April 9–10^th brought to Louisville, KY a flowering of my dogwood trees and some occasional violets pushing their way through my grass. Spring is a fertile season for new thinking, and I wish to share new ideas. Some discussions I have had with certain medical physicists over the past several days have been especially thought‐provoking and caused me to reflect on some of the character and substance of medical physics practice. I herewith offer some personal anecdotes that resonate with my experience of medical physics education and practice along with some contemporary thoughts.

My first story stems from 1966 and my 8^th‐grade math class. Dyke Goodin, my instructor, offered that anyone who earned a 100 average on all tests, given weekly, would earn an A+ in the class. I took him up on this challenge as I thought I only had to be careful and I could do it. In 2018, I contacted Dr. Goodin, and asked if he remembered me. I wrote: “One of your challenges to our class, so long ago, was to strive for perfection. Your standard for an A+ was daunting. Nothing less than a 100% average on all weekly tests (with no extra credit) including the final would earn it. I determined I would do it, and indeed, in the final quarter, I earned that elusive and rare A+. Let me tell you what that did for me. I had the confidence I would go as far as I could go in whatever my calling chose for me.” His response: “It might behoove you to know that you were the first student to make a 100 average without bonus points. There have been only 17 young people to accomplish this feat in my 47 years. I remember you very well. You thrived on the challenge of academic excellence. You made a 100 on my most challenging test.” My 50^th (plus 1) class reunion is in June, and I hope to see Dr. Goodin in Atlanta for the first time in 54 years. In 1966, the goal to strive for perfection was unquestioned. A career in medical physics may mean over 50,000 calculations, all of them perfect or a patient may suffer injury or worse.

My second anecdote (from 1973) comes from when I was working at Doctor’s Hospital in Tucker, Georgia. A gentleman having a lumbar spine exam was asking a lot of technical questions of our flustered technologist. I was a senior physics major and I volunteered to answer his questions. He asked about the grid, the bucky, the energy, the collimation, the radiation safety procedures in place, and a few other questions; I was able to satisfy him. He asked me what I planned to do, and I told him I was planning to attend the MS program in Health Physics at Georgia Tech next year. He smiled and said he would see me in class. I looked up and remembered his name: Karl Z Morgan. Some of you may recognize who he was: The Director of Health Physics at the Oak Ridge National Laboratories in the 1940s and 1950s, the founder of the Health Physics Society and the first Editor of the Health Physics Journal. He became my advisor for my first Master’s degree.

My third story is from my PhD Advisory Committee meeting at the MD Anderson Cancer Center. My advisor was the renowned Ray Meyn, one of the world’s leading radiobiologists and ultimately the acting Chair of the Department of Experimental Radiotherapy at the MD Anderson Cancer Center. However, in 1977, he was an Assistant Professor just beginning his career and I was his student. I put together a project, which I thought was acceptable. His friend and a member of my committee was a very bright scientist whose name was Roger H_. Every student was afraid of him. After presenting my project, Dr. H_ said, “all of this is good, but what is your goal in accomplishing this project since you want to become a medical physicist?” I replied, “my goal is to do such a good job with the experiments, the writing, the conclusions and the publication of this work that it makes my supervisor, Dr. Meyn, an eminent scholar, known around the world for the value of his creative science.” Ray Meyn chipped in, “Well, now that is a goal and ambition I can wholeheartedly endorse!” Ultimately, the two articles from this project received 156 citations, according to the Web of Science. Ray told me in 2007 that this was the most cited project in his career.

