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Some of these challenges experienced in our field are well described in a recent article published by NPR, “Time to Ditch Those Awful Zoom Calls, CEOs Say,” as many other fields experienced many of the same challenges https://www npr org/2020/10/14/923428794/from‐the‐folks‐who‐brought‐you‐boring‐meetings‐ceos‐want‐to‐ditch‐sterile‐zoom‐c Other workflow challenges that were exposed include the benefit of in‐person interactions that allow the immediate resolution of questions and complexities associated with patient care [ ]some argue that in‐person interaction is critical to the field in order to demonstrate the value imaging physics providers must reinforce to administrators [ ]given the circumstances of this transition, it was found that regular rounding and interaction with frontline healthcare workers provided important emotional support to overwhelmed essential medical staff at work The continuation of scholarship also depends on the continued publication of science Because scholarship related to COVID‐19 was in huge demand, JACMP publisher Wiley initially expressed concern in their ability to manage the throughput of unrelated articles

The pandemic situation with COVID-19 has changed many things in the world. This Focus series book collects early reactions in the medical physics profession related to changes in professional activities during the pandemic time in 2020. This chapter collects information from the editors-in-chief of various medical physics journals aiming to present an overall view of the publication activities and readership interest during nine months of the pandemic. Most journals report that although not overwhelming, they have received COVID-19 submissions. Some of these submissions have been rejected as being more medical than medical physics submissions. The collaborative work and analysis of the editors, presented in this chapter, emphasised the service that these journals offer to our profession, even in such difficult times. They also underline the need for further collaboration between the leads of the professional journals, as well as expansion of international networking in medical physics.

The medical physics profession is undergoing significant changes. Starting in 2014, candidates registering for certification exams by the American Board of Radiology must have completed a CAMPEP‐accredited residency. This requirement, along with tightened state regulations, uncertainty in future reimbursement, and a stronger emphasis on board certification, have raised questions concerning the state of the medical physics workforce and its ability to adapt to changing requirements. In 2012, ASTRO conducted a workforce study of the comprehensive field of radiation oncology. This article reviews the findings of the medical physics section of the study, including age and gender distribution, educational background, workload, and primary work setting. We also report on job satisfaction, the perceived supply and demand of medical physicists, and the medical physicists' main concerns pertaining to patient safety and quality assurance. PACS number: 87.90

The JACMP has lost a dear friend, Larry Berkley. Among his many other services to the medical physics community, Larry was the Chair of the JACMP Journal Business Management Committee for almost ten years, first under the ACMP, and then under the AAPM. He leaves a heritage of knowledge, integrity, and passion for open-access publishing. Larry and I go back to the 1969 summer “Rat Camp” at Georgia Tech. I have known him longer than any other medical physicist. I thank Joe Grant for this tribute to Larry’s life and legacy. – Michael D. Mills, Editor-in-Chief

