POINTÕCOUNTERPOINT

Suggestions for topics suitable for these Point/Counterpoint debates should be addressed to the Moderator: William R.
Hendee, Medical College of Wisconsin, Milwaukee: whendee@mcw.edu. Persons participating in Point/Counterpoint
discussions are selected for their knowledge and communicative skill. Their positions for or against a proposition may
or may not reflect their personal opinions or the positions of their employers.

The growth of biomedical engineering is a major challenge

to medical physics
Randell L. Kruger
Radiology, Marshfield Clinic, Marshfield, Wisconsin 54449
(Tel: 715-387-9056, E-mail: kruger.randell@marshfieldclinic.org)
Bruce H. Curran
Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan 48109
(Tel: 734-936-4309, E-mail: bcurran@umich.edu)
William R. Hendee, Moderator
共Received 29 March 2004; accepted for publication 29 March 2004; published 13 August 2004兲
关DOI: 10.1118/1.1781175兴

OVERVIEW Arguing against the proposi-

tion is Bruce Curran, ME, MS.
Educational programs in biomedical engineering are rapidly Mr. Curran received his Mas-
establishing and growing, in large measure because of fund- ters Degrees from Dartmouth
ing from the Whitaker Foundation and National Science College 共Engineering Science-
Foundation. In these programs, the most popular instruc- Biomedical Engineering兲 and
tional track is imaging. Some diagnostic physicists feel that Northeastern University 共Com-
this pipeline of imaging-trained biomedical engineers is a puter Science兲. He is Clinical
major challenge to physicists in imaging. Others think that Assistant Professor of Radia-
this influx of engineers is an opportunity that should be capi- tion Oncology at the Univer-
talized on. This difference in perspective is the subject of this sity of Michigan and respon-
month’s Point/Counterpoint. sible for clinical physics
within the Department of Ra-
diation Oncology. He currently serves as chair of the Meet-
ing Coordination Committee of the AAPM and co-chair of a
task group on clinical implementation of Monte Carlo dose
Arguing for the Proposition is calculations. He is a fellow of the AAPM and the ACMP.
Randell Kruger, Ph.D. Dr.
Kruger is the Medical Physics FOR THE PROPOSITION: Randell L. Kruger, Ph.D.
Section Head in the Radiology
Opening Statement
Department of the Marshfield
Clinic. Dr. Kruger received his Can an engineer become a medical physicist? I am a per-
Ph.D. from the Medical Col- sonal testimonial that engineers can and do migrate into
lege of Ohio and completed a medical physics, after receiving the proper educational and
post-doctoral medical physics clinical training. During the 2003 AAPM Annual Business
residency at the Mayo Clinic. Meeting in San Diego the topic of changing the academic
Prior to his doctoral program requirements for AAPM membership was discussed. The
he earned a master’s degree in proposed amendment adds two words to ARTICLE IV, Sec-
mechanical engineering from tion 4 of the Bylaws—they are 共‘‘or Engineering’’ added to
Arizona State University. He has seven years of engineering the existing text of Physical Science兲. This change would add
work experience with the U.S. Air Force and Allied-Signal, engineering degrees to the criteria for AAPM Membership
Inc. He is certified in Diagnostic Physics by the ABR and is eligibility. The motivation for the change is the need to cre-
president of the North Central Chapter of the AAPM. ate consistency between current practice and the bylaws.

2375 Med. Phys. 31 „9…, September 2004 0094-2405Õ2004Õ31„9…Õ2375Õ3Õ$22.00 © 2004 Am. Assoc. Phys. Med. 2375
2376 Kruger and Curran: PointÕCounterpoint 2376

