AAPM Newsletter July/August 1998 Vol. 23 No. 4

Newsletter AMERICAN ASSOCIATION

OF

PHYSICISTS

IN

VOLUME 23 NO. 4

MEDICINE JULY / AUGUST 1998

AAPM President’s Column Summer Festivities

by Lawrence Rothenberg New York, NY

for President, Ken Hogstrom and Jean St. Germ a i n, each of whom was willing to serve us with their expertise and leadership qualities, and to make the incredible commitm ent of t ime an d e f f o r t re q u i red of those who serve in our highest office.

Annual Meeting in San Antonio I hope you are all enjoying an exciting and pro d u c t i v e s u m m e r, and I look forward to seeing you mid-August in S an Ant on io fo r our 4 0t h AAPM Annual Meeting. Our Headquarters staff and many dedicated AAPM volunteers a re expending a tre m e n d o u s e f fo r t t o i ns ur e t hat th e S ci en ti fic , E duc at io nal , P rofessional, and Social programs will all be outstanding.

In addition, you will all be r ec eivi ng a publ i cat i on reviewing the 40-year history of AAPM thanks to the diligence of John Laughlin and Paul Goodwin .

D ue to t he ver y w ar m wea the r ex pe c te d in Sa n Antonio, you are all encouraged to be comfo rtab le b y observing the casu al dre s s code at all events, with the po ssi bl e ex ce pti on o f th e Aw a rds Ceremony. My wife Laura and I and our children look forward to meeting with you and your families at the social events, and to enjoying e xce lle nt S ou th wes t s ty le food and several delicious f ro zen Mar gar it a s i n th e

Headquarters Site Visit AAPM is most grateful for t he re ce n t e f for ts o f t h e balmy San Antonio evenings.

My Presidential Symposium will focus on PACS and elect ro ni c i ma gin g f rom t he viewpoint of the radiologist, the imaging phys icist, the radiation oncology physicist, an d the clinical physicis ts involved in quality assurance acti viti es. The symposi um will kick off an outstanding four-day scientific and educational program with re c o rd numbers of attendees and excellent presentations.

Executive Directors Column. . p. 11

Elections and Candidates

ISEP Report . . . . . . . . . . . . p. 12

By the time you read this column our 1998 AAPM election will have been completed. I wa n t t o t a ke t his opportunity to thank all of the outstanding candidates who have agreed to run for office in AAPM, in particular our two superb candidates

Graduate Education Future . . p. 13

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INSIDE TABLE OF CONTENTS President’s Column . . . . . . . . p. 1 ACR Activities . . . . . . . . . . . p. 3 ABR Oral Exam . . . . . . . . . . p. 6 ABR Exam Restructure . . . . . . p. 6 Letters to Editor . . . . . . . . . . p. 9

Pakistan Trip . . . . . . . . . . . p. 16 Jack Krohmer Praise . . . . . . p. 18 NCRP Meeting . . . . . . . . . . p. 19 X-Ray Spectra. . . . . . . . . . . p. 21 Announcements . . . . . . . . . p. 22

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H eadqu arte r s S ite Vi s i t Com mi tte e, co ns is ti ng o f Bhudatt Paliwal, Chair, Phil H e i n t z, Ken Kase, Jean St. G e rm a i n , a nd B e rn a r d K h o u r i, Executive Dire c t o r of AAPT. The Committee visited our College Park headquart e rs aft e r r e v i e w i n g extensive documentation provided by Executive Dire c t o r Sal Trofi and his staff, evaluated the staff activities and current space allocations, and th e n p rov i ded a d eta ile d report with numerous recommendations which will allow th e HQ S taf f t o pro v i d e i m p ro v ed ser vi c es t o the Association. The Board has a l re ady ac t ed on som e o f th e recom mendat ions and will be considering several oth er s at th e S an A nt oni o Board Meeting.

Since our lease with AIP at the Am er ica n C en ter for Physics expires in 2001, I will so on b e app oi nt in g a Committee to examin e the HQ site options available to AAPM and make re c o m m e ndations for the future headquarters location. All options will be evaluated, including staying at ACP, leasing space at another location near D.C., moving to another geographic area, or possibly constructing or purchasing our own building at some convenient location. We look forward to hearing your suggestions for the future HQ location.

A Solution to Board Duplication?

The AAPM was ask ed by Alex Turner, Chairman of the B o a rd of Chancellors of the American College of Medical Physics (ACMP), to support

an ACMP proposal to eliminat e d uplic ati on of Board certification in areas of radiological physics. The proposal, which was to be sent to the American Board of Radiology (ABR) and had the full support of the American Board of Medical Physics (ABMP), consisted of the following three sections: 1. The ACMP seeks to become a full sponsor of the ABR with three trustees.

2. The ABMP will dissolve or relinquish certifying in competing medical physics subspecialties.

3. The ABR issues a certificate of equivalence in areas of common certification to all existing diplomates of the ABMP. Also, the ABR establishes a mechanism to allow candidates who are in the process of completing certification through the ABMP to continue their certification process through the ABR. At t he M ay AA PM Executive Committee Meeting, t he E XCO M v ote d u nani mously to provide a letter of support from AAPM for the ACM P p rop os al , pro v i d e d t ha t the A APM B oard o f D i rectors was in agre e m e n t .

B y ma i l b a llo t t he AA PM Board voted overwhelmingly (32 in favor, 3 against, and 2 abstaining) that I as President sh ou ld se nd a let te r on behalf of AAPM stating that “the AAPM strongly supports t he ACMP proposal to th e ABR for the resolution of the duplication of board certification in areas of radiological

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physics” as presented in Dr. Tu r ner’s letter to Dr. Sarah Donaldson, President of the ABR. Dr. Faiz Khan attached a let ter of support for t he proposal on behalf of ABMP. This proposal has also been discussed at several re c e n t A APM C hapt er me et in g s w h e re it generally re c e i v e d s t rong support of the members present.

I am hopeful that the ABR w il l p r ovi de a p osit ive response to this proposal so that the detailed process of elimi nat in g dup li cati on of c er ti f ica t io n ef f ort s ca n b e gin a nd p roc ee d t o a successful conclusion.

AAPM Symposium at CRCPD Meeting AAPM greatly strengthened the bonds between medical physicists and the regulatory community by its participation in the recent Conference of Radiation Control Program D i rector s (CRCPD) held in Mesa, AZ. A highlight for the attendees was a full day symp osi um , g i ven b y A APM members, on image quality and dose considerations in various areas of imaging. The group, organized by moderator Chuck Kelsey i n c l u d e d D o n Fr e y , Jo e l G r ay , Melissa Martin, Bob Pizzutiello, Keith Strauss, and myself. (I was particularly pleased to present Don’s talk on Digital Imaging with a b out 10 mi nut es' not i ce, si nc e D on wa s u na ble t o attend due to serious back p roblems. Of course he did send a superb set of slides by express mail which guided me through the talk. Hope y o u ’ re all healed and re a d y

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for San Antonio, Don.) All the speakers gave excellent p re s ent ati on s a nd had d et ail e d han dou ts f or t he audience, which stayed for all the talks from 8:00 AM to 5:00 PM in spite of the beaut i fu l 80˚ F we ath er in th e Ph oen ix a rea . F r a n c e s H a r s h a w a n d Di c k La n e also represented AAPM at the CRCPD Meeting.

We are pleased that CRCPD P resident Steven Collins and P a s t - P resident Dr. Jill Lipoti will be spending time with us in San Antonio.

ASTRO Roundtable on Intravascular Radiotherapy AAPM has been asked by T he Am eri can Soc iet y of T her ap e utic Rad ia tio n

Oncology (ASTRO), thro u g h its Chariman of the Board of Trustees Dr. Richard Hoppe, to participate in a Roundtable on Intravascular Radiotherapy.

I have appointed Ravi Nath, C ha ir o f bot h o ur Sc ien c e Co un ci l a n d of t he A AP M Ta sk G rou p pu blis hi ng a report on intravascular proced u res, and Steve Balter, who is deeply involved in clinical e f f ort s in i nt ra va scul a r brachytherapy, to re p re s e n t AAPM at the Roundtable.

Odds and Ends AAPM will participate with several radiological organizations in providing a significant contribution to “The Marc h : Coming Together to Conquer Cancer” in September 1998.

EXCOM has approved a doc-

JULY / AUGUST 1998

ument which the International A ffairs Committee will use to obtain re c i p rocal agre ements with the national medical physics organizations of other countries.

AAPM will provide support to AIMBE and various radiological organizations in an effort to establish an Institute of B io engi nee ri ng an d Biomedical Imaging Research with NIH. A AP M, t hrou g h t he P ro f essi on a l C ou ncil , th e Radiation Safety Committee, a nd th e Le g is lat io n and Regulations Committee, conti nu es to mon it or an d re s pon d t o d ev elo pme nts related to the NRC revision of 10 CFR, Part 35.

See You in San Antonio! ■

Activities of the ACR Commission on Medical Physics

by Don Tolbert Tripler Army Medical Center, Hawaii This report of our activities during the past year includes what has been, and w hat will be accomplished. There are several issues in development stages.

