AAPM Newsletter January/February 1998 Vol. 23 No. 1 by AAPM Docs

Newsletter AMERICAN ASSOCIATION

PHYSICISTS

VOLUME 23 NO. 1

MEDICINE JANUARY / FEBRUARY 1998

AAPM President’s Column New Beginnings by Lawrence Rothenberg New York, NY I am most pleased to have this opportunity to speak to y ou as you r Pr esi de n t i n AAPM’s Fortieth Anniversary Ye a r. I am ho n o red a nd delighted to be able to follow in the footsteps of so many th at I h a ve k no wn wel l, both as mentors and friends. A s w e e nte r 1 99 8, A APM h as m any st re n gth s a nd some weaknesses which must be addressed. Our strength derives fro m the strong leadership of our o rg anizatio n o ver th e past years. Many thanks are due to Bhudatt Paliwal, outgoing C h a i rman of the Board, and Jim Smathers, our long time Tre a s u re r, b ot h of who m have worked diligently for A APM for m any y ea rs . B hu dat t wi ll cont i nue t o s erve AAPM, mo st notabl y as Cha i r ma n of th e H ea dqu a rter s S ite Vi s i t C omm i tt ee , wh il e J im i s moving into a leadership role i n A CMP. O ur E x ec utiv e Co mm itt ee r e ta i ns g re a t s t rength for 1998 with S t e v e T h o m a s mo v in g f rom a n o ut st and ing e ffo r t as President to Chairman of the Board, Jim Galvin continuing as Secretary, Geoff Ibbott to

P resident-Elect following a most su cc essful ten ure as Ch a ir o f the P ro f e s s i o n a l Council, and Melissa Martin becoming Treasurer following major efforts on the Finance Committee. Sincere thanks a r e al so du e to J o n Tr u e b l o o d for his tire l e s s e fforts as Education Council C h a i r ma n . Jon wi ll no w apply his education leadership to activities of ACR. I loo k f orw ar d t o w ork in g wi t h ou r C oun c il Ch air s : Ravi N ath and Ron Price con ti nu in g a s Sc ien c e Council Chair and Co-Chair, Do n F r e y a s Edu ca tion Council Chair after chairing the C on tinu in g Ed uca ti on Committee, and Mike Gillin as Professional Council Chair following leadership posts in both ACMP and ACR. I eagerly anticipate greeting

all of you at an outstanding 40th Annual Meeting in San Antonio in mid-August, with a f ull p r og ram o f Sci ent ifi c, Educational, Professional, and Social Activities which will be ma d e p os sibl e onl y through the dedicated efforts of so m any : our P r o g r a m Committee chaired by B o b G o u l d , th e Co n ti nui ng Education Committee chaired b y To n y S ei b e r t, a nd the Annual Meeting Coordination Co mm itt ee ch aire d by K en Van e k. We exp r ess our t ha n ks i n adv an c e to Scientific Program Director Mary Martel and Co-Director

INSIDE TABLE OF CONTENTS President’s Column. . . . . . . p. 1 Executive Director’s Column. p. 4 ABR Oral Exam. . . . . . . . . p. 5 1998 AAPM Budget . . . . . . p. 6 Mammography Rules . . . . . p. 9 ABR Exam Restructuring . . p. 18 CAMPEP Accredits Program p. 19 Announcements . . . . . . . . p. 19 Letters to the Editor . . . . . p. 20 THERAPLAN Plus. . . . . . . p. 21

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Maryellen Giger, Education P rogram Co-Director To n y Seibert, a nd L o ca l Arrangements and Te c h n i c a l Exhibits Chair Jim Marbach f or t he H e rcu lea n eff o r t s w hi c h w il l b e re q u i r e d of them. Of c ou rse , ma n y of ou r efforts can reach fruition only with the aid of our outstanding Headquarters Staff, led by Executive Director Sal Trofi, A n gel a Ke y s er , and L i s a Rose S ullivan with stro n g support from Penny Atkins, Andrea Hoopes, Jean Rice, J a n i e S te p l o w s k i , a n d Nancy Vasquez. In addition, our Web Page and Intern e t se rv ic es hav e ex p and e d greatly under the stewardship of Mike Wo o d w a rd. (Many more of our efforts and activit i es w il l b e ca rr ie d o ut t h r o ugh e -ma i l an d t he I n t e r net over the next few years, so I urge those of you not connected to arrange to log on as soon as possible.)

