Empowering Women in Medical Physics

Ashley Rubinstein

Ashley Rubinstein, PhD, a medical physics resident at the UTHealth McGovern Medical School, contributed this article.

As we celebrate the achievements of women across the globe this Women’s History Month, I want to take a few moments to honor women who have made extraordinary contributions to the advancement of medicine — and, in particular, medical physics.

A medical physicist myself, I’m inspired by pioneers like Marie Curie, the first woman to win a Nobel Prize, let alone win the Nobel Prize twice, and a physicist who made groundbreaking discoveries, developing the field of nuclear physics and implementing the use of radiation in medical imaging and therapy.

Edith Quimby changed the trajectory of thyroid disease treatment, brain tumor diagnosis and nuclear medicine. She won numerous awards, including the Janeway Medal from the American Radium Society, honorary degrees from Whitman College and Rutgers University. She served on the Atomic Energy Commission and was a founding member of the American Association of Physicists in Medicine (AAPM).

Rosalyn Yalow, another pioneer in medical physics, won a Nobel Prize for developing the radioimmunoassay. She won several awards throughout her career and was elected as a member of the National Academy of Sciences. Along with Quimby, Yalow was a charter member of the AAPM and her contributions greatly impacted our field.

Throughout my career, I’ve been privileged to learn from female mentors, including my chair of radiology, program director and chief of physics. But I also realize how incredibly fortunate I am to have direct access to female leaders in my field.

The State of Gender Diversity in Medical Physics, a recent article published in Medical Physics, reported that as of 2019, only 23% of AAPM members are women. What’s more, women only accounted for 12% of members reporting clinical leadership roles. There is a clear gender disparity in the field, especially among those holding leadership positions. This isn’t to say that things aren’t improving – the latest report from the Society of Directors of Academic Medical Physics Programs found that 42% of first-year medical physics PhD students were women. Contrast that with a report from the American Institute of Physics showing that only 20% of first-year physics PhD students were women.

This change is in large part due to the American College of Radiology® (ACR®), AAPM and other organizations making substantial positive strides towards increasing representation all-around and achieving gender equity. From increasing access to resources and support to developing diversity and inclusion-focused committees, these institutions are providing the tools we need to tackle gender equity.

I am lucky to have trained in a time and place where I was supported by mentors and guided by trailblazers like Curie, Quimby, and Yalow. When I applied for the ACR’s Richard L. Morin, PhD, Fellowship in Medical Physics, I did so with the privilege of not having to fight against all odds to get there. The fellowship gave me the opportunity to attend the ACR annual meeting and Capitol Hill Day, participating in various advocacy efforts and meeting with ACR staff members at their headquarters in Reston, Va. I learned the importance of demonstrating the value that the medical physics community holds. I found my voice advocating for my field, and I hope to empower other medical physicists to do the same.

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When the Radiologist Becomes the Patient: My Colorectal Cancer Screening

Chang, KevinKevin J. Chang, MD, FSAR, director of MRI at Boston University Medical Center and adjunct associate professor at Brown University Alpert Medical School, contributed this post.

Every March, during Colorectal Cancer Awareness Month, we revisit the importance of screening for colorectal cancer. As a disease that is estimated to be newly diagnosed in more than 147,000 patients and kill 53,200 people across the United States this year alone, and the third largest cancer killer among both men and women, it’s crucial to realize that colorectal cancer can be entirely avoided through timely screening.

Unlike screening tests for many other cancers, there is significant consensus and little controversy regarding the overarching lifesaving impact of colorectal screening. However, screening rates remain far short of the 80% goal that multiple societies, including the American College of Radiology® (ACR®), had set. For this reason, many groups including the United States Preventive Services Task Force (USPSTF), American Cancer Society (ACS) and the ACR have advocated for multiple screening options to be made available to maximize screening rates. It is also for this reason that CT colonography (CTC), also known as virtual colonoscopy, was added to the list of Grade A screening options when the USPSTF updated their guidelines in 2015. Among the multiple options available, CTC and optical colonoscopy are the only two exams that reliably detect precancerous polyps throughout the entire colon, resulting in true prevention of colorectal cancer.

Increased screening rates have helped to reduce the overall incidence of colon cancer over the past decade; however, a disturbing increase in the incidence of early onset colorectal cancer has recently been documented. In light of this alarming trend, the recommended age to begin screening in individuals without risk factors was lowered to 45 by the ACS in 2018, a move supported by the ACR.

