Health and Technology https://doi.org/10.1007/s12553-023-00756-0 ORIGINAL PAPER Science diplomacy in medical physics – an international perspective Eva Bezak1,2,11,13 · Cari Borrás3 · Francis Hasford4,5,11 · Nupur Karmaker6 · Angela Keyser7 · Magdalena Stoeva8,11 · Christoph Trauernicht5,12 · Hong Chai Yeong9,14 · Loredana G. Marcu1,10,15 Received: 2 May 2023 / Accepted: 3 May 2023 © The Author(s) under exclusive licence to International Union for Physical and Engineering Sciences in Medicine (IUPESM) 2023 Abstract Purpose Science diplomacy in medical physics is a relatively young research field and translational practice that focuses on establishing international collaborations to address some of the questions biomedical professionals face globally. This paper aims to present an overview of science diplomacy in medical physics, from an international perspective, illustrating the ways collaborations within and across continents can lead to scientific and professional achievements that advance scientific growth and improve patients care. Methods Science diplomacy actions were sought that promote collaborations in medical physics across the continents, related to professional and scientific aspects alike. Results Several science diplomacy actions have been identified to promote education and training, to facilitate research and development, to effectively communicate science to the public, to enable equitable access of patients to healthcare and to focus on gender equity within the profession as well as healthcare provision. Scientific and professional organizations in the field of medical physics across all continents have adopted a number of efforts in their aims, many of them with great suc- cess, to promote science diplomacy and to foster international collaborations. Conclusions Professionals in medical physics can advance through international cooperation, by building strong communi- cation across scientific communities, addressing rising demands, exchange scientific information and knowledge. Keywords Teaching and education · Research and development · Gender equity · Leadership · STEM fields · Scientific collaboration Loredana G. Marcu 8 Department of Diagnostic Imaging, Medical University of loredana@marcunet.com Plovdiv, Plovdiv, Bulgaria 9 1 Medical Radiations, University of South Australia, Adelaide, School of Medicine, Faculty of Health and Medical Sciences, SA, Australia Taylor’s University, Subang Jaya 47500, Malaysia 10 2 School of Physical Sciences, University of Adelaide, Faculty of Informatics and Science, University of Oradea, Adelaide, SA 5001, Australia Oradea 410087, Romania 11 3 Radiological Physics and Health Services, Washington, DC, International Organisation for Medical Physics (IOMP), USA York, UK 12 4 Department of Medical Physics, University of Ghana, Accra, Division of Medical Physics, Tygerberg Hospital and Ghana Stellenbosch University, Cape Town, South Africa 13 5 Federation of African Medical Physics Organizations Asia-Oceania Federation of Organizations for Medical (FAMPO), Accra, Ghana Physics (AFOMP), Bangkok, Thailand 14 6 Department of Medical Physics and Biomedical Engineering, South-East Asian Federation of Organizations for Medical Gono Bishwabidyalay) University, Savar, Dhaka, Bangladesh Physics (SEAFOMP), Subang Jaya, Malaysia 15 7 American Association of Physicists in Medicine (AAPM), European Federation of Organisations for Medical Physics Richmond, USA (EFOMP), Utrecht, The Netherlands 1 3 Health and Technology 1 Medical physics – the profession behind the development of the whole medical physics community, advances in medical technology and it has been critical to ensure their employment globally, in particular in the developing countries, with the growing Medical physicists are professionals actively involved in need for building capacities in medical physics [4]. science diplomacy mainly due to the multidisciplinary char- WHO promotes medical physics activities through pro- acter of their work, whether it be in research, education, grams in the areas of medical devices and radiation safety, or clinical service. They regularly interact with clinicians, often working in collaboration with its six Regional Offices. technologists, nurses, hospital administrators, other health In the America’s Region, the Pan American Health Orga- professionals such as radiation protection experts, radio- nization (PAHO), an international organization on its own pharmacists or maintenance technicians. In addition, they right, founded in 1902, serves as the Regional Office for the consult for government regulators, in relation to new medi- Americas. PAHO has had medical physicists as Regional cal technologies or various safety aspects (e.g. radiation or Advisers in the so-called Radiological Health Program laser safety). They also interact with patients, either in a since 1960 [5]; the program carries out activities in medical clinical setting or during stakeholder engagement activities, physics and radiation protection. such as public and or educational talks on various technical The IAEA supports many programs and has several med- aspects of health technologies. ical physicists in their team covering the areas of diagnostic Over the years, medical physicists have been instrumen- and interventional radiology, radiation oncology, nuclear tal in the development and implementation of new tech- medicine, and radiation protection and safety [6]. nologies for diagnosis or