A National Survey of Medical Physicists: Part 1-Practice Patterns for High-Dose-Rate Brachytherapy.

Abstract

High-dose-rate (HDR) brachytherapy (BT) is an effective but resource-intensive treatment modality, demanding a highly skilled workforce, team coordination, and logistics. This study presents findings from a comprehensive national survey conducted in 2023, targeting all registered IROC-Houston (Imaging and Radiation Oncology Core) sites in the United States. The primary objective was to analyze national BT practice patterns and workload dynamics among medical physicists involved in HDR BT treatments. A secondary aim, explored in a companion publication (part 2), examines work effort, job satisfaction, and challenges faced by medical physicists in this field. The survey received 365 complete responses, revealing an experienced workforce, with 71% reporting over 10 years of BT service and 75% performing complex gynecologic treatments involving more than 3 channels. Two-thirds of respondents were employed at nonacademic institutions, and 53% indicated that the medical physics full-time equivalent was <1 at their clinic. The most frequently performed procedure was gynecologic BT (96%), followed by skin (34%), prostate (33%), and breast (23%). Adoption of advanced planning tools was variable, with 66% using inverse planning and 34% employing automatic catheter reconstruction. Additionally, 32% of all respondents performed magnetic resonance imaging (MRI) based planning, with 14% reporting frequent use. Of the subgroup performing complex gynecologic treatments, 38% reported the utilization of MRIs. Uptake of MRI-based planning appears to have increased only slightly over the past decade. The survey demonstrated that medical physicists are involved in and responsible for nearly every technical aspect of the HDR BT process. This study presents one of the largest national surveys on medical physics practice patterns to date. The findings highlight ongoing challenges in allocating resources, varying procedure complexity, and logistical demands. Future initiatives should focus on developing improved resource allocation metrics to optimize staffing based on procedure complexity and caseload.