Assessment of Activities I believe that our educational activities in AAPM are very strong: at our Annual M ee t in g , a t our an nu al S umm er S cho ol , at RS NA a nd els ewh er e. So on y o u w il l be enc ou nt eri ng Remotely Directed Continuing Education (RDCE) - methods to obtain continuing education credits if you are unable t o atten d meetings. Th ese RDCE efforts will functio n through our journal, M e d i c a l P h y s i c s, an d thr ou gh o ur web page. In addition, the lengthy efforts to form a l i z e Medical Physics education are coming to fruition thro u g h our sponsorship of CAMPEP,

and the establishment and a c c r edi ta t io n o f Me d ic a l Physics Graduate Education Programs and, more recently, Medical Physics Residency Programs. Currently there are ten accredited graduate program s an d on e a ccre d i t e d residency program. Some graduate and residency programs are being supported with funds obtained by AA PM fr om A S T R O , Varian Associates, and most r ec ent ly fr om Elekta Oncology Systems, thanks to ef f ort s of o ur Development Committee, in particular Steve Goetsch. In addition, Steve Thomas and others have worked diligently to persuade RSNA to provide funding for two additional residencies in imaging, with current expectations for success being very high. Our scientific activities are v ery s t rong in rad ia tio n oncology and protection, but could be greatly strengthened in the diagno stic areas - a theme, alas, of many other Presidentâ&#x20AC;&#x2122;s Columns over the years. The Science Council has recently approved task g roup reports in four are a s : HDR brachytherapy delivery safety, quality assurance for clinical radiotherapy tre a tm en t p l an ni ng, r ea l- t im e B-mode ultrasound quality c o n t rol test pro c e d u res, and intravascular brachytherapy physics. The council has also e s ta b li sh ed five n e w t ask g roups: to develop re c o mm en da tio ns o n p e rson ne l m on it ori ng i n h ea lt h c a re facilities, to update material on r ad ia ti on c on t rol an d quality assurance for medical l a ser s y ste ms, to de ve lop

guidelines for photodynamic t h er apy do si me tr y an d physics training for PDT, for inhomogeneity corre c t i o n s , and for acceptance testing a nd qua l ity c on tro l o f e l e c t ronic devices for softc op y di sp lay o f med ic al ima ge s . In t he s cie n ti f ic a rena, we must expand our efforts to attract to AAPM scientists who are working in areas of medical physics outside of traditional radiology. I will address this task in detail in future Newsletters. O ur J ou r na l, M e d i c a l P h y s i c s, continues to thrive a nd pr ovi de n ew fe at ure s under Editor Colin Orton. We are all looking forward to re cei vin g a CD- RO M f ro m Medical Physics early in 1998 containing the complete 1997 articles along with abstracts of all articles published in M e d i ca l P hy s ic s s in c e its inception. I am delighted that f o r me r Ed it or John L a u g h l i n, with assistance f rom Charter Member P a u l G o o d w i n , is working on a history of AAPM and Medical Ph y sic s f or ou r For ti e th Anniversary celebration. This i n f o rmation will appear in a special second section of the July Medical Physics j o u rn a l . Many thanks are also due to E di to r B ob D i x on a n d M ana g ing Edi tor M a r s h a D i x o n for providing this bimonthly Newsletter. (Look for the Newsletter on our We b Page as well as in hard copy in 1998.)

Professional Matters & Certification Boards The efforts of our Executive Committee, of Geoff Ibbott, Mary Fox, and Dick Lane

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f ro m th e Pro f e s s i o n a l C o unci l, and o f co un tl ess other AAPM Members have established, continued, and extended strong interactions and collaborations of AAPM with a wide variety of regulatory, accrediting, and professional organizations. These i nc lu de JC A HO, C R CP D, MQSA, CDRH, ACR, ACMP, H C FA , and ma jo r scien tific organi zatio ns as well. Through the Tr i l a t e r a l Committee which meets three times per year, our President, President-Elect, and Chair of the Professional Council are making a concerted effort to c o o rdinate medical physics p r of ess io na l ef f or ts wi th t he AC MP, cha i red b y Alex T u rn e r, and the ACR Co mm is sion o n M edi c al P hy sic s, ch air ed by D o n Tolbert.

