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Background Tumor Treating Fields (TTFields) have demonstrated a survival benefit in patients with glioblastoma and are increasingly being investigated for concurrent use with radiotherapy. However, published data regarding the dosimetric impact of TTFields transducer arrays during photon irradiation remain limited, particularly with respect to surface dose enhancement and attenuation at treatment depth. A clear, quantitative understanding of these perturbations is necessary to optimize clinical implementation. Purpose This study aimed to directly quantify the physical dosimetric perturbations introduced by TTFields transducer arrays during megavoltage photon irradiation and to evaluate whether array repositioning mitigates surface dose enhancement and depth attenuation. Methods An experimental measurement was conducted using a solid‐water slab phantom and a 6‐MV Varian TrueBeam linear accelerator with both flattened and flattening‐filter‐free (FFF) beams. An Optune 3 × 3 ceramic transducer array was placed on the phantom surface. Dose at depths of 1.5, 5, and 10 cm was measured using a Farmer‐type ionization chamber. Surface dose was assessed using silicon diodes, MOSFET detectors, and Gafchromic EBT3 film (referred to as radiochromic film in this paper). Measurements were performed with and without the array to establish baseline comparisons. To evaluate mitigation strategies, the array was shifted by one transducer diameter in four cardinal directions, and measurements were repeated. Dose ratios were calculated relative to baseline conditions without the array. Statistical significance was assessed where appropriate. Results The presence of the TTFields array resulted in statistically significant attenuation at depth, with dose reductions of approximately 2%–4% up to 10 cm (p < 0.001). Surface dose increased substantially, with MOSFET and diode measurements demonstrating enhancement factors ranging from 1.81 to 1.87 relative to baseline. Radio film showed higher apparent enhancement, attributed to energy‐dependent over‐response in the high‐gradient surface region. Repositioning the array reduced peak surface dose by up to 40%. Film‐based dose profiles demonstrated a 24% reduction in localized hotspots following array shifts. Despite mitigation, residual surface dose remained elevated at approximately 1.6–2.3 times baseline values. Conclusions TTFields transducer arrays introduce clinically meaningful dosimetric perturbations, characterized by significant surface dose enhancement, and measurable attenuation at depth. While array repositioning reduces localized hotspots, it does not eliminate elevated scalp dose.These findings underscore the importance of treatment‐specific dosimetric evaluation and careful surface dose assessment when delivering radiotherapy concurrently with TTFields.

Purpose Stereotactic radiosurgery (SRS) for brain metastases using volumetric modulated arc therapy (VMAT) is increasingly utilized. While high‐dose conformity guidelines relative to tumor volume exist, recommendations for intermediate and low‐dose regions remain undefined. This study explores tumor‐specific characteristics and new dosimetric parameters to develop regression models for standardizing intracranial SRS planning. Materials and Method We introduce two dosimetric quantities: R6Gy, the 6 Gy cloud volume ratio to the PTV, and %D1cm, the maximum dose at 1 cm from the PTV relative to the prescribed dose. These, alongside R50% and the volume of normal brain receiving 12 Gy (V12Gy), were analyzed retrospectively in 290 VMAT SRS plans from 151 patients treated between January 2021 and September 2023. The data were stratified into single‐ and three‐ fraction arms. Statistical tests, including Spearman's rank correlation, and Normalized Mutual Information (NMI) evaluated relationships between dosimetric parameters, number of metastases (n), and total PTV volume, PTVTotal. Significant correlations were modeled using regression analysis. Results Strong correlations were found between PTVTotal and all dosimetric metrics in the single‐fraction arm; weaker but significant correlations were noted in the three‐fraction arm. Power‐law regression best described R50% and R6Gy, while linear regressions best described %D1cm and V12Gy. Moderate monotonic correlations were observed between n and the dosimetric metrics. Conclusion This study proposes regression‐based models for predicting dose spill based on tumor burden, total PTV volume and number of targets. These models provide a framework for model‐based SRS planning, offering clinical physicists patient‐specific guidance to improve consistency, optimize plan quality, and support future standardization efforts.

