AAPM Newsletter September/October 1998 Vol. 23 No. 5

Newsletter AMERICAN ASSOCIATION

OF

PHYSICISTS

IN

VOLUME 23 NO. 5

MEDICINE SEPTEMBER / OCTOBER 1998

AAPM President’s Column Summer Festivities

by Lawrence Rothenberg New York, NY

tion Program Director P a u l F e l l e r and Annual Meeting C o o r d in a t i o n C o m m i t t e e C h a i r m a n K e n Va n e k , a s well as many other dedicated AAPM members, pro v i de d t he ef f or t t o a ss ur e an ou t st a nd in g m ee t in g . T he Local Arrangements Committee, headed by Jim Marb a c h , pr ov i d e d e x c e l le n t s u p p o r t f o r a l l s c ie n t i f ic , educational, technical, and social events. The fabulous

Annual Meeting in San Antonio Our 40th Anniversary Meeting in San Antonio was a great success. We received the marvelous 40-year history of AAPM as a supplement to Medical Physics j u s t b e f o re the meeting thro u g h t he ou ts t an di ng e f fort s o f J o h n L a ug h l i n an d P a u l Goodwin. We were able to register and send in abstracts by electronic means, than ks to our Prog r a m C o m m it t e e ’ s e f f o r t s under Bob Gould, and HQ support from Mike Wo o dwar d and the staff. Ou r c o ffers will be ful l due to re c o rd setting sales of technical exhibit space. We had a very larg e attendance of almost 2500 registrants.

O v e r 6 0 0 a b s t r a c t s we r e submitted. Lisa Rose Sullivan, Deputy Executive D i r ec t or A n g e l a K e y s e r , and Executive Director S a l Tr o f i , al on g wi th se ve ra l other Headquarters staff members worked extre m e l y h a rd to assure the success of the meeting.

I w o u ld l i k e t o t ha n k those who part icipat ed i n

the President’s Symposium, “Filmless Radiology - PA C S is here to stay!”: Radiologist L a w r e n ce S c hw a r t z and physicists Gig Mageras, Tony Seibert, and K e v i n Junck. (Our best wishes for a speedy recovery to R i c k M o r i n who was unable to participate due to a medical emergency.) In addition we w e re most pleased to have RSNA President David Frase r f ro m Nova Scotia off e r g reetings to th e au dience and part icipate in several other events at the meeting.

Dr. Fraser continued the tradition of the presidents of the two organizations off e ring greetings at the start of the respective annual meetings.

Scientific Program Director Mary M art el, Co-Dire c t o r Mary Ellen Giger, Educa-

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INSIDE TABLE OF CONTENTS President’s Column………………p. 1 Election Results………………..…p. 4 Summer School………………..…p. 4 International Affairs……………...p. 5 Executive Directors Column……p. 6 Professional Achievment Award ...p. 7 Travel Award………………..……p. 8 Correction………………….……p. 10 Letters to Editor………………...p. 11 Certification Summary…….……p. 12 Announcements………………...p. 13

AAPM NEWSLETTER

SEPTEMBER / OCTOBER 1998

Night Out at La Villita had ov e r 2 0 0 0 a t t e n d e e s . I n addition, we all had access to excellent restaur ants in an attractive setting by m e rely walking out of our h o t e ls o n t o t h e b e a ut i fu l San Antonio River Walk.

Congratulations to those honored at the Awards Ceremony. The Coolidge Aw a rd was p resen ted to B e n g t B j a rn g a rd, following introductions by Wendell Lutz and Ken Kase. The Achievement in Medi cal Phy sics Aw a rds went to John Hale, Jo n Tr u e b l o o d, and K e n Wr i g h t. The AAPM Medical Physics Travel Grant went to Roger Johnson, the Farrington Daniels Award to C o re y Z a n k o w s k i and Ervin Podgorsak, and the Sylvia Sorkin G reenfield Aw a rd to S c o t t Hwang, Felix We h r l i, and John Wil lia ms . The John Cameron Young Investigators Competition Aw a rds went to C o rey Zank owski ( F i r s t ) , Samuel Ar m a t o ( S e c o n d ) , an d M il l er M ac P h er so n (Third).

T he n e w A A P M F e l lo ws a re F r a n k B o v a , Pe n n y B u t l e r, Ramesh Chandra, Ed Chaney, Jim Chu, Larry D e We rd, Bob Dixon, Paul Goodwin, Charles Griffith, Ed He n dri ck , Jo hn Hor t o n , Di c k L a n e , R a l ph Lieto, Chris Marshall, R i c h a r d M a ug h a n , R i c k Morin, Tom Payne, Larry Reinstein, James Rodgers, U lf R o s e n o w , S u r e n d r a R u s t g i , C h e n g B. S a w , Mike Schell, Don To l b e r t, and Marilyn Wexler.

Elections Results

New Members Symposium

The results of this year’s AAPM elections were announced by Secretary Jim G a l v i n at the Annual Business Meeting: PresidentElect Ken Hogstro m, Secretary J im Ga lv in, and Board Members-at-large Cy nt hia M cC oll oug h, Rock Mackie, Mary M a r t e l, and Dave Rogers.

