PURPOSE:Many undergraduate students are eager to learn more about potential career opportunities. While physics majors are often aware of research opportunities within their home department, students may not be aware of how physics can be applied in medicine. An alternate framework for a 10-week summer undergraduate research experience using a collaborative Team Science approach is presented. METHODS:The Team Science program is described, with feasibility shared based on the experiences of four students who piloted the program. Students explored four different projects throughout the summer as part of the 10-week program and assumed different team roles for each project fostering experience understanding team dynamics. Changes in student attitudes toward science research were quantified using validated surveys and qualitative responses are also summarized. RESULTS:Average self-reported student scores in the Attitudes and Approaches to Problem Solving Survey increased 9.8% and Colorado Learning Attitudes about Science Survey for Experimental Physics increased 14.2% after the summer research experience. Areas with the highest reported gains from the program from the Undergraduate Research Student Self-Assessment Survey included understanding what everyday research work is like, engaging in real-world science research, and preparation for the future. CONCLUSIONS:Using a Team Science approach allowed for students to explore multiple research questions during the summer and experience a more authentic and integrated approach to how research is conducted. This model can be expanded and adapted for students to identify medical physics as a career for applying their physics knowledge to solve problems that will advance human health earlier in their career.

IntroductionMedical physics is a fulfilling profession where physics is applied to advance human health. However, many are uninformed of the role of physicists in medicine, and students are unaware of this career pathway. This study presents a pilot 1-year program for science teachers to learn about physics in medicine and share with students and teachers.MethodsA cohort of middle school and high school science teachers were selected to learn about physics in medicine, develop lesson plans for their students, participate in a Physics in Medicine field trip hosted at a cancer hospital, and concluded with a professional development day for other regional science teachers. Surveys were conducted throughout the program to assess attitudes toward teaching medical physics, content knowledge of medical physics, collaboration, and demographic information from participants.ResultsThe program was implemented over the course of a year which included 5 school districts, 10 science teachers, and hundreds of students. After participating in the program, teacher scores on surveys regarding attitudes toward teaching medical physics and content knowledge significantly increased for the cohort. Strong collaboration between teaching pairs was maintained throughout the program based on survey responses. Teachers participating in the 1-day professional development program also benefited from the program based on survey responses regarding attitudes toward medical physics and interest in learning more about medical physics.DiscussionThis pilot study demonstrated the feasibility and effectiveness of an educational model for teachers' understanding and connecting medical physics with students in their schools. The program was well received by teachers and students, and this manuscript provides guidelines for effective replication of the curriculum at other institutions.

INTRODUCTION:The American Association of Physicists in Medicine (AAPM) recently shared results and recommendations from its first Equity, Diversity, and Inclusion (EDI) Climate Survey, which was designed to assess the climate at the workplace, the AAPM organization, and the AAPM regional chapter level. This work further explores the status of EDI at the regional chapter level. METHODS:AAPM's EDI Survey was distributed to 5500 members and had a response rate of 25%. In the survey, three open-ended comment boxes were provided for feedback, including one for regional AAPM members. Sixty-four percent of respondents indicated they were part of a regional chapter, and 6% provided written responses to the regional chapter question. Responses were analyzed using a mixed methods approach with an exploratory sequential design. Two phases were conducted; the first relied on a Grounded Theory quantitative systemic approach, and the second applied qualitative analysis. Chapter member demographic data were collected to support findings. RESULTS:Survey respondents provided open comments and feedback on their regional chapter's climate. Data are summarized as five themes: positive experiences, negative experiences, challenges within chapters, diversity and inclusion, and changes observed. Experiences of regional chapters were rated positively by 75% of respondents. Respondents found their chapters were welcoming, and some noted their great chapter leadership. A number of incidents of sexual harassment, bullying, and discrimination incidences were also shared. Other respondents observed exclusion based on their gender, race, highest degree, and medical physics specialty. Chapter leadership data aligned with these claims, with most leaders to-date being white males, doctoral degree holders, and/or specializing in radiation therapy. CONCLUSION:AAPM chapters provide rewarding professional opportunities. This study has highlighted positive and negative experiences reported by its members. The major themes identified can guide chapter leaders to continue to cultivate welcoming communities for regional AAPM members.