The C MP is considering final revisions to a bro c h u re entitled "Why Should Medical Physicists Join the American College of Radiology.” The long awaited “ACR Guide to Medical Physics Practice” may have been sent to the CMP for consideration by the time this is in print. An instrument for survey of our membership (see Committee on Human

Resources) has been sent to the CMP for review. When this review is complete, a recommendation will likely be made to the Commission on Human Resources.

Following a re c o m m e n d atio n from with in ( see Committ ee on Rad io lo gic Unit s, Sta ndards and Protection - CRUSP), the CMP recommended that the ACR fund training of state employees to continue the National Evaluation of X-ray Tre n d s (NEXT) study. On behalf of the ACR, Don To l b e r t received a thank you resolution from the Conference on Radiation Control Pro g r a m Directors (CRCPD) during the recent CRC PD meeting in

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Mesa, AZ. The CMP and ACR st aff (Charlie Showalter and Pam Wilcox) play a leadership role in the ACR’s interaction with the CRCPD. In a departure f rom the past, a radiologist (John Ca rd ell a, M. D. , an d

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CMP member) was funded by ACR t o attend the CR CPD meeting. John spoke on the use of C-Arm fluoroscopy outside the radiology setting and both his message and pre sence during the meeting was very well received. During the above-mentioned meeting in AZ , the AC R hos ted a recep tio n f or the CRCPD B o a rd. All CMP memb ers, ACR staff, FDA attendees, and all medical physicists attending the meeting w ere invited.

This provided the opportunity for formal acknowledgments as well as informal discussions between medical, physicists and acknowledgments and discussion of potential issues relevant to that interactions between the ACR and CRCPD. After Don Tolbert’s observati on th at the re l a t i o n s h i p between the CRCPD and medical physicists had impro v e d cons iderably over the past several year s, one o f the Board members remarked that it had taken awhile for them to gain trust in medical physicists but agreed that considerable improvement had taken place.

Jill Lipoti, who became PastChair of t he C RCPD at the end of the Mesa meeting, is th e CRCPD li aison to the ACR and w ill be attending meeti ng s with both the G o v e r nment a nd P ubli c Relati ons a nd CR USP Committees. Upon re q u e s t she will attend CMP meetings.

George T. Y. Chen, has been named the Liaison fo r th e CMP to the Commission on Radiation Oncology.

There are seven Committees und er the CMP. The Committee activities - with the

Chair names, are as follows: Committee on Economics James M. Hevezi The effort here continues with work on developing proposals for new CP T V and ICD 10 codes. Much of this work involves keeping abreast of new technologies together with the medical physics components.

This Committee continues to provide input for the development of the Radiati on Oncology User’s Guide.

Via this Committee's eff o r t , medical physics is represented on the new Medi care Commit tee u nder th e ACR Commission on Economics.

D r.’s Hevezi, Bogardus, and Brickner met with the Rocky Mountain Regional Carrier Medical Director and Grant S t e ffan in January of 1998 to propose that Medicare accept th e new ACR ’s Radiati on Oncology Procedure Guide.

The Committee has named Marilyn Wexler (Californ i a ) and James Hevezi ( Texas) to th e ACR’s Carrier Advisory Committee Specialty Commissions.

James Hevezi will serve on a subcommittee to oversee the possible implementation of HCFA’s proposed Ambulatory Patien t C enters (APC).

Technical reimbursement components of hospital- based outpatient radiology and radiation oncology procedures will be affected.

Committee on Education Jon Trueblood The Committee is organizing an ACR symposium to be held at the 1998 annual meeting of the AAPM. It will be entitled “ACR Standards and JCAHO Guideli nes for Medical

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Physicists.” T he cou rse is designed to inform the clinical medical physicist about his/her role in carrying out the activities detailed in the ACR stand a r ds .

The course has ACR/MEP accreditation as an education activity.

Plans for the 1999 ACR/CMP medical physics course will be initialized during this year’s AAPM annual meeting.

Suggestions for topics should be sent to Jon Trueblood.

Co mm it tee on G o v e r nm e nt an d Pub li c Relations - Richard Morin The Committee is reviewing p ro pos ed revisi on s to the Nuclear Reg ulato ry Commission’s Part 35. These regulations have to do with medical us e of licensed radioactive materials.

Th e Co mmit tee is act ive regarding the functions of the CRCPD and has begun planning for presentations at the next CRCPD meet in g.

Ongoing discussions include the NEXT study. how to use the data; what pro c e d u res to recommend for i ncl usion ; How to interact pro - a c t i v e l y with the NEXT Committee.

Committee on Standard s and Accreditation - David Vassy, Jr. Work is underway on the development of the following s t a n d a rds for 1998: “ACR S t a n d a r d for Dia gn osti c Medical Physics Perf o rm a n c e Monitoring of Computerized Tomography E qui pmen t,” “ ACR Standard f or Qu ali ty Assurance for the Te c h n i c a l Aspects of Radiation Therapy Tr eatment Planning,” and “ACR Standard for Med ical Nuclear Physics Perf o rm a n c e Moni toring of Nuc lear

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Medicine Imaging Equipment.”

The 1994 ACR Standard for Radiation Oncology Physics for External Beam Therapy has b een revi ewed and revised.

The following standards are being considered for 1999.

“ACR Standard for Diagnostic Medical Physics Monitoring of U ltraso und and MR I” as well as review of th e 1995 “AC R Standard fo r Brach ytherapy P hysics: Manually Loaded Sources.”

Dr. Mary Vogetsong Graham has been named the liaison to th e Co mmit tee from the Radiation Oncology Standards and Accreditation Committee.

Committee on Researc h and Technology Assessment - Perry Sprawls A DICOM booklet continues to be pre p a red for publication. This will provide an overview of pertinent facts and vocabulary associated with this increasingly important component of radiological practice.

A project has been initiated to evaluat e t he effec ts of image compression on diagnosis. Based on commentary received in reviewing the proposed limited pilot project on the rapid assessment of image c o m p ression, a more thorough full scale project is now in the works. The proposed study will be a multi-center trial with H enry Ford Ho spital, Univers it y of Michigan, and Mallinkcro d t Institute of Radiology. The study will evaluate the diagnostic impact of image compression utilizing a differential RO C techn iq ue to anal yze perceived differences between p a i red image sets in 4 cate-

gories of images (chest, bone, peds, and GU). Funding will be pu rsued from either an NIH grant or industry grants.

Co mm it tee o n H uma n Resources - Joel Gray A survey of the ACR medical physics membership has been designed, reviewed by the Committee and Jonathan Sunshine (Senior Director of R e s e a rch), an d sen t to the C M P. The p urpos e of th is survey is to gain profile information about the practice of our membership, of the professional issues considere d important, on whether or not they are on e-mail , and a co mpariso n of pr o f i l e s between those on e-mail and those not. It is hoped that this survey may be complete in time to have pre l i m i n a r y results by ou r meeting at RSNA. Committee on Radiation Uni ts , St a nda r d s, a nd P rotection - Fred Mettler, Jr., M.D. The Committee has requested the Commission’s support

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of ef forts t o as certai n t he number and type of radiological pro c e d u res b ein g perf o r med by rad io lo gists through ACR’s annual practice survey.

The Committee recommended that the CMP take a positive position on ACR support of t he NEX T survey. T hi s was acted upon and an ACR grant was made.

In addi tion to t he Committee Chairs, the CMP consists of: Priscilla (Penny) B u t l e r, John Cardella, M.D., Robert Dixon, Cassandra Sue Foens, M.D., Michael Gillin, and George Chen. The individuals comprising the CMP bring much leadership experience to our table. The CMP is active in its consideration of i ssues importan t to medical physics and the relati on ship of medi cal ph ysi cs t o our physici an col leag ues. I’m pro ud to chair this group.

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ABR Oral Exam Report Results of 1998 Oral Exams

by Ed Chaney Chapel Hill, NC A to tal of 162 candi dates took the 1998 ABR oral examination in one or more subfields of radiological physics.

The results are summarized in the table below. The examination covers five categories in each subfield as described in the ABR Booklet of I n f o rmation for Radiological Physics. Candidates who fail two or more categories must repeat the entire examination.

Candidates who fail in one category (conditional pass) are

o ff e red an examination in Novemb er to remove the condition.

Reminders Example questions from the written examination can be found at the ABR web site, http://The ABR.org. Other useful i n f o rmation such as the ABR

Field(s) Pass Dx 19 Tx 65 Nx 1 Dx, Nx 4 Tx, Dx, Nx TOTALS 89

Fail 14 31 3 3 52

Booklet of Information for Radiological Physics is also available on line.

The deadline for applying for the 1999 written exam is September 30, 1998. Information can be found at the ABR web site. Application materials can be obtained by writing to the American Board of Radiology, 5255 E. Williams Circle, Suite 3200, Tucson, AZ 85711, by faxing a letter to (520) 790-3200, or by sending an e-mail request

Condition 7 10 3 1 1 21

Total 40 106 7 8 1 162

Second Update on ABR Physics Exam Restructuring

by William Hendee ABR Physics Trustee Milwaukee, WI Th e R est ru ct uri ng Committee for the American B o a rd of Radiol ogy (ABR) Ph ysi cs C erti f ic a tio n Examination held its second meeting in Louisville on June 3, 1998. Participants included D rs.. H ubba rd, B ar is h, Banerjee, Graham and Morin (physics written examination chairs); Drs.. Coffey and Frey (AAPM appointees); and Drs..