They will take office in Janu ary 1999. I loo k forwa rd to working with these new o f f i ce r s and o f fe r sinc e re a p p reciation from the Association for those who stood for office and were not successful. A great strength of AAPM is that man y of our o ut st a nd in g m em be r s a r e willing to run for office e ven tho ugh th e y a re not guaranteed victory.

An o t h e r r e c e n t l y e s t a blished event at Annual Meetings is the New Member Symposium at w hi c h EXCOM and Council Chairs meet with new members to explain the many functions of the Association. Greetings f r om t he na tio nal of f i c e r s w e re followed by Pre s i d e n t Elect G e o f f Ib bott’ s b r i e f overview of the structure of AAPM. A group discussion p e r io d w a s f o l l o w e d b y one-on-one conversations.

N e w m e m b e r s i n qu i r e d a b o u t A A P M C om m i tt e e membership, the relationship between AAPM and the prof e s s i o n a l o r g a n i z a ti o n s A C MP a n d A C R - C M P, a n d the status of the Certification B o a r d s - A B R a n d A B M P. Lively discussions ensued.

Chapter Representatives Breakfast

Headquarters Site Visit Committee

The C ha p t e r R e pr e sentatives Breakfast has become an important function at our Annual Meeting.

Representatives of the AAPM Regional Chapters meet with the Executive Committee to d is cu ss ma tt ers o f mu tu a l i n t e rest. Among the topics explored in San Antonio w e re: the proposals of the A d - h o c C o m m i t te e f o r AAPM Board Reorg a n i z a t i o n (mainly opposed), mandatory chapter membership for new AAPM members (mainly opposed), calendar year (Jan-Dec) terms for chapter o fficers (most chapters have c h a n g e d t o th i s f o r m a t ) , c u r rent efforts to eliminate the duplication of certification boards (update provided).

In San Antonio, the AAPM B o a rd of Directors voted to implement many of the re commendations of the Ad-hoc Headquarters Site Visit Committee which presented its report to me th is s pring .

Because of these changes, we will have a stronger Headquarters Office to support your many Association activities. In addition steps were taken to p ro vide in dependen t an d s t ronger electronic support t h rough the AAPM LAN and our Web Page for the many new activities available to us, including Remotely Dire c t e d Continuing Education, Electronic Registration and Submission of Abstracts, and mass emailings to members.

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Headquarters Office Space Committee I r e ce n t l y a pp oi nt e d a n Ad-hoc Committee on Headquarters Office Space (AHCHOS). This committee, composed of Tre a s u rer M e l i s s a M a r t i n , C h a i r, E xe c u t iv e D i r e c to r S a l Tr o f i , J i m Deye, Ned Sternick, Jean St. G er main, and Real E s ta t e C o n s u l t a n t L a r r y Wa l k e r. Wit h EX CO M as e x - o f f i c io me mb e r s , t h e y will look at various altern atives for our Headquarters l o c a t i o n a n d s p a c e w he n our current lease expires in 2001. The Committee, which had its first meeting in San Antonio, will provide interim reports at all EXCOM a n d B o a r d M e e t in gs , a nd w i ll pr o v id e f in al r e c o m mendations at the December 1999 Board Meeting at RSNA.

Relationship with ASTRO Although AAPM members have strong participation in ASTRO Meetings and committees, there is not a formal r e l a t io n s h i p suc h as t ha t between AAP M and RSNA. I n th e nex t f ew ye a rs th e AAPM leadership, particularly current President-Elect Geoff I b b o tt and 1999 Pre s i d e n t Elect Ken Hogstr o m, will explore the possibility of setting up such a relationship.

NRC Part 35 Revision Through the efforts of seve r a l AA P M m e m b e r s a n d E x e c u ti v e Di r e c t o r S a l Trofi, AAPM Representatives will have an official place o n t he po di um for three upcoming regional meetings t o b e he l d by t h e N RC t o

discuss revisions to Part 35.

A APM w il l be re p re s e n t e d

by Mel is sa M a rti n in San Francisco, by Ralph Lieto in K an sa s Cit y, a nd by M a r y Fox in Rockville, MD.

Solution to Board Duplication In the July/August AAPM N e w s l e t t e r, I discussed the A APM Board ’s s trong sup port for a proposal, sent to the ABR by the ACMP (with t he s u pp o r t o f A B M P) , to e li m i n a t e d u p li c a t i o n o f B o a rd Examinations in Radio logical Phys ics. This pro posal was a constant topic o f d i s c us s i o n a t t h e S a n Antonio meeting: in individual groups at social events, in the halls, on the exhibit f l o o r, at the Chapter Repres e n ta t i v e s Breakfast, at the New Members Symposium, at the Annual Business Meeting, and at the Board of Directors Meeting. While everyone does not fully support all aspects of the proposal, the vast majority of p h y s i c is t s w h o m I s p o k e w i t h w o u l d l i k e t o se e the ABR give very s e r i o us c o n s i d e r a t i o n t o this proposal.