Certification Boards Finally, the question of certification boards for medical physics must be addre s s e d . A s y ou ar e al l aw a re th e AAPM Board reiterated at the 1 997 Ann ual Meet i ng i n Milwaukee that it sponsors the ABR and does not sponsor any other board. An adhoc committee has presented a r epo r t t o the E xec ut iv e Committee concerning the implications of sponsorship. EXCOM is in the process of reviewing and refining this document for consideration by the Board. In addition, many individuals and some Chapters have e x p r e ss ed gr ea t co nc er n , of te n i n ve ry e mot io nal t e r m s, abou t t he cu r re n t duplication of certification p rocesses available to med-

ical physicists through the ABR and ABMP examinations. (Please note that although all members of EXCOM read the MedPhys Bulletin Board, they choose to reply only occasionally in that forum, with factual information. Matters of AA PM p ol ic y ca n on ly b e decided in discussion with the AAPM Board an d then p resented through off i c i a l AAPM channels.) A re c e n t Ad-hoc Committee effort initiated by President Paliwal and continued under Pre s i d e n t Thomas was unsuccessful in resol vi ng t he cert ifi cat ion b o a rd duplication. However, because of the importance in the minds of most medical physicists of avoiding conflict and duplication of effort, the Board voted at our December meeting to direct that a letter be sent, co-signed by both the immediate Past President Steve Thomas and myself, to b ot h A BM P a nd A BR , requesting that discussions between the two boards be resumed in hopes of finding an acceptable solution to the duplication of effort. In my view, much more is required for the resolution of t he t w o bo a rd i ss ue tha n simple statements of the positive features of each board examination process, whether t hey ar e, or ar e n o t, endorsed by organization A or B, whether there is appropriate peer review, etc. We must put aside personalities and issues of control by individuals, groups, and/or organizations if we are to achieve a r ea li st i c s ol ut io n. I cal l upon the re p resentatives of bot h b oar d s to st op t he excessive public posturing

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w hic h is no w g oin g on at meetings, on bulletin boards, and elsewhere. The problem can be resolved only if the physics trustees and off i c e r s of the ABR and the members of the ABMP board of direct ors ar e w i ll in g to m ee t together in the spirit of compromise, in order to find real solutions to the duplication of effort. AAPM is willing to assist in any way possible to obtain such solutions. â&#x2013;

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Executive Director’s Column By Sal Trofi College Park, MD In this my first column for the 1998-year, I would like to po in t o ut some n e w a n d exciting first time occurrences that will take place in 1998. I am sure there will be others a nd I w ill r epo r t tho se t o you in coming issues of this newsletter.

New—Remotely Directed Continuing Education (RDCE) T he A A PM Boa rd o f D i rectors, at their December 1997 meeting, approved a plan devised by members of the Education Council to prov i de A APM m em be rs t he opportunit y to ear n RDC E credits. This plan will be submitted to CAMPEP for hourly Medical Physics Continuing Education Credits (MPCEC). Each month questions will be posted on the AAPM web site based on the content of a selected article published in M edica l P hysic s. Members can answer the questions to e a rn credits. The headquarters office will have a comp ut e r p rogr am w rit t en t o s c o re the tests, respond to t he m emb e r wi t h r e s u l t s , keep track of credits earned, a nd p ass on t o CAM PEP a list of credits earned by each m e m b e r. Look for this program to be available in the se c o nd q u art e r of 1 998 . During the 1998 year, there will be no charge to members for this service and an evaluation will be made if

fee s wi l l a p ply to fu tu r e years.

New—Medical Physics Journal CD-ROM A CD-ROM containing the full text of all 1997 articles from Medical Physics and all abstracts from the journal for the years 1975 through 1996 will be included in the April 1998 AAPM monthly mailing. The CD will contain approximately 3,800 abstracts and about 2,200 pages o f 1997 full text pages. Only memb ers of AAPM will r e c e i v e this CD at no charge The so ftware to be u sed w i ll be Ado be A c ro b a t Reader and Acrobat Searc h fo r C D. A ll a rt i cl e s an d abstracts will be fully searchable, readable and printable. The CD will be fully functional on Apple Macintosh, Windows and Unix. In future years, we plan to provide a new CD containing all past information plus the f ul l t ex t pa ges o f th e la s t completed year.

New—AAPM Newsletter on the Web T he ent i re AA P M N e w s l e t t e r, beginning with this issue, can be accessed on the AAP M web si te. In t he p as t , o nly t h e AA P M Presidentís Column was available. We plan take advantage of the opportunity this new tec hn ol ogy p rov ide s by adding more and more useful i n f o r mation. Checkout the AAPM.org web site frequently. Peri od ic al ly we e-m ail

tim el y in fo r m ati on to a ll AAPM members that have an e-mail address. Please provide yours if you have not already done so.

New—Books and Reports T he AA PM in v ent ory o f books and reports has been m o ved f rom a l oca ti on in Ve rm o nt to Ne w Yo r k . Springer-Verlag will now provide the sales and fulfillment f un cti on s. Thi s m o ve was made necessary because the American Institute of Physics (AIP) recently made the same arrangements. AIP and AAPM shared the same contact with the Ve rm ont pro vid er and this arran gement followed t h rou g h to t he Sp rin ge rVerlag contract.