C hane y, Hen dee an d S im mo ns ( AB R ph y si cs trustees). ABR staff pre s e n t during parts of the discussion were Drs.. Capp, Merritt, and G e rdeman and Mr. Becker.

AAPM appointee Dr. Biggs

was unable to attend. The meeting yielded the following conclusions and assignments: Committee members were reminded that compre s s e d oral examinations for simultaneous certification in more than one area of physics are no longer an option, and that candidates wishing to be certified in more than one are a of p hysi c s mu st pa ss th e complete certification examin a ti on in e ac h ar ea. Th e certification classification of Rad iolo gical Physics is no longer available; instead, a certificate will be issued for each c ertif ica tio n that th e ph ysicist achieves. Thes e changes were announced following the November 2, 1998 meeting of the Restructuring

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Committee. The only excepti on to th e ch a nges is fo r candidates who failed or condi ti on ed a pre vi ou s com p r e sse d exa min ation , and wish to retake the examination no later than May, 1999.

Candidates may take Part I of the written examination b e f o re they fulfill eligibility

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requirements for certification.

For example, they may take Part I during their graduate training. However, they must retake Part I if they do not apply for Part II of the written examination within five years of passing Part I. T he Res t ruc t uri ng Committee devoted considerable time to discussion of the c redentials of physicists for admission to candidacy for certification, including undergraduate and graduate educati on al r e q u i r em ent s. An u n d e rgr adu a te d e gre e in physics from an institution recognized by the appro p r iat e regi onal a cc re d i t a t i o n agency, or a degree in physical science or engineering from an accredited institution and with appropriate courses in physics, was considered to be appropriate undergraduate preparation. Individuals who do not meet these qualifications (e.g., graduates of foreign institutions or persons with undergraduate degre e s other than those described above) can be admitted to c and id a cy pr ovi de d th e y demonstrate adequate physics knowledge in some fashion, p e rha p s by ta ki ng t he advanced Graduate Record Examination. The Committee asked that a subcommittee of Drs.. Simmons (chair), Coffey, H u b b a rd, Morin and Barish continue exploration of this i ss ue i n pr ep a rat ion f or f urt her d is cuss io n a t th e nex t m ee ti ng of th e Restructuring Committee.

Th e " Ess ent ial s f or Education and Experience" do cu me nts for p hys ic ist s applying for candidacy in the d i ff e rent certification are a s

were discussed at length, and several changes were proposed. Committee members w e re ask e d to se n d by Au g us t 1 a l l p ro p o s e d changes to Dr. Barish who serves as the subcommittee chair for this issue. He will di str ib ute t he p ro p o s e d cha nge s to the r em ain de r of t he s ubc o mm itt ee (Drs. Banerjee, Graham, and Morin), and recommendations of th e su b com mi tte e wil l be pre s ent ed at th e next m eet in g of th e Restructuring Committee.

D r. C h an ey su bmi tt ed a d raft l ett er re q u e s t i n g endorsement from a candidate's re f e rences. The draft letter is more specific and complete than the letter used in the past. Comments on the letter should be sent to D r. Chaney by August 1 for incorporation into a final lette r wh ic h wi ll be us ed t o sol ic it i nf orma ti on fro m a candidate's references.

Begin ning with the 1998 written examination, multiple ch oi ce, mul t ip le cor re c t answer questions are gradually being replaced with multiple c ho ice , s in gl e co r re c t answer questions. This move reflects the advice of ABR's p syc ho me tr i cian , D r.

Gerdeman, that single correct answer questions provide a m o re thorough sampling of the knowledge re q u i red of cand idates . The chairs of each of the written examination committees agreed to p re p a re a " bl uep rin t" fo r ac q ui si ti on of ques t io ns a c ro ss t h e s pec t rum o f k now le dge b ein g te s te d in ea ch pa rt of the written examination.

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Drs. Chaney and Gerdeman agreed to compare results on the written examination with the oral examination score s of can di dat es to i dent i fy whether changes should be mad e on th e sel e ct i on o f passing scores for the written examinatio n. However, it was acknowledged that the written and oral examinations test two dif f e rent types of knowledge, and that perf o rma n ce o f ca n did at es on th e tw o e x am i nat i ons may not necessarily be closely correlated.

T he R e st ruc tur ing Committee agreed that oral examinations in each of the t h ree sp ec ial ty a re as o f ph ysi cs (Di ag no stic Radiologic, Medical Nuclear and Therapeutic Radiological) s hou ld ut il iz e c omp ut er workstations. This change wi ll p er mit gr eat er use o f images and graphics in these o ra l e xam i nat io ns.

Th e cha nge i s targeted f or t he o ral ex ami nat io n i n 200 0, with the oral examination in May, 1999 serving as a staging mechanism for the transition. A committee of Drs. Frey, Madsden and Biggs will p re p a r e ques ti on s f or the 1999 oral examination that can be translated into comp ute r for m at fo r th e 2 000 examination.

The oral examination categories will be changed beginning with the 1999 examination. A committee of Drs..

Si mm on s, Ch a ney a nd Hendee was empowered to implement the changes. The changes for 1999 are shown below. Further changes may occur in the future: Be gin ni ng i n 19 99, th e

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n umber of oral ex am iners pe r c and id a te w ill be r ed uc ed fr om 6 t o 5, a s evidence suggests that the s ix th e xam in er is alm os t always superfluous in decidi ng whe t her a c and id a te p a ss es eac h c a te go ry of the examination.

The Rest ru cturing Committee was re m i n d e d

ra di ol ogi c p hys ics.

Additional questions in this s ubj e ct wi ll be a va ila bl e beginning with the 1999 certification examination.

The next mee tin g of the Restructuring Committee will b e he ld i n Lou is vil le in November. â–

that beginning in 2002 tenyear time-limited certificates will be issued in all areas of physics certification.

Input from AAPM members in response to a query in the AAPM new slett er sugg ests s t ro ng supp ort for add in g m o re questions in magnetic resonance to the certification examin ati on in diagn os ti c

OLD

NEW

Design of Radiation Installations Radiation Protection and Safety Calibration of Radiation Equipment Patient-Related Measurements Radiation Hazard Control Image Acquisition, Processing and Display Radiation Dosage Calibration, Quality Control and Quality Assurance Equipment Equipment

DON’T FORGET You can send revisions for your directory address, as well as your address(es) for mailings, billings, and correspondence, at any time through the AAPM Web Page:

http://www.aapm.org NOTE: These are not automatic changes to your file. Your submission will enter a queue and will be processed as quickly as possible.

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Letters to the Editor On the AAHP Sponsorship of ABMP

by Don Tolbert Tripler AMC, HI Notice of this development in the last newsletter accentuated a concern I’ve had. I applaud the ABMP’s Medical He al t h Ph y si cs ca te go ry .

H o w e v e r, I have grave concerns re g a r ding the Ce rt i fi c ati on of He al th Physicists in this category.

This does not reflect a specific b ias a g ai ns t H e alt h P hys ici st s. I d o h av e a gen e ra l b ia s ag ai ns t an y certifying board with a specialty re f e rence in its title certifying members of a different specialty.

The profession of medical physics is relatively young and r ela ti v ely l ow on th e curve for developing creden-

tialing criteria. We lack the d e fi ni t io n t o ade q uat ely define our profession, and we don’t educate the healthcare industry in general, and h e a l t h c a re administrators in p a r t i c u l a r, on how to re c o gni z e a q ua lif i ed me dic al physicist. This exposes us to the risk of having medical physics jobs go to people in a nc ill a ry pr o f e s s i o n s .

Consider for example a nonmedical physicist certified by the ABMP in Medical Health Ph y si cs t alki ng w ith an a dmi ni st ra tor w ho n eeds someone to calibrate his/her x-ray tubes. “Are you certified by either the ABMP or ABR?” “Yes I am.” That’s enough for many healthcare administrators to feel comfortable that they have select-

ed a qualified individual.

I n m y o pini on , med ic a l physicists should be encouraged to prepare and examine in this important category.

The role of Radiation Safety O fficer is filled many, many times by the medical physicist because the facility does not have the size to justify a fu ll tim e R SO. Of t en t he medical physicist does not have the technical nor people management training and skills to sufficiently fulfill this high profile role. Many medical physicists have acquired these skills. Training programs are improving with the technical training, and hopef ully p eopl e man age me n t training is being pro v i d e d more also.

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CHPs Left Out in the Cold

by Louie Tonry, CHP Georgia I have been a member of AAPM and the Health Physics S ocie ty f or a nu m ber o f years. In 1994 I graduated f r om t he Un ive rs it y of Massachusetts at Lowell with a M ast er s i n R ad iol og ic al S af ety a n d tha t summ er p a ss ed bo th par ts o f t he American Board o f Health Physics examination. It was

by far the hardest examination I’ve ever taken!

I feel it necessary to let the AAPM know that I am very upset that the Society has left a per ce nta ge of q ua li f ied Medical Health Physicists out in the cold and is creating a division between radiation p ro f essi on a ls wi t h wha t I perceive as an elitist attitude.