Purpose/Objective(s) High-performance imaging (HPI) cone beam computed tomography (CBCT) on a c-arm linear accelerator (Linac), now a clinical imaging option, is designed to improve image quality through advanced reconstruction algorithms (iCBCT), a larger imaging panel, and faster gantry speed (9 deg/s). This study evaluates clinical workflow changes resulting from implementing HPI. Materials/Methods Treatment plans were created on anthropomorphic phantoms for four anatomical sites (brain, thorax, pelvis, and spine). Users were asked to acquire and match images from HPI-CBCT (iCBCT reconstruction, 9 deg/s) and standard CBCT (FDK reconstruction, 6 deg/s), randomizing the order of acquisition method and disease site per user. Users matched images based on the institution’s typical clinical workflow (auto-matching followed by manual adjustments) for each disease site. An additional acquisition was completed for each treatment plan with auto-matching only. Time was recorded for acquisition, match, and total session. Registration shift results were compared between HPI and standard CBCT for clinical and auto-matching scenarios in brain, thorax, and pelvis workflows. To evaluate the increased gantry speed on treatment delivery, six treatment plans were identically delivered with automation on different Linac control console versions and session times were recorded. Results Compared to standard CBCT, HPI decreased the average scan times for 200O and 360O acquisitions by 10.7 ± 0.4s and 19.8 ± 1.2s, respectively. Reconstruction times increased by 22.9 ± 2.0s for 200O and 39.0 ± 1.9s for 360O acquisitions when comparing iCBCT reconstruction to FDK. Clinical workflow average match time difference between HPI and standard CBCT are -3.7 ± 10.5s, 6.6 ± 22.4s, -2.4 ± 39.9s, and 1.2 ± 16.4s for brain, thorax, pelvis, and spine, respectively across five users. The average maximum shift differences for clinical matching between HPI and standard CBCT are reported in Table 1. Auto matching resulted in maximum vertical, longitudinal, lateral, and couch rotational shift differences of 0.02 cm, -0.03 cm, 0.06 cm, 0.2 degrees. Average time savings using automation of 3D and static gantry IMRT plans with fast gantry speed is 8.7 ± 3.3 seconds. Conclusion HPI on a Linac results in similar match times and positioning results as standard CBCT. While reconstruction time increases with iCBCT when compared to FDK backprojection methods, HPI acquisition is consistently faster. HPI acquisition speed coupled with FDK reconstruction could result in an efficiency gain without a reduction in image quality required for accurate patient setup. Faster gantry speed capability during automated treatments results in faster treatment delivery for 3D and IMRT plans.

PurposeTo identify high-priority risks in a clinical trial investigating the use of radiation to alleviate COVID-19 pneumonia using a multi-phase failure modes and effects analysis (FMEA).MethodsA comprehensive FMEA survey of 133 possible causes of failure was developed for the clinical trial workflow (Phase I). The occurrence, severity, and detection risk of each possible cause of failure was scored by three medical physicists. High-risk potential failure modes were identified using the risk priority number (RPN) and severity scores, which were re-scored by 13 participants in radiation oncology (Phase II). Phase II survey scores were evaluated to identify steps requiring possible intervention and examine risk perception patterns. The Phase II participants provided consensus scores as a group.ResultsThirty high-priority failure modes were selected for the Phase II survey. Strong internal consistency was shown in both surveys using Cronbach's alpha (alpha c >= 0.85). The 10 failures with the largest median RPN values concerned SARS-CoV-2 transmission (N = 6), wrong treatment (N = 3), and patient injury (N = 1). The median RPN was larger for COVID-related failures than other failure types, primarily due to the perceived difficulty of failure detection. Group re-scoring retained 8/10 of the highest-priority risk steps that were identified in the Phase II process, and discussion revealed interpretation differences of process steps and risk evaluation. Participants who were directly involved with the trial working group had stronger agreement on severity scores than those who were not.ConclusionsThe high ranking of failures concerning SARS-CoV-2 transmission suggest that these steps may require additional quality management intervention when treating critically ill COVID-19+ patients. The results also suggest that a multi-phase FMEA survey led by a facilitator may be a useful tool for assessing risks in radiation oncology procedures, supporting future efforts to adapt FMEA to clinical procedures.

