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The history of Medical Physicists is linked to the discovery of radioactivity and x-rays and their diagnostic and therapeutic use. Although physicists were involved since the earlier pioneering radiotherapy applications in the last years of XIX century, the first physicists officially appointed to hospital positions happened in Munich and in London in 1912 and 1913 respectively. Ever since, Medical Physicists have largely contributed in the technological and clinical advances of radiation therapy, and constitute a key group with a central role within the multidisciplinary approach of oncological care. Today, Medical Physicists are, more in general, responsible for guaranteeing a safe and optimal use of radiation in medicine; their flexibility, intrinsic translational character and their unique skills represent an important added value in the scientific and clinical contexts within the rapidly changing scenario of radiation oncology of current times. The rapid change of radiation oncology as a relevant branch of precision oncology together with the rapid growth and spread of high-tech radiotherapy and the consequent increased commitment of medical physicists opened a debate in the radiation oncology physics community regarding the redefinition of roles and responsibilities of medical physics in this new scenario. This debate should focus on the new scientific challenges to be faced in Radiation Oncology and on how medical physicists could contribute to find solutions. Then, in 2014 a task group on the “Future of Medical Physicists in Radiation oncology” (FUTURE_ESTRO) was created by the ESTRO physics committee. This initiative was in part inspired by the one represented by the AAPM Future task group in the USA. The mandate of both groups is to develop strategies to prepare medical physicists for future roles and responsibilities in clinical practice, research, product development, and education. The future group, acknowledging the inseparability between clinical service and research, wants to increase awareness of the importance of the research role of Medical Physicists. One of the actions proposed by the future task group was the organization of the think tank meeting on provocative questions for medical physicists in Radiation Oncology.  This workshop, held in Budapest in November 2019, involved not only medical physicists but other in-field experts (radiation oncologists, biologists, RTTs) and out-of-field experts. The process for question selection started in January 2019.   The question selection followed the following scheme, first a call to all medical physicists ESTRO members asking for challenging questions and to all in-field debaters was launched. Then, among the 108 collected questions/statements, four were selected following a two-step procedure (grouping them in 4 categories and then selecting the most provocative/relevant from each category).

The four statements finally selected were:

1.       Medical physicists will transform tumor target definition from an art to science
2.       Medical physicist will drive development and implementation of artificial intelligence in Radiation Oncology
3.       Medical physicists will substantially contribute to modeling biological effects in the era of personalized Radiation Oncology
4.       Medical physicists will be leaders in the changing world of Radiation Oncology