F u r t h e rm o r e , in r e c e n t m o nt hs , I ha ve h ad an o ppo r tun it y to sp eak wi t h va ri ous ABR O ff i c e r s i nc l udi ng Pa st Pr e s i d e n t S arah Donaldson, curre n t President William Casarella, E xec ut iv e Di re ct or P a u l C a p p , as well a s w it h o ur Physics Trustees. All the radiologists indicated that their decisions would be stro n g l y i nf l uen ced by t he a dvi c e g iven th em by t he A B R P hysi c s Tr us te es : E d

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Chaney, Bill Hendee, a n d Guy Simmons.

I c al l u po n t he A B R P hy s i c s Tr us te e s t o w or k diligently to insure serious consideration and eventual acceptance of the pro p o s a l , w i th p o ss i b l e m u t u a l ly a g reed upon modifications, so that the physics commun it y c a n m a r c h in t o t h e ne w mil l e nni u m s tr o n g e r, and more united than ever before! â–

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SEPTEMBER / OCTOBER 1998

It Takes a Village to Put on a Summer School

Election Results

by Bruce Thomadsen Madison, WI

President-Elect Kenneth Hogstrom

Board Members at Large

Thomas Rockwell Mackie

Mary Martel

Cynthia. McCollough

David Rogers

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For all of the success of the 1998 AAPM Summer School, I am deeply indebted to the many people who donated so much time and effort for the simple reward of being part of a worthwhile venture. (It was fun, they got some free meals, and heard some re m a r k a b l e good presentations.) Without the support from Headquarters, particularly from Angela K e y s e r, the program would never have happened.

For help in planning the local arrangements and preparation, the Local Arrangements Committee deserves exemplary plaudits: Kathy McSherry, Al Alter Larry DeWe rd, Richard Frayne, Carin Flint, Eric Hendee, Mike Kowalok, Jeff L i m m e r, Kevin McCollough, Thad Wilson, John Wo c h o s , and Julie Zachman.

AAPM members who have been there and came to help, n e s t e r, advise, remind, and work like dogs, Sherry Connors, Lee Goldman, and Marlene McKettey, made sure things actually worked. Stephan Thompson, next years Local Arrangement Chair, also pitched in as he gained experience for the future (Heaven help him).

Much of the actual burden of executing the many activities supporting the Summer School was shouldered by an elite cadre of graduate students at the University of Wisconsin: Carla Bradford, Warren DSouze, Jeffrey

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Kapatoes, Weiguo Lu, Ken Rushala, Dean Skuldt, Ralph Suarez, Karl Vigen, Kris Wedding, Oliver Wieben, Chuan Wu, and Yong Zhou. Great thanks to these tireless persons who mostly worked behind the scenes so things looked like they ran

smoothly.

Special thanks goes to Gammex/RMI for their support in providing the tee shirts for the School even though rules prohibit advertising on the shirts. Their generosity is greatly appreciated.

SEPTEMBER / OCTOBER 1998

Special thanks go to Mary Lawrence, Andrea Romine, and Christine Shin at the University of Wisconsin (the Great Institution by the lake) who went out of their way to provide an environment conducive to the School.

International Affairs

by Perry Sprawls Atlanta, GA This is the first edition of the international affairs page that will appear in each newsletter.

The purpose is to keep the membership informed on the i n t e rnational activities of the AAPM and the opportunities for members to participate in a variety of international activities and projects.

Many of these opportunities are developed and coordinated by the International Affairs Committee (IAC) that is made up of five geographic regional subcommittees. Anyone interested in the activities associated with a s pecific re g i o n should contact the appropriate subcommittee chair.

Partners in Physics The Partners in Physics Prog ram i s the gr as s ro o t s approach of AAPM members to work with medical physicists in the developing countries of the world. Partnerships are established between a sponsoring AAPM member in t he U .S. and a p ar tn er medical physicist in a developing country. The objective is for the partners to communicate and work together on

projects of mutual interest. In f u t u re editi on s we wil l be highlighting some of the existing partnersh ips that have been a rewarding experience for both partners.

T h e re is currently a need for additional members to participate in this program. If you are interested contact the chair of the regional subcommittee where you would like to participate.

South African Association of Physicists in Medicine and Biology SAAPMB has become the first medical physics organization from another country to officially become a cooperating partner with the AAPM. Through this agreement members of one organization can participate in the activities of the other organization at membership rates. There is also the opportunity for exchanging publications and joining together in a variety of programs and other activities. Negotiations are now underway with several other national organizations to develop a similar relationship.

Exchange Scientist Program Under the new exchange scientist program of the AAPM, the IAC will establish a pool of qualified exchange scientists

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with a desire to visit specific countries for scientific purposes. Medical physicists interested in participating in the exchange program must be full members of the AAPM, board certified by the ABR or the ABMP in the field of their expertise and have a minimum of five years of research, clinical or teaching experience in medical physics.

T he p rimary f un ction of t h e p ro g ra m is to m a tc h r equests from host institutions in other countries with individuals who can provide specific kinds of expertise.

The appointed person will b e g i v e n t he t it l e “A A P M Exchange Scientist” and provided with a l etter t o this effect.

All financial arrangements, if any, are to be made dire c t l y between the requesting host institution and the appointed exchange scientist.

Applications for becoming a qualified exchange scientist c an be o bt ain e d f rom R aym o nd Wu, C hai r of th e E xcha n ge Sci ent i st Subcommittee.