treatment of disease, for example new techniques for delivery of radiation therapy for cancer patients or development of new diagnostic equipment (e.g., 2 Science diplomacy in medical physics high Tesla magnetic resonance units or whole-body posi- tron emission tomography equipment). They have also been Science diplomacy (SD) is a novel field of research and instrumental in communicating radiation risks to public and translational practice that employs integration of science and developing emergency procedures in radiology departments technology and international collaborations (whether scien- during the recent COVID pandemic. As such, this paper tific, professional, or political) to address essential questions looks at the broader role of medical physicists as science that mankind faces globally [7]. It also involves community diplomats within national and international communities. engagement so that the various national and international Being the global leader in the field of medical physics, policies and actions are made based on the societal needs the International Organization for Medical Physics (IOMP) while, at the same time, these actions are informed by sci- plays a key role when it comes to science diplomacy. Work- entific facts and advice, as appropriate. The need for science ing in close collaboration with its members and interna- diplomacy was evident during the COVID pandemic with tional partner organizations, IOMP sets the global standards lots of misinformation circulated in the media, social plat- for science diplomacy in medical physics and healthcare forms and/or actions determined by various governments [1, 2]. IOMP represents over 27,000 medical physicists, not having the full buy-in from the public. Other global 87 adhering national member organisations, 2 affiliates, 6 issues where science diplomacy can play a significant role regional organizations (EFOMP, MEFOMP, SEAFOMP, include climate change or the use of radiation for medical AFOMP, FAMPO, ALFIM), corporate members and is in purposes and/or energy production. official relations with WHO and the IAEA. There are a number of definitions and descriptions of sci- The international recognition of the profession is an ence diplomacy in current literature and as defined by vari- important aspect in the global development of medical ous organizations, with a couple of examples shown below: physics where the key role is played by the IOMP. The International Labor Organization (ILO) classified medi- ● • “Science diplomacy seeks to build scientific collabo- cal physicists as a profession in the International Standard ration that enhances relationships between nations. It Classification of Occupations-08 (ICSO-08), one of the can also inform foreign policy objectives by supplying most important reference documents for governments for scientific advice and facilitate international cooperation recognition and classification of occupations [1, 3]. Medical and investment.” [8]. physicists are classified under physics and astronomy within ● • “Science is a process for pursuing answers, while the category “Science and Engineering Professionals” and diplomacy is a process for dialogue and cooperation as “Health Professionals” when they are part of the health between countries and citizens. By integrating the work force. This achievement of international recognition two, we can face challenges and take opportunities to of the profession of medical physics is an important step for advance humanity.” [9]. 1 3 Health and Technology In short, the main objective is to use science to advance policy scientists,…. mediating between science and political and diplomatic objectives, with the common aim diplomacy.” of increasing equity and prosperity of all mankind [9]. It is a collaborative relationship between scientists and gov- Similar to leadership and/or management, good scien- erning bodies where diplomatic and/or political decisions tific professionals do not automatically become good can enable faster translation of scientific knowledge into science diplomats, thus relevant training and support practice and vice versa, so that the relevant administrative is required. It appears that SD has been mostly taught decisions, policies and international advocacy are being through workshops or is organized by professional informed by the latest scientific knowledge and evidence. groups, and limited education is currently available The process is multifaceted and can happen on multiple lev- at a university level as formal training – both a gap els and through various engagements, including cooperation and an opportunity for academic programs around the agreements, transnational research organization, funding world [14]. programs, international science exchange, open access pub- Opportunity also presents itself from the point of lishing, consumer engagement, scientific advisory commit- view of various medical physics organizations, who tees to governing bodies, etc. can play active role in SD nationally and internation- According to the Madrid Declaration on Science Diplo- ally. The missions and visions of these organizations macy [10], science diplomacy is a transboundary field sit- are already aligned with the main objectives of SD ting across: by advancing the medical physics worldwide, foster- ing professional development and education and thus ● • “National borders, entailing bilateral or multilateral contributing towards safe and high-quality