Other Items of Interest T he 199 8 M em bers h ip D i re ct or y w i ll be m ail ed F e brua ry 1 5. Th is is la t er then we like, but we experienced delays due to a larg e number of member questionn a i r es r e t u r n ed and th e installation of a new database. For those of you with access, the latest information p ro ces se d i s ava i lab le b y accessing the AAPM web site, which is updated twice daily at noon and 5 p.m.

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Registration forms for the 19 98 Su mme r Sch oo l on Imaging in Radiotherapy and a Mi ni- Summ er Schoo l o n Nuclear Medicine Physics are included in this mailing. If you ha ve ac ce ss to t he I n t e rnet, you will find these f o r ms on th e AAP M si te. Registering this way is easy and saves you postage costs.

Staff News Na ncy Va zque z, ou r e x t rem el y com pe ten t A d mini str at ive A ssi st a nt, announced that she would be a mother for the first time nex t Jul y . Sh e mad e th e an no un ce me n t vi a of fic e E -m ai l a n d t he r o ar o f a p p roval from the staff was about the decibel level of a small atomic bomb explosion. Nancy reports that her husband, Donnie, is doing just fine. He has not shown any signs of morning sick ness yet, but h e does have this strange craving for ice cream and pickles. ■

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The ABR Oral Exam by Edward Chaney Chapel Hill, NC All approaches for conducting oral examinations can be classified as a variation on one of two basic formats: 1) on e- on -one e n co un te rs between the examinee and one or more examiners, and 2) evaluation by a panel of tw o or m o re exa min e rs. Whatever approach is used, a fun da me n tal pri ncip l e of good testing is to eliminate fa ct or s t h at c a n af f ect a n examinee’s perf o rmance or bias the score. This principle is particularly challenging to apply for oral exams, which by nature involve subjective as well as objective evaluati on . E a ch in te ra ct io n between the examinee and examiner(s) involves personality and interpersonal factors tha t af f ec t th e sub je c tive com p on ent of th e sc ore . Unfortunately these factors a re d if f icul t to c ont rol o r m e a s u re, and their eff e c t s b ec ome mor e va ri ed a nd com pl ex w hen m ore tha n two individuals interact during the examination. The ABR oral exam is actual l y a h y bri d o f the t w o approaches mentioned above. The exam is a series of oneon-one encounters, but the ex aminee’s overall perf o rma n ce i s r ev i ew ed by a panel of all the examiners who interviewed the candidate. This structure was chos en t o t a ke a dva nta ge of strengths of both approaches. The exam comprises a series

o f six 30-min ute sessio ns . During each session, the candidate is tested by a single exa min e r wh o a sk s on e question in each of five categories. Currently th e categories are design of radiation installations, calibration of radiation equipment, radiation h a z a rd co ntr ol , ra d iat io n dosage, and equipment. Each examiner assigns a score to the response to each question. The assigned score is f ree of potential bias fro m two sources. First, the rating is an individual decision that is unbiased by interactions or discussions with other examin e rs. S ec ond , s in ce e ac h ex ami ne r a s ks o nl y one question per category, the rati ng i s i nd e pe n dent of responses to other questions in t he sam e ca t egor y th at could b ias t he ex a mi ner’ s opinion of the can didate’s competence in that category. The final score in a particular category is the average of six scores assigned by the six examiners. Thus the candidate’s fate in any one category does not rest in the hands of a single examiner. When

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all six sessions are complete, the candidate’s perf o rm a n c e is evaluated by the full panel o f examiners. Only at this stage does group interaction and opinion play a role, and only in a way that can benefit the candidate. In particular the panel has the discre t i o n to determine that an average score in one category can be i n c reased from a failing to a passing score to correct for a spurious poor perf o rm a n c e . N o decreases are allowed. Raising a score is an option when the raise would allow

t he c and id a te t o p a ss th e e n t i re exam or to condition in one category. The ABR has embarked on a comprehensive psychometr ics pr o gra m to st ud y and improve both the written an d o ral ex am ina t io ns. (Psychometrics is the field of psychology that deals with t est i ng. ) Th is pr o g r a m includes an inhouse psychometrics staff to work closely with the trustees and exam c ommittees . P sycho metr ic analysis of results from recent physics oral examinations has

1998 AAPM Budget by Jim Smathers Los Angeles, CA F ollo wi ng t h ese fe w r em ark s yo u w il l f i nd t he 1 998 A AP M b udg et as a p p roved by the Board o f D i rectors at their December meeting in Chicago (RSNA). This is my last report to you as you r Tre a s u r er and th e experience has been an educational and challenging one. Reflecting back over the last six years we had the challenges of moving the headqu a rter s fr om New Yo r k , replacing our complete headquarters staff, and the movement of the Journal administrative staff in the Maryland headquarters. Your new treasurer, Melissa Martin, will have her hands f ul l too a s the c oncer n of maintaining the $370,000 of advertising revenue for the

J o u rn a l while moving to elect ronic pu blis hing will be a tough nut to crack. Melissa will report to you in the spring of 1998 as to the auditors statement of how we did in 1 99 7. T he cu rre n t es t ima t e is th at we w il l a d d abo ut $4 00 ,0 00 to our reserves.