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SEPTEMBER / OCTOBER 1998

Executive Director’s Column

By Sal Trofi College Park, MD 1998 Annual Meeting-San Antonio The electronic abstract s u b m is s i o n p r o c e s s w a s great success. A total of 540 ab str act s w ere s ubmi tted ; 50 8 el e c tro n i c al l y an d 32 via hardcopy. This is a 17% increase from the 463 abstracts submitted for the 1997 Annual Meeting and a 94% electronic submission rate in our first year. Over 65% of the abstracts included supporting documentation. Authors were notified e l e c t ronically re g a rding the disposition of their abstrac ts, savi ng posta ge, paper and time.

T h e Wo r k s i n P r o g re s s submission process was the same as the regular abstract p rocess. The electronic vs. paper submission ratio was about the same as abstract submissions. The system also generated the meeting p rogram that was published in Me di cal P hys ic s and posted o n the meeting home page. The system has some glitches that need to be worked out before the WC2000 meeting, but all indicators s how that the system is up to the task of a 2000 abstract meeting.

Exhibit Revenue exceeded last year’s total, and sale of b oo th spac e wa s up 16% .

This is 52 more booth equivalents than last year’s grand total and includes 15

n ew ex hibitors. Li sa R os e Sullivan, Exhibits and Scient if i c Pr og ra m M a n ag er, i s mostly responsible for this success. She has been able to increase booth sales by 67% in five years.

S t a ff News A ngela K eyser h as been p romoted to the position of Deputy Executive Dire c t o r.

Angela is one of the original employees who began wo rk when the AAPM mo ve d f rom N ew Yo rk to College P ark, Maryland in 199 3. She has played a major role in the success of the Headquarters operat i o n s . A n g e l a h as g a in e d the confidence and re s p e c t of the staf f by her work e thic, k nowl edge of p roces ses , and leadershi p qualities. The need for this position was recognized by a H e a d q u ar t e r s S i t e Vi s i t Committee to provide contin ui t y of lea d e rs hi p w h en t he Ex e cu t i v e D i r e c t o r i s away from th e office. The activity at Headquarters has b e c om e m o r e v a r i e d a nd c om pl e x s i nc e 1 9 9 3 w it h

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t h e a dd i t io n o f n e w p r o grams and the overal l g rowth in the AAPM. M i c h ae l Wo o d w a r d h a s been promoted to Dire c t o r of Information Systems. This n ew d epartment has been c reated to provide a central responsibility for all of the AAPM’s needs in electro n i c p rocessing. Mike’s work is k nown to mo st of you if y o u h a v e a c ce s s e d t h e AAPM web page at h t t p : / / w w w . a a p m . o rg . H e has designed a page that is p rofessional in appearance and easy to navigate. T he newly created Remotely D i rected Continuing Education (RDCE) quizzes is one such acco mplis hmen t that will better service members.

B e c k y B i b l e h a s be e n h i red as an Administrative Assistant. This fills one of th e two posit ions th at t he Headquarters Site Visit Committee recommended to be established. Becky graduated from West Virginia University in 1990 with a B.A. in History. Her work experience is diverse and includes a good deal of accounting, which is e sp eci a ll y hel pf u l f or t he Headquarters Office. She is a native of southern Maryland, but went to college in We s t V i r g i n i a w h e r e sh e s ta y e d a n d w o r k e d f o r a f e w y e a r s . Be c k y t h e n moved to Iowa to be close to her brother and his family. She decided to come b a c k to t h e M a r y la n d a r e a an d a c c e p t e d a j o b with AAPM.

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S h a r on C oh e n h as be en h i red as AAPM’s Receptionist. This fills the second of the two positio ns that the H eadqu arte rs S it e Visit Co m m it t e e r e c o m m e n d e d t o be es tab li shed. She graduated from the Univers it y of Ma rylan d with a B. A. de g ree in T heatr e in 1998. While attending coll ege , Shar on wo r ked i n a multi-faceted position with a t hea t er, t ak i ng r e s e r v a tion s, operating the box o ffice, and assisting players with lighting and sound needs. Her experience with cus t om er re lat ion s and h and li ng a mul ti-lin e ph one s ystem wil l b e a gr eat as set to the Head quarters operation.

Janie Steplowski is re t i ri n g a t th e e nd o f A u g u s t b ecau se her daughter is s t i l l i n c o l l e g e a n d J a ni e has ch osen to pr ovide c h i l d c a re for her grandson.

Janie announced her re t i remen t ea rly in M ay, w hi ch p rovided plenty of time to work out an orderly transit io n. J anie is l eavin g a legacy of many innovative o r im p r o v e d pr o c e d u re s , such as the committee appointment system, membe rship D ire ctory pro d u ction, and the org a n i z a t i o n of the on-site headquarters office at the Annual and R SNA mee tin gs. J an ie h as a g reed to manage the onsite headquarters o ffice at S a n A n to n i o a n d to h e l p t hi s Fall wi th the 1 999 Membership Directory. All o f th e above is indicati ve of Ja nie ’s wo rk e thi c an d as an empl oyee we co uld count on.

