Life of Pi

The fantasy novel Life of Pi, written by the Canadian author Yann Martel and published in 2001, has probably been read by several of you. If not, you should definitely consider reading it. The novel received the Man Booker Prize in 2002 and has received several other prizes since then. The story is about a young Indian boy with the name of Piscine Molitor Patel, son of the owner of the zoo in Bondicherry. His given name, after a swimming pool in France, has various, not always so pleasant, associations and he decides to change his name to Pi. That name of course is associated with π. Pi was born a Hindu, but when he turned 14 years old he was introduced to both Islam and Christianity. He shows an interest in religion and establishes contacts with the local representatives of each of the three religions. His reflections about key aspects of each religion are highly interesting. When it comes to special situations, Pi uses the best of them all. This part of the book in my view is well worth reading by itself.

The main story in the adventure novel describes the emigration of the entire family from India to Canada, the reasons being difficulties to continue with the zoo. Pi is then 16 years old. They travel by boat, and the family brings along many animals from the zoo. The characters of some of the animals are well described. One night, something happens to the boat. Pi wakes up, while most of the other passengers do not. Members of the crew, many considered incompetent by Pi, are awake but do not handle the situation properly.

Shortly thereafter, Pi finds himself in a lifeboat together with a few of the wild animals, a wounded zebra, a hyena, an orangutan and, appearing after a short time, a 450 pound Bengal tiger, called Richard Parker. Pretty soon, only Pi and the tiger are left, the rest being killed by first the hyena and finally the tiger. We understand the final outcome already at the beginning of the book, which is told by Pi as a middle-aged man. Still, the 227 days in the lifeboat is a thrilling description of the physical and mental fight between the two survivors from the ship wreck.

Why do I then bring up this fantasy novel, almost a religious allegory, in an editorial of Acta Oncologica? Well, the ISI journal impact factor for Acta Oncologica from 2010, released in June 2011 showed a marked increase from 2.265 in 2009 to all time high of 3.137. The impact factor is always given with three decimals. This high precision is difficult to understand, but, if rounded up, it becomes 3.14 or pi (π). By coincidence, it seems that physics is to a great extent responsible for this increase. Pi is maybe the best known constant in the natural sciences. It is a mathematical constant but also very frequently occurs in physics descriptions (i.e. equations) of processes in nature, including the Maxell equations that are the basis for electromagnetics and thereby also radiation physics. Anyhow, Acta Oncologica is a general oncology journal and radiation/medical physics has been an important part of the content ever since the foundation of the journal almost 50 (or 25) years ago in 1963 (or 1987), see [1]. The proportion of the articles devoted to radiation/medical physics was high during the early years, since radiotherapy was then the predominant non-surgical therapy. With time and the general development in oncology, the relative contribution decreased. During the first half of the past decade, around five to 10 medical physics papers were published each year, contributing to between 4% and 8% of an increasing number of total publications each year. Starting in 2008, a marked increase has been seen with about 35 medical physics papers (15–20%) during the past three years [2]. In 2011, this number will be even higher (about 54 articles, or 28% of all articles).

The number of published articles does not in itself raise the impact factor of the journal. However, publication of many good articles in an active research area, like medical physics, results in more citations. The number of citations during one year (e.g. 2010) divided by the number of citable articles published during the two preceding years (2008 and 2009) gives the journal impact factor.

Medical physics is presently a very active research area and an important component of radiotherapy and has been traditionally strong in the Nordic countries, as emphasised in an evaluation of radiotherapy research by the Swedish Cancer Society [3]. Radiotherapy continues to be an important part of cancer therapy with an increasing role to a large extent caused by the improvements in planning and delivery technology achieved particularly during the past decade. The development in medical oncology with new drugs contributes to the increased role of high precision radiotherapy (and surgery) to attack tumour deposits that frequently are left once the drugs have killed all non-visible subclinical metastatic tumour deposits.

Radiotherapy and medical physics have been the topic of several Acta Oncologica symposia during the past few years. As a chief editor, it has been a great pleasure to notice the activities from the Nordic Association of Clinical Physics (NACP) and their interest in publishing articles from a series of symposia in Acta Oncologica. This was particularly so when NACP asked to have Acta Oncologica as their scientific periodical [2]. The journal was already the scientific periodical of the Nordic Oncological Societies and the Scandinavian Breast Cancer Group.

The present series of Acta Oncologica symposia in radiotherapy and medical physics started in 2006 with a symposium in Copenhagen, Denmark (but arranged by the group in Aarhus) devoted to stereotactic body radiotherapy (SBRT) [4]. The second symposium in Aarhus, Demark in 2008 dealt with image-guided and adaptive radiotherapy (IGRT) [5]. An NACP symposium was held back-to-back to this symposium [6]. Two very interesting commentary articles in the issue (number 2, 2009) outlined the bright future of physics in medicine and biology [7,8].

In 2010, the series continued with another symposium addressing an emerging development in radiotherapy, biology-guided adaptive radiotherapy (BIGART) [9], again held in Aarhus. The most recent symposium was held in Uppsala, Sweden in April 2011. It dealt with yet another “next logical” step in the improvement in radiotherapy, particle therapy [10]. Similar to the situation in Aarhus in 2008, a NACP symposium was organised immediately following the Acta Oncologica symposium. Papers from the two symposia were published in issue number 6 in 2011.

After a few years of fruitful engagement, the marriage between NACP and Acta Oncologica took place in 2011 (see above [2]). The marriage builds on good communication, mutual respect and understanding. More symposia will follow; it has already been decided to hold the next one in Turku, Finland.

Even if, from the above description, it may appear as if Acta Oncologica is turning into yet another radiotherapy/medical physics journal, besides the “Red”, “Green” and “Blue” journals, this is not true. Thanks to support from the Acta Oncologica Foundation that owns the journal, publication of the many radiotherapy and medical physics papers has been made possible by expanding the number of printed papers. The issues have simply been much thicker for those subscribers worldwide reading the paper version. The number of papers published in other areas has thus remained at about the same level throughout the past years. The time from acceptance and publication online to publication of the paged and printed version has unfortunately been prolonged somewhat, but I strongly believe that it is the electronic publication date that is most important for authors as well as readers. All articles are freely available on the net from the day of publication, whereas other articles are available for non-subscribers after six months. It should also be pointed out that several symposia in other topics than radiotherapy and medical physics have taken place. In 2009, we published two extensive papers about occupation and cancer follow-up of 15 million people in the Nordic countries, based upon the Nordic occupational study (NOCCA) [11,12]. A whole issue (number 5, 2010) was devoted to updated survival analyses of all major cancer sites in the five Nordic countries [13]. The analyses were based upon NORDCAN – a Nordic tool for cancer information, planning, quality control and research [14]. More recently, a symposium about Cancer Rehabilitation was organised in Copenhagen, Denmark with publication of the papers in issue number 2 in 2011 [15]. Further, the foundation has also supported a WHO symposium about prostate cancer held in Stockholm in September 2010. The symposium dealt with Screening, Prevention and Therapy – lessons learnt from current trials [16]. It was published as a supplement, the first one in many years, further increasing the value of each subscription.

These diverse activities in active research fields within oncology have led to the publication of many good articles. The increase in citations of the articles, increasing the journal impact factor, have likely contributed to further increased numbers of submissions, possibly coming close to 700 in 2011 from being only about 200 some years ago. Even with a clear increase in the number of printed pages, this has led to an increased number of rejections, also of scientifically good and interesting papers. It is my hope that the editorial board, now consisting of nine members representing the most important topics of oncology, will administer and further develop the increased attractiveness of Acta Oncologica.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.