For those of you who don’t identify with the title of this editorial, it is from the lyrics of a song in the 1964 Broadway musical “Fiddler on the Roof”, which was adapted into a successful motion picture in 1971.(1) You may wonder what a story about Russian peasants in the late 19th century has to do with medical physics today. When I was asked to write an editorial about the 2015 MedPhys Match (MPM),(2) that line came to mind almost immediately. One of the main threads in the story is about finding suitable spouses for the main character’s three daughters. At that time, it was common practice in some cultures to employ the assistance of a matchmaker to find a suitable spousal match. Taking into account preferences of all eligible parties, the matchmaker would propose spousal matches. Although one can argue that such an important decision should not be left to an outside party, current divorce rates and the success of online matchmaking services could be viewed as evidence to the contrary. Many articles about algorithms to solve this type of problem refer to it as the stable marriage problem.(3) In my years as a medical physicist, I’ve witnessed many changes in the medical physics education and training landscape. The need for medical physicists has created a very rewarding (in many ways) profession, and as a result, competition to get into training programs and positions is intense. The American Board of Radiology (ABR) now requires medical physicist students to have CAMPEP-accredited residency training to complete their board certification process. With the transition to this new requirement, there was a noticeable “flood” of candidates getting into the board certification process before the new requirements took hold. I’m not going to debate the merits of the current landscape, but wanted to note that it is now here, and we have to deal with it. Sapareto and et al.(4) debated the merits of using a matching program for medical physics residency recruitment earlier in 2014 (before the MPM came into being). References in that article provide a history of how matching programs came into existence, and it is fairly obvious that there are several parallels between medical residency training recruitment (many years ago) and the current situation with medical physics residency training. As pointed out in the article, there were a variety of problems with the state of medical physics residency recruiting prior the MPM being put into place. There was an attempt at having a gentleman’s agreement* between programs to provide a fair playing field for recruiting. I could give many anecdotal examples showing “bad behavior”, but as pointed out in the article, there wasn’t anyone who was willing to provide any penalty for not following the agreement. The article suggests that an organization like CAMPEP could discipline programs that don’t follow the agreement, but this is not within CAMPEP’s mission.(5) Through the efforts of too many people to name, we were able to implement the MPM to create a better recruiting environment for the 2015 recruiting season, and participation in the program is much better than we had hoped. As of late October 2014, we have more than 70 programs participating in the MPM, and more than 140 applicants have registered. The program looks like it will be a success in its first year. In some ways, program directors went out on a limb when signing up this year and I would like to thank all of them for their faith in the system. I would like to use the rest of this editorial to deal with a few nagging questions that some might have regarding how the MPM works and whether it is really better than what we had before. First and foremost, I think that program directors and applicants worry about not being

Lake suckers of the genus Chasmistes are a unique and important component of the fish assemblages of the western USA. To review recent research, discuss issues, and exchange information, researchers and managers working on the various species participated in a symposium on lake sucker biology as part of the 2010 annual meeting of the Western Division of the American Fisheries Society, held in Salt Lake City, Utah. This special feature of the Western North American Naturalist is dedicated to lake sucker ecology and natural history and provides a central venue for publication of several papers presented in the symposium. To provide a link to the broader peer-reviewed, published literature on lake sucker biology, we have included a bibliography as an (appendix.

This issue's editorial is an invited commentary authored by Per H. Halvorsen.* It discusses an essential question for clinically practicing medical physicists: How are external factors likely to change the way we practice our profession in the next decade? The topic is both timely and essential, as the AAPM is actively engaged in developing guidance on many related aspects. This editorial sets the framework and provides the personal observations of an individual who has led the AAPM's Professional Council for the past six years.

Significant controversy surrounds the 2012 / 2014 decision announced by the Trustees of the American Board of Radiology (ABR) in October of 2007. According to the ABR, only medical physicists who are graduates of a Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) accredited academic or residency program will be admitted for examination in the years 2012 and 2013. Only graduates of a CAMPEP accredited residency program will be admitted for examination beginning in the year 2014. An essential question facing the radiation oncology physics community is an estimation of supply and demand for medical physicists through the year 2020. To that end, a Demand & Supply dynamic model was created using STELLA software. Inputs into the model include: a) projected new cancer incidence and prevalence 1990–2020; b) AAPM member ages and retirement projections 1990–2020; c) number of ABR physics diplomates 1990–2009; d) number of patients per Qualified Medical Physicist from Abt Reports I (1995), II (2002) and III (2008); e) non‐CAMPEP physicists trained 1990–2009 and projected through 2014; f) CAMPEP physicists trained 1993–2008 and projected through 2014; and g) working Qualified Medical Physicists in radiation oncology in the United States (1990–2007). The model indicates that the number of qualified medical physicists working in radiation oncology required to meet demand in 2020 will be 150–175 per year. Because there is some elasticity in the workforce, a portion of the work effort might be assumed by practicing medical physicists. However, the minimum number of new radiation oncology physicists (ROPs) required for the health of the profession is estimated to be 125 per year in 2020. The radiation oncology physics community should plan to build residency programs to support these numbers for the future of the profession. PACS numbers: 87.90.+y, 87.53.‐j