My final anecdote stems from when I was teaching a laboratory in radiation safety in 1979. It was about 7:30PM and the clinic was empty. I had two students, and we had access to the Atomic Energy of Canada Limited (AECL) Therac 20. I set the energy for 18 MV, the jaws for 40 x 40 cm, pointed the unit at 180 degrees (straight up), and told the students to find where the beam was coming out and measure it with the survey meters I provided. After one minute, I activated the beam. After 10 minutes, they returned. The beam was exiting into a physician’s office with the center of the beam right under the chair! The office was occupied by Dr. Bill Spanos, the man who ultimately became Chair of Radiation Oncology at the University of Louisville, and the gentleman who hired me to be Chief of Physics. His message through my students was: “Thank you very much, I appreciate knowing about this.” I later found out that, at least for some of his patients, four field techniques were eliminated in favor of three field wedged techniques, removing the 180‐degree beam.

So many in our culture approach life seeking to obtain power and to put themselves in a position where they do not need to practice excellence and are free from being questioned or criticized about their true goals and ambitions. Today, we can also be faced with significant social criticism of such perfectionistic goals and ambitions in education as a challenge to attain a 100 average. Does our culture welcome critical questions, or are we more often expected to trust powerful authorities without questioning them? Is it all about us and our goals, or is it still about making our employers and supervisors successful? Do we relentlessly strive to eliminate even small risks or do we minimize some significant risks while greatly magnifying others for personal gain or convenience? Is it wise to hold such self‐interested thinking and to welcome and empower those with such attitudes in the medical physics profession? How will this affect the practice of medical physics and ultimately the outcome of our patients?

What things do we not know that are putting ourselves, our patients or our employers at risk? After striving for excellence, asking critical questions, focusing on our goals, and examining the limits of our knowledge in a profession we are spending a lifetime to master, we often still find ourselves quite vulnerable to the unknown. Patients are ultimately best served by medical physicists who strive relentlessly for excellence, in a work environment unafraid to identify deficiencies or errors. Medical physics differs from many contemporary vocations with flexible missions where the time’s social priorities merge naturally with the profession’s flexible mission. At the end of the day, all medical physics work critically and heroically deals with human lives, their conditions improved or harmed by our actions according to the mindset we embrace.

4月9^日至10^日，肯塔基州路易斯维尔市开花了我的山茱flowering树，偶尔有一些紫罗兰穿过我的草丛。春天是新思维的肥沃季节，我希望分享新想法。我过去几天与某些医学物理学家进行的一些讨论特别发人深省，使我对医学物理学实践的某些特征和实质进行了反思。我在此提供一些个人轶事，这些轶事与我在医学物理教育和实践方面的经验以及一些当代思想相呼应。

我的第一个故事源于1966年，而我的第八^个故事小学数学课。我的教练戴克·古丁（Dyke Goodin）提出，凡在每周一次的所有考试中平均得分达到100分的人，都将获得全班A +分。我认为他只需要小心就可以做到，所以他接受了这一挑战。2018年，我联系了古丁博士，问他是否记得我。我写道：“很久以前，您对我们班级的挑战之一就是追求完美。您的A +标准令人生畏。包括期末考试在内的所有每周考试（不计任何额外学分）均不低于100％的平均水平。我下定决心去做，实际上，在最后一个季度，我赢得了那可捉摸和稀有的A +。让我告诉你那对我有什么帮助。我有信心可以尽我所能，尽我所能。他的回应：“您可能很想知道自己是第一个在没有奖励积分的情况下平均100分的学生。在我的47年中，只有17个年轻人完成了这一壮举。我很记得你 您在学业卓越的挑战中蒸蒸日上。在我最具挑战性的测试中，您获得了100分。” 我的50^第一场（加1分）同学聚会是在六月，我希望54年来第一次在亚特兰大见古丁博士。1966年，追求完美的目标毫无疑问。医学物理学的职业可能意味着超过50,000次计算，所有这些计算都很完美，否则患者可能遭受伤害甚至更严重。