My professional experience has been primarily in Medical Phys ic s . I’ ve b ee n t he

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Radiation Protection Off i c e r on three NRC licenses, two w e re T ype A broad scope.

Wh il e t he RP O o n t hes e li c enses , I ’ ve a ls o been responsible for quality control evaluations and equipment p e rf o r mance testing on all types of X-Ray equipment.

I’ve been perf o rming these duties since 1985.

I have voiced my opinions at many of the AAPM meetings but the issue has never

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been formally addressed. l’d li ke t o s ee t h is don e in the newsletter.

Cle ar ly t her e a re ma n y fields in Radiation Protection: ind ustrial, envi ro n m e n t a l , nuclear power plant, medical, site remediation to name just a f ew, w hi ch sh ow s t he divers ity of our sp eci alty.

BU T t her e i s a c om mo n thread through all these fields - they deal wi th Rad iation Protection.

My footer on all my reports i s “Qu al ity Im age s wi th Minimal Exposure”.

Is th er e no t a w ay in wh ich the c om muni ty c an recognize those professionals wh o ma y no t b e A BR or ABMP certified, rather being ABHP certified as being qualified to do what they have b ee n d oi ng f or n ume ro u s years? I’II tell you candidly, I am qualified to do what I’m doing and I do not want to have to take another certification exam to prove it! Why should I? At one of the annual meetings in a meeting with the FDA, I asked about the CHPs b ein g a ll owe d to pe rf o r m mammography surveys. One member of the AAPM said to me i n a ra the r i ndig n an t m a n n e r, th a t h e wo ul dn ’t think of perf o rming Health Physics at a nuclear power plant, why would I think I c o uld pe r f o r m M edi cal Physics. Frankly, although the comment demonstrated this individuals shortsightedness, I wouldn’t’ t practice out of my field either. But this is the point - Medical Physics IS my field. It just seems rather arbi trary which board one takes. We all hopefully have

p rofe ss io nal eth ics wh ic h gu id e our ac t io n s . We prac t ice w here a nd wh at we know.

I think this problem is just part of a greater philosophical issue. Who runs our profe ss io n? Is i t the p olit i ca l Iobbyists for the various societies or is it the membership?

A re we too parochial in our thoughts to the detriment of the profession as a whole? I hope AAPM will think about their children who they’ve left out in the cold!

It wasn’t a good solution to the issue.

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AAPM NEWSLETTER

JULY / AUGUST 1998

Executive Director’s Column

By Sal Trofi College Park, MD AAPM Reports Two new reports are being produced and will be distribute d t o a l l me mb e rs a s a benefit of membership in th e A AP M. Rep or t #58 entitled "Managing the Use of F l u o ro sc op y in M edica l Institu tions: Report of the R adi at i on P ro t e c t i o n Committee Task Group #6" wil l be av ai l ab le in Ju ly. Rep ort # 60 ent itl e d "Inst rumentat io n Req ui re men ts of D iag n os ti c Radiological Physicists: Report of the AAPM Diagnostic XRay Imaging Committee Task G roup #4" will be available in August.

Report #59 entitled "Code of Practice for Brachytherapy Physics: Report of the AAPM Radiation Therapy Committee Task Group #56" was published in Medi cal P hys ics, Volume 24, Issue 10 (October 1997). Additional copies of the report will be available for sale as part of the official report series in July.

AAPM Books Mon og rap h #24 ent i tl e d "Im ag i ng in R a di ati on Th e rapy , th e pro c e e d i n g s f r om t he 199 8 Su mmer Sc h ool hel d i n Ma di so n, Wisconsin" will be available by t he e nd of June . Th e Editors are John Hazle and Arthur Boyer. The AAPM Me mbe r pr ice is $6 0, the non-member price is $90.

P roceedings #10 entitle d

" Volume And K inet ics in Tumor Control And Norm a l Tissue Complications: Based o n t he Proceedings of the Fifth International Conference on Dose , T ime a nd Fractionation In Rad iation Oncology" will be available b y the end o f Ju ne . Th e Editors are Bhudatt Paliwal, Jack Fowler, Donald Herbert, a nd Min esh M eh ta. Th e AAPM Member price is $75; the non-member price is $95.

To place an order for these or other AAPM publications, p le as e co nt act : Spr ing erVerlag New York, P.O. Box 24 85, Secaucus, NJ 070962485, phone 800-SPRINGER, Fax: 201-348-4505 or E-mail: orders@springer-ny.com

Staff News J an ie S te pl ows k i h a s chosen to resign her position a s t h e A AP M' s C omp ut er Services Manager to stay at home and provide childcare to allow her daughter, Emily, to continue to attend college.

Janie is delighted and enthusiastic about taking care of he r gra nd so n C ol in .

H e r resi g nat io n w ill ta ke effect September 4. Between no w and th en, J an ie wi ll work fewer hours to accomm o dat e h e r new rol e a s childcare provider.

Th is a llow s u s t o f in d a replacement and have Janie train the new person. Janie has also agreed to take on the responsibility of managing the headquarters office at the San Antonio meeting (a r o le a t wh ic h s he h a s

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become expert). If you are attendi ng the San Antonio m ee ting , s to p by an d sa y goodbye to Janie.

Nancy Vazquez and hu sband Donnie are expecting the birth of their first child on July 24. Although the sex of the child was determined by sonogram, Nancy and her husband decided to wait for the delivery to find o ut .

So fa r t hey h a ve se ttl ed o n a g i rl’ s na me and have about five names for a boy.

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AAPM NEWSLETTER

JULY / AUGUST 1998

ISEP Report

by Azam Niroomand-Rad Washington, DC T he 7t h AA PM Sc ien tific Exchange Course/Wo r k s h o p in Radiation Therapy Physics w a s h e ld su cce s sful ly i n C a i r o ,E gypt , Ma y 10 - 14 , 1998. The Course/Wo r k s h o p w as c o-sp on sor ed by t he International Organization for M edi c al Ph ysi c s ( IO MP) E d uca tio n a nd Tr a i n i n g Committee. The objectives of this course/workshop were t o e xcha n ge in f or ma t io n c o n c e r n in g th e me di cal p hysic s p rof ess io n and to p resent advanced radiation therapy physics to clinical p hy s icis t s i n Egy p t an d nearby countries.

This Course/Workshop was o ff e red in collaboration with the Egyptian Association of Medical Physics, EAMP at the K asr El Ei ni Cen t er of On c ol ogy and Na tion a l C a nce r Ins t it ute in C air o , E gyp t. Pro f esso r A hme d Sh afei, President o f EAMP was the Host Director and D r. Na d er and. Z e in ab e l Taher and Mr. Kasem Abd El Halim(EAMP Treasurer) were th e orga ni ze rs o f t hi s Course/Workshop. The AAPM f a cu lt y w er e: D rs. Mad ji d Aissi, Leroy Humphries, Faiz Khan, Azam Niroomand-Rad, Bhudatt Paliwal, and James Purdy. In addition, Drs.. Nisar Syed and Aly Razek presented some clinical aspects of this program. About 93 medical physicists and radiation o nco lo gis ts a tt end e d t hi s C o u r s e / Works hop .

T he

Course/Workshop also included contained calibration of photon and electron beams as well as chamber calibration intercomparison. Eight e l e c t r o me te rs a nd 14 i on c ham ber s we re i nt er c o mpared using Co-60 beam and CNMC dosimetry equipment that had been calibrated by the AAPM ADCL at University of Tex as MD A n derso n.

T h ree cobalt machines, one 18 MV and one 6 MV photon beam and one electron beam w e re calibrated using AAPM TG-21. Calibration discrepancies up to 10% were detected and resolved. A total of 28 of D r. Kh a n’s bo oks , w ith au th or’ s di sco un t, an d 10 A APM re p ort s and m ono graphs were also donated to the major radiation therapy centers in Egypt. Certificates of P ar ti c ip ati on an d Certificates of Appre c i a t i o n were presented to the participants and faculty. The certificat es w er e s ign ed by D r s . R o t h e n b e r g, AAP M President, Azam NiroomandRa d , AA PM IS EP C h a ir, Colin Orton, IOMP President, and Ahm ed S h a fe i EAMP President.

The local expenses of the faculty were supported by the host institution and their t ra ve l ex pe ns es w er e financed by funds pro v i d e d by the AA PM , Me d ic a l Physics Foundation, and vendor s . C or pora t e Spo ns ors ( +$ 1, 0 00) w er e: C NM C Co mpa n y, C omp ut eriz ed Medical System (CMS), Cook Inc., Hek Med izi ntechni k,

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Gmbh,, and Varian Oncology Systems. Contributors ($100499) were Argus Software , H ue s ti s M edi c al, and N u c l e t r on .

C orp or at e S po nso rs w er e of f e re d a tabletop space for exhibition of their products in a ro o m adjacent to the lecture hall.

We are grateful to these organizations and companies for their generous contributions.

We also wish to acknowledge the commitment and effort of Drs. Aissi, Shafei, Sherbiny, Zei na b el Ta h e r, a n d M r.

Kasem Abd El Halim in the past few years in org a n i z i n g a nd i mpl e ment i ng thi s C o u r s e / Workshop as well as the effort of the local org ani z in g com mit t ee sta f f i n Egypt. We also like to thank D r. Humphries for donating his time and expertise repairing dosimetry equipment and to the AAPM faculty for volu nt ee rin g th ei r ti m e and effort in this endeavor.

