So Many Parallels

According to a 2010 paper by Andrei Linde and Vitaly Vanchurin from the Stanford Department of Physics, if calculated using the principles of inflationary cosmology, the total number of universes in the multiverse might exceed 10¹⁰¹⁰⁷, a number the authors themselves described using the scientific term “humongous.”¹

Naturally, after this instantly controversial analysis was published, many armchair string theorists threw their honey-and-lime rimmed martinis² at the crazed chalkboard exercise of Drs. Linde and Vanchurin. Man Ho Chan from The Education University of Hong Kong, for example, mercilessly shredded the falsifiable arguments advanced by multiverse stans, insisting that such theories still cannot pass or satisfy the required assessments based on the new theoretical virtues and the nonempirical arguments.³ Fellow contrarian physicists around the world were heard yelling into their computer screens, “Yeah, that’s right, go get ‘em, you the Man!”

Exact numbers are hard to come by, but there are probably no more than 5 x 10⁵ or so radiation oncologists and medical physicists on Earth, give or take 5 x 10⁴. Thus, the total number of actual parallel universes occupied by all of us would be far less than the upper limits of Drs. Linde and Vanchurin. Nevertheless, we do practice in a variety of social, cultural and economic environments. And so, the intent of this issue was to hear from individuals thriving in a wide range of geographic and professional settings so that we might gain appreciation of their lived experiences.

In the 21st century, the three greatest mysteries surrounding hidden celebrity identities from the worlds of art, music and medical science are the following:

1. Banksy, the UK graffiti artist whose identity remains unknown.
2. Daft Punk, the influential French electronic music duo, who wore sci-fi-inspired helmets when they performed to remain anonymous from around 2001 until disbanding in 2021.⁴
3. The Founding Authors of QuadShot, the amazing email/online educational forum for radiation oncology, without which our field would be measurably less smart. Trust me: if you are not on their email distribution list, sign up now.⁵

In recent years, though, that last group has also been unmasked. We now know that Laura Dover, MD, Sam Marcrom, MD, and Caleb Dulaney, MD, were the OG QS masterminds. We are fortunate that for the current issue of ASTROnews, Drs. Dover and Marcrom graciously agreed to serve as Guest Editors and interview a number of the colleagues profiled in these pages. You will recognize their contributions as semi-structured Q&A conversations interspersed among other pieces that have a narrative form. For the latter group of essays, special thanks to Editorial Board members Drs. Julianne Pollard-Larkin and Sandra Turner for their important contributions.

One last thing: the tone and content of this issue is intended to be lighthearted infotainment, but there is one piece that stands apart. You will know it when you see it. We have nothing but respect for the courage of the individual featured and send our best wishes for peace. 

Guest Editors

Radiation oncologists across the United States and globally practice in a diverse range of settings — from large world-renown academic institutions to smaller stalwart community clinics — each with unique patient populations, resource availability and institutional cultures. Some carve their marks with steadfast pursuits of cutting-edge research that will shape the next era of our field, while others build their legacies by daily navigating the delivery of world-class radiotherapy in rural or underserved areas utilizing whatever tools they have at their disposal. These differences, at times, can create a sense of disparate visions for policy goals, research initiatives and future directions of radiation oncology and can shape clinical and professional experiences that seem worlds apart.

Which brings us to the theme of this issue of ASTROnews: Parallel Universes. Herein we explore how our most fundamental motivations — to heal and to comfort — transcend any personal career aspirations. Despite obvious practice distinctions, radiation oncologists all over the map share a core commitment to deliver evidence-based cancer care to the patients who entrust us with guiding them through their most vulnerable times.

We are honored to serve as guest editors for this particular issue, as we feel it captures the essence of QuadShot News. As co-residents, we formed bonds wherein we taught one another (thank you, Sam), learned to face the sometimes-impossible heaviness of our profession with humor (thank you, Caleb Dulaney, MD, co-founder), and modeled that it is always ok to cry when other emotional outlets fail (thank you, Laura). With each of us — now eight years ago — readying to embark on careers in vastly different clinical settings spanning Meridian, Mississippi, to Manhattan, we sought to develop a platform that would allow us to maintain that sense of communal learning while acknowledging the reality of what each touted advancement may look like on the ground in our own clinics.

This issue depicts radiation oncologists and physicists throughout the globe facing similar obstacles: handling increasing patient loads and faster patient turnover, managing and curbing prior authorization battles, and facing the emotional toll of treating seriously ill patients. At the same time, we find a clear collective interest in leveraging artificial intelligence to offload the escalating manpower required for complex treatment deliveries, re-exploring and expanding radiotherapy indications for benign diseases, and searching for the ever-elusive “work-life balance.”

Our differences undoubtedly enrich the specialty, while our common experiences reinforce a collective identity and purpose. Through international societies such as ASTRO, we continue to learn from one another, adapt and standardize best practices, and advocate for our patients. Whether we arrive at clinic via a NYC subway, a Portland bike ride, or a minivan with a pitstop to drop off kids at school, we are all stamped by the same mission: to deliver life-saving care to the patients sitting in our waiting rooms today while striving to advance our repertoire for generations to come. These universal foundational principles will forever bind our fragmented realities into one cohesive and ever-evolving field.