However, some diagnostic medical physicists are concerned engineers and medical physicists. The logic he employs to
that imaging-trained biomedical engineers would challenge support the equivalence of biomedical engineering and medi-
the role of, and seek to replace, the diagnostic medical physi- cal physics is flawed.
cist. Medical physics is a focused field of study that requires
The clinical and research applications of medical imaging clinical training or preceptorship. Biomedical engineering is
in bioengineering have contributed to the explosive growth a broad interdisciplinary field of study with little or no clini-
of biomedical engineering jobs.1–3 Of the more than 100 cal training. A description of biomedical engineering pro-
college and university programs that offer academic pro- vided from a large state university biomedical engineering
grams in biomedical engineering, more than half offer imag- department9 states ‘‘the Biomedical Engineering Graduate
ing educational or directed-research programs.1 Significant Program is an interdisciplinary program designed to provide
job growth and interest in biomedical imaging has been ac- broad familiarity with the interactions among the engineer-
celerated with the lure that ‘‘all teaching hospitals, have a ing, biological and medical sciences and in-depth training in
growing need for bioengineers trained in imaging one of the traditional engineering disciplines.’’ Medicine in
methods.’’ 2 The U.S. Labor Department’s Bureau of Labor general is an application of science to the treatment of hu-
Statistics projects that the number of biomedical engineering man disease and health, and its practitioners are educated and
jobs will increase by 31.4 percent through 2010.1 Are all of trained specifically for expertise in their field. It appears my
these imaging-trained biomedical engineers planning to work colleague proposes an exception to this rule for biomedical
for industry or in research? The National Institutes of Health engineers. Medical physics is significantly influenced by the
Bioengineering Consortium provides a definition of bioengi- technological advances, as is all of medicine. An individual
neering, which does not include the word ‘‘imaging’’ any- with broad familiarity would lack the specific training and
where in its 59-word statement.4 Yet the rapid development experience necessary to provide the required clinical ser-
of a biomedical imaging curriculum and career field in bio- vices.
medical engineering indicates a shift in focus of the biomedi- I think it is important to consider the fundamental factors
cal community. driving this issue. The Whitaker Foundation’s funding has
The roles of the medical physicist in diagnostic imaging significantly accelerated and expanded educational programs
have been well documented and comprehensively defined by in biomedical engineering. The expansion of biomedical en-
the AAPM, the American College of Radiology 共ACR兲, and gineering into medical imaging, interestingly, comes at a
the European Federation of Organisations for Medical time when the medical physics profession is experiencing a
Physics.5–7 These organizations have described and defined shortage of practitioners and a limited number of training
the diagnostic medical physics professional role, and the programs. Donald Frey’s statement10 ‘‘one of the more seri-
practice, training, and qualification requirements in the field. ous problems facing the profession of medical physics is the
A primary responsibility of the diagnostic medical physicist shortage of practitioners’’ highlights this problem. The laws
is the development and supervision of a quantitative quality of supply and demand cannot be ignored.
control program. However, the diagnostic medical physicist Can an engineer become a medical physicist? The answer
has several other responsibilities and duties 共such as: radia- is yes, provided he or she obtains the proper academic prepa-
tion safety; compliance activities; radiobiological, shielding ration and clinical experience.
and equipment evaluations; educational activities; and re-
search, to name just a few兲. An imaging-trained biomedical AGAINST THE PROPOSITION: Bruce Curran,
engineer is not prepared or trained to perform these duties ME, MS
and responsibilities. Most members of the biomedical engi-
neering and medical physics communities understand the dif- Opening Statement
ferences between a diagnostic medical physicist and a bio- According to the AAPM, medical physics is ‘‘an applied
medical engineer. The concern is that other members of the branch of physics concerned with the application of the con-
medical community might assume 共or be misled to under- cepts and methods of physics to the diagnosis and treatment
stand兲 that an imaging-trained biomedical engineer can per- of human disease.’’ 11 This definition focuses on the applica-
form the duties and responsibilities of a diagnostic medical tion of training and experience to the diagnosis and treatment
physicist. This would jeopardize the quality of diagnostic of patients. There are few 共if any兲 medical physicists en-
imaging services provided to the medical facility and its pa- gaged in pure research without thought to its future imple-
tients. mentation, which distinguishes us from many of our col-
leagues engaged in more theoretical branches of physics
共defined, at least from one source, as ‘‘the science of matter
and energy and of interactions between the two,...’’兲.12 An
interesting observation on these definitions is that, for many
Rebuttal
universities, education in the field of ‘‘Applied Physics’’ of-
I agree with my colleague that medical physics is an ap- ten appears under the domain of the College of
plied branch of physics that deals with the application of Engineering.13
physical principles to the diagnosis and treatment of human Appropriate to this discussion is a look at the profession
disease.8 However, I disagree with his statements that link of engineer. One dictionary defines an engineer as ‘‘one who