我的第二个轶事（来自1973年）来自我在佐治亚州塔克市的医生医院工作时。一位接受腰椎检查的绅士向我们心慌的技术专家询问了许多技术问题。我是一名高级物理专业的学生，​​我自愿回答了他的问题。他询问了电网，bucky，能量，准直，适当的辐射安全程序以及其他一些问题。我能够使他满意。他问我打算做什么，我告诉他我打算明年参加佐治亚理工学院健康物理学的MS计划。他笑了，说他会在课堂上见到我。我抬起头，想起他的名字：卡尔·Z·摩根（Karl Z Morgan）。你们中的有些人可能会认识到他是谁：1940年代和1950年代橡树岭国家实验室的健康物理学主任，健康物理学会的创始人，《健康物理学杂志》的第一任编辑。他成为我的第一个硕士学位的顾问。

我的第三个故事来自我在MD安德森癌症中心的博士咨询委员会会议上。我的顾问是著名的雷·梅恩（Ray Meyn），他是世界领先的放射生物学家之一，并最终担任MD安德森癌症中心实验放疗科的代理主席。但是，在1977年，他是一名助理教授，刚刚开始他的职业生涯，而我是他的学生。我整理了一个我认为可以接受的项目。他的朋友和我的委员会成员是一位非常聪明的科学家，名字叫Roger H_。每个学生都怕他。在介绍完我的项目后，H_博士说：“所有这些都很好，但是既然您想成为一名医学物理学家，那么完成此项目的目标是什么？” 我回答说：“我的目标是在实验，写作方面做得如此出色，这项工作的结论和出版使我的上司Meyn博士（一位著名学者）因其创造科学的价值而享誉全球。” 雷·梅恩（Ray Meyn）插话说：“好吧，这是我可以全力支持的目标和抱负！” 据《 Web of Science》称，该项目的两篇文章最终获得156条引用。雷在2007年告诉我，这是他职业生涯中被引用次数最多的项目。

我的最后轶事来自当我在1979年教放射安全实验室时。那时大约是晚上7:30，诊所是空的。我有两个学生，我们可以使用加拿大原子能有限公司（AECL）的Therac20。我将能量设置为18 MV，钳口设置为40 x 40 cm，将设备指向180度（笔直），然后告诉学生找到光束的出处，并用我提供的测量仪对其进行测量。一分钟后，我激活了光束。10分钟后，他们返回了。光束正从椅子的正下方射入医生的办公室！办公室由Bill Spanos博士担任，他最终成为路易斯维尔大学放射肿瘤学系主任，并雇用了我担任物理主任。他通过我的学生们传达的信息是：“非常感谢您，对此我深表感谢。” 后来我发现，至少对于他的某些患者，取消了四项野战技术，而采用三项野战楔形技术，消除了180度光束。

在我们的文化中，如此众多的人追求生活，以寻求获得力量并将自己置于不需要实践卓越的地位，而不会受到质疑或批评其真正目标和抱负的情况。如今，我们也面临着社会对这种完美主义目标和教育抱负的重大批评，这是实现100分平均水平的挑战。我们的文化是否欢迎关键问题，还是我们更常被期望在不质疑它们的情况下信任强大的权威？这是关于我们和我们目标的一切吗？还是要使我们的雇主和主管取得成功？是我们不懈地努力消除甚至很小的风险，还是将某些重大风险降到最低，同时又为了个人利益或方便而大大放大了其他风险？在医学物理学界坚持这样自私自利的思想并欢迎和赋予这种态度的人明智吗？这将如何影响医学物理学的实践，并最终影响我们患者的结局？

我们不知道哪些事情使我们自己，我们的患者或我们的雇主处于危险之中？在追求卓越，提出关键问题，专注于我们的目标以及研究我们一生要精通的专业中知识的局限性之后，我们经常仍然发现自己很容易受到未知事物的攻击。最终，医学物理学家将为患者提供最好的服务，他们会在不怕发现缺陷或错误的工作环境中不懈地追求卓越。医学物理学不同于许多具有灵活任务的当代职业，在现代职业中，时间的社会优先事项与专业的灵活任务自然地融合在一起。归根结底，所有医学物理学都对人类生活进行了批判性和英雄式的处理，根据我们所接受的思维方式，人类的状况因我们的行动而得到改善或损害。