Globalism versus Nationalism in Medical Physics

Nowadays we medical physicists are bombarded with guidelines and task reports, and we may see similar ones from different organizations in the United States of America or worldwide. Many extraordinary and diligent medical physicists have devoted their time and knowledge in creating these documents. Yet some of us might be wondering: should we optimize the use of our resources by establishing a global medical physics society? One global medical physics organization may eliminate redundancies and improve cost-effectiveness. However, it may also bring in inefficiency, lack of diversity, or poor environmental adaptation. Our debate topic in this issue is: A global medical physics organization in science, education, professional, and administrative structures will result in greater advancement of the medical physics profession. Arguing for the proposition is Scott Dube. Mr. Scott Dube is a solo medical physicist at Morton Plant Hospital in Clearwater, FL. He is also on the faculty of Radiological Technologies University and enjoys teaching aspiring medical physics and medical dosimetry students. Arguing against the proposition is Jeroen van de Kamer. Mr. Jeroen van de Kamer is a medical physicist working at the Netherlands Cancer Institute at the department of radiation oncology. Together with his colleagues, he is involved with linac and patient-specific QA, the clinical use of PET/CT, and the continuous development of the treatment for head and neck cancer. Jeroen is chair of the Netherlands Commission on Radiation Dosimetry, a Dutch–Belgium consortium of scientist aiming to promote the appropriate use of dosimetry of ionizing radiation. He was course director of the 2016 pre-meeting ESTRO course “Multidimensional dosimetry systems.” Jeroen is a member of the advisory board of the Dutch Metrology Institute VSL. 2 | OPENING STATEMENT


2.A | Mr. Scott Dube
One of the leading controversies today is globalism versus nationalism. Globalism is based on all nations working together for the betterment of the planet. Nationalism is based on a single nation acting independently to pursue its best interest. The two ideologies have clashed on issues such as trade, immigration, human rights, climate change, and so on. In some ways, the practice of radiotherapy has been globalized by vendors such as Accuray, BrainLab, Elekta, Philips, RaySearch, Varian, and others who have created products which are standardized regardless where they are used.
There are also organizations striving to globalize the practice of  In short, setting up local protocols is quicker, is better suited to specific needs, and provides the best education for those involved.
Dissemination of this knowledge is most efficient when done locally.
Let us beware of the one ring to rule them all.

3.A | Mr. Scott Dube
My admirable adversary said, "On top of that, one tends to understand the advantages and shortcomings of new wheels better if one is actively involved in the invention." One definition of the word "protocol" is "a procedure for carrying out a scientific experiment or a course of medical treatment." In other words, a protocol is prescriptive. It does not matter how well the nuances of the procedure are understood. Calibrating a linear accelerator involves making measurements and applying factors which are not meant to be deviated.
It's a simple as that.
He also said, "The scientific struggle for life gives rise to a Darwinian competition, resulting in the survival of the fittest dosimetry protocols." That sounds compelling but we know it is not true. The fittest as well as the weakest dosimetry protocol will survive regardless of the competition. That is because nationalism has allowed individual countries to choose their protocol without restriction.
And he also said, "If only one lab would define the Gy, such errors may go undetected and propagate all over the world and more." That may be true. But which paradigm creates the greatest opportunity for error: Six committees developing six different protocols or one committee developing the protocol and the other five committees evaluating the same protocol? And which would be the most efficient use everyone's time? We must keep in mind that much of the work required to develop new protocols is done by volunteers. They must balance their time with the demands of their employer such as clinical duties, quality assurance, program development, teaching, research, and other activities which the employer expects of the physicist. The incentive for performing such work is not just job security but also service to the patients.
It is often said that organizations such as American Association | 7 better in line with local habits, requirements, and circumstances so why not jot it down for the benefit of others? The One Protocol will inescapably result in multiple local protocols, just by trying to implement it. Although my opponent refers to this as "unproductive," it is just our job.
What is more problematic is that not all regions develop at the same speed. So what is needed and possible for one is impractical or not adequate for another. For example, dosimetry for flattening filter free systems, as those described in my opening statement, cannot be performed as demanded by the One Protocol since there is no flattened region over a 10 9 10 cm 2 surface. Should we, therefore, stop using such clinical devices?
And while it is commendable that RadiatingHope and MPWB offer to help implementing the latest One Protocol, what happens after they have left? If the state-of-the-art One Protocol is not in the genes of the local physicists, the problems will be larger than adhering to older, local dosimetry protocols that are tailored to the local level of expertise. I am convinced that the bottom-up approach is better: let the local physicists decide when it is time to revise dosimetry protocols or setup IMRT/VMAT QA protocols; let them choose which way to implement it, either by copying a published protocol that is closest to their needs or by devising their own.
Helping each other to obtain the best possible results is highly commendable but please do not tell others what to do. There is no need to put the One Protocol into Mordors Mount Doom but the exclusive nature of it should.

ACKNOWLEDG MENT
Although I take full responsibility for the extreme points of view and the fallacies in this article, I thank Ben Mijnheer, Jacco de Pooter, Leon de Prez, and Frits Wittk€ amper for the fruitful discussions we had while undertaking this fun task.