Purpose Patient motion during radiation therapy treatment is a concern, especially for spine stereotactic body radiation therapy cases where the sharper dose gradient presents a toxicity threat to the spinal cord. Intrafraction motion review (IMR) is an application used to monitor patient position during treatment. The presence of spinal fixation hardware presents an opportunity for motion tracking to manually pause the beam. Methods and Materials A cohort of 17 clinicians were shown a video of the imaging console during a simulated treatment. Participants decided after each triggered image if they would pause the treatment beam, indicating that they believed the phantom to have moved outside of clinical tolerance. A spine phantom with hardware intact was positioned on a motion platform, which was programmed to make shifts ranging in size from 0.5 to 1.5 mm. A 1-mm isotropic expansion contour from the hardware was overlayed on the triggered planar x-ray images using the IMR application. Results User perception sensitivity did not exceed 0.5 until there was a physical shift of 1.4 mm, indicating that most users will not be able to reliably discriminate submillimeter shifts using contour-based shift identification. Conclusions If adaptations to standard of care are implemented clinically, the proposed method should be evaluated and the role of training and education should be examined before implementation. However, contour-based IMR could still provide beneficial information for larger intrafraction motion during treatment and could be valuable for identifying gross anatomic motion during treatment.

Background: Ultra-high dose rate radiation (UHDR) is being explored by researchers in promise of advancing radiation therapy treatments.Purpose: This work presents the commissioning of Varian's Flash Extension for research (FLEX) conversion of a Clinac to deliver UHDR electrons.Methods: A Varian Clinac iX with the FLEX conversion was commissioned for non-clinical research use with 16 MeV UHDR (16H) energy. This involved addition of new hardware, optimizing the electron gun voltages, radiofrequency (RF) power, and steering coils in order to maximize the accelerated electron beam current, sending the beam through custom scattering foils to produce the UHDR with 16H beam. Profiles and percent depth dose (PDD) measurements for 16H were obtained using radiochromic film in a custom vertical film holder and were compared to 16 MeV conventional electrons (16C). Dose rate and dose per pulse (DPP) were calculated from measured dose in film. Linearity and stability were assessed using an Advanced Markus ionization chamber.Results: Energies for 16H and 16C had similar beam quality based on PDD measurements. Measurements at the head of the machine (61.3 cm SSD) with jaws set to 10x10 cm(2) showed the FWHM of the profile as 7.2 cm, with 3.4 Gy as the maximum DPP and instantaneous dose rate of 8.1E5 Gy/s. Measurements at 100 cm SSD with 10 cm standard cone showed the full width at half max (FWHM) of the profile as 10.5 cm, 1.08 Gy as the maximum DPP and instantaneous dose rate of 2.E5 Gy/s. Machine output with number of pulses was linear (R = 1) from 1 to 99 delivered pulses. Output stability was measured within +/- 1% within the same session and within +/- 2% for daily variations.Conclusions: The FLEX conversion of the Clinac is able to generate UHDR electron beams which are reproducible with beam properties similar to clinically used electrons at 16 MeV. Having a platform which can quickly transition between UHDR and conventional modes (<1 min) can be advantageous for future research applications.

PURPOSE:Ring and tandem (R&T) applicator digitization is currently performed at our institution by manually defining the extent of the applicators. Digitization can also be achieved using solid applicators: predefined, 3D models with geometric constraints. This study compares R&T digitization using manual and solid applicator methods through Failure Modes and Effects Analyses (FMEAs) and comparative time studies. We aim to assess the suitability of solid applicator method implementation for R&T cases METHODS: Six qualified medical physicists (QMPs) and two medical physics residents scored potential modes of failure of manual digitization in an FMEA as recommended by TG-100. Occurrence, severity, and detectability (OSD) values were averaged across respondents and then multiplied to form combined Risk Priority Numbers (RPNs) for analysis. Participants were trained to perform treatment planning using a developed solid applicator protocol and asked to score a second FMEA on the distinct process steps from the manual method. For both methods, participant digitization was timed. FMEA and time data were analyzed across methods and participant samples RESULTS: QMPs rated the RPNs of the current, manual method of digitization statistically lower than residents did. When comparing the unique FMEA steps between the two digitization methods, QMP respondents found no significant difference in RPN means. Residents, however, rated the solid applicator method as higher risk. Further, after the solid applicator method was performed twice by participants, the time to digitize plans was not significantly different from manual digitization CONCLUSIONS: This study indicates the non-inferiority of the solid applicator method to manual digitization in terms of risk, according to QMPs, and time, across all participants. Differences were found in FMEA evaluation and solid applicator technique adoption based on years of brachytherapy experience. Further practice with the solid applicator protocol is recommended because familiarity is expected to lower FMEA occurrence ratings and further reduce digitization times.

