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Medical Physicists are the guardians of quality and safety in radiation oncology, but this is not the only role they play. They are also, more importantly, disruptors. Historically, Medical Physicists have led on all main technological developments in Radiation Oncology. However, technology only serves a purpose if it addresses a clinical need. Technological development ad infinitum is not needed, and time and resource should not be wasted on it. The future of Radiation Oncology will be in personalization. This will be achieved through individualized biological based decisions underpinned by robust models. These models will be developed through deep learning and data mining for which the standardization and creative development will be led by Medical Physicists. Hence, we will need synergy between Radiation Oncologists and Medical Physicists to lead the field together.

To continue to be leaders, the responsibility is with the medical physicists themselves. The majority of clinical medical physicists are doing routine things. To change the culture to be innovative again we need to a) have the right leaders in the right position and b) have the right education and training to drive innovation. The fact that Radiation Oncology has worked so well in the past decades is because the Medical Physicists were part of the team; this is a key difference to other disciplines. The future role of the Medical Physicists could be in leadership of all technological innovations (in both soft and hard technologies) that will be introduced in the hospital ie the Medical Physicists will lead the clinical engineers, data scientists and biomedical engineers and guide them in asking the right questions. 

Different disciplines in Radiation Oncology have different training, which give them different skills. Radiation Oncology needs all types of skill to effectively move the field forward and therefore the leadership needed to achieve this must be composed of Medical Physicists and other Radiation Oncology professionals. The key lies in choosing the right areas for each to lead in. In order to avoid a return to “interventional radiology” the changing world of Radiation Oncology will need Medical physicists to be leaders. Medical physicists will continue to lead in facilitation of implementation of technology and new techniques, including new directions such as AI. This has a wider reach in the hospital than in only in Radiation Oncology/Radiology/Nuclear medicine depts and therefore, for optimal effective leadership, Medical Physics departments should be independent from Radiation Oncology departments such that they have the ability to employ a greater variety of scientist. Furthermore, the independence of the Medical Physics department would better facilitate the ability to employ ‘out of field experts’ such a computer scientists and data scientists. In this way both Radiation Oncology and other medical disciplines would benefit from the inter-disciplinarity across the whole field of Medical Physics.