The COVID‐19 pandemic has disrupted traditional onsite support for radiotherapy clinics in low‐ and middle‐income countries (LMIC). Clinics there have struggled to commission new techniques and receive onsite training for their staff. We sought to evaluate whether an offsite approach could fill this gap at a clinic in Jordan by requesting a clinical audit and attempting to commission volumetric modulated arc therapy (VMAT). Over 13 months, a consultant provided remote support for a radiotherapy center that had already obtained treatment equipment and licenses. The consultant began by conducting a virtual audit, using a remote login to the center's R&V and TPS, to identify any gaps in the clinical workflow. Suggestions for improving the clinical workflow were proposed, and change implementation was tracked through emails, social media apps, and video conferencing. An extensive table outlined the commissioning process, including all measurements to be done. Social media apps and shared documents were used to track measurements and analysis. The lack of person‐to‐person interaction in this new remote‐support ecosystem created conflicts; we have highlighted some of these, as well as their resolution and the lessons learned from them. The virtual audit identified gaps categorized as machine QA, treatment plan review, and treatment delivery processes. Following the implementation of the proposals, motion management was added, and machine QA became more comprehensive. VMAT was commissioned using the reports of the AAPM and the IAEA. The main challenges for remote support were time difference, establishing an appropriate form and frequency of communication, tone of voice used in messages, and buy‐in from local staff. This evolving practice will enable medical physicists to use modern, multimodal remote communication pathways to effectively transfer knowledge to centers in LMICs. The audit–proposal–improvement pathway for remote support can be incorporated to help others while avoiding the pitfalls we faced.

Purpose Medical physicists are essential healthcare professionals who bridge the gap between technology and patient care, particularly in radiation oncology and medical imaging. With the profession expanding its clinical and global roles, the need for competencies beyond technical expertise—such as communication, leadership, and cultural awareness—is increasingly evident. These competencies, commonly referred to as soft skills, are critical for patient‐centered care but remain insufficiently integrated into formal education and training pathways. The aim of the present work was to identify soft skills relevant to medical physics practice and investigate where in a career they are acquired and used. Methods This paper presents the views of a group of medical physicists affiliated with leading organizations in medical physics education and professional development. The group conducted a comprehensive analysis of the role and relevance of soft skills in clinical practice, academic settings, and international training programs. Their discussions led to the identification, classification, and mapping of essential soft skills across different career stages and professional roles within the field. The findings aim to inform curriculum development, professional standards, and capacity‐building initiatives in medical physics worldwide. Results A framework of core soft skills was developed and categorized into seven domains: professionalism, leadership, cultural/political awareness, communication, adaptability, emotional intelligence, and ethical reasoning. These skills were mapped to various career stages of medical physicists, from university coursework to clinical practice and international expert missions. The analysis demonstrated that soft skills are dynamic, teachable, and essential across academic, clinical, and global contexts. The study also reviewed current gaps and opportunities in integrating soft skills into medical physics curricula, clinical residency programs, and continuing professional development. Conclusion To meet the evolving demands of healthcare, soft skills may need to be embedded in the education, training, and professional development of medical physicists. These skills enhance interdisciplinary collaboration, patient engagement, and leadership capacity, positioning medical physicists as integral members of the healthcare team. Academic institutions, professional societies, and global organizations are encouraged to work together to define, teach, and assess these competencies in ways that are practical and culturally adaptable.