Osteoarthritis (OA) is a painful, degenerative disease that affects the tissues of the joint spaces, such as the shoulder. Conventional medical treatment options, such as corticosteroid injections and anti-inflammatory medications, are not always sufficient to alleviate the symptoms from this disease. Low dose radiotherapy is a newer treatment option for patients with shoulder osteoarthritis and has shown positive outcomes. However, the problem is that there is a paucity of literature about treatment planning considerations for this new treatment option. The purpose of this case study was to provide an example of treatment planning techniques and considerations for shoulder osteoarthritis. Treatment techniques for shoulder LDRT, such as treatment field borders, prescribed dose, beam arrangements, appropriate beam energy, and special considerations are discussed.

Purpose/Objective(s) The goal of this study is to evaluate clinician preference of cone beam computed tomography (CBCT) imaging with Metal Artifact Reduction (MAR) vs. standard (FDK) reconstruction algorithms with common implants for a standard c-arm linear accelerator with novel CBCT technology. Materials/Methods A survey was developed with sets of MAR and FDK images displayed side-by-side with the same window/level in randomized order. Images included four different fiducial markers embedded in an anthropomorphic phantom, a spinal fixation device and a hip implant placed in a water phantom, and an electron density phantom with a titanium insert. The survey was completed by physicians, physicists, dosimetrists, and therapists at an academic cancer hospital. Respondents selected which of the two images had superior image quality based on better ability to distinguish the metal implant and less surrounding artifact. Test reliability was conducted by repeating a subset of randomized images. Results In the completed surveys, the MAR algorithm was preferred 99% of the time for the electron density phantom, 99% for a spine fixation device, and 86% for the hip implant. The preference for fiducial markers had more variation with MAR preferred 57% for a carbon fiducial, 55% for a cylindrical gold marker, 37% for a gold chain, and 27% for an S-shaped platinum fiducial. Summary of results from clinician roles is shown in Table 1. Using test-retest theory for the questions repeated during the survey, the Pearson Correlation Coefficient was 0.989 indicating very strong reliability. The MAR algorithm reduced the visible streaking artifacts for spinal fixation device, hip implants, titanium rods, and for gold fiducial markers compared to the standard reconstruction algorithm. Greater streaking artifact was observed in the MAR than standard reconstruction for the other fiducial markers. Conclusion By comparing images of commonly used metal implants, we observe that the MAR algorithm is the preferred image for clinicians for hip implants and spinal fixation devices. Greater variability was shown in the preference between the algorithms among fiducial markers.

Carbon-fiber reinforced (CFR) polyetheretherketone hardware is an alternative to traditional metal hardware used for spinal fixation surgeries before postoperative radiation therapy for patients with spinal metastases. CFR hardware's radiolucency decreases metal artifact, improving visualization and accuracy of treatment planning. We present the first clinical use and proof of principle of CFR spinal hardware with tantalum markers used for successful tracking of intrafraction motion (IM) using Varian TrueBeam IMR (Intrafraction Motion Review) software module during postoperative spine stereotactic radiation. A 63-year-old woman with history of endometrial cancer presented with acute back pain. Imaging demonstrated pathologic T12 vertebral fracture with cord compression. She underwent T12 vertebrectomy with circumferential decompression and posterior instrumented T10-L2 fusion at our facility using CFR-polyetheretherketone hardware with tantalum screw markers followed by postoperative stereotactic body radiation therapy to 3000 cGy in 5 fractions delivered to T11-T12. Tantalum screw markers were used for IMR tracking. During irradiation, 260 kV images were acquired, and IMR software was able to identify and track markers. During the entire treatment, the IM motions were less than 3 mm. This is the first presented case of CFR spinal hardware with tantalum markers used for successful IMR tracking of IM during daily spine stereotactic treatment. Future work will be needed to improve workflow and create a spine-specific IMR protocol.