Editor’s Note: We all thank you for an outstanding job for the past six years. Bob Dixon, Editor

shown that the exam has a high degree of reliability, that i s, the gra de s a ss ig n ed t o candidates by the examiners are strongly correlated. Other s t udi es ar e i n p ro g res s t o m o re fully describe the psychometric characteristics of th e ora l exa m. To da te , results indicate that the oral exa m is a dm ini ste red i n a manner that is reliable and fair to the candidates. ■

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1998 AAPM Budget

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1998 AAPM Budget

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The Final Rules – MQSA by Priscilla Butler Washington, DC Th e Foo d and Dru g Administration’s Final Rules for Mammography were published October 28, 1997 and become effective April 28, 1999. Embedded within the 144 Federal Register pages of comments and re g u l a t i o n s are specific requirements for equipment quality assurance. M o st o f t he r e q u i re m e n t s will remain the same as they w e r e d ur i ng t he I nte ri m Rules...that is, the same tests a nd pe r f o r m anc e cr i te ria described in the 1992 or 1994 AC R Qu ali ty Co ntrol (QC) M an uals . H owe ver, th e re wi ll be some chan ges and new twists to our old set of quality assurance (QA) activities. For example, the phantom image evaluation must now be done weekly, medi cal ph ysic is ts must add a m e a s u rement of radiation output (rate) and a check of pa d dle d e com pr e ssion to their annual survey and all personnel involved with QC must be aware of what must be do ne i f a t e st f ail s ( in some cases, the n ew rules prohibit the conduct of mammo gra ph y on th at u nit o r component until the problem is corrected). Although the re q u i red perf o rmance levels f or so m e tes t s w il l n ot change upon initial implementation of the Final Rules, more stringent levels will be phased in at a later time. Mobile mammography units are not exempted from meet-

A detailed comparison of the QC tests cover ed in both the Interim and Final Rules is outlined in the tables that follow this article. ing these re q u i rements and, in addition, must be able to verify that adequate image quality will be produced at each location of operation before exams are conducted. T he w ay t o d o t hi s i s not specified, therefore allowing some flexibility in developing performance tests. The Final Rules also go furt her t ha n th e Int er im b y specifying responsibilities of v ar iou s m em b ers of t he m am mogr ap hy t ea m. T he lead interpreting physician ha s the r es po ns ib il ity of ensuring that all QA requirements are met. As part of this responsibility, the lead i n t e r p reting physician must d e t e rmine whether individuals are qualified to conduct their QA responsibilities and whether their performance is adequate. The facility must allow enough time for these in di vid ua ls to per f o r m their QA duties. The medical physicist must oversee the equipment-related quality assurance practices a t t h e fa ci lity. As p a rt o f this, the medical physicist (or an individual under the direct supervi sion o f a qualif ied medical physicist) must conduct a survey of the mamm og ra phy f a cil i ty a t lea s t annually.(“Direct supervision” m ea n s tha t th e qua l if i ed

physicist must be present to supervise the individual during the survey.) His or her report must be sent to the facility within 30 days of the s urv ey dat e. In a ddi tio n, facilities are required to have their medical physicist conduct “mammography equipment evaluations” when new u ni ts or p r oce ss ors ar e installed, after disassembly a nd r ea ssem b ly , or ma jo r components of the mammography unit or processor are changed or re p a i red. These evaluations are not complete s urv ey s bu t o nly i nc l ud e t h e tes ts pe rt i nent t o the situation. Responsibility for all QA activities not assigned to the lead interpreting physician or medical ph ysi cis t mu st be assigned to a quality control tec hn ol ogi st (s ) or o th e r per s onn el q ua l if i ed t o perform the tasks. The Final Rules also cover in more general terms, QC tests for o th er mod ali ti es, facility cleanliness and infection control. The College is currently in the process of reviewing the new rules and revising their Qu ali t y C o ntr ol Ma n ual to be c ons is t ent wit h these changes.

