Remote medical physics: what actually can — and can't — be done off-site.

"Can physics really be done remotely?" is the first question most administrators ask — and it deserves an honest answer, not a sales one. The honest answer: most of the recurring clinical physics load can be done off-site, a specific set of tasks cannot, and the right program is almost always a blend. Here is where the line actually falls.

What can be done remotely

More than most centers expect. The recurring clinical load — the work that has to happen every week whether or not a physicist is in the building — is largely location-independent:

• Chart checks. Initial, weekly, and final chart QA against the written directive.
• Independent second-check. Independent MU / dose verification and plan peer review — a second board-certified set of eyes on every plan.
• Patient-specific QA. IMRT, VMAT, SBRT and SRS patient-specific QA, where your platform is remote-capable (log-file, portal-dosimetry, or cloud-based QA).
• Treatment planning and dosimetry. Remote planning and plan second-check by certified dosimetrists, including backlog and peak-volume overflow.
• Program work. TG-142 QA program design, policy and procedure documentation, shielding review, and accreditation-survey preparation.
• Consultation. The clinical problem-solving a physicist is called for — reachable, not resident.

None of this needs a person standing in the vault. It needs a board-certified physicist with access to your record-and-verify system, your QA platform, and your plans — and a defined schedule so the work lands on time.

What has to be on-site

Be wary of anyone who tells you otherwise. Some work puts hands on the machine, and that happens in person, on your treatment schedule:

• Machine QA. Monthly and annual machine QA, output calibration (TG-51 / TG-142 measurements), and mechanical and imaging checks.
• Commissioning and acceptance. Bringing a new linac, or a new planning or delivery system, into clinical use.
• Anything with a phantom or water tank. Physical measurement on the unit is physical, by definition.
• Certain regulatory roles. Depending on your state and your facility license, the Qualified Medical Physicist of record or the Radiation Safety Officer may be required to be physically present or licensed in-state. That is defined by your state's regulations — not by preference.

A firm that promises all of physics can be remote is either misunderstanding the work or hoping you won't ask. Beam measurements happen on the machine.

The real answer is hybrid

In practice, the strongest programs run remote for the recurring load and on-site for the periodic, hands-on work — machine-QA days scheduled around your treatment calendar, with weekly chart checks, second-checks, and planning happening off-site in between. You pay for the hours the program actually consumes instead of carrying a full seat year-round, and the machine work still gets done in person, by the same physicist who knows your program.

Get the scope in writing

Whatever the split, the engagement should state — in writing — who holds clinical responsibility, which tasks are in scope, and which are explicitly not. State rules vary, and "we assumed the physicist was covering that" is exactly the ambiguity that gets a program cited. Scope it to what your state actually permits, and say so plainly when a role has to be on the floor.