medical relationships; services for patients globally. In addition, these orga- ● • policy frameworks, combining the policy realms of nizations already have strong links with other multi- science, technology, innovation and foreign affairs — national and global organizations such as the IAEA each with clear-cut definitions of competencies, actors and WHO, as well as other stakeholders such as uni- and levels — and establishing complex and fluid inter- versities and governments. Therefore, they can build actions with joint jurisdictions; bridges between individual countries, societies, and ● • stakeholders of all natures, involving government international institutions to lead and support develop- actors as well as international organisations, scientific ment of strategies for the advancement of biomedical institutions, non-governmental organisations (NGOs), sciences worldwide. Additionally, they are in a posi- the private sector and so forth; and. tion to provide education in SD as well as to assist ● • professional backgrounds.” publicizing the role of SD to communities and govern- ment bodies. Geographically, science diplomacy occurs at a national level, determining the actions that would address the An example of the excellent collaboration between the inter- needs of any particular country. At the next level, SD governmental and the scientific/professional organizations informs decisions that improve cross-border collabo- is the inclusion of “medical physicist” in the publication rations and interests. Finally, at a global stage, SD The Radiation Protection and Safety of Radiation Sources: influences actions designed to address world-wide International Basic Safety Standards (BSS), sponsored by issues [11]. The additional potential benefit of SD all the intergovernmental organizations involved in radiation is enabling collaboration and providing stabilizing protection and safety and published by the IAEA in 2014 influences between countries of varied cultural back- [15]. The importance of this publication is that it is adapted/ grounds and political systems [12] – it could serve as adopted by most of the countries as their radiation control a unifying international platform. regulations. To ensure consensus by the Member States, the To enact science diplomacy into practice, the so-called IAEA hosted during the drafting process ‘Technical Com- science diplomats are required. According to Melchor mittee Meetings’. It was during one of these meetings, that, [13], a science diplomat is: mainly due to the input provided by medical physicists rep- resenting the IOMP, EFOMP, AFOMP, PAHO and WHO, it ● • “The diplomat scientist. was decided to incorporate “medical physicist” to the list of ● • The scientist diplomat. “parties” that “shall have specified responsibilities in rela- ● • All different actors — civil servants, science/pol- tion to protection and safety”. It was the first time such a icy managers, innovation delegates, liaison officers, term -as defined by the IOMP- appeared explicitly in a BSS. 1 3 Health and Technology 3 Science diplomacy actions in medical Medical Physics College during its 30 years of history [17, physics across the continents 18]. It has educated more than 1000 students from around 100 Low-and-Middle-Income Countries (LMICs) apply- 3.1 Education and training ing train-the-trainer scheme which subsequently led to the creation of national educational programs, formation of All the IOMP regional organizations are involved in educa- national medical physics societies, and direct contribution tion and training activities. Because of their uniqueness, we to regulatory agencies and healthcare in those countries. 35 will present here some of the efforts carried out by EFOMP, of the students educated during the period 2002–2018, 40% AFOMP, SEAFOMP and FAMPO. of which were women, took leadership positions at national In a European context, there are a number of issues per- and/or international level. taining to science diplomacy in medical physics that are Medical physicists in Asian countries are under the worth mentioning in terms of education and training. The umbrella of one of the three organisations encompassing European Federation of Organisations for Medical Phys- countries from middle east (MEFOMP), southeast (SEA- ics (EFOMP) is the umbrella organisation for all National FOMP) and the larger geographical area (AFOMP). The Member Organisations (NMOs), currently including 36 Asia and Oceania region are home to 60% of the world’s European countries [16]. The European and International population, and it includes the world’s most populous coun- Matters Committee is one of EFOMP’s six committees and tries, China and India [19]. The region is popular for its vast its responsibility is to represent the interests of EFOMP to diversity in demographic, economy, politics, languages, various European and international bodies related to medi- religions, social and cultural aspects. Therefore, AFOMP cal physics. The main roles of this committee are: (i) to rep- plays a vital role in connecting and enhancing the medi- resent the interest of the Federation to various European and cal physics profession in the region via science diplomacy. international bodies related to medical physics, (ii) to follow In 2020, AFOMP celebrated its 20th anniversary with the developments both within the European Union and Inter- theme of “Twenty Years of Teamwork” to mark cooperation nationally in relation