IMRT plans generated in Eclipse use a fast algorithm to evaluate dose for optimization and a more accurate algorithm for a final dose calculation, the Analytical Anisotropic Algorithm. The use of a fast optimization algorithm introduces optimization convergence errors into an IMRT plan. Eclipse has a feature where optimization may be performed on top of an existing base plan. This feature allows for the possibility of arriving at a recursive solution to optimization that relies on the accuracy of the final dose calculation algorithm and not the optimizer algorithm. When an IMRT plan is used as a base plan for a second optimization, the second optimization can compensate for heterogeneity and modulator errors in the original base plan. Plans with the same field arrangement as the initial base plan may be added together by adding the initial plan optimal fluence to the dose correcting plan optimal fluence. A simple procedure to correct for optimization errors is presented that may be implemented in the Eclipse treatment planning system, along with an Excel spreadsheet to add optimized fluence maps together. PACS number: 87.53.Bn, 87.56.By

The American Association of Medical Dosimetrists (AAMD) designed and directed 2 surveys of the AAMD membership. The first was in 2011 and the second in 2014. There were a number of questions common to both surveys, and this article seeks to evaluate these common questions to determine trends among the professional membership of the AAMD. It is demonstrated that the observed trends are consistent with the goals and objectives established by the leadership of the AAMD and the Medical Dosimetry Certification Board (MDCB) for the medical dosimetry community. In addition, certain challenges and opportunities involving the scope of practice for the medical dosimetry profession are discussed.

Respiratory monitoring systems are required to supply CT scanners with information on the patient's breathing during the acquisition of a respiration‐correlated computer tomography (RCCT), also referred to as 4D CT. The information a respiratory monitoring system has to provide to the CT scanner depends on the specific scanner. The purpose of this study is to compare two different respiratory monitoring systems (Anzai Respiratory Gating System; C‐RAD Sentinel) with respect to their applicability in combination with an Aquilion Large Bore CT scanner from Toshiba. The scanner used in our clinic does not make use of the full time dependent breathing signal, but only single trigger pulses indicating the beginning of a new breathing cycle. Hence the attached respiratory monitoring system is expected to deliver accurate online trigger pulse for each breathing cycle. The accuracy of the trigger pulses sent to the CT scanner has to be ensured by the selected respiratory monitoring system. Since a trigger pulse (output signal) of a respiratory monitoring system is a function of the measured breathing signal (input signal), the typical clinical range of the input signal is estimated for both examined respiratory monitoring systems. Both systems are analyzed based on the following parameters: time resolution, signal amplitude, noise, signal‐to‐noise ratio (SNR), signal linearity, trigger compatibility, and clinical examples. The Anzai system shows a better SNR (≥28 dB) than the Sentinel system (≥14.6 dB). In terms of compatibility with the cycle‐based image sorting algorithm of the Toshiba CT scanner, the Anzai system benefits from the possibility to generate cycle‐based triggers, whereas the Sentinel system is only able to generate amplitude‐based triggers. In clinical practice, the combination of a Toshiba CT scanner and the Anzai system will provide better results due to the compatibility of the image sorting and trigger release methods. PACS numbers: 87.57.Q‐, 07.07.Df

Intraoperative radiation therapy (IORT) has been customarily performed either in a shielded operating suite located in the operating room (OR) or in a shielded treatment room located within the Department of Radiation Oncology. In both cases, this cancer treatment modality uses stationary linear accelerators. With the development of new technology, mobile linear accelerators have recently become available for IORT. Mobility offers flexibility in treatment location and is leading to a renewed interest in IORT. These mobile accelerator units, which can be transported any day of use to almost any location within a hospital setting, are assembled in a nondedicated environment and used to deliver IORT. Numerous aspects of the design of these new units differ from that of conventional linear accelerators. The scope of this Task Group (TG-72) will focus on items that particularly apply to mobile IORT electron systems. More specifically, the charges to this Task Group are to (i) identify the key differences between stationary and mobile electron linear accelerators used for IORT, (ii) describe and recommend the implementation of an IORT program within the OR environment, (iii) present and discuss radiation protection issues and consequences of working within a nondedicated radiotherapy environment, (iv) describe and recommend the acceptance and machine commissioning of items that are specific to mobile electron linear accelerators, and (v) design and recommend an efficient quality assurance program for mobile systems.