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AAPM NEWSLETTER

JULY / AUGUST 1998

Report on the ABR Seminar on the Future of Graduate Medical Education (GME) in Radiology

by Guy Simmons Lexington, KY Those of us who assume federal funding for Diagnostic R adi ol ogy a nd Rad ia tio n oncology residents will continue ad-infinitum may be in for a rude awakening. That message was evident in the keynote address of a seminar ho st ed by t he A me ri c an Board of Radiology (ABR) in t he Di str ic t o f Col um b ia March 5-6, 1998. In addition to ABR Physicist Trustees Ed C hane y, B il l H end e e and Guy Simmons, the AAPM was re p r e s ent ed b y P r e s i d e n t Larry Rothenberg, Pre s i d e n t El ec t G eof f I bbo tt, pl us James Purdy, Russell Ritenour an d C ha rl es Wil son . Al l other ABR sponsoring organizations were re p resented in l ik e fas hi on . T hos e wh o read the following account w i ll see ma ny p ar all els between the problems facing the future of graduate medical education and those of graduate and post-graduate training for medical physicists. Moreover the factors that affect GME funding in the future will most certainly have an impact on medical p hys ic i sts a s ed uc ato rs, researchers and practitioners.

Sarah Donaldson, MD., ABR President, stated the purpose of the seminar in her opening remarks; viz., to identify educational obstacles to GME in Radiology and lay out a road map to overcome the obstacles. Doug Maynard ,

MD., chair of the org a n i z i n g committee, established the f o rmat and ch allenged the participants to leave with a clear pat h i dentified as to how we sh oul d p re p a re trainees to be successful in the medical environment of the future.

The keynote speaker, introduced by Bill Hendee, was Gail Wilensky, Chair of the M e d i c a re Payment Advisory Committee (MEDPAC) which advises congress on matters re g a rding funding of GME. Her opening statement was “I’m not sure where it’s going to go ( fu tu re f und in g of GME) - this is the bad news.

T he go od n ew s is , t hi s means we have the ability to imp act the o utco m e”. Dr Wilensky emphasized there are no agreed-upon roles for the federal government in the f u t u re funding of GME, and it is not an issue that will be easily resolved. The difficulty st ems from attempts by the feds to engage in policy decisions without defining the role of the federal gove rn m ent in f und in g GM E. C o n g res si onal support for plans to finance GME at the federal level is not identified.

Medicare changes are forcing the fe ds to lo ok a t is su e s re g a rding funding for GME. The traditional role of the federal government is to provide direct support for students through grants, fellowships, etc. In GME the feds are asked to provide support for the institutions that pro-

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vide the training. Specific issues listed by Dr. Wilensky include: 1. Why should the federal g o v e rn ment support GME? Should not the individuals who receive GME finance the training themselves? What abou t p rivat e foundatio ns and communities as sourc e s of funding?

2. What is the appropriate role for the feds in supporting GME? 3. Wo ul d st ud ent s fro m certain backgrounds be able to con ti nu e th e ir t ra i ning w e re it not for federal support to institutions?

4. Specialist versus generalist training - the feds have expressed concern about this as wel l as t he geog ra phi c distribution of the graduates.

5.

Shou ld sup po rt be d i rec t ly t o s tu de n ts or t o institutions?

6.

The i ss ue o f d ebt forgiveness.

7. Ho w to e nsu re th at GME is available to minorities and fiscally disadvantaged individuals.

To date, little thought has

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JULY / AUGUST 1998

been devoted to these issues at the congressional level.

They are intensely political issues, and the type of rational discussion Dr. Wi l e n s k y regards as necessary may not occur - at least not until the redesign of Medicare funding for the twenty-first century is settled, which probably will not happen until the middle of the next decade.

D r. Wilensky opined that change in the federal funding o f G ME is ne ede d: i t ha s been discussed, but Congress i s s lo w t o mo v e. H e nce t h e re is ample time for the medical community to help shape the decision making, through organizations as well as individually.

A pa n el o n “G ra dua te M edi c al Ed uc at io n in th e Next Millennium”, moderated

by Jay Harris, M.D., followed.

Robert Dickler, Senior Vi c e P r esi de n t f or He alt h Ca re A f f ai rs, A sso cia tio n of American Medical Colleges, s po k e on t h e “ Fut ur e o f Graduate Medical Education”.

He pointed out the uniqueness of the fed’s role as the l a rgest payer of health care f in anc in g in th e U nit e d States. DME (Direct Medical E du ca ti on) pa yme nt s a re s ti p ends a nd o th er dir e c t s u ppo r t t o t rai ne es. IM E ( I n d i rect Medical Education) pa ym ent s a re lin ke d t o DRG ’s a nd a ppl y only t o M e d i c a r e pa ti ent s.

Mr. Dickler stated that it is erroneous to talk about Medicare as a source of full funding for GME. It has been easy to fund GME out of patientc a r e d ol lars . We nee d t o find other ways to finance the costs. The responsibility

for GME should be linked to its funding.

M r. Dickler cited the size and scope of GME, the question of too many physicians, and specialists versus generalists as important issues. He als o drew attenti on to the five-fold increase in IMG’s ( I n t e r na tio na l Me d ic a l Graduates) over the last several years, with no incre a s e in the total number of medical students graduating in the US, as a factor that must be included in a long-term solution to the GME funding p roblem. Neither of these issues (IMG’s nor a glut of p hy sic ian s) r es ona te s in Congress.

M r. Dickler believes that regulation is not the answer to the GME issues. GME is e x t re mely d iv ers e - be ing hospital-based as opposed to medical school based. One possible solution is for medical schools to assume the responsibility for GME; i.e., e m ul a te t he C an ad ian a p p roach. Everyone wants the money - deans, hospitals, p r og ra m d ir ec t o rs . T he question is who should get it ? Th e deba te sh ou ld b e driven by educational considerations; i.e., what is the best wa y to ed uc ate g r ad ua t e medical trainees?

Another area discussed by M r. D ic k l e r is th a t o f t h e c o n t e n t a n d l oc a t i o n o f GME training. Should the content change, and should m o r e t r a i ni n g t a k e pl a c e outside the traditional inpatient environment? The latt e r i s a l r e a dy o c c u r r in g .

The next five years will see m o r e co n s o l i d at i o n o f health-care systems. Should

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there be dichotomy between where you practice and where you educate?

Maintaining the quality of GME through accre d i t a t i o n is of utmost importance. At p resent institutions must be a c c redited in order for indiv i d u al p r o g r a m s t o b e a c c r e d i t e d . M r. D i c k l e r r ai s e d t h e q u e s t i o n o f w he t he r w e s hou ld m ov e exclusively to institutional a c c reditation and no longer a c c r e d i t p r o g r am s . T h e idea is not popular, but will be debated. The re is a sense that programs are not adequately measured within th e co ntext of the perf o r ma nc e of th eir g raduat es.

It goes beyond passing the b o a rds - how well do they serve the community?

S am uel T hi er, M. D., P r esi dent and CE O o f Partners Health Care System, Inc. (PHCS), spoke on the “R ol e of GME i n an I nte gra te d He al th C ar e Sys t em ( IHC S). D r. T hi er heads an IHCS consisting of M ass ach use t ts G ene ral Hospital, Brigham Hospital a nd Nor th Sh or e M edi c al C e n t e r, plus others. It was organized to combat the penetration of managed care in the Boston area. The need is to protect educational and research functions while competing in the marketplace.

GME is evolving to include facilities other than teaching hospitals as training sites.

Diversification of GME training will enhance exposure to a wider variety of disease.

PHCS is developing joint vent u res with major clinics in Massachusetts. Developing co mmuni ty-based tr aining

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facilities is an important goal.

Dr. Thier informed the group that payment can be made for residents going off - s i t e under the Balanced Budget Act of 1997.

Obstacles to communityba se d G ME i nc l ud e th e i n c reased cost of training in an ambulatory setting comp a r ed to a hospital . Who b ears the extra cost? Th e managed care industry has not taken the cost of training a s one o f i t s c ha rg e s .

Managed care groups that do bu s i ne ss w it h PH C S mu st a c ce p t th e r e s e a rch a nd training component of the PH CS m i ss io n. Ve ry f ew managed care companies are investing in re s e a rch. This i mp l ie s th e y ar e i n th e health-care field for the short t e r m a n d ar e t ak in g th e re s o u rces out now. Time is another important issue. If f a cu l t y are p re ss e d t o d o p e rf o rmance work, it leaves less ti me for re s e a rch and education. Needs include 1) contracts with part-time facul ty, 2) t ea chi ng s pac e in clinical facilities, 3) better t e l e c o n f e rencing facilities, and 4) valid and re a s o n a b l e p e rf o rmance indicators: e.g., processes of care as opposed to outcome analyses.

H o w a r d K ess ler, M .D ., spoke on “Graduate Medical Education as Viewed by the Ins u ran ce I n dus t ry”. D r.

