Together with the Department of Medical Physics, the Advanced Radiation Treatment Planning course (MP 772) continues to be one of the most popular elective courses for medical physics graduate students. Exciting new hardware and software additions to the State of the ART (START) computer-based treatment planning lab have enabled more students than ever to work independently on the integrated treatment planning lab exercises. This expanded capacity has been made possible by a School of Medicine and Public Health educational grant and along with strong collaboration between the Departments of Medical Physics and Human Oncology and an ongoing partnership with our clinical vendor RaySearch.
MP 772 gives graduate students the unique opportunity to learn and practice the physics of clinical, computer-based radiotherapy planning using commercially available radiotherapy planning programs as part of a didactic three-credit graduate course. Boasting the largest Medical Physics Graduate program in the country, UW-Madison has offered this course for 17 years and was the first graduate program in the country to do so. As more students pass through this class under the instruction of Dr. Jennifer Smilowitz and Dr. Dustin Jacqmin, many of them have started offering similar courses at the medical schools and training programs where they now teach.
When Dr. Smilowitz graduated from the Medical Physics program at UW, there were no dedicated treatment planning courses for physicists. After graduation, she felt underprepared for commissioning and planning in clinical treatment planning systems. Upon returning to the department as a faculty member, Dr. Smilowitz developed the first treatment planning course designed for Medical Physics graduate students. In the time since the class’s inception, Medical Physics residencies have become available and mandatory at medical schools across the nation. This has also allowed the focus of the class to shift over time away from clinical planning and back to a strong focus on the underlying physics of treatment planning.
After 15 years of leading the class, Dr. Smilowitz teamed up to co-teach with Dr. Jacqmin, one of the lead physicists doing treatment planning for patients at the University Hospital clinic. Dr. Jacqmin has brought in a fresh perspective and each year, new modules are added to teach students about the latest innovations in the field and improvements constantly happening to the equipment technology.
Dustin Jacqmin notes, “In the time that Jeni has been teaching the course, there’s been a big revolution in how treatment planning is done in the clinic. She didn’t create this course just once. She’s had to recreate it probably every five to seven years to keep it relevant, which is a big undertaking.”
“That’s true”, adds Dr. Smilowitz, “This topic was grouped into other physics classes, and it evolved as the treatment planning became more advanced and required more physics input. It became more technologically advanced and more mathematically heavy.”
Originally the course was designed to be vendor agnostic and several commercial treatment planning systems were available in the lab. However, maintaining current software versions, anonymous data and accurate beam models became too cumbersome. By 2021, the class evolved to focus on RayStation from RaySearch to more closely align the treatment planning strategies and beam models with the clinical system used at UW Health. Clinical scenarios also inspire training modules for the trainees.
Early in the semester, the lab exercises follow a step-by-step process for treatment planning, but as the students become more confident, creativity and trial and error are encouraged. Much of radiotherapy physics is focused on algorithms and learning to calculate proper dosage of radiation; the math has a right and a wrong answer. In contrast, radiotherapy treatment planning is much more open-ended, and students are encouraged to explore many solutions to learn what works best in different scenarios. The goal is to prepare students for a career where they will use their deep understanding of treatment planning physics to shape and guide the treatment planning process and be an expert resource for dosimetrists and physicians.
“In class, we outline what an example physician might be asking for in terms of the plan they want for their patient. We encourage the students to experiment and give us a starting point for the dosimetrists. Once the plan has been executed, we discuss what worked, what did not work, what else we could have adjusted or tried. A lot of the lab is exploratory and the goal isn’t to make the best plan, but to figure out like what influences plan quality,” says Dr. Jacqmin.
Dr. Smilowitz adds, “Sometimes students who are very physics-driven can be hesitant to experiment and get the wrong answer. We try to help them realize that no one knows the right answer when they begin and the only way you get to the right answer is by playing in the space and getting better each time. We encourage a little bit of bravery to get them to thinking about what they’re doing and understanding the cause and effect in the planning process.”
The course continues to be in high demand and often had a waitlist for enrollment due to computer lab space limitations. The Associate Chair of Physics for DHO, Dr. Carri Glide-Hurst, took note of this and identified the roadblock keeping us from expanding class size was the number of computers in the lab which limited the number of learners who could benefit from this world-class training program. She applied for a School of Medicine Laboratory Modernization Grant and was awarded the funding to purchase more computing infrastructure in 2021.The State of the ART (START) lab expanded in several phases and was completed in 2023 to train more learners than ever in the art of treatment planning.
Dr. Glide-Hurst sums it up best as, “The Treatment Planning Course and START Lab is such a great example of the collaboration taking place between the Department of Medical Physics, the Department of Human Oncology, and UW Health. We would not be able to have access to such modern planning algorithms and research licenses without our partnership and the strong support of our collaborators at RaySearch Laboratories. The START Lab—started by one of our own graduates Dr. Smilowitz—stands out as a distinctive feature of our medical physics and radiation oncology training programs at UW, showcasing our commitment to innovation and excellence in advancing cancer technologies. On, Wisconsin!”