developed an education and capacity building strategy, based on the revolutionary application of digital resources combined with experience sharing through large international network.

Status of medical physics education and training in AFOMP region

Medical physicists are health professionals recognized by the International Labour Organization (ILO) and hence medical physicists working in a clinical environment should have the required competency and undergo a structured training program and residency under an experienced medical physicist in a recognized institution. Furthermore, medical physics is a rapidly growing area needing a high degree of knowledge and professional competency due to the rise in complexity of treatment procedures, increasing access to medical technology, and the requirement of coordination between the disciplines of medicine, physics and biomedical engineering. The unprecedented surge in medical physics competency in the last 2-3 decades is due to the implementation of specialized physics intensive procedures such as particle therapy, image-guided & intra-operative radiotherapy, advanced imaging and nuclear medicine techniques. In this scenario to handle this new technology era the quantity of qualified medical physicists needs to be in consonance with the competency needed. There is a special requirement for education and training of medical physicists which led to the opening of numerous educational programs around the world. The Asia-Oceania Federation of Organizations for Medical Physics (AFOMP) was founded in 2000 and today 19 countries national medical physicist associations (NMPO) are member of AFOMP. The AFOMP region is populated by over 4.5 billion people and socioeconomically is very diverse with GDP per capita as high as around US $60,000 [Australia] to as low as around US $750 [Nepal]. We conducted a survey by sending questionnaires to AFOMP NMPOs to assess the status of medical physics education and training in the region. We have received responses from 20 countries in the AFOMP region to the questionnaire. It was observed that 16 [80%] countries from AFOMP have well organized master program in medical physics, however only 8 [50%] programs were accredited and in only 9 [45%] countries are medical physicists registered as health professionals.

Examining gender diversity growth as a model for inclusion of all underrepresented persons in medical physics

The labor force of Medical Physics is one of the most gender diverse in the field of Physics, as it has attained the proportional achievement of ~30% women worldwide (Tsapaki et al. Phys Medica. 2018;55:33-39). While great strides have been made toward a gender diverse workforce, women still comprise an underrepresented group. Many strategies have been suggested to increase the participation of underrepresented persons by addressing unconscious biases, increasing opportunities, dedicated hiring policies, and providing support networks in science and medicine (Barabino et al. Sci Eng Ethics. 2019; Coe et al. Lancet. 2019), yet the personnel landscape remains largely uniform. Herein, the conditions, strategies, and approaches that facilitated gender diversity in Medical Physics are considered as a means to further the inclusion of other underrepresented groups through exemplars of mentorship, addressing unconscious biases and the implementation of inclusive practices. Furthermore, the potential for gender diversity to act as a catalyst to create an environment that is more accepting of diversity and supports and encourages inclusive practices for the participation and inclusion of other underrepresented groups in Medical Physics is discussed.

Radiotherapy in the Caribbean: a spotlight on the human resource and equipment challenges among CARICOM nations

BACKGROUND

There is limited data on access to radiotherapy services for CARICOM nations.

METHODS

This was a descriptive mixed-methods observational study which used data collected via survey from staff working in Radiation Oncology in 14 CARICOM countries. Benchmark recommendations from the International Atomic Energy Agency were compared to existing numbers. The Directory of Radiotherapy Centers, World Bank, and Global Cancer Observatory databases were all accessed to provide information on radiotherapy machines in the region, population statistics, and cancer incidence data respectively. Both population and cancer incidence-based analyses were undertaken to facilitate an exhaustive review.

RESULTS

Radiotherapy machines were present in only 50% of the countries. Brachytherapy services were performed in only six countries (42.9%). There were a total of 15 external beam machines, 22 radiation oncologists, 22 medical physicists, and 60 radiation therapists across all nations. Utilizing patient-based data, the requirement for machines, radiation oncologists, medical physicists, and radiation therapists was 40, 66, 44, and 106, respectively. Only four (28.6%) countries had sufficient radiation oncologists. Five (35.7%) countries had enough medical physicists and radiation therapists. Utilizing population-based data, the necessary number of machines, radiation oncologists, and medical physicists was 105, 186, and 96 respectively. Only one county (7.1%) had an adequate number of radiation oncologists. The number of medical physicists was sufficient in just three countries (21.4%). There were no International Atomic Energy Agency population guidelines for assessing radiation therapists. A lower economic index was associated with a larger patient/population to machine ratio. Consequentially, Haiti had the most significant challenge with staffing and equipment requirements, when compared to all other countries, regardless of the evaluative criteria. Depending on the mode of assessment, Haiti's individual needs accounted for 37.5% (patient-based) to 59.0% (population-based) of required machines, 40.1% (patient-based) to 59.7% (population-based) of needed radiation oncologists, 38.6% (patient-based) to 58.3% (population-based) of medical physicists, and 42.5% (patient-based) of radiation therapists.

CONCLUSION

There are severe deficiencies in radiotherapy services among CARICOM nations. Regardless of the method of comparative analysis, the current allocation of equipment and staffing scarcely meets 50% of regional requirements.

Present status of Medical Physics practice in Mexico: An occupational analysis

PURPOSE

To present an overview of the status of Medical Physics practice in Mexico, promote the legal recognition of Medical Physics high-end training, and provide information that will potentially improve the Mexican healthcare system.

METHODS

For the purpose of this research, the concept of "Medical Physics Professional/s" (MPP) is introduced to refer to any person/s executing the role of a clinical medical physicist (cMP) in whole or in part independent of academic profile, training or experience. A database of MPP in Mexico was built from official sources and personal communication with peers. Database records included the following fields: employer/s, specialty, academic profile, and annual income (when available).