Kessler is Associate Dire c t o r of Aetna/US Health care. He spoke of the need for analyses of radiolog y re s o u rc e s utilization by primary care p hys ic i an s as a mea n s o f ass e ss in g th e dem and f or radiology services. On the q uest i on o f wh eth er th e

in su ran ce in dus tr y has a re s pon sibi li t y to sup po rt re s e a r ch and G ME, D r.

Kessler said there are no simple answers.

The final presentation in the session was “Present and F u t u r e Rol e of H CFA i n Funding Graduate Medical Education” by Mark Hartstein, Health Insurance Specialist with HCFA Health Insurance Sy s te ms .

M r. Ha rt st ei n detailed the provisions of the Balanced Budget Act of 1997 (BBA) as they affect GME. Additional payments for each d i s c h a rge in teaching hospitals are reduced incrementally f r om t he pr ese nt 7. 7% t o 5. 5% af te r th e y ea r 2 00 0.

The BBA also caps payments for osteopathic care and caps the resident-to-bed ratio to the prior year’s ratio. Other p rovisions include caps on the number of FTE’s for certain sp ecialties. The BBA allows affiliated hospitals to ha ve an a ggr egate cap o n resident FTE’s and allows for direct GME payments to federally qualified health centers, ru ra l h e alt h c l in ic s a n d Medicare-plus-choice organizations. The BBA also provides incentive payments to hospitals that downsize.

The remainder of the time was spent in break-out sessions with assigned topics followed by a plenary session in which reports were presented and discussed. Space does not permit a detailed ac c oun t o f th e re m a r k s .

While many questions regarding the future of GME remain u n a n s w e r ed, th e se mi na r afforded a unique opportunity t o ai r th e issues and to put forth the viewpoint of

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JULY / AUGUST 1998

the radiology community as the debate continues.

A fair question some may ask is, “Why is this seminar important to medical physicists? Why should medical p hys icis t s be con c er n e d about the future funding for diagnostic radiology and radiation oncology re s i d e n t s ? ” The answer lies in the fact that our professional lives are intimately entwined with radiologists and radiation oncologis ts . We teach re s i d e n t s , and we work daily with academic physicians and clinicians. A secure source of funding for residents in any medical specialty is essential for the survival of the specialty. It is in the interest of all med ical p hys icists t hat diagnostic radiology and radiation oncology survive and p rosper as medical specialties. The ABR recognizes the importance of medical physicists to the continued growth and viability of the radiology specialties, as we re c o g n i z e the importance of physicians in our profession. Medical physics is an important integra l co m po nent of ev ery aspect of the ABR mission.

It is there f o re to our mutual advantage that we participate as partners in activities such as the Seminar on the Future Funding of Graduate Medical Education in Radiology.

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AAPM NEWSLETTER

JULY / AUGUST 1998

Report on Pakistan Trip

by Geoff Ibbott Lexington, KY In June and July of 1997, I was given the rather extraordinary opportunity to spend three weeks in Pakistan. My vi si t was to th e Sha ukat Khan um Memori al Ca ncer Hospital and Research Centre in Lahore, where I was a consultant and educator in the radiation therapy department.

Pakistan was for med 50 years ago when two predominantly Muslim regions were partitioned from predominantly H in du India. In 1949, India and Pakistan won their independence from England, a nd in 1971, the re g i o n known as Eas t Pa kist an became Bangladesh with a separate government.

Pakistan stretches from the Indian Ocean, where it has a short coastline of appro x imately 500 miles, northward into the Himalayas, where it i s h om e t o n i ne o f t h e world’s 10 tallest mountains.

The n or t h e r n border between the Kashmir re g i o n and China is the site of one of the world’s highest driveable passes at over 15,000 feet elevation. India lies to th e e ast , a n d on th e wes t a r e Ira n and Afg ha ni sta n.

P a ki st a n e n co m pa s s e s a p p r ox i m a t e l y 3 00 , 00 0 s q u a re miles, about double the area of California. Its total population is about 150 million, roughly five times that of California.

There are four major cities i n P ak is ta n . Ka r a c hi is a

port on the south coast and is the center of commerc e .

Lahore is a sprawling city of 8 m i l l io n o n th e c e n t r a l plains near the eastern border with India. Islamabad is pl e a sa nt l y si tu at e d at t he foot of th e mountains and was built in the 1950s to be th e na t io n ’s ca p it a l . T he northwestern c it y of Peshawer is familiar as the g at e w a y to th e f amo us Khyber pass on the bord e r with Afghanistan. Unlike the o th er c it ie s , Is la ma ba d is clean and modern with wide s t reet s and moder n build i ng s. N earby Rawalpindi , p e rhap s fam il iar fr om the PBS series “The Jewel in the C rown” is more re p re s e n t ative of Pakistani cities with c rowded dusty streets and high poverty rate.

Being situated as it is on b road plains at an elevation of approximately 1,000 feet, L a h o re can be hot. Ty p i c a l daytime temperatures are 42˚ Cel si us ( 107 . 6˚F) an d c an r eac h 50 ˚ Ce ls iu s (12 2˚F) .

O f c ou rs e , it i s c oo le r a t night ; whe n I ste pp ed o ff the plane at 2:00 a.m., the t e m p e r a t u re was only 36˚ C (9 7˚F) . Th e lo ng awa ited r a i n y s e as on ha d n ot y e t arrived, so Lahore was subj e ct e d t o h ig h le ve l s o f humidity instead.

T he S h au k a t K ha nu m Me mo ria l Cancer Ho spita l a n d R e s e a r c h C e nt r e wa s built by Imran Khan, a hero in Pakistan for his role as captain of the World Cu pw i n n i ng c r i ck et t ea m in

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1992. After his mother died o f c a n c e r, I m r a n K ha n undertook to raise funds to build a private cancer center that would be s uperior to the government-run hospit al s . To a ss i st hi m , h e recruited his cousin, Dr. N. Burki, a professor of medic in e at t h e U n iv e r s i t y o f Kentucky Medical Center in Lex in gto n. Dr. Burki was instrumental in coord i n a t i n g the design and construction of th e ho s pi t a l, re c r u i t e d most of the senior staff, and a r r a ng e d f o r v i s it s b y A me r ic a n a nd Eu r o p e a n experts to provide expertise an d g u id a nc e . P r in ce s s D ia n a c o n t r ib u t e d t o t h e fundraising and visited the Centre se v e ral t im e s .

Patients who are unable to pay receive their tre a t m e n t at no charge, and housing is provided for those in need.

S K M C H i s c o m p a r a bl y equipped to western hospitals, with medical, surg i c a l a n d r a d i a ti on o n c o lo g y departments. The radiology d epart ment of fers C T and MR, and the nuclear medicine department has a dualhead camera capable of S P E CT im a g i n g . Un l i k e m o s t w e s t e r n ho s pi t a l s, S K M C H i s a ls o e q u ip pe d with two huge generators,

AAPM NEWSLETTER

each capable of sustaining the hospital during the frequent electrical outages.

T h e r a d i a ti o n on c o l o g y department is equipped with a modern, dual-photon energy linear accelerator, a 60Co t e l e th e ra p y u ni t, a r a di o g r a p h i c / f l u o roscopic radiotherapy simulator, and a 3-D treatment planning computer.

Ancillary equipment includes a 3-D scanning water phant o m sy s te m, a s t y r o f o a m bl o c k c ut t e r, a c al i br at e d ionization chamber and elect r o m e te r s y st e m , a n i o n c h am b e r Q A t oo l , an d a diode in-vivo dosimetry system. The department also has an inventory of 137Cs s o u rces for brachytherapy.

A record and verify compute r s y s te m w a s i ns ta l le d wh ich is i nter faced t o the s i m ul a t o r a nd th e l i na c .

W h i l e m o st of t he eq u ip ment was functioning pro pe r ly a n d w a s w e ll m a in ta i n e d , l ik e m a n y ne w l y d e v e lo pe d co un t r i e s, Pakistan frequently experiences difficulties in obtaining qualified service for major equipment. During my visit, se v e r a l ma l f un ct i o ns o c c u r red which would have been corrected promptly and easily in the U.S., but which required days or even longer t o c o r r ec t i n Pa k i s t a n.

L a h o r e ’s e l ec t r ic a l p ow e r su pp ly f ai ls a t l e a st on c e each day, and the hospital’s generators take over when th is ha pp e ns . H ow e v e r, there is always a momentary o u t a g e . M o s t e q u i pm e n t was p rotected by un in terruptable power supplies, but the accelerator would turn o f f e a c h t i m e t he p o w e r

fluctuated. Unfortunately, patient treatments were often delayed by these interruption s. N oneth eless, I was i m p ressed by the quality of patient treatments, and the d e g ree to which tre a t m e n t techniques were comparable to those I am familiar with in the U.S. The two radiation oncologists (one trained in Europe, the other trained in the U.S.) follow the development of clinical re s e a rc h closely, and were utilizing up-to-date techniques.

The quality of the equipment at SKMCH was in stark c o nt r as t to th e a gin g a nd l a rg e ly n o n -f u n c ti on in g equipment I observed at one of the government-run hospitals. At this facility, nothing was working; neither the a c c e l e r a t o r, the cobalt unit, the remote afterloader, nor the treatment planning comp u t e r. Patients were being r e f e r re d e ls ew h e r e .