Background and purpose The AAPM TG‐43 formalism has long served as the clinical standard for brachytherapy dose calculation but assumes a homogeneous water equivalent medium, overlooking limited scattering conditions and tissue heterogeneities. Model‐based dose‐calculation algorithms (MBDCAs), including Monte Carlo (MC) simulations overcome these limitations by accounting for real tissue composition, scatter, and applicator attenuation. This systematic review evaluates TG‐43, MBDCAs/MC methods in terms of dosimetric accuracy, validation strategies, computational feasibility, clinical implementation barriers, and emerging innovations. Methods A PRISMA‐guided literature search was conducted using the Scopus database, identifying 284 records, of which 42 full‐text studies met inclusion criteria. Eligible studies compared at least two of the three dose‐calculation approaches (TG‐43, MBDCAs and MCs) in pelvic, breast, or head‐and‐neck brachytherapy. Extracted data encompassed dosimetric discrepancies, validation approaches, computational performance, workflow integration, and enabling technologies. Results Across anatomical sites, TG‑43 showed no consistent bias. Its differences from heterogeneity‑aware models depended on tissue composition, scatter conditions, and source geometry. In soft‑tissue regions with minimal heterogeneity, TG‑43 generally overestimated target coverage by about 0.5%–5%. Near low‑density interfaces or in reduced‑scatter configurations, TG‑43 could instead yield lower doses than Monte Carlo or MBDCAs. For OARs, discrepancies were site‑specific: skin dose was often overestimated, while other organs showed smaller or opposite variations. Overall, MBDCAs and Monte Carlo agreed with experimental or benchmark data within roughly 3% and produced more reliable biological metrics. GPU‑accelerated and deep‑learning engines reduced computation times from hours to seconds, shifting remaining challenges toward standardization, commissioning, and QA. Successful clinical adoption relied on TG‑186–aligned validation, staff training, and integrated automated workflows. Conclusion Evidence from the systematic review supports a clinical transition toward TG‐186–compliant, heterogeneity‐aware dose‐calculation frameworks. MBDCAs/MC algorithms provide superior dosimetric and radiobiological accuracy and are increasingly compatible with adaptive and biologically guided planning. Broad implementation is now supported by established QA standards and benchmarking datasets, which connects dosimetric precision with patient outcomes. The transition beyond TG‐43 marks a pivotal step toward precision, safety, and personalization in modern brachytherapy.

One of the main challenges of delivering high quality of care to cancer patients in developing countries is the lack of well-trained radiation oncologists. This is a direct cause for the lack of residency programs coupled with lack of resources. This article describes and details establishments of a successful and sustainable radiation-oncology residency program in our country. The program has been in operation for 14 years and has trained and graduated radiation oncologists who are now working in various countries. The curriculum of the 4-year residency program, fashioned according to American College of Radiologists (ACR) recommendations, includes site-specific clinical rotations and didactic lectures in clinical oncology, radiobiology, medical physics, statistics, and epidemiology. It also includes a component of advanced clinical experience in the form of 3-month externship at one of collaborating centers outside the country. Evaluation of the residents is conducted annually via written exams and 360° feedback. Residents also sit for the formal certification exam in radiation oncology from the national Medical Council. The exam consists of 2 written exams and one oral. As a form of benchmarking residents’ knowledge, they are required to sit for the ACR examinations held annually and conducted in Amman in tandem. The program has successfully trained and graduated 28 residents, who now work as consultant radiation oncologists locally and abroad. Each resident has gone through a structured training that includes exposure to a Western-style patient-management culture, enhancing the breadth and width of their clinical experience. The residency program, initiated in a developing country, underwent many challenges, yet it overcome all obstacles and resulted in a successful training of competent radiation oncologists serving the region.

This research investigates the use of a low-strength (≤1.0 T) longitudinal magnetic field with external photon beams in improving the dose coverage of the regions around air cavities. This is a problem relevant for tumors of the head and neck, where the presence of sinus cavities leads to loss of dose at the air/tissue boundaries. The loss of dose is attributed to loss of lateral electronic equilibrium in the air gap, which depends on the size of the cavity and the size and energy of the irradiating beam. The loss of dose was found to range from minimal to more than 60%, depending on the beam-cavity combination. The magnetic field prevents the lateral spread of the electronic fluence, and hence maintains electronic equilibrium in air and thus improves the dose at the interface. Improvement in dose was found to range from minimal to about 2.3 times its original value, depending on the strength of the magnetic field and the beam-cavity combination. The effect of air-gap perturbation on depth dose, beam profile, isodose line distributions, and two dose points, one beyond the interface and the other one at a side-wall, is investigated under different irradiating beams and different air gaps. The dose improvement with the magnetic field on all of the above parameters under the different beam-cavity combinations is studied.