Purpose: To systematically review the evidence for the use of stereotactic radiosurgery or stereotactic fractionated radiation therapy in adult patients with malignant glioma. Methods: Key clinical questions to be addressed in this evidence-based review were identified. Outcomes considered were overall survival, quality of life or symptom control, brain tumor control or response and toxicity. MEDLINE (1990–2004 June Week 2), CANCERLIT (1990–2003), CINAHL (1990–2004 June Week 2), EMBASE (1990–2004 Week 25), and the Cochrane library (2004 issue 2) databases were searched using OVID. In addition, the Physician Data Query clinical trials database, the proceedings of the American Society of Clinical Oncology (1997–2004), ASTRO (1997–2004), and the European Society of Therapeutic Radiology and Oncology (ESTRO) (1997–2003) were searched. Data from the literature search were reviewed and tabulated. This process included an assessment of the level of evidence. Results: For patients with newly diagnosed malignant glioma, radiosurgery as boost therapy with conventional external beam radiation was examined in one randomized trial, five prospective cohort studies, and seven retrospective series. There is Level I evidence that the use of radiosurgery boost followed by external beam radiotherapy and carmustine (BCNU) does not confer benefit with respect to overall survival, quality of life, or patterns of failure as compared with external beam radiotherapy and BCNU. There is Level I-III evidence of toxicity associated with radiosurgery boost as compared with external beam radiotherapy alone. The results of the prospective and retrospective studies may be influenced by selection bias. Radiosurgery used as salvage for recurrent or progressive malignant glioma after conventional external beam radiotherapy failure was reported in zero randomized trials, three prospective cohort studies, and five retrospective series. The available data are sparse and insufficient to make absolute recommendations. Stereotactic fractionated radiation therapy has been reported as boost therapy with external beam radiotherapy for patients with newly diagnosed malignant glioma in only three prospective studies. As primary therapy alone without conventional external beam radiotherapy for newly diagnosed malignant glioma patients, stereotactic fractionated radiation therapy has been reported in only one prospective study. There were only three prospective series and two retrospective studies reported for patients with recurrent or progressive malignant glioma. Conclusions: For patients with malignant glioma, there is Level I-III evidence that the use of radiosurgery boost followed by external beam radiotherapy and BCNU does not confer benefit in terms of overall survival, local brain control, or quality of life as compared with external beam radiotherapy and BCNU. The use of radiosurgery boost is associated with increased toxicity. For patients with malignant glioma, there is insufficient evidence regarding the benefits/harms of using radiosurgery at the time progression or recurrence. There is also insufficient evidence regarding the benefits/harms in the use of stereotactic fractionated radiation therapy for patients with newly diagnosed or progressive/recurrent malignant glioma.

Purpose The initial Abt Study of Medical Physicist Work Values for Radiation Oncology Physics Services was published in October 1995. That study measured qualified medical physicist (QMP) work associated only with routine radiation oncology procedures. In the intervening years, medical physics practice has changed dramatically. Three-dimensional treatment planning, once considered a special procedure, is the standard of care for many patient presentations. Prostate seed brachytherapy, stereotactic procedures, and intensity-modulated radiation therapy now constitute a large portion of the time medical physicists devote to clinical duties. Special procedures now dominate radiation oncology, leading to the request for an updated work and staffing study for qualified medical physicists. Methods The updated Abt Study of Medical Physicist Work Values for Radiation Oncology Physics Services: Round II was published in June 2003. Round II measures and reports QMP work associated with both routine and most contemporary special procedures. Additionally, staffing patterns are reported for a variety of practice settings. Results A work model is created to allow medical physicists to defend QMP work on the basis of both routine and special procedures service mix. The work model can be used to develop a cost justification report for setting charges for radiation oncology physics services. The work and cost justification models may in turn be used to defend medical physicist staffing and compensation. Conclusion The updated Abt study empowers medical physicists to negotiate service or employment contracts with providers on the basis of measured national QMP work force and staffing data.