At another government hospital, I was not permitted to see the eq uipment, and I suspected th at the s taff w ere too embarrassed to show it to me.

My principle host during t he v is it w a s M r. A m j a d Wa h e e d, S e ni or M e d i c al Ph ysi cis t and Dep ar tm en t M a n a g e r. M r. Am j a d h a s about s ix years of experience in several subfields of m ed ic a l p hy s ic s, ha v i n g worked at several other hosp it al s i n P a ki st a n b e fo re com i ng t o SK MCH . H e is joined by two more junior colleagues; Mr. Mohammed A l i S h ah a nd M s . M a hn a z Q a m a r. All three physicists h a v e MS c d e g r e e s f ro m Pakis tan i universities , but

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JULY / AUGUST 1998

only Mr. Amjad has additional formal training in medical physics. All three struck me as ent hu siastic, energ e t i c , and bright, and had worked h a rd t o l ea r n m e d ic a l physics from the re s o u rc e s available to them. That they a re hard-working and dedicated was clearly evi dent, and th ey kep t me bu sy at night and on weekends also!

While my visit to Lahore was primarily hard work, it was also very enjoyable and a wonderful opportunity to l e a rn about a culture quite different from ours.

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AAPM NEWSLETTER

JULY / AUGUST 1998

Praise for Jack Krohmer

by Bill Hendee Milwaukee, WN M edi c al phy si cis ts a nd p hy s ici a ns h a ve mut ua lly benefited over the years from a collaborative working relationship devoted to impro ving diagnostic and therapeutic medicine. This re l a t i o nship has not evolved casually . It h a s b een nu rtu re d c a r e ful ly b y i nd ivi du a l physicists and physicians with th e v is io n t o re cog n ize t he i mpo rta n ce o f th e r ela tio ns hi p, an d t he c redibility to foster it within their professions.

Jack Krohmer is one physicist who has held this vision for many years and worked t i re l ess ly to b rin g it i nt o focus for others. He started teaching residents in 1947, a nd has p r ob abl y ta u ght physics to more radiologists th a n a ny o th e r ph y sici st a c ti v e to day.

He h a s undoubtedly served as a consultant in radiological physics to more hospitals, clinics and physician-groups than anyone else. He has held leadership po sition s in t he Ameri ca n College of Radiology and the Radiological Society of North A m eri c a, a s w el l as t h e Am eri c an Ass oc iat i on o f P hys ici st s i n Me di cin e (AAPM). And he has probably examined more physicists a n d ra di ol ogi sts t ha n any other physicist in the history o f the A me ri c an Boa rd o f Radiology (ABR).

Jack Krohmer began examining for the ABR in 1961,

and was appointed in 1967 to succeed Edith Quimby as a m emb e r of the B oar d Ă­ s Ph y si cs Cr e d e n t i a l s Committee. In 1980 he was e le ct e d t o t he A BR a s t he first non-physician to serve in su ch a capacity on that or any other medical specialty b o a rd r ec ogni ze d b y th e American Board of Medical Specialties. In this position he encouraged both the ABR an d the AAPM to agree to the AAPM becoming an official sponsor of the ABR, an objective met in 1991. He also urged expansion of the ABR to three physics members, which was achieved in 1996. Over his 1980-93 term as ABR trustee, Jack Krohmer i m p roved the examination and certification process for ph y sici st s , e nh anc ed t he r ec o gni tion of me dica l ph y sic s w it hin the w i der s p h e r e of m edi c in e an d h e a l t h c a r e del iver y, and encouraged opportunities for medical physicists to succeed in a variety of clinical and re s e a rch settings. Everyone practicing medical physics t od a y ow es m uc h to Jack K ro h m e r.

Th is a rti cle acknowledges our gratitude.â–

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AAPM NEWSLETTER

JULY / AUGUST 1998

NCRP Annual Meeting 1998

by Edward Webster Boston, MA Cosmic Radiation Exposure of Airline Crews, Passengers and Astronauts At the annu al sci ent ific meeti ng o f the NCRP in Crystal City, MD, 17 one-halfhour papers were pre s e n t e d on the relatively new types and levels of o ccupational radiation exposure re c e i v e d by persons traveling in several regio ns of th e space surrounding the earth. The topic is of great significance in the field of radiation pro t e c t i o n since airline crews are now one of the mos t h eavil y exposed “radiation worker” g roups with doses exceeded only by astronauts.

Th e P rogr am Committee c h a i r man, L awr e n c e Tow nsend (Universit y o f Tennessee ) introduced the program and its organization: differences between the near an d far radiati on envi ro n ments; radiation exposure in spacecraft and in commercial supersonic aircraft; epidemiology studies; and radiation regulatory programs. Two types of cos mic radi atio n w ere noted: the chronic galactic co mpo nent and th e sol ar component highly variable in time, place and int ensity.

John Wilson (NASA) reviewed several basic radiobiological factors including the variation with LET of wR ranging from 1 for photons to 20 for neutrons in the energy range 0.1

to 2 MeV, alpha particles and heavy nuclei. He noted current trends in air transportation: for subsonic carriers, lo nger hauls with doub le flight crews and higher altitudes (42,000 ft); for supersonic carriers, altitudes fro m 60,000 t o 80,000 ft . He emphasized the large increase in neutron exposure with altitude, geographical flight path and period i n s ol ar cyc le.

For example, at 65,000 feet, the intensity increased by a factor of 6 at the geomagnetic poles relative to the equator.

There is also a change in the mix of radiation: at 60,000 feet 2/3 of the radiation has a wR > 1.

Eleanor Blakely (Lawre n c e Berkeley National Lab.) next reviewed the determ i n i s t i c and stochastic effects of cosmic radiations, based on laboratory studies of acceleratorproduced radiations including heavy ions. The more massive DNA damage from neut rons and heavy ions comp a red with gamma rays was discussed. Significant chromoso mal aber rati ons have been seen in long-term (> 6 months) crew of t he MIR spacecraft, e.g., chromosomes with 11-29 breaks. An important conclusion reached for high-LET radiations (e.g. 100 keV/micron) is that fractionation increases chro m o s o m a l damage, in contrast to the d e c rease seen from low-LET radiation.

Four papers discussed radiation measurements made in space and in high altitude air-

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craft. G. D. Badhwar (NASA) provided information on doserate (µGy/day) received by low-earth-orbiting crew members. The dose-rate increases by a f actor o f about 100 ( f rom 30 to 3000 µG y / d a y ) for 600 km altitude compared with 200 km. Of interest was the accrued dose for Hubbell mission personnel of about 3.2 cGy. The m ax im u m dose to MIR personnel (not including neutrons) was reported as 8 cGy. At an altitude of 470 km, a doserate of 460 µ Gy/ day fro m neutrons with wR = 8 (i.e., 3.7 mSv/day) was reported.

John Wilson (NASA) presented radiation dose estimates for a hypothetical 2.5 year mis si on to Mars wit h total transit time 1 year and s u rface residence time 1.5 years. The total dose estimate was 50 cSv, not including po ssible con tribu tions from solar flare activity during the mission.

Paul Goldhagen (U.S. Dept. of Energy) presented estimates of radiation doses to the crew of future high-speed commercial jet aircraft flying at 65,000 feet based on measure m e n t s made on multiple flights of an experimental NASA ER-2 aircraft with 14 recording instruments. H e no ted th at air shielding at that altitude drops to about 5% of the shielding on the ground so that exposure from galactic cosmic rays at that altitude would be 500 times greater than at sea level.

In addition, due to geomagnetic shielding, the dose per

AAPM NEWSLETTER

JULY / AUGUST 1998

1000 hours at 65,000 feet would range from ab out 3 mSv at the equator to about 19 mSv at the poles.

Uncertainties arise from solar cosmic ray events which produce a much larger dose at altitude than on the ground.

Bagshaw (British Airways) summarized radiation measurements made on the crews of the Concorde supersonic aircraft since their introduction i n 1969. Most fl igh ts are m ade at 59, 000 f eet but because of higher radiation levels northern flights are at 38,000 feet. Gamma rays are measured with TLD and neut rons with BF3 pro p o r t i o n a l counters. The effective doserate for flying crew is 5µSv/hr for a total of 6 mSv/year. A long-term epidemiology study of the crew members to date has shown no medical problem.

A. Ch ee (Boei ng Corporation) also discussed radiation doses to passengers and crew of supersonic transports flown at 65,000 feet.

N e u t ron doses made with a tissue-equivalent proportional counter were highly variable d ue to a smal l n umber o f high lin eal energ y events.

Typical of the dose levels is 6.4 µS/hr for the Los AngelesTokyo flight for a total of 0.03 µ Sv. This is 3% o f the 1 µSv/year limit for publ ic exposure.

Waters (NIOSH) described studies of aircraft cabin expos u r es du rin g c ommerc i a l flights of female flight attendants. Cosmic radiation levels on commercial flights have been measured with a tissueequ ivalent pro p o r t i o n a l counter. Doses ranged from

0.9 to 6.0 µSv/hr and for a working year in flight of 600 hours the annual dose would range from 0.54 to 3.6 µS v .

The latter exceeds the general public 1 µSv/year limit but is only a small fraction of the occupational exposure limit.

