Medical Physicists Play Crucial Role at Baptist Health Cancer Care

What exactly are medical physicists and what role do they play in cancer care? For patients being treated with proton therapy and other forms of radiation therapy, the medical physicist is a crucial member of the care team. Their mostly behind-the-scenes work ensures that every patient’s radiation therapy – regardless of how it is delivered – is properly dosed and precisely targeted.

(Watch now: Medical physicists with Baptist Health Cancer Care in Miami and Boca Raton talk about what they do and how they contribute to the excellent patient care at Miami Cancer Institute and Lynn Cancer Institute. Video by Eduardo Morales.)

Medical physicists: a crucial part of the radiation oncology team

“We’re sort of the ‘glue’ between the  radiation oncologist, dosimetrist, therapist and other members of the patient’s care team,” says Andrew Wroe, Ph.D., director of the proton physics division in radiation oncology at Baptist Health Miami Cancer Institute, which along with the Eugene M. and Christine E. Lynn Cancer Institute in Boca Raton is part of Baptist Health Cancer Care.

Dr. Wroe says medical physicists are physicists who have advanced training and certification allowing them to specialize in cancer care. They help achieve the physician’s treatment plan by ensuring that the radiation technologies prescribed consistently deliver the most accurate therapy possible, offering patients the very best chance for a successful outcome.

According to the American Association of Physicists in Medicine (AAPM), medical physicists are heavily involved in cancer diagnosis and treatment, providing an “indispensable service” by accurately measuring the radiation output from technology employed in cancer therapy.

“In radiation oncology departments, one important example is the planning of radiation treatments for cancer patients, using either external radiation beams or internal radioactive sources,” the AAPM states. “Other important services are rendered through investigation of equipment perfor­mance, organization of quality control in imaging systems, design of radiation installations, and control of radiation hazards.”

The advantages of proton therapy in treating cancer

Dr. Wroe says that advanced cancer-fighting technologies such as proton beam therapy allow radiation oncologists to precisely target the tumor and minimize potential damage to healthy surrounding tissue.

“With proton therapy, we can better control the radiation dose, which means fewer side effects, decreased radiation dose deposited in other parts of the body and a more positive quality of life for the patient post-treatment,” Dr. Wroe explains. “This is advantageous when treating a wide range of tumors, including brain, breast, lung and prostate. It’s especially important when treating pediatric cancer patients, for whom ‘less is more’ when it comes to radiation therapy.”

As Dr. Wroe points out, it is the medical physicist’s responsibility to make sure that technology prescribed by the radiation oncologist is perfectly calibrated and that it delivers the precise amount of radiation required – no more and no less – to the precise spot where it is needed.

Unlike X-rays, which shoot through the patient, a proton beam stops within the body, depositing most of its tumor-killing dose wherever it is directed, says Dr. Wroe. Noting the importance of precision in proton therapy, he says that advanced technology available at Miami Cancer Institute can adjust in real time for even the slightest shifts in position. “We’re able to make sure the beam is targeted precisely where it needs to be at all times.”

Miami Cancer Institute: every cancer-fighting technology under one roof 

According to Ranjini Tolakanahalli, Ph.D., director of the photon physics division in radiation oncology, one of the things that sets Miami Cancer Institute apart from other cancer centers is that it has all of the different radiation therapy technologies under one roof, including some of the most advanced available anywhere in the world.

“Every state-of-the-art machine for radiation treatment available today is here at Miami Cancer Institute,” says Dr. Tolakanahalli. “We have the CyberKnife, a high-energy linear accelerator mounted on a robotic head that moves around the patient. We have machines for intracranial or brain treatments, and MRI-guided radiation therapy for those very hard to visualize tumors. We also have one of the most advanced proton therapy systems on the planet.”

Lynn Cancer Institute: building its own proton therapy program

Approximately 60 miles to the north, Lynn Cancer Institute at Boca Raton Regional Institute delivers what doctors there say are the “most advanced therapies and best outcomes” of any cancer center in Palm Beach County.

“Our Medical Physics and Dosimetry team is committed to delivering exceptional cancer care by utilizing the latest advancements in radiation therapy. We are equipped with state-of-the-art radiation therapy technology and a dedicated team of medical physicists and dosimetrists who bring unmatched expertise to every treatment plan,” says Suresh Rana, Ph.D., director of medical physics at Lynn Cancer Institute.

Shyam Pokharel, Ph.D., lead medical physicist at Lynn Cancer Institute, says the team works very closely with physicians to generate radiation treatment plans meticulously tailored to each individual patient. “By combining the latest radiation therapy technology with the specialized knowledge of physicists and dosimetrists, we ensure that every patient receives personalized care,” he says.