Penny Atkins, AAPM’s Ma n u sc r i p t s E d i t o r, i s engaged to b e married on O c t ob e r 1 0 a t a s m a l l chapel at the University of Maryland. Her husband-tobe is Mike Slattery. Penn y and Mike went to elementary school together, but lost contact for 25 years. After reuniting, Mike popped the question in front of the National Christmas tree this past December. Penny and Mike will be honeymooning i n M a u i , an d w i l l li v e i n Mike’s condo on the waterf ro nt in Wash in gton, D. C. until th ey find a hou se in the suburbs.

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Faiz Khan Receives the American College of Medical Physics Award

Faiz Khan, Professor and Director of Radiation Oncology Physics at the University of M in ne so ta M e di c a l School, received the Marvin M.D . Wil liam Pro f e s s i o n a l Achievement Aw a rd of the American College of Medical Physics (ACMP) for the year 1998. This award is given every year to an individual for outstanding professional, s cien ti fic and educ atio na l contributions to the field of medical physics.

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SEPTEMBER / OCTOBER 1998

Report of the 1997 AAPM/IPEM Travel Award

by Donald Herbert Mobile, AL It has seemed to me for some time that there are several important areas developing in medical science today in which there are opportunities for medical physicists to assume not only a larger role than they currently play, but a major role and, indeed in a few areas, a decisive role, in the further development and applications of these are a s .

H o w e v e r, it also appears to me that these opportunities a re not infr equen tly overlooked or avoided. Nonetheles s, the developments i n these several areas will have p ro found implicatio ns for how, where, when, for whom, and for how long providers physicians and physicists - can practice their respective professions. These developments will also result in substantial changes in the nature of both p rofessions. Evidence of the n a t u r e and the g ro w i n g importance of these developing areas can be readily found in the current medical science l i t e r a t u re. The possible ro l e s for the medical physicist can be as readily inferred therefrom. For just a few examples: (1) Medical Te c h n o l o g y Assessment and Outcomes Research (Clinical Trials, RiskAdjustment Procedures); “ Tr ials, as they have been struct u red, have not been able to answer our questions.” (G. Silv e r man, 1993) “It is not enough to provide high-quality c a re: To survive in the market

place one must be able to meas u re, demonstrate, and pro v e superior performance” (C. Gaus et al, 1996) “Health plans are besieged by employers’ erq u e s t s for information on quality.” (A. Epstein, 1995) “We will need to change our way of thinking f rom qualitative reasoning to quantitative r e a s o n i n g . ”(Eddy, 1994) …retrospective trials have enormous practical and ethical advantage over concurrent trials.” ( P. Urbach, 1993) “ T h e ‘ i n t e n t - t o - ter at’ paradigm provides no useful information to either practicing physician or to the maker of public policy.”

(D. Salzburg, 1994) “The number of technologies to be asses sed far outstrips the r e s o u rces available to assess them.” (D. Eddy, 1989) (2) Integration of Information (Meta-Analysis, CrossDesign Synthesis, Bayesian Inference): “Meta-analysis is going to revolutionize how the sciences, especially medicine, handle data. And it’s going to be the way many arg u m e n t s will be ended.” (T. Chalmers, 1990) “ S t a n d a rd statistical analyses [i.e., Neyman-Pearson] of randomized clinical trials

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fail to provide a direct assessment of which tr eatment is superior or the probability of a clinically meaningful dif f e re n c e . [Statistics means never having to say you’re certain?] A Bayesian analysis permits the calculation of the pro b a b i l i t y that a treatment is superior based on the observed data and prior beliefs.” (J. Brophy et al, 1995) “... physicians have d i fficulty incorporating information about probabilities of disease and outcomes into the decis ions t hey make.” ( W. Roper et al, 1988) “A Bayesian a p p roach allows for calculating predictive probabilities such as that Ms. Smith will re s p o n d to therapy A. Probabilities of future observations are not possible in a formal fr e q u e n t i s t [i.e., Neyman- Pearson] a p p ro a c h . ” (D. Berry, 1993) Nonlinear Dynamics ( D e t e rministic Chaos, Fractal Geometry, Catastrophe Theory, Epigenetic Inheritance) “ … c h a o s will be fusioned with statistics into universal discipline of growing importance in the 21st century. …chaos will spawn a new fundamental science [and] …a great many tenured positions may be waiting in the next century, across all academic departments having anything to do with real life data.”

(O. Rössler, 1992) “ We are trying to fit dynamic nonlinear change into a linear theory of th e gene and it will not fit t h e re.” (R. Strohman, 1997) “…the brain is fundamentally a patter n - f o rming, self-org anized system governed by nonlinear dynamicsl laws.”… “The

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actual trajectory of the main spatial pattern of the brain displays the geometry… characteristic of Sil’nikov chaos.” (J.A.S. Kelso, 1997).

(4) Statistical Modelling (G eneralized Linear and Nonlinear Models): “ … a model is a tool that converts data into insights …By their explicitness, power, and pre c ision, mathematical models can p rovide a powerful aid to human judgement in the interp retation of data from clinical r e s e a rch …work is needed in the quality control of models and their application.” (Institute of Medicine, National Academy of Sciences, 1985).