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Update on ABR Physics Exam Restructuring by William Hendee Milwaukee, WI The restructuring committee for the American Board of Ra d io lo gy (A BR) P hys ic s Certification Examination held its first meeting in Louisville on No ve mbe r 2 nd . P arti cip ant s i nc luded Drs. Hubbard and Barrish (physics w ritten exam chairs); Drs . C o f fey , Fr ey a nd Bigg s (AAPM appointees); and Drs. C ha n ey , H end ee and S i mm o ns (ABR ph ysi c s trustees). Two physics written e xa mi na tio n c hai rs (D r s. Gr ah am an d M ori n) we re unable to attend. The meetin g yiel de d th e f ol lowi ng conclusions and assignments: • C ert i fi cati on by the ABR signifies that the physicist has demonstrated knowledge and competence suff icient to practice independently in the designated are a ( s ) of medical physics. • Physicists wishing to be certified in more than one area of medical physics must pass the complete examinat i on i n ea ch ar ea. A co mp r ess e d or al ex am in a ti on encompassing two or thre e a reas of physics will not be o ff e red af t er next June ’ s examination. • The certification classi f ica t io n of R a di olo gi ca l Physics will not be off e re d after next June. Instead , a certificate will be issued for e ach certifi cati on t ha t t he physicist achieves (i.e. curr en t ly T her apeu t ic Ra d io lo gica l P hys ic s,

Diagnostic Radiologic Physics, Medical Nuclear Physics). • To be ce rt ifi e d, an individual must demonstrate a(n): A deq ua t e ph y si cs bac kground and knowledge. Understanding of and ability to practice the appropriate area(s) of medical physics. Integration into the healthcare environment sufficient to serve as a clinical resource. • U n d e r gra du ate and graduate credentials required for admission to candidancy for certification: after long di sc u ssi on, t his i ssue was referred to a subcommittee of D rs. Cof fey, Simmo ns and H u b b a rd for re c o m m e n d ations. Included in this assignment is the issue of evaluating credentials of fore i g n trained physicists. • A committee of Drs. Bannerjee, Barish, Graham and Mori n wil l revise a nd e xp and t he present “Essentials” dociment for ABR tra i ni ng t o p rod uc e a Guidelines document to serve as a(n): S tud y a n d p re p a r a t i o n guide for potential candidates for ABR physics certification. E v alu ati on g uid e f or physics trustees evaluating the credentials of certification applicants. Knowledge guide for physicists preparing questions for the written and oral physics examinations. • In struct io ns wi ll be provided to a candidate’s refe r enc es d et ai l in g th e e vidence sought in validating

the candidate’s physics and clinical acumen. Dr. Chaney will draft these instructions. • Up on th e a dvi ce o f Mr. Gerdeman, ABR’s psychmetrician, Parts 1 and 2 of the physics written examination will move towards more multiple choice, single correct answer questions and fewer multiple choice and multiple correct answer questions. Mr. G e rdeman will work closely w i th th e ph ysi cs wr it t en e xam i nati on cha irs (Dr s. Hubbard, Barish, Graham and Morin) to enhance the statistical reliability of all parts of the written examination. • Medical physicists will be surveyed about the desirability of greater emphasis on Magnetic Resonance Imaging (including Functional Imaging and Spectroscopy) as part of the ABR physics examination. • T he de s ir ab il i ty o f migrating the oral examination to a computer-based form at wa s e ndo rsed by t he Restructuring Committee. Drs. B ig gs, Fre y a nd eith er Trueb lo od o r M adsen wi ll develop a plan and timetable for this migration. They also

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will consider new category headings and new questions for the oral examination. • The committee recognized the objectivity of the current ABR approach to oral examin iation of physicists w h e r eb y ca n di dat es ar e quizzed by several examiners independently in each category of the examination. This approach eliminates the possibility of examiner prejudice based on answers the examiner has heard to pre v i o u s questions in the same category . T he r at io nal e of th is approach is explained in the accompanying article by Dr. Chaney in this newsletter. • The committee re a ffirmed the desirability of 10year time-limited certificates with a target date of June, 2001 for initiation. A targ e t date of June 2005 was selected for availability of a voluntary ABR recertification program for medical physicists. • The next meeting of t he P hy sic s C ert if ica ti on Restructuring Committee will be held next Spring. ■

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CAMPEP Accredits First Medical Physics Residency Program by Kenneth Hogstrom Houston, TX The Commission on A c c reditation of Medical Physics Education Pro g r a m s , Inc., (CAMPEP) is pleased to announce accreditation of the Radiation Oncology Physics Residency Program at the B a r nes-Jewish Hospital/ Washington University School of Medicine. Accreditation is for a period of five years commencing October 1, 1997. Under the leadership of d i rector James Purdy, the P rogram has been one of the pioneers of Medical Physics Residency Education P rograms. There have been five graduates of the two-year p rogram, and there are p resently two residents in the program.