The American Association of Physicists in Medicine began the Medical Physics Leadership Academy Journal Club in the fall of 2020. The initiative was launched to provide a forum for medical physicists to learn about leadership topics using published material, discuss and reflect on the material, and consider incorporating the discussed skills into their professional practice. This report presents the framework for the MPLA Journal Club program, describes the lessons learned over the last 2 years, summarizes the data collected from attendees, and highlights the roadmap for the program moving forward.

Purpose: The eFLASH Mobetron delivers UHDR doses at discrete combinations of pulse width (PW), pulse repetition frequency (PRF) and number of pulses (N), which dictate unique combinations of dose and dose rates. Currently, obtaining pulse parameters for the desired dose and dose rate is a cumbersome manual process involving creating, updating and looking up values in large spreadsheets for every collimator. The purpose of this work is to present a MATLAB based pulse parameter optimizer tool to match intended dose and dose rate more precisely and efficiently. Methods: A constrained optimization problem for the dose and dose rate cost function was modelled as a mixed integer problem in MATLAB. The beam and machine data required for the software were acquired using GafChromic film and Alternating Current Current Tranformers (ACCTs), including dose per pulse for every collimator, pulse widths measured using ACCT, and air gap factors. Results: Using N, PRF, PW and air gap factors as the parameters, the software was created to optimize for dose and dose rate. By largely automating this dose calculation part, we have greatly reduced safety concerns associated with manual look up and calculation of these parameters, especially when many subjects at different doses and dose rates are to be irradiated. Conclusion: A pulse parameter optimization tool was built in MATLAB for the eFLASH Mobetron to increase efficiency in the dose, dose rate and pulse parameter prescription process

Purpose: Commercial UHDR platforms deliver Ultra-High Dose Rate (UHDR) doses at discrete combinations of pulse parameters including pulse width (PW), pulse repetition frequency (PRF) and number of pulses (N), which dictate unique combinations of dose and dose rates. Currently, obtaining pulse parameters for the desired dose and dose rate is a cumbersome manual process involving creating, updating, and looking up values in large spreadsheets for every treatment configuration. The purpose of this work is to present a pulse parameter optimizer application to match intended dose and dose rate precisely and efficiently. Methods: Dose and dose rate calculation have been described for a commercial electron FLASH platform. A constrained optimization for the dose and dose rate cost function was modelled as a mixed integer problem in MATLAB (The MathWorks Inc., Version9.13.0 R2022b, Natick, Massachusetts). The beam and machine data required for the application were acquired using GafChromic film and Alternating Current Current Transformers (ACCTs). Variables for optimization included dose per pulse (DPP) for every collimator at a specific treatment configuration, PW and PRF measured using ACCT, and airgap factors. Results: Using PW, PRF, N and airgap factors as the parameters, the application was created to optimize for dose and dose rate. Largely automating dose and dose rate calculation reduces safety concerns associated with manual look up and calculation of these parameters, especially when many subjects at different doses and dose rates are to be safely managed. Conclusion: A pulse parameter optimization application was built in MATLAB for a commercial electron UHDR platform to increase efficiency in the dose, dose rate, and pulse parameter prescription process.