Dr. Rana adds, “We recognize that each patient’s treatment needs are different and not all cases can be treated with the same technology. Lynn Cancer Institute offers various radiotherapy technologies such as MRIdian, Radixact, TrueBeams, CyberKnife and Flexitron. It is essential to have physicists with specialized skills to ensure that each of these sophisticated technologies is precisely calibrated and functioning as intended.”

Lauren Rigsby, D.M.P., senior medical physicist at Lynn Cancer Institute, says the MR-based Linear Accelerator (MRIdian) has been an invaluable addition to the Institute’s lineup of treatment delivery options. It allows radiation oncologists to deliver precise radiation therapy while simultaneously visualizing tumors in real-time with MRI guidance.

Tino Romaguera, Ph.D., who has very instrumental in commissioning and implementing MRIdian at Lynn Cancer Institute, adds, “This technology allows radiation beams to remain precisely targeted, accounting for any variations that occur during the treatment course. The integration of MRI scan for online adaptive radiotherapy is a significant advancement in this area.”

“Radixact, or tomotherapy, is different compared to other external beam radiotherapy technology,” says Awens Alphonse, M.S., medical physicist at Lynn Cancer Institute. “It resembles a large CT scanner, combines a continuously rotating linear accelerator with a fan beam to deliver both imaging and radiation treatment.”

According to Nishan Shrestha, Ph.D., medical physicist at Lynn Cancer Institute, collaboration between physicists and engineers is essential in maintaining the accuracy of both imaging and radiation delivery, “We ensure that this highly sophisticated technology provides the most effective treatment for each patient,” Dr. Shrestha says.

Nebi Demez, Ph.D., senior medical physicist at Lynn Cancer Institute, says the CyberKnife, a robotic linear accelerator, “It delivers radiation beams with remarkable flexibility, allowing radiation doses to be directed from potentially hundreds of unique angles.” “This machine provides us another option to deliver stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) treatments for a wide range of tumor types,” says Brian Laffey, M.S., senior medical physicist at the Institute.

In addition to external beam radiation therapy, Lynn Cancer Institute also offers comprehensive brachytherapy services. Jeremy Cole, M.S., senior medical physicist at Lynn Cancer Institute, says “Our brachytherapy program is highly active and demands specialized training, with our brachytherapy physicists playing a crucial role. Their expertise and collaboration with our world-class physicians ensure precise, targeted radiation delivery.”

Lynn Cancer Institute is undergoing a major 16,000-square-foot expansion that will include a new, state-of-t he-art proton therapy machine. On track for completion in 2026, it will offer residents of Palm Beach County a highly effective technology capable of treating a variety of cancers – without having to cross the county line for treatment.

Dr. Rana says, “The addition of pencil beam scanning proton therapy at Lynn Cancer Institute is part of our commitment to providing the most advanced and effective radiotherapy treatments available. We will be equipped with the next generation proton therapy technology. Preparations are underway to recruit a team of highly trained medical physicists and dosimetrists who specialize in proton therapy.”

New opportunities in radiation therapy for medical physicists

As promising as today’s cancer treatments are, Dr. Tolakanahalli says the future of radiation therapy offers abundant opportunities for anyone considering a career in medical physics.

“The use of artificial intelligence, or A.I. – in terms of automation, efficiency improvements and outcome analysis – will allow us to fine-tune our patient treatments, while real time adaptive therapy will give us the ability to actually view and adapt our radiation treatments in real time,” she says. “Used properly, I think A.I. has such potential to ensure that we’re able to provide fast and highly accurate treatments.”

On the pharmaceutical side, Dr. Tolakanahalli notes that there has been a surge in radiopharmaceutical treatments in recent years. “These are drugs administered orally or intravenously that contain molecules so specific to your cancer cells that they attach to them, allowing the radioisotope to be delivered directly to those cells,” she says.

Dr. Tolakanahalli also foresees in the near future a dramatic decrease in treatment time for patients undergoing radiation therapy as part of their cancer treatment. “I think that within the next decade, a patient will be able to walk in, have their imaging done and proceed to treatment in a couple of hours rather than having to go back home and wait for seven to 10 days,” she says.

And for aspiring medical physicists, Dr. Tolakanahalli says there is no better place to be working than at Baptist Health Cancer Care. “Every single person here – from the radiation therapists, the physicians, the physicists and the dosimetrists – is highly passionate about their work. They all want to bring their very best to the table and to push the envelope further in terms of what is possible,” she says. “At the same time, they never compromise a patient’s quality of treatment.”