to medical physics, (iii) to formulate for sustainable growth of medical physics in the region. The proposals addressed to appropriate bodies of the European AFOMP Monthly Webinar Series and the AFOMP School Union (including the European Parliament and Commis- were launched to provide free education and continuous sion) on matters related to medical physics, and (iv) to liaise professional development to the medical physicists in the with European and International organisations through vari- region. Southeast Asia consists of eleven countries that are ous professional activities for the common benefit of medi- culturally and ethnically diverse. To strengthen regional col- cal physicists. laboration and development, ten countries from the region To attain all the above goals, science diplomacy is a key have formed the Association of Southeast Asian Nations, aspect for successful collaborations and establishment of a regional organization established for economic, politi- strong partnerships with the industry, research organisa- cal, social, cultural and educational partnership amongst tions and regulatory bodies. Medical physics across Europe its members [20]. Structured clinical training programmes presents a greatly varied landscape in terms of training, such as Clinical Training of Medical Physicists Specializing education, research and development, as well as the roles in Radiation Oncology, Diagnostic Radiology and Nuclear and responsibilities amid these professionals. EFOMP is Medicine are established under the IAEA Regional Coop- working towards a more uniform platform by strengthen- erative Agreement. To further facilitate the clinical training ing scientific and educational collaborations across its mem- in countries/areas with no clinical supervisors, IAEA also ber countries, through implementation of various European provides an online platform known as the Advanced Medi- Council directives across the continent, and most impor- cal Physics Learning Environment. It is an e-learning tool tantly, by gaining recognition of our profession on a Euro- developed by the IAEA to provide junior medical physicists pean level in order to facilitate mobility across borders. with guided learning materials and remote mentorships to The Medical Physics College hosted by the International enhance their clinical training in hospitals. Using this plat- Centre for Theoretical Physics Abdus Salam in Trieste, form, residents who are working at a hospital, but lack of a Italy is a unique development targeting the global advances supervisor can share a clinical supervisor from other cen- in and support for medical physics through education & tre through remote supervision. One of the current active training, capacity building, networking and collaboration. regional projects of SEAFOMP is the establishment of Among all the important activities related to the profes- regional diagnostic reference levels (RDRLs). The project sional growth of the medical physicists, special focus is aimed to collect updated national DRLs on common radio- given to gender balance and leadership whereas recent sta- logical procedures from SEAFOMP countries, to estab- tistics show some remarkable global achievements of the lish RDRLs based on the clinical indications in diagnostic 1 3 Health and Technology Fig. 1 Number of collaboration links established by high-income countries within H2020 (data from [25]) Fig. 2 Number of collaboration links established by lower- income countries within H2020 (data from [25]) radiology, interventional radiology and nuclear medicine into regulatory and legislative developments as experts in procedures, and to review the progress on implementation the field. of RDRLs in each country. To further the profession through a common platform, In African settings, a harmonized syllabus for aca- the International Medical Physics Certification Board was demic and clinical medical physics training programmes established in 2010, by eleven medical physics organiza- was developed through regional projects under the African tions across the world that served as Charter Members. The Regional Co-Operative Agreement for Research, Develop- goals were to establish minimum professional standards and ment and Training Related to Nuclear Science and Technol- advance the practice of medical physics. The main objec- ogy in collaboration with the IAEA [21]. Academic training tive of this board is to continue education and professional is currently happening in only ten African countries, while development for certified medical physicists to generate only seven offer clinical training. An urgent expansion of qualified medical physicists across the globe [24]. these training programmes is required, potentially through the use of regionally designated centres that train in certain 3.2 Research and development or all aspects of medical physics. IAEA and African experts established the first harmonized imaging quality control An important aspect of science diplomacy for advancing protocols for Africa in 2020 to help achieve a minimum research in medical physics and adjacent fields is scientific standard throughout the region [22]. An initial study on collaboration across nations. This requires a diplomatic regional diagnostic reference levels for computed tomogra- approach on several levels resulting in equitable project phy included data from Ghana, Kenya, Namibia, and Sene- calls, evaluation, and funding for all European