Purpose: The American Association of Physicists in Medicine (AAPM) shares the results, conclusions, and recommendations from the initial Equity, Diversity, and Inclusion Climate Survey conducted in 2021. Methods and Materials: The climate survey targeted medical physicists who are full members of the AAPM and included demographic inquiries and questions intended to assess the working environmental climate in terms of a sense of belonging and inclusion, experiences of discrimination and harassment, and obstacles to participation within the AAPM. The survey invi-tation was sent to 5,500 members. Responses were collected from 1385 members (response rate of 25%) between January and February 2021.Results: Overall, the medical physics workplace climate was positive. However, some demographic and professional subgroups reported lower levels of agreement with positive characteristics of their workplace climates. Compared with men, women ranked lower 7 of 8 categories that characterized the workplace climate. Other subgroups that also ranked the workplace cli-mate descriptors lower included individuals not originally from the United States and Canada (3/8). Most respondents strongly agreed/agreed that the climate within the AAPM was welcoming. However, 17% of respondents reported personally experienc-ing or witnessing microaggressions within the AAPM. Overall, medical physicists reported low levels of agreement that oppor-tunities within the AAPM were available to them, from 34% to 60% among 8 categories, including opportunities to volunteer, join committees, and compete for leadership positions within the AAPM. Several subgroups reported even lower levels of agreement that these opportunities are available. Asian and Asian American respondents (3/8) and physicists with origins in countries outside the United States and Canada (7/8) reported fewer opportunities to participate in the AAPM. Medical physi-cists reported their experiences of discrimination and sexual harassment in their workplaces and within the AAPM. For those who reported personal experiences of sexual harassment, only 24% (15/63) felt comfortable reporting when it occurred within their workplaces, and 35% (9/26) felt comfortable reporting when it occurred within the AAPM.Conclusions: The report concludes with several recommendations for action. & COPY; 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Purpose: The feasibility of blinding applications for a medical physics residency program has yet to be demonstrated in the literature. We explore the application of an automated approach with human review and intervention to blind applications during the annual medical physics residency review cycle. Methods and Materials: Applications were blinded using an automated process and used for the first phase of residency review in the program. We retrospectively compared self-reported demographic and gender data with blinded and nonblinded cohorts from 2 sequential years of review from a medical physics residency program. Demographic data were analyzed comparing applicants with candidates selected to move to the next phase of the review process. Interrater agreement was also evaluated from the applicant reviewers. Results: We show the feasibility of blinding applications for a medical physics residency program. We observed no more than a 3% difference between the gender selection within the first phase of application review but greater differences when examining race and ethnicity between the 2 methods. The greatest difference was shown to be between Asian and White candidates, where there are statistical differences in the scores in the rubric categories of essay and overall impression. Conclusions: We suggest that each training program critically evaluate its selection criteria for potential sources of bias within the review process. We recommend further critical investigation of processes to promote equity and inclusion to ensure the methods and outcomes are aligned with the mission of the program. Finally, we recommend that the common application provide an option for blinding applications at the source so this can be an option to facilitate efforts for evaluating unconscious bias in the review process.

Purpose: Increasing evidence suggests that ultra-high-dose-rate (UHDR) radiation could result in similar tumor control as conventional (CONV) radiation therapy (RT) while reducing toxicity to surrounding healthy tissues. Considering that radiation toxicity to gonadal tissues can cause hormone disturbances and infertility in young patients with cancer, the purpose of this study was to assess the possible role of UHDR-RT in reducing toxicity to healthy gonads in mice compared with CONV-RT. Methods and Materials: Radiation was delivered to the abdomen or pelvis of female (8 or 16 Gy) and male (5 Gy) C57BL/6J mice, respectively, at conventional (∼0.4 Gy/s) or ultrahigh (>100 Gy/s) dose rates using an IntraOp Mobetron linear accelerator. Organ weights along with histopathology and immunostaining of irradiated gonads were used to compare toxicity between radiation modalities. Results: CONV-RT and UHDR-RT induced a similar decrease in uterine weights at both studied doses (∼50% of controls), which indicated similarly reduced ovarian follicular activity. Histologically, ovaries of CONV- and UHDR-irradiated mice exhibited a comparable lack of follicles. Weights of CONV- and UHDR-irradiated testes were reduced to ∼30% of controls, and the percentage of degenerate seminiferous tubules was also similar between radiation modalities (∼80% above controls). Pairwise comparisons of all quantitative data indicated statistical significance between irradiated (CONV or UHDR) and control groups (from P ≤ .01 to P ≤ .0001) but not between radiation modalities. Conclusions: The data presented here suggest that the short-term effects of UHDR-RT on the mouse gonads are comparable to those of CONV-RT.