(5) Evidence-Based Medicine (EBM) and Evidence-Based Health Care (EBHC): “ S e r i o u s , w i d e s p er ad problems exist in the clinical literature … The findings… suggest that the average practitioner will find relatively few journal articles that are scientifically sound in reporting usable data and providing even moderately stro n g support for their infere n c e s . ”(J. Williamson et al, 1986) “ … t h e purpose of journals is not to disseminate information, but to promote faculty - this is the sole reason, and justification for the j o u rnals’ existence.” (R. Brook, 1993) ” R e s e a rch on medical interventions is often poorly designed and methodologically flawed.” (W. Roper et al, 1988).

I have previously lecture d and written on various aspects of the above topics in symposia, re f r esher courses at AAPM, ASTRO, and RSNA, etc.

I am currently working on a review paper and two monographs as well as trying to develop a graduate-level short course on one or two of them.

Last year it occurred to me that it would be quite useful to this work to have the benefit of the perspectives and insights of British medical physicists and physicians on these issues. I therefore made application to the AAPM.

Awards and Honors Committee for the UK Travel Award.

Subsequent to receiving the award, I prepared a menu of lecture topics, together with a p recis of several hundre d words for each lecture, to several of the leading institutions in the United Kingdom and indicated that I would appreciate the opportunity to present a lecture on any selection(s) therefrom which might be of interest to them: I was very pleased that six institutions accepted my offer: The lectures were given between 17 April and 6 May 1998: Friday, 17 April 1998 London The Royal Marsden Hospital (University of Lond o n ) “What Works in Medicine. An Introduction to Te c hnology Assessment and Outcomes Analysis in Radiology.”

Monday, 20 April 1998 - London University College (University of London) “The New Physics: Catastrophes, Fractals, Chaos, and Solitons. An Introduction with Applications in M e d i c i n e . ” Tuesday, 21 April, 1998 -C ambri dge A d d e nb roo ke’s Hospital (Cambridge Univ ersity) (1) “Does the Model ‘Fit?” An Introduction to Modern Statistical Modelling of Radiobiological Data.” (2) “What Works in Medicine? An Introduction to Technology Assessment and Outcomes Analysis in Radiolo-

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g y . ” Thursday, 23 April 1998 Bristol United Bristol Cancer Center (Royal Infirm a r y ) “The New Physics: Catastrophes, Fractals, Chaos, and Solitons.

An Introduction with Applications in Medicine.” Thursday, 30 April 1998 - Edinburg h Western General Hospitals (Edinburgh University) “Does the Model ‘Fit?’ An Introduction to Modern Statistical Modelling of Ra diobiological Data.”

Wednesday, 6 May - Manchester Christie Hospital - Paterson Research Institute (University of Manchester) “ D o e s the Model ‘Fit?’ An Introduction to Modern Statistical Modelling of Radiobiological Data.

In general, the institutions that I visited seem to have embraced the principles and practices of technology assessment and evidence-based medicine to a greater degree than have the American institutions with which I am familiar. They have a well-informed and active program in each, especially at Addenbrooke’s and the Royal Marsden. They are also proceeding apace in the development and application of various topics in nonlinear dynamics, especially at University College, London, and at Bristol. Manchester has an e x t remely active and quite sophisticated program in mathematical modelling as does Edinburgh.

The British medical physicists and physicians were generous and gracious hosts and wellinformed audiences. I learned a great deal from the insightful comments and sharp questions at every institution. In the early days of radiotherapy it was e v e r y w h e re believed to be important to ask “What does

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Manchester think?” concerning any developing area. For my work on the developing areas described above I believed it was important to ask, “ W h a t do London, Cambridge, Bristol, E d i n b u rgh and Manchester t h i n k ? ” and it certainly proved to be.

I was able to spend thre e or fo ur da ys in Wi l t s h i re between Bris tol an d Ed inb u rgh and an other fo ur or five days in Yo r k s h i re after M a n c h e s t e r. I have not lived in Britain for over thirty years; I was g lad to find that the British countryside is still the

loveliest one on the planet.

Fo r pr ovi di ng t h is mo st re w a rding opportunity, I am especially indebted to David D elp y and Jem Hebden at University College, London; David Dance and Marg a re t Bidmead at the Royal Marsde n Ho sp ita l, Lon do n ; Katherine Goldstone, Phillip Dendy, and Adrian Dixon at A d d e n b r o oke’ s Ho sp it a l, Cambridge; Alan MacKenzie an d P au l G od da rd at t he United Bristol Cancer Center, Bristol; David Thwaites and A . T. Re dp at h at We s t e r n

General Hospitals, Edinburgh, and Jolyon Hendry, Ranald MacKay and Stephen Roberts at Christie Hospital and Paterson Institute, Manchester.

I want to express my deep a p p reciation to Dr. Charles Lescrenier, the British Institute of Physics and Engineering in Medicine and Varian TEM Ltd. for the AAPM Travel Aw a rd an d to the US A COM Department of Radiology for providing additional financial support for this trip.

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Letters to the Editor Editor’s Note: In printing Ted Webster’s NCRP Annual meeting report, mSv was inadvertantly changed to µSv in layout. We apologize. Corrected sections are shown below.