RESULTS

133 centers in Mexico employ MPP, 49% of which are public institutions. 360 positions involving cMP roles were identified at the National Healthcare System (occupied by 283 MPP), 77% of which corresponded to radiation therapy. Public healthcare services hold 65% of the reported positions. Only 40% of MPP hold a graduate degree in Medical Physics, 46% of whom were located in the most densely populated region of Mexico. Of all MPP, 32% were women.

CONCLUSIONS

This work allowed to clearly identify the current challenges of Medical Physics practice in Mexico, such as: insufficiency and uneven geographical distribution of qualified manpower, gender imparity, multishifting and wage gap. The products derived from this work could be used to guide the efforts to improve the Mexican healthcare system.

Awareness and Training in Medical Physics: An Avenue to Enhance Cancer Care Delivery in a Low-Resource Setting

PURPOSE

Awareness and training in medical physics (MP) is crucial to enhance productivity and safety in cancer management. We evaluated the impact of the pioneer teaching hospital in Nigeria on awareness and training in MP in an attempt to appraise and enhance cancer care delivery.

METHODS

We reviewed physics students’ training records in the MP unit of University College Hospital (UCH), Ibadan, Nigeria, from June 2009 to June 2019. These included demographic data, institutions, levels of study, time and training duration, and contact details. Trainees were contacted for updated information on their professional status. Awareness of the profession had been created at UCH and institutions within and outside Ibadan. Data were analyzed using Microsoft Excel 2016.

RESULTS

One hundred thirteen trainees (mean age, 24.1 ± 2.3 years) composed of 65.5% male and 34.5% female students attended UCH within the 10-year period. They were categorized as undergraduates, (n = 83; 73.5%), Master’s students (n = 25; 22.1%), Doctoral students (n = 2; 1.8%), and workers within nuclear field (n = 3; 2.7%). Of the 83 undergraduates, 5 (6.0%) were on training as of mid-September 2019, 25 (30.1%) were still in universities or serving in the mandatory national youth service, 11 (13.3%) were in the MP profession, and 42 (50.6%) were in other career pathways. Candidates’ institutions spread across 5 of the 6 geopolitical zones in the country. Furthermore, 207 physics students took part in awareness seminars at 2 universities in commemoration of International Day of Medical Physics.

CONCLUSION

Candidates from almost all parts of Nigeria benefitted from workplace experience at UCH, which continues to promote the profession. A greater feat will be attained when the University of Ibadan commences MP postgraduate programs.

The state of gender diversity in medical physics

The purpose of this study was to quantify gender diversity in leadership positions within the field of medical physics, as well as within award categories and other recognitions by the American Association of Physicists in Medicine. The April 2019 PDF version of the AAPM membership directory was searched for all users self‐reporting as holding a leadership position at their place of employment, those elected to leadership positions within the AAPM, those serving as chair of an AAPM council, and those listed as having received an award or other such recognition from AAPM (beginning in 1972 with the William D. Coolidge Award). Historical data for these categories were obtained from archived membership directories on the AAPM website. The AAPM website was also used to identify members who have served on the Medical Physics Editorial Board. The Commission on Accreditation of Medical Physics Education Programs (CAMPEP) website was used to identify the current directors of graduate and residency programs (as of July 2019). Because gender was not a reported field in any of these categories, gender was assigned by reviewing names and photographs. Percentage representation in these respects was compared to the overall percentage of women in the AAPM in 2019 (23.3%) and reported the number of women working as medical physicists globally (29.8%). Within the AAPM, the percentage of women reporting clinical leadership roles is 12.0% within the US, 13.6% in Canada, and 18.0% in all other countries combined. Women comprise only 7.5% of CAMPEP graduate program directors and 21.5% of residency program directors. The percentage of female presidents in AAPM is 8.1%. A woman has never served as Editor‐in‐Chief of Medical Physics, and the average for the past 10 yr for female board membership is 13.6%. With the exception of the John R. Cameron Young Investigators Symposium Award, the percentage of all female AAPM awardees is less than the percentage of women AAPM members. The lowest percentage of female representation within AAPM is among council chairs with only one woman having held a chair position out of 42 positions (2.4%) from 1970 to July 2019. Similar to the traditional discipline of physics, medical physics displays a clear gender disparity with regard to leadership positions, both within educational training programs and the AAPM. Further investigation into the demographics of the field and psychosocial factors affecting medical physicists may help to elucidate the origin of these disparities and inform strategies to address them.

Survey of postgraduate medical physics programmes in the Asia-Oceania region

The increased use of medical imaging and radiation therapies has resulted in a high demand for medical physicists. Although medical physics programmes are well established in advanced countries, the same cannot be said for many low- and medium-income countries. In some countries, there may be huge variations in the graduates' skill and quality, which pose a problem in ensuring patient safety, providing quality assurance in treatments, optimisation of protocols and standardisation of quality. It also makes any yet-to-be-established regional peer recognition efforts problematic. In order to understand the depth of this problem, a survey was carried out as part of the home-based assignment under the RAS 6088 IAEA programme. A large diversity in terms of course content, duration, clinical training and student profile could be observed across the Asia-Oceania universities surveyed. Out of 25 programmes, only six received recognition from professional bodies, and they were mostly in Australia and New Zealand. Hence, to ensure quality education, a regional curriculum model needs to be developed to harmonise standards. And there is still a long way to go towards standardizing medical physics education and clinical training in the region.