countries. gal [23] indicating that regional collaboration is expanding. Horizon 2020 (H2020) was the European Union’s research Results of studies like these may eventually trickle down and innovation funding programme (2014–2020) with a into national regulations or similar. One of the major issues generous budget that aimed to foster scientific collabora- in African countries regarding medical physics is the recog- tions by financing multinational projects [25]. Differences nition of the profession. In the field of science diplomacy, a of over two orders of magnitude between high and lower- national society can offer a powerful tool to engage with a income European countries were found when comparing national Health Professions Council to promote the registra- the number of collaboration links established via H2020 tion of medical physicists as healthcare professionals, while (Figs. 1 and 2). These large discrepancies are linked to the at the same time this opens up an avenue to offer advice already mentioned varied landscapes in terms of training, 1 3 Health and Technology research priorities, staffing levels, and professional exper- Health professionals must explain the benefits and tise. Science diplomacy could narrow science and research- risks of medical imaging to policy makers, care providers, related disparities across European countries through the patients, family members, and the public. In an effort to establishment of a common training and education frame- provide guidance in this area, AAPM has published a com- work in medical physics and other biomedical fields and munication guide “Radiation and Medical Imaging: Com- broader collaborations on all aspects of research and profes- municating Clear Answers to Top Questions [28]. sional development. It should be noted that EFOMP’s role extends beyond 3.4 Enabling equitable access of patients to EU-based countries in Europe and aims to involve all healthcare NMO’s in the organisation of local and regional meetings in the “four corners of Europe”. EFOMP also endeavours to Biomedical diplomacy is gaining importance in low and keep fees for the European congresses to a low level, facili- middle-income countries to abate health challenges by tating access from lower income European countries, thus using resources, streamlining procedures, fostering col- supporting the aims of EFOMP to communicate, integrate laboration, promoting innovative and sensitive approaches, and educate. developing education, professional training, capacity- Early career professionals play a key role in the progress building plans, sharing experience through worldwide net- and expansion of any profession, as the young scientists of works [29]. Through collaborative activities, one nation can today will become the specialists and leaders of tomorrow, achieve better outcomes in diagnosis, treatment, quality and the future science diplomats. To fulfil this goal, they control, and policy development [30]. The significance of require continuous motivation and an adequate environ- science diplomacy is better acknowledged in LMICs now, ment to develop. In view of this EFOMP is establishing a especially since the COVID-19 situation, which disrupted Special Interest Group (SIG) encompassing early career the global health system [31]. At that time, it was difficult medical physicists from all European member countries to to upgrade imaging technology, use medical devices and provide an official platform for educational and professional continue radiotherapy services [29]. Without collaborative networking covering all aspects of the profession [26]. Most activities, it was not possible to develop and maintain medi- importantly, it is expected that the SIG will stimulate the cal physics services in some LMICs. development of much needed soft skills among young pro- The Federation of African Medical Physics Organiza- fessionals, including strategic planning, marketing, commu- tions revealed that for radiology and nuclear medicine nication, and pedagogical skills, but also skills in conflict medical physics, the number of clinically qualified medical resolution, organizational politics, negotiation, and team- physicists is inadequate by at least a factor of 20 in almost all building [27]. The creation of the SIG was received with countries in the region, to cover existing services adequately great enthusiasm by young and senior professionals alike, [32]. The Lancet Oncology Commission for Sub-Saharan foreseeing fruitful collaborations among European coun- Africa estimated that at least 5000 additional megavoltage tries in biomedical fields, by stimulating young minds, fos- radiotherapy machines are required in Africa over the next tering new ideas and employing science diplomacy across 15 years to ensure equity in cancer care [33] and each of the borders. It is hoped that the involvement of early career these will require adequate medical physics support as well. researchers in science diplomacy will accelerate collabo- It is thus very clear that scientific collaborations across bor- rations between low- and high-income countries and will ders are required to address this need. facilitate scientific mobilities within Europe to achieve a IAEA establishes a milestone for cancer management more unified training, education and research platform in with a focus on initiatives to advance radiotherapy globally. medical physics and related biomedical fields. IAEA expands their services to