A c c reditation aff o rds many benefits to the program and its residents, including eligibility for various fellowships. CAMPEP encourages other programs to apply for accreditation. Copies of the “Guidelines for A c c reditation of Medical Physics Residency Education Programs” and information on how to apply are available f rom AAPM Headquarters or from: Kenneth Hogstrom, Chair CAMPEP Residency Education Program Review Committee M. D. Anderson Cancer Center - Box 94 515 Holcombe Blvd. Houston, TX 77030 The application fee for a c c reditation is $3,00 0. CAMPEP is sponsored by the AAPM, ACMP, and ACR.. ■

Announcements February 8-11, 1998 31st Midyear Topical Meeting of the Health Physics Society Mobile, Alabama Theme: “Good Practices in Health Physics”

July 12-16, 1998 43rd Annual Meeting of the Health Physics Society Minneapolis, Minnesota

January 1999 32nd Midyear Topical Meeting of the Health

Physics Society Albuquerque, New Mexico

June 26- July 1, 1999 44th Annual Meeting of the Health Physics Society Philadelphia, Pennsylvania For more information: Health Physics Society 1313 Dolley Madison Blvd., Suite 402 McLean, VA 22101 Tel: (703) 790-1745 Fax: (703) 790-2672 e-mail: hps@burkinc.com

AAPM NEWSLETTER

JANUARY / FEBRUARY 1998

Letters to the Editor The AAPM Job Placement Service and the Musical Chairs Phenomenon by Howard Amols New York, NY Every once in a while I see s ur vey s pub li sh ed o n t he number of jobs that are availa bl e in me dica l ph ysi cs . Most of th ese surveys are based on the number of jobs being advertised in the AAPM job placement “blue book.” While these are useful numbers, I believe caution must be excercised when trying to interpret these data. To whit, I present one example of a m usic al cha ir s ep is od e o f job s w aps w hi ch r e c e n t l y o c c u r r e d in m y a re a, an d which makes it appear as if there are more jobs opening up than is real ly the case. T he na mes h a ve b e en c han g ed t o p r ote ct t he innocent. Ph y sici st Bob r e c e n t l y re t i r ed from a very sen io r po si tio n at B igt own University Hospital. Job ad n um b er one ap pe ar s . Physicist Tony accepts job at BUH, leaving another senior position vacant at Other big University Hospital. Job ad num b er tw o a p pear s . Physicist Clyde accepts job at OUH, leaving a vacancy at A l most bi g M etro p o l i t a n Ho sp it al . J ob a d nu m ber three appears, which is filled by p hy s ic is t Cl aud e wh o m oves up fr o m Co un ty General Hospital, at which time CGH places an ad. This cascade continues, I’m

actually not sure how many m o re times, or even if this particular serenade of musical chairs is finished yet. The point being that the end of year statistics erro n e o u s l y indicate that at least 4 or 5 new jobs opened up, when i n fa c t o nl y o ne p e rso n re t i red, and zero hospitals actually increased the number o f p hy s ici st s e mpl oye d . Thus, the job picture, dismal a s it may a ppe ar, i s actually worse! ■

AAPM NEWSLETTER

Letters to the Editor Grandfathering Licensure of Medical Physicists by Dick Peskins St. Petersburg, FL Florida, following the example of Texas, has finally instituted l icen sure of Medic al Physicists with a deadline of applications set for 1 October of this year. Separate applications are re q u i red for diagno st ic ra d io lo g y, n ucle ar medicine, therapeutic physics and health physics. Each specialty application re q u i res a fee of $500 with a potential total cost of $2105 for four specialties plus $105 for gener al a p plic at io n f ee s. Unfortunately, it seems that money can also buy respect, if not creden ti als. Cu rre n t prac tic ing “physicists” are being “grandfathered” into the system. Only new applications, after the October deadl in e , ar e r e q u i red to ha ve b o a rd certification. In other words, Florida has pulled up t he g an gpl a nk t o p re v e n t additional rats from coming aboard, but has no policy for e x t e r mi nat ing th e cu r re n t stowaways. Practicing “physicis ts” in Florida have various backg r o und s. For ex am ple , an individual with an Associate D e g r ee in Ra di ol og ic Technology and a one-year graduate deg ree in H ealth Physics can qualify under the “grandfather” clause. I have b ee n un de r the m i sta ken assumption that the re q u i rement for licensure should follow tha t o f the “Qu alif ied