This is where the story takes a very personal turn. As a 45-year-old with a family history of colon cancer, it was time to begin my own screening. As a longtime advocate, I naturally chose CTC as a noninvasive, yet equally accurate, alternative to colonoscopy for my screening. As the Patient Protection and Affordable Care Act mandates that all private insurers now cover screening CTC, I knew the cost of the exam was covered. As no sedation was involved, I could drive myself home and immediately resume daily activities afterwards. While the bowel prep is widely regarded as the most onerous step in either CTC or colonoscopy, I found the low-volume magnesium citrate and barium and iodinated oral contrast tagging agents relatively tolerable and not as bad as I expected. The CT scan the following morning was only transiently uncomfortable during CO2 insufflation. My discomfort eased quickly, and the whole exam was finished within 10 minutes. As a radiologist, I was able to check the adequacy of my own colonic inflation while on the CT bed, and that was when I first noticed something very wrong with my exam.

I reviewed my own study and found a large pedunculated polyp on a long stalk, measuring greater than four centimeters, arising from my terminal ileum and prolapsing through the ileocecal valve between supine and prone positions. I showed the images to a good friend and gastroenterologist who was surprised that I hadn’t already developed a bowel obstruction. I am forever grateful to him for squeezing me into his schedule two hours later and spending another nearly three hours endoscopically resecting the entire polyp in piecemeal fashion from my terminal ileum, a location that could theoretically be overlooked in the absence of a preceding CTC.

I was very fortunate to be plugged into a health system where a same-day colonoscopic biopsy was feasible (in much the same way that same-day CTC is made available for incomplete colonoscopies). I feel this should be the future of colorectal screening, especially if — and when — increasing numbers of patients begin screening and potentially overwhelm endoscopy capacity. There is no shortage of CT scanners in the US! Approximately 9 in 10 CTCs will not need a colonoscopy, reducing both cost and strain on limited resources.

There were a few other important takeaways from that fateful day:

In addition to being feasible to perform on the same day, CTC and colonoscopy serve highly complementary roles in colorectal screening. CTC is often better able to visualize the right colon, particularly in the setting of an incomplete colonoscopy, and colonoscopy remains essential for polypectomies.

Secondly, while private insurers cover screening CTC, Medicare and Medicaid’s refusal to cover screening CTC continues to unfairly leave millions without access to this alternative screening option — a lower cost option which has been shown to increase overall screening rates and save lives.

Thirdly, 45 is definitely not too young to start colorectal cancer screening, especially when 1 in 7 are now diagnosed under the age of 50.

And finally, pathology of my specimen revealed a benign hamartoma, one big bullet dodged! There is nothing like an existential health scare to gain valuable perspective on life and personal health. I urge you, your loved ones and your patients to be screened starting at age 45.

For more information, visit the ACR’s Colon Cancer Screening Resources, RadiologyInfo.org and the ACR’s new My CT Colonography Locator Tool to find or add a location near you.

  • Join the conversation all month long on social media using #VirtualCT, #CTColonography and #CRCAwareness, and by following @RadiologyACR on Twitter.

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Diversity in Radiology: An Inside Look

Watson, NinaAnika Nina Watson, MD, attending radiologist in Atlanta, GA, contributed this post.

After several years of playing the violin, I made the decision. Enthralled by the deep, rich notes and the tall, commanding presence along the periphery of the orchestra, I was going to play the string bass. Rather than continue as one musician in a large section of violinists, I would create the bass beat. Often as the only person in my section – and even more uniquely, a female bassist. The resolve to pursue interests that most fascinated and intrigued me would lead to other important decisions later in my life. At times, it would mean standing out again.

During my first year of medical school, my fascination with anatomy and the critical information obtained from images drew me to radiology. At points along my course to become a radiologist, it was challenging to remain as enthusiastic. I would look at residency class pictures, browse the websites of private practices and enter conference rooms containing thousands of radiologists, yet sometimes rarely see another face that looked like me. At these times I was most aware that I stood out and felt that I stood alone.

However, those uncomfortable feelings quickly dissipate when thinking back on numerous rewarding experiences with patients and colleagues. I think fondly of the elderly patient who called me at the end of an arduous day to let me know how much it meant to her to have a black, female radiologist perform her breast biopsy. It brings to mind the enjoyable opportunities that I had to give presentations in rooms filled with women of color and discuss the importance of screening mammograms, one black woman to another. I consider the calls and emails that I have received from medical students and residents whom I have never met in search of advice and support.

Minority patients face countless barriers in the pursuit of quality care. According to a Journal of the American Medical Association study, these barriers include less access to care, using fewer health care resources and less satisfaction with the care they receive. Data from the Commonwealth Fund’s Minority Health Survey indicates the importance of racial and cultural factors in the patient-physician relationship. According to the survey, patients who receive care from concordant physicians are more satisfied with the care they receive and more likely to pursue preventive and necessary medical care.

Now, in this period of reflection as we observe Black History Month, I realize that although at times I may stand out, I don’t stand alone. Just as an orchestra is composed of numerous musicians playing various instruments, each has an individual and unique role in the creation of something great. I treasure the unique opportunities that I have in patient care, education and mentorship.

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