Medical Physics, Vol. 31, No. 9, September 2004

2377 Kruger and Curran: PointÕCounterpoint 2377

is trained or professionally engaged in a branch of 关engineer- Does an education in biomedical engineering prepare in-
ing兴 the application of scientific and mathematical principles dividuals less well for entering our field? It certainly pre-
to practical ends such as the design, manufacture, and opera- pares them differently. A biomedical engineer specializing in
tion of efficient and economical structures, machines, pro- biomechanics would be no more suitable for clinical practice
cesses, and systems.’’ 12 Since physics is clearly a member of than the theoretical nuclear physicist. A review of the course
the sciences, it appears that engineers are individuals who offerings in a biomedical engineering program reveals
can also be considered to be involved in the application of courses in anatomy, instrumentation, physiology, radiological
physics to the solution of a certain class of problems such as health, imaging 共radiation, MR, optical兲, and medical imag-
the diagnosis and treatment of human disease. It would thus ing systems,15 all appropriate to our profession.
seem that, with a slight twist on the origins of the phrase, So how do we ‘‘separate’’ those engineers 共and physicists兲
‘‘We have met the enemy and he is us.’’ 14 not appropriately qualified to practice medical physics from
For the majority of medical physicists today, technologi- those who are? Ideally, the certification/licensure process
cal advancements in imaging and therapy have led to a new would ensure that only qualified individuals attain the title of
role for the medical physicist, namely that of manager of the medical physicist. The reality is, however, that many indi-
complex equipment necessary to our profession. We are no viduals are given the title long before they acquire the skills
longer expected only to understand how different radiations necessary for practice. This is mostly a result of history; the
interact with materials and patients. Today, physicists must small number of educational programs in medical physics,
also be knowledgeable about computer systems, networks, the lack of appropriate residence and training programs that
and the myriad of new technologies essential to current clini- give us the time to acquire needed skills before certification,
cal practice. The influx and influence of individuals with and the rapid increase in the need for properly trained pro-
advanced training that includes an in-depth understanding of fessionals in our profession.
the technology itself is helpful, perhaps even necessary, to Medical physics as a career will continue to attract a poly-
effectively carrying out our duties, as well as advancing glot of engineering and scientific professionals. It offers the
state-of-the-art patient care. A collaborative environment that alluring combination of interesting, challenging problems,
includes professionals with skills both in physics and engi- the satisfaction of helping humanity, and good salaries and
neering appears to be the best of all worlds. benefits. The incorporation of such diverse backgrounds has
Patients benefit from having a team of individuals with a helped to keep the field fresh and innovative. We should
broad range of skills available for designing, building, test- continue to encourage entry into medical physics of persons
ing, and monitoring the techniques and equipment needed in with diverse backgrounds, while striving to improve the pro-
the practice of medical physics. These skills require signifi- cesses by which we identify those individuals who have
cant education, training and experience, and it is unlikely earned the title of medical physicist.
that any single individual will master all aspects. The inclu- 1
www.whitaker.org
sion of biomedical engineers, with their strengths in equip- 2
http://summit.whitaker.org/white/imaging.html
3
ment and biological/equipment interfaces, in the profession http://summit.whitaker.org/white/basic.html
4
of medical physics will strengthen our profession and allow www.becon.nih.gov/bioengineering – definition.htm
5
www.AAPM.org
it to grow. This in turn will improve our stature and acknowl- 6
www.ACR.org
edgement as key individuals in the diagnosis and treatment 7
The European Federation of Organisations for Medical Physics 共EFOMP兲
of patients. Policy Statement Number 5, ‘‘Departments of Medical Physics—
advantages, organization and management,’’ Physica Medica XI共3兲, 126 –
128 共1995兲.
8
Rebuttal ACR Guide to Medical Physics Professional Practice, http://www.acr.org
9
www.whitaker.org/academic/database/index.html 共search under: Univer-
One might as well ask ‘‘Can a theoretical nuclear physi- sity of Minnesota兲
10
cist become a medical physicist?’’ The answer of course, is January/February 2004 AAPM Newsletter
11
yes, as many of our colleagues can attest. Did their initial www.aapm.org/org/aapm – fact – sheet.html
12
The American Heritage® Dictionary of the English Language: Fourth
education completely prepare them for our field? Probably Edition, 2000.
not. As Dr. Kruger notes, proper education and clinical train- 13
www.engin.umich.edu/departments/
14
ing is necessary for most individuals entering our field, what- Walt Kelly, Earth Day Poster, 1970.
15
http://www.engin.umich.edu/students/current/academics/courses/biomed.pdf
ever their educational background.

Medical Physics, Vol. 31, No. 9, September 2004