improve the Member States’ capacity to meet needs related to the prevention, diagnosis, 3.3 Communicating to public and treatment of health disorders. Both the developed and developing worlds benefit from using nuclear and radiation Increasing the visibility of the profession is directly con- procedures within a framework of quality assurance by the nected with the organization of large-scale events that IAEA [34]. The IAEA assist the Member States in the Asia attract medical physicists and the public. The International and Pacific region to plan, launching, and expand radiother- Day of Medical Physics and the International Week of Med- apy services in a safe and effective manner. This support ical Physics are celebrated annually and medical physicists is provided in collaboration with the Regional Cooperative throughout the world celebrate it through various activities Agreement (RCA) for research, development, and training related to the profession. related to nuclear science and technology. IAEA-RCA proj- ects provide a variety of online and offline activities [35]. 1 3 Health and Technology LMICs highly benefited from IAEA Technical Cooperation close collaboration with the IUPESM Women in Medical (TC) project, e-learning, and regional training. IAEA Marie Physics and Biomedical Engineering (WiMPBME) group Sklodowska-Curie Fellowship Programme contributes to [43]. women in the nuclear field by driving global scientific and technological innovation [36]. On December 6, 2022, the IAEA entered into a “Practical Arrangements on Coopera- 4 Conclusions tion in the Area of Radiation Oncology, Imaging and Medi- cal Physics” with 11 professional organizations [37]. This is There are several aspects of science diplomacy that can assist a significant partnership to improve access to radiotherapy with the progress of a profession, such as medical physics. services and reduce the global inequities in cancer treatment. Whether through international or national organisations, Additionally, both international and many national orga- science diplomats have an important role of initiating and nizations have their own special committees that work in the substantiating projects and activities that would lead to the area of supporting low to middle income countries in regard benefit of medical physicists worldwide. With the growing to education and training of medical physicists, or support need of oncological patient care through novel technology during implementation of new medical technologies. This in and well-trained staff, it is essential for the medical phys- turn improves patient access to safe medical technologies. ics community to continuously improve their skills and help For example, the AAPM, has an international library pro- those peers with limited access to the latest technology and gram where a number of LMIC medical physicists can get knowledge. This way, the large gap between countries and free access to medical physics educational materials, guide- continents concerning cancer patient care, will be reduced lines and/or publications [38]. The Australasian College of and high-quality healthcare will be offered to all. Physical Scientists and Engineers in Medicine (ACPSEM) has its own charitable foundation, The Better Healthcare List of Abbreviations Technology [39] that communicates the complex medical AAPM American Association of Physicists in technology in simpler lay terms to broader public, including Medicine patients and their families. The foundation is also home to AFOMP A sia–Oceania Federation of Organizations Asia-Pacific Special Interest Group (APSIG) that over the for Medical Physics years sponsored visits of volunteer medical physics experts ALFIM Asociación Latinoamericana de Fisica for training and support assignments to Papua New Guinea, Médica Vietnam, Philippines, Myanmar, Cambodia, Laos and Mon- EFOMP European Federation of Organisations for golia. These assignments ranged from 8 to 10 weeks to 12 Medical Physics months. The group also regularly organizes fundraising FAMPO Federation of African Medical Physics events to support its international outreach activities. Organizations Another example is a volunteer organization Medical IAEA International Atomic Energy Agency Physics for World Benefit [40], which, according to their ILO International Labour Office mission statement, they aim “to provide Medical Physics IOMP International Organization for Medical support with the goal of improving the effectiveness and Physics safety in the use of physics and technologies in medicine, IUPESM International Union for Physical and Engi- especially in low-to-middle income countries. To sup- neering Sciences in Medicine port activities which will yield effective and safe use of LMICs Low-and-Middle-Income Countries physics and technologies in medicine through advising, MEFOMP M iddle East Federation of Medical Physics training, demonstrating, and/or participating in medi- NMOs National Member Organizations cal physics-related activities, especially in low to middle PAHO Pan American Health Organization income countries.” SD Science diplomacy SEAFOMP S outh East Asian Federation of Organiza- 3.5 Gender equity in MP and healthcare provision tions for Medical Physics WHO World Health Organization The IOMP focuses on diversity and inclusion as evidenced WiMPBME Women in Medical Physics and Biomedical by IOMP’s structure and activities [41, 42]. 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