G . Kendall (NR PB, U.K.) reported the variation of dose f rom galactic c osmic rays (mainly protons) with altitude ranging from 0.3 µSv/hr in a jet aircraft at 33,00 ft. to 0.5 µSv/hr in a Concord e at 49,000 ft. He also noted the 11-year solar cycle and its periods of sunspot activity as a highly variable cosmic ray source. H. Menzel, a member of the European Commission also reported studies on cosmic ray dosimetry at flight altitudes in civil aviation and not ed the 1 99 6 Eur at om D i r ective specifying aircrews as radiation workers in the year 2000. A typical dose of 3 to 4 µSv/hr was reported. Measurements have also been made on mountain tops ranging from the Alps to the Andes. P. Tume (Royal Military College) discussed Canadian air crew doses in comp arison wi th th e ICRP/NCRP g eneral public limit . A neutron bub ble detector was employed yieldi ng app rox imately 4 b u b b l e s /µSv. Annual doselevels for various flight paths were reported for cabin crews and pilots. The doses were all bel ow the pre s e n t Canadian limit of 5 mSv/year, but all exceeded a proposed new limit of 1 mSv/year.

J. Boice (Inter n a t i o n a l Epidemiology Institute) presented the only contribution on epidemiological studies of

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c o m m e rcial ai rcraft cre w s describing them as low power studies exhibiting a stro n g healthy worker effect. Five studies over the period 1975 to 1996 were summarized, all too small to detect a radiation e ffect. Environmental confounding factors were noted: jet fuel, ozone and tobacco smoke; and lifestyle factors.

W. Si nclair (NC RP) discussed the proposal in 1970 by the NAS/NRC for dose limits for astronau ts. At tha t time, both short-term limits to avoid deterministic effects and a career limit of 4 Sv based on cancer risk were re c o mmended. Subsequently, the NCRP in 1989 (Report 98) recommended career limits based on age and sex from 1 to 4 Sv. These limits are currently being revised to reflect the subsequent increase in stochastic risk estimates, and a decrease in industrial hazards.

The current risk estimate for lifetime cancer mortality is 4%/Sv. Using the example of the crew of MIR receiving 0.6 mSv/day a proposed maximum an nual dos e of 60 mSv/year would be re a c h e d in approximately 3 months.

If a maximum lifetime cancer risk of 3% is adopted, the lifetime maximum perm i s s i b l e dos e wo uld be 750 mSv which would permit a total e x p o s u re time (on MIR) of abou t 1 2 years at 3 months/year.

W. Friedb erg (Federal Avi ati on Ad min is trati on) reviewed the guidance provided regarding cosmic radiation e x p o s u re during air travel, presenting summary information on galactic radiation levels and the radiation “mix” by

AAPM NEWSLETTER

altitude and latitude. He cited a dose for the Athens to New York flig hts for a 700-hr. year as about 4 mSv, but 3 mSv at 80,000 ft. from an 11hour “solar event ” in November 1997.

A panel discussion followed involving 6 of the speakers. It was agreed that fre q u e n t business travelers are occup ati o nal ly ex p os ed a t 1 µS v / y e a r, but also that the r is k is lo w er t ha n th e annual risk in “safe” industries and almost negligible

c o m p a red with the risk of death in a crash!

Roger Clarke (Director of the UK National Radiological P rotection Board) concisely summarized the findings of the meeting by assessing airc rews as similar in average annual dose to nuclear worker s each w ith abo ut 3 µSv/year and each with an annual fatal cancer risk of about 1 in 10,000, similar to the a nnual fatal in dust rial acci dent risk. The ris k to p regnant workers was also similar and reduced by similar

JULY / AUGUST 1998

e x p o s u re restrictions. The risk to occasional passengers was much smaller: Two-hund red hours of long-haul flying/year would give a dose of about 1.5 µSv. Astro n a u t s w e re at th e greatest r isk, receiving up to 2-3 µS v / d a y in earth orbit. A career limit of 3% excess cancer risk was p robably acceptable when compared to the normal 30% cancer risk and therefore the consequent career dose limit of 0.6 µSv seemed reasonable.

This was the last word in a timely review of a new are a

Catalogue of Diagnostic X-ray Spectra and Other Data on CD-ROM IPEM Report No.78 K Cranley, B J Gilmore, G W A Fogarty and L Desponds E l e c t ronic version pre p a re d

by D Sutton A se con d edi tio n of t he essential data book for scientists working in diagnostic radiology and mammography has just been published by the Institute of Physics and En gin e erin g in M edi ci ne (I P EM) on C D-RO M. Thi s re p resents an exciting new venture for the IPEM publications committee.

The large amount of data in this report naturally lends itself to presentation on CDRO M, m aki ng i t easi e r to handle, search and otherwise manipulate. The data itself comprises a set of more than 4000 files, totalling some 13 Mbytes and in clud es basic sets of unattenuated X-ray spectra, data for estimating X-

ray tube filtration, photon to kerma conversion factors and linear attenuation coefficients for some common materials.

Also included is a Spectrum P r oc ess or pr o gr am whi ch allows spectra to be attenuated by a wide range of attenuating materials and thicknesses. It is easy to use and has great flexibility allowing any co mb inati on filtration an d a tte n uat or. A fu ll explanatory text is pro v i d e d on dise which can be re a d u si ng a n Acr o bat re ad er (also supplied).

The data has many applications, which include patient dosimetry, radiation pro t e ction and modelling experiments. X-ray spectral data is now more accessible th an ever before.

Copies are available fro m IP EM , P O B o x 303 , Yo r k , Y0 1 2W R, pri c e £2 0.00 (postage and packing +10% UK, +15% Europe or +20%

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outside Europe.) with a 10% discount for IPEM members .

For more information, contact IPEM as below, or call: Kieran Cranley Medical Physics Forster Green Hospital Belfast, BT8 4HD Telephone: 01232 793681 Ext. 2390 ■

AAPM NEWSLETTER

JULY / AUGUST 1998

Announcements George Meckstroth Tribute

by The New Orleans Medical Physics Community George Meckstroth, professor of radiology at Tu l a n e U n iv er s it y Sc hoo l of M ed ic i ne. d ie d in Ne w Orleans, Louisiana on March 2 4, 1998 at t he age of 6 2.

His passing leaves a significa n t vo id in t h e me d ica l physics community.

G e o rg e a rri v ed i n Ne w Orleans in 1963 as an assist a nt prof es so r at T u l a n e Medical School. He re c e i v e d his bachelor and doctorate d e g rees from the University of C in c in na t i. He so on be ca me a c o nsu lt ant t o almost every major medical c ent e r in N ew O rl ea ns a s we ll as m any mor e i n the So utheast. In time, his expertise was sought on a national level.

The majority of the practicing radiologists in Louisiana received their physics training f rom Dr. Meckstroth as did countless nuclear medicine and radiology technologists.

He was responsible for the tra i ni ng p rogr am s a t t he Tulane/Charity/LSU complex for many years. He was still active in the radiology re s idents’ program at the time of his death.

G e o rg e w as t he g u id in g f o rce in many major expansion projects at both Tu l a n e a nd Ch arit y. He served a s Acting Dean of the Tu l a n e Medical School from February to June 1993.

He was especially proud of t he Ins ti t utio na l Re vi ew Board which he helped initiate at Tulane and served for many years.

G e o rge wa s a lso ver y active in t he New Orleans social arena. He was a member of s ev era l com mu ni ty o rg an iz at io ns . He al so co ntribut ed ge nerousl y to the arts.

George Meckstroth was the consummate professional and a good friend to many. He will be missed.

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12-16 July, 1998 43rd Annual Meeting of the Health Physics Society Minneapolis Convention Center Minneapolis Hilton & Towers 1001 Marquette Ave. Minneapolis, MN 55403 (612) 376-1000 Single $135/Double $150

January 1999 32nd Midyear Topical Meeting of the Health Physics Society Albuquerque, New Mexico

26 June- 1 July, 1999 44th Annual Meeting of the Health Physics Society Philadelphia, PA For more information: Health Physics Society 1313 Dolley Madison Blvd., Suite 402

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McLean, VA 22101 Tel: (703)790-1745 Fax: (703)790-2672 e-mail hps@burkinc.com The 3rd Annual Symposium on Radiotherapy to Reduce Retenosis

January 15 & 16, 1999 Sheraton Grande Torrey Pines Hotel in La Jolla, CA S p o n s o r ed by S cr ipp s Clinic. Category 1 CME credi t s a vail a ble . C ou rse C oD i rectors are Paul Te i r s t e i n , MD; Shirish Jani; and Vincent Massullo, MD. Registration fee is $495 and includes course re g i s t r a t i o n , course syllabus, bre a k f a s t s , breaks, lunch and a welcoming reception. For inform at io n, pl e ase c a ll th e Dep a rtme n t o f Aca d em ic A f fa ir s at S cr i pp s C li ni c (619)554-8556 phone (619)554-1310 fax ■

AAPM NEWSLETTER

JULY / AUGUST 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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Editorial Board Benjamin Archer Bruce Curran Don Frey John Kent Richard Morin Alfred Smith

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AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE One Physics Ellipse College Park, Maryland 20740-3846 (301) 209-3350 Phone (301) 209-0862 Fax e-mail: aapm@aapm.org http://www.aapm.org

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