JANUARY / FEBRUARY 1998

THERAPLAN Plus is Alive and Well

Medical Physicist” stated by the ACR. In other words, an individual with board certifica tio n! If a “gr an df ath e r” clause is adopted, shouldn’t it p rovide for a clemency period t o a ll ow individual s to seek certification rather than obviating the requirement? A two -y ear wi nd ow wo ul d seem appropriate. In addition, I believe that the ABR, with the i np ut of t he A APM trustees, should scrutinize all b o a rd appl icants to insure that individuals have both a fou r y ea r und e rg r a d u a t e degree and a graduate degree in medical physics? As the AAPM has donated money to th e li ce nsu re pr o ce ss i n Flor ida , I be liev e t hat t he desired result of quality assurance remains a charade. An add it io nal pro blem i s t he re q u i r em en t t ha t on ly “licensed” physicists can perf o r m st ate ma n date d Q A. With the current “grandfather” clause, it is conceivable that a PhD medical physicist would be re q u i red to have his calibration checked by a health physicist with no experience in radiation therapy. Is this the intent of licensure? ■

by Nancy Lambrects Theratronics International, Ltd. O ne o f o ur p hys ic is t s pointed out that the article “A Note on the Hi st or y o f 3- D Tr eat m ent Pla nni ng Systems” did not include any reference to the THERAPLAN Plus system from Theratronics International Limited. The THERAPLAN Plus was officially released as a produc t i n O ct ober 19 96 . We received a 510(k) for software ver s ion 1.0 on November 12, 1996 and for Version 1.2 on July 9, 1997. We ar e p rou d o f o ur progress in one short year. Please feel free to contact me for further information. lambrects.n@theratronics.com

AAPM NEWSLETTER

JANUARY / FEBRUARY 1998

Letters to the Editor The H & H Curve by Stewart Bushong Houston, TX In October I participated in a two-day symposium, the Ist An nu al North eastern C o n f e rence on Radiological Sciences, on mammography and related issues attended by a p p rox imately 200 medical physicists and radiologic technologists. Dennis Watts, the p rogram director should be very proud. It was an excellent conference. I was delighted with the presentations of my colleagues, Joel Gray, Art Haus and Ed H end rick. I gleaned information from each of their talks that I was able to transfer immediately to my practice here at Baylor College of Medicine. I found one item particularly interesting and I would like to pass this on to other practicing medical physicists with commen t. Ed Hendrick presented some preliminary information on const ructing wh at he called a “contrast curve.” He obtains this “contrast curve” by plotting the slope of the characteristic curve (H & D curve) as a function of opti cal den sity (Figure 1).

D r. Hendrick showed how this simple maneuver could be used to extend the evaluation of film-based images. Of course his particular interest is mammo graph y and h e described how such an analysis i s a sen si tive QC too l especially for mammography. It can easily and quickly be used to 1) evaluate and optimize p r oces sing conditions for a given type of mammography film, 2) interc o m p a re sites for film-processing contrast across the range of optical densities, and 3) help guide the setting of technique factors and resultant ODs to match the contrast p r op erties of th e film and processing. At the end of the day, over bot tled water, I wa s discussing this pro c e d u re with my colleagues. I expressed to Dr. Hendrick how delighted I was with his presentation and the possible application of this technique to my practice. When I suggest ed th at we identif y this c urve as a Hend rick cu rve, Dr. G ray quickly pointed out that this was not new with Hendrick,

but rat her Haus h ad published on this procedure some years ago. Haus confir m e d that he had published this t r a n s f o rmation some twenty ye ars ago when we were kids!). He called it a “gamma plot ” bu t d id not describ e how it was useful in the field or any practical applications. Hendrick has taken this transformation to another level. I propose that we recognize the efforts of these very productive and senior medical physicists (Haus is re t i r i n g April, 1998 and Hendrick is not far behind!) by identifying this curve as the Haus/Hendrick curve or better yet, the H&H cu rve. The descriptive statement is that “the first d erivati ve of the H&D c urve results in th e H&H curve”. I will certainly u se this descr iption in my future reports. ■

AAPM NEWSLETTER

JANUARY / FEBRUARY 1998

AAPM NEWSLETTER MANAGING EDITOR Marsha Dixon

EDITOR-IN-RESIDENCE Robert Dixon Send information to: Marsha Dixon Broadcast News Public Relations 201 Knollwood Street Winston-Salem, North Carolina 27104 (336) 721-9171 Phone (336) 721-0833 Fax Internet: brdcst @ aol.com The AAPM newsletter is printed bi-monthly. Deadline to receive material for consideration is four to six weeks before mailing date. We welcome your entries, and encourage authors of articles to supply a photo. Please send material via e-mail, disks or mail. Faxes are encouraged as back-up, and are acceptable alone.

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