Misleading Errors in Cosmic Radiation Exposure Article

by Robert Barish New York, NY Ted Web s te r’s o the r wis e excellent narrative of the 1998 NCRP meeting on the topic of Cosmic Radiation Exposure of Airline Crews, Passengers, and Astronauts which appeared in t he J uly - Aug ust AA P M N e ws le t te r is m arr e d by n u m e rous examples in which the units of radiation dosee qu iv a le nt a r e m i sst at e d, sometimes impacting critically o n t he c on clu sio ns th a t a reader might draw from the summary of a particular presentation at the meeting.

In particular, there are many p lac es in w hich the un its “microsievert” and “millisievert” a re interchanged. This diff e r-

ence of a factor of 1000 might have significant implications with respect to the levels of interest that could be produced in a reader who is unfamiliar with this topic.

I won’t attempt a point-bypoint critique of these erro r s .

I n t e rested readers can work them out themselves b y remembering that the doseequivalent rate at airliner altitudes is som ewhere in th e n e i g h b o rhood of 3-7 m i c ro s i e v e r t / h r, and the MPD for a member of the public is 1 millisievert/yr.

I will, however, make a definite correctio n to the f i n a l , emphasized, (by bold print) part of Dr. Webster’s summary regarding business frequent flyers, since I chaired the panel

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discussion which is described.

Business frequent flyers who travel more than 75,000 miles per year generally will exceed the current value of the annual MPD of 1 mSv (100 mrem).

This level of dose-equivalent carries with it an increased risk of death from a fatal cancer of 1 in 25,000 which can be multiplied by the number of years of fl ying to give a l ifetime increase in risk. For a 25 year career, the risk would become 1 in 1,000. This incre m e n t a l risk is in fact smal l (<0.5%) compared with the current statistic of 220 in 1,000 fatal cancers in the general population, but it is in fact very significantly gr eater than th e ris k o f death in a fatal commercial air-

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Corrections to Ted Webster’s Narrative Typical of the dose levels is 6.4 µSv/hr for the Los AngelesTokyo flight for a total of 0.03 mSv. This is 3% of the 1 mSv/year limit for public exposure…

F o r a wo r k i n g y e a r i n flight of 600 hours the annual d ose wo uld r ange f ro m 0.54 to 3.6 mSv. The latter exceeds the general public 1 mSv/year limit…

It w as agr eed t ha t f re quent business travelers are occupationally exposed at 1 mSv/year…

Roger Clarke (Dire ctor 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 workers each wi th abou t 3 mSv/year and each with an annual f at al canc er risk o f about 1 in 10,000, similar to the annual fatal industrial accident risk. The risk to pre gnant workers was also similar and reduced by similar exposure restrictions. The risk to occasional pass engers was much smaller: Tw o - h u n d re d hours of long-haul flying/year would give a dose of about 1.5 mSv. Astronauts were at the greatest risk, receiving up

to 2-3 mSv/day in earth orbit.

A career limit of 3% excess cancer risk was p ro b a b l y acceptable when compared to the normal 30% cancer risk and therefore the consequent c a reer dose limit of 0.6 Sv seemed reasonable. This was th e last word in a ti me ly review of a new area of radiation protection.

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Medical Physics or Health Physics?

by Robert Matthews Coos Bay, Oregon The letters to the editor written

by Don Tolbert and Louie Tonry in t h e J ul y /Au g us t 1 99 8 A A PM Newsletter had a peculiar effect on me. I was left ambivalent ... in the sense that I felt strongly both ways.

I identfy myself as a Medical Health Ph ysic ist i n my s ignature bl ock , because I represent myself as someone who does medical physics and health physics and who is qualified by training and experience. I hold ABR certificates in diagnostic and therapy physics and the ABHP in comprehensive health physics. I do not consider myself a health physicist who happens to work on the m e d ic al si de . Dr . T ol be rt ha s expressed his reservations to me personally regarding the ‘medical health physicist’ title, however, I have not discussed the matter in great depth with him. I assumed his

re s erva ti o ns had to do w it h my own regarding the hazards of trying to be all things to all people. Dr. Tolbert does acknowledge the pressure at small medical institutions for the physicist (usually a one man show) to wear many hats. I have not discussed Mr. Tonry’s position with him, athough I believe I have some insight into his background and professional development. I offer the following comments as my own perspective, and would ask Dr. Tolbert and Mr. Tonry, “Where do we go from here?”

I agree strongly with Dr. ToIbert’s comment that “I do have a general bias against any certification board with a specialty reference in its title certifying members of a different specialty.” The implication is that we (Dr. Tolbert and I) have a clear notion in our mind as to what these s pe ci a lti e s a re , th a t i s , h e alt h physics vis a vis medical physics; th a t th e y ca n b e i n p ri n ci pl e defined, and the differences recog-

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nized and illustrated. Dr. Tobert tends to lose me after that. First, he throws out what was implied in the b e g in ni ng b y as s ert i ng th a t w e (medical physicists) lack definition in our profession. Second I am a struck by the seeming agreement between Dr. Tolbert and Mr. Tonry that working in a health care facility is on the medical physicist’s turf.