To systematically review the evidence for the use of stereotactic radiosurgery in adult patients with brain metastases.Key clinical questions to be addressed in this evidence-based review were identified. Outcomes considered were overall survival, quality of life or symptom control, brain tumor control or response and toxicity. MEDLINE (1990-2004 June Week 2), CANCERLIT (1990-2003), CINAHL (1990-2004 June Week 2), EMBASE (1990-2004 Week 25), and the Cochrane library (2004 issue 2) databases were searched using OVID. In addition, the Physician Data Query clinical trials database, the proceedings of the American Society of Clinical Oncology (ASCO) (1997-2004), ASTRO (1997-2004), and the European Society of Therapeutic Radiology and Oncology (ESTRO) (1997-2003) were searched. Data from the literature search were reviewed and tabulated. This process included an assessment of the level of evidence.For patients with newly diagnosed brain metastases, managed with whole-brain radiotherapy alone vs. whole-brain radiotherapy and radiosurgery boost, there were three randomized controlled trials, zero prospective studies, and seven retrospective series (which satisfied inclusion criteria). For patients with up to three (4 cm) newly diagnosed brain metastases (and in one study up to four brain metastases), radiosurgery boost with whole-brain radiotherapy significantly improves local brain control rates as compared with whole-brain radiotherapy alone (Level I-III evidence). In one large randomized trial, survival benefit with whole-brain radiotherapy was observed in patients with single brain metastasis. In this trial, an overall increased ability to taper down on steroid dose and an improvement in Karnofsky performance status was seen in patients who were treated with radiosurgery boost as compared with patients treated with whole-brain radiotherapy alone. However, Level I evidence regarding overall quality of life outcomes using a validated instrument has not been reported. All randomized trials showed improved local control with the addition of radiosurgery to whole-brain radiotherapy. For patients with multiple brain metastases, there is no overall survival benefit with the use of radiosurgery boost to whole-brain radiotherapy (Level I-III evidence). Radiosurgery boost is associated with a small risk of early or late toxicity. In patients treated with radiosurgery alone (withholding whole-brain radiotherapy) as initial treatment, there were 2 randomized trials, 2 prospective cohort studies, and 16 retrospective series. There is Level I to Level III evidence that the use of radiosurgery alone does not alter survival as compared to the use of whole-brain radiotherapy. However, there is Level I to Level III evidence that omission of whole-brain radiotherapy results in poorer intracranial disease control, both local and distant (defined as remaining brain, outside the radiosurgery field). Quality of life outcomes have not been adequately reported. Radiosurgery is associated with a small risk of early or late toxicity. Radiosurgery as salvage for patients with brain metastases was reported in zero randomized trials, one prospective study, and seven retrospective series.Based on Level I-III evidence, for selected patients with small (up to 4 cm) brain metastases (up to three in number and four in one randomized trial), the addition of radiosurgery boost to whole-brain radiotherapy improves brain control as compared with whole-brain radiotherapy alone. In patients with a single brain metastasis, radiosurgery boost with whole-brain radiotherapy improves survival. There is a small risk of toxicity associated with radiosurgery boost as compared with whole-brain radiotherapy alone. In selected patients treated with radiosurgery alone for newly diagnosed brain metastases, overall survival is not altered. However, local and distant brain control is significantly poorer with omission of upfront whole-brain radiotherapy (Level I-III evidence). Whether neurocognition or quality of life outcomes are different between initial radiosurgery alone vs. whole-brain radiotherapy (with or without radiosurgery boost) is unknown, because this has not been adequately tested. There was no statistically significant difference in overall toxicity between those treated with radiosurgery alone vs. whole-brain radiotherapy and radiosurgery boost based on an interim report from one randomized study. There is insufficient evidence as to the clinical benefit/risks radiosurgery used in the setting of recurrent or progressive brain metastases, although radiographic responses are well-documented.