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Mrs. Gump:

Well, I happened to believe you make your own destiny …. Life is a box of chocolates, Forrest. You

never know what you're gonna get.

Fostering a Successful

Career in Research

Radhe Mohan, PhD, Professor

Department of Radiation Physics

MD Anderson Cancer Center, Houston TX

AAPM Annual Meeting, Washington DC

July 31-Autust 4, 2016

Lessons from a Career in

(or Involving) Research

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Career Involving Research in Medical Physics

Research & Development + Clinical

For research to be relevant, clinical knowledge is essential

For enhancing clinical effectiveness, it is important to understand what is possible through research

Beats insecurity of being a pure researcher

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Importance of Research & Development in Medical Physics

Contributions to the knowledge base

Contributions to the improvement in safety, quality and clinical effectiveness of treatments and diagnostic procedures

Enhancement of the stature of physicists and the recognition of the intellectual and creative contributions we can make

Avoidance of

Being considered expensive technicians

The risk of being automated

…

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Challenges Facing Career in Research in the Current Environment

Focus on

Short-term vs. long-term

“Billables”, margins and bottom line vs. creative contributions and advancement of the state of the art

Reduced research funding

Job insecurity

Disparity in clinical versus research compensation

…

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Is it then appropriate to recommend a purely research career in medical physics?

A career that combines clinical and research may be a safer and more effective

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Environments Needs to Change for the Future Wellness of our Field

And the younger generation

can be the agent of such change

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Lessons Learned

Personal Perspectives

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My First Task as Medical Physicist (Early 70’s @MSKCC) Treatment Planning System (2D)

The high you get when you see the results of what you created

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The Thrill of Discovery

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The Very First Computerized Dose Distribution Measurement System (Early 70’s @MSKCC)

Mohan Caley

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Use your impatience / frustration with routine and repetitive tasks and inefficient practices

as drivers of innovation and solutions

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“3D Conformal Therapy is Impractical” – RM in 1978

“No radiation oncologist is going to draw tumor and normal tissue contours on so

many CT sections”

Mcshan, BJR 78 Goitein, IJROBP 83

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Fortunately …

John Laughlin (Chair @MSKCC) prevailed …

NCI Contract (1983-1987) to Develop and Evaluate 3DCRT

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3DCRT & MLC

(1980’s)

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Be Open to New Ideas and Different Points of View

Embrace Change

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IMRT & DMLC (Circa 1995 @MSKCC) – A Collaboration with Bortfeld

The "Photon Bragg Peak” Intensity Distribution

Sliding Window Delivery With Dynamic MLC

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Comments at my presentation in 1996

“IMRT is too complicated and not Practical”

“Why do we Need it? We have been doing intensity modulation with wedges and compensators for ever”

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Ridding the 50 Year Fetish with Flat Fields

In this day and age of intensity modulation,

who needs flattening filter?

Vassiliev, et al (MDACC)

• High dose rates • Cleaner beams • Reduced shielding

• Reduced secondary cancers • ….

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“If people aren’t laughing at your dreams…then they aren’t big enough!”

Grayson Marshall

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Proton Therapy – Hype of Hope (MDACC)

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Physical and Biological Uncertainties in Proton Therapy

“There is no problem”

“We will scare patients and providers”

Acknowledging the problem is the first step in solving it

Program project grants and awards (2009-2014, 2014-2019) to improve our understanding and enhance the effectiveness of proton therapy

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Protons vs. Photons Randomized Lung Trial (Part of the P01 Program Project)

“Unnecessary – We already know protons are better.

“Unethical to randomize patients to an arm known to be inferior”

“Patients will no accept to be randomized”

0.0

00

.25

0.5

00

.75

1.0

0

Pro

po

rtio

n

57 56(0) 48(5) 44(1) 41(0)Proton92 86(1) 78(3) 74(2) 72(0)IMRT

Number at risk

0 3 6 9 12Months

Grade >3 TRP

0.0

00

.25

0.5

00

.75

1.0

0

Pro

po

rtio

n

57 40(6) 21(8) 12(1) 9(0) 3(0) 1(1)Proton92 66(10) 38(11) 21(1) 14(0) 6(1) 0(1)IMRT

Number at risk

0 12 24 36 48 60 72Months

Local Failure

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Question everything, be curious

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And More Advice …

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Failing Forward (Whitelaw)

"Failure is merely an opportunity to intelligently begin again."- Henry Ford

Persistence Pays Off

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Focus and finish

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Collaborativeness is an Essential Ingredient of R&D

Be the First to Trust

Don’t Jump to Conclusions

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Dream Big

And

Out of the Box

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0.6 0.8 1.0 1.2 1.4 1.6

0.00

0.02

0.04

0.06

0.08

0.10

0.12

D / A

.U.

deff

/ rel. u.

3He

4He

Protons

12

C

Beamlet Integral Depth Dose

2 3 4

0

20

40

60

80

100 protons

3He

4He

12

C

D / %

r / cm

Profiles of 6 cm dia field

Heavy Ion Therapy … Physical, Biological and Immunogenic Properties

Loeffler and Durante, Nature Rev 2014

Immunogenicity

Carbon

Protons

Carbon

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Thank You

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Passion for Values

Caring and respect

Integrity and honesty

Excellence

Openness and free flow of communication

Teamwork and collaboration

Rewarding progress and demanding commitment and accountability

“Hatred for” bureaucracy and resisting desire to control

Recognizing change as an opportunity for growth

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Working closely with physicians to understand the clinical and biological response

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The Very First Record and Verify System (Late 70’s)

Microprocessor-controlled data

acquisition and communication system

Mohan, Caley, Ferber, Podmanniczky,

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IGRT, Deformable Registration, Auto-Segmentation Dose Accumulation, Adaptive RT – 2000’s

Dong

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"The biggest risk is not taking any risk. In a world that is changing really quickly, the

only strategy that is guaranteed to fail is not taking risks."

Mark Zuckerberg

Research, by definition, is risky

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“New ideas pass through three periods:

1) It can't be done; 2) It probably can be done, but it's not worth doing; 3) I knew it was a good idea all along”

Arthur C. Clarke

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“No idea is so outlandish that it should not be considered.”

Winston Churchill