The difference between medical physicists and health physicists is not just where we work, but more what we do and the depth we pursue those activities. Within a health care facility, many medicaI physicists view themselves as a part of the professional staff working for t he b enefi t o f a pa tie nt and t he health physicist on the administrative staff as RSO working for regulatory compliance and general radiation protection. Training, experience and collegiate association is often different.

Conflicts of interest between the camps can arise and helps define

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Letters to the Editor the different roles. There can also be a different perception on the p os s ib i li t y o f l at er a l o r ve r tic a l m o veme nt wi th in the cor po rate s truc ture d epending with whic h camp one identifies. Notwithstanding the qualifications to calibrate x-ray tubes, in my opinion certification of health physicists in the categ or y o f AB MP M e di c al H e al t h Physics will lead to unnec essary c onf u si o n. O n t h is , I t hin k D r.

ToIbert and I agree, and I appear to not agree with Mr. Tonrey’s definition of a Medical Health Physicist.

In concession to them both, I will consider changing my representation as a Medical Health Physicist.

I ns t i t ut i o nal bi a s is of te n th e source of c onf usi on, a nd hea lth care administrators take advantage of the wiggle room more often than they are duped by unqualified individuals. Obviously, accrediting agenc ies put pressure on health care facilities to hire certified individuals and this should be recognized as a principle of best care and practices.

Th e Am eri can Boa rd o f Medica l Specialties lists only my ABR certificates and not the ABHP. Oregon Administrative Rules require that all diagnostic, therapeutic and nuclear medicine technologists must be certified by relevant boards, period. It is not so clear what credentials a physicist is expected to present. An RSO can be certified by a number of different boards including ABHP or ABR or just be board eligible. A teletherapy or brachytherapy physicist must be board certified by the ABR or the physicist must have a m as te r ’s or d oct or ate de gre e i n physics, biop hysics, radiological physics or health physics and have o ne year of r elev ant super vised experience. A ‘qualified expert’ (any individual deemed qualied by the state) for surveying a mammography unit must be certified by the ABR or so deemed to be qualified.

A ‘qualified expert’ for calibrating therapy x-ray equipment must be certified by the ABR or hold a master’s or doctorate degree in physics, biophysics, radiological physics or

Summary of Physics Certification

by AAPM Members From the AAPM Directory (NOTE. ABHP Certification not included)

by Jack Krohmer Georgetown, TX I. Certification by the ABR only 2. Certification by both the ABR & the ABMP 3. Certification by the ABMP only 4. Canadian CM or CF certcation only 5. Canadian CM or CF + ABIMP certification 6. Canadian CM or CF + ABR certification 7. Canadian CM or CF + both ABMP & ABR cert.

1237 273 131 82 15 6 3

NOTES : a. Most individuals in categories 2 and 5 were grandfatered by the ABMP. b. Some indivlduals (about 25) in category 3 were grandfathered by the ABMP by having extensive prior experience or by the being certified by the ABHP or the ABSNM. c. There are “pockets” of ABMP-only certification as follows: Michigan, NE Ohio & N Indiana Miinnesota & Wisconsin New York, NE PA, CT & RI Texas, NM & AZ California, OR & WA

25 15 31 14 14

NOTE: These are probably related to the influence of a small number of “Senior Advisors”

Summary by Certifying Body: ABR Total Diplomates 1519 (% examined = 100) ABMP Total DipIomates 422 (Probable % examined = 25 Canadian College of M.P. total Diplomates 100 (Probable % examined = 100 - I assume they examine.)

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health physics, plus one year full time training in therapy physics, plus one year of full time proctored experience in a therapy clinic. The cal ibration of a CT unit must be don e by a ‘ qu a li fi e d ex pe r t’ or under his direction while he is pres e nt a t t h e f ac il i ty . Th e re i s n o ‘qualified ecpert’ requirement for calibrating other diagnostic x-ray equipment since this responsibility is assumed by the state. The Oregon Administrative Rules, rev 1995, do not explicitly recognize any certification category of the ABMP or ABR Diagnostic Physics although it is implicit that individuals certified through these boards, or anybody actually, can be recognized as ‘qualified experts’ by the Oregon Health Division. I am sure other agreement states are as confusing. It is not surprising that human resources pers onn e l i n O r eg on c o n ve ni en t ly develop the baseline for the physicist’s pay scale based on average salaries of all physicists at health facilities only in Oregon and tend to dismiss any board certification

out of hand at negotiation. Indeed, M r. Ton r y, w hy tak e a n y b o a rd exam at all? Officers in the Medical S er v ic e C o rp s in t he US A rmy engaged as radiological physicists prefer to be called heath physicists and will typically prepare for the ABHP with limited exceptions. The ra ti on al e i s sim ple, the me di cal physicist is identified with fix ed health care facilities and the heath physicist, it is argued, is operational, theref ore, the health physicist is mo re d e pl o y ab l e a n d h as mo re career potential. There are no more medical physicists in army uniform, only health physicists. The US Army is not always deployed, and as a result these officers are trained as, among other skills, RSOs in health care facilities and to survey and calibrate diagnostic x-ray equipment there. These kinds of institutional biases not only lends to frustration and confusion in professional identity, but defeats us all.

I was pleased to see the report on the move to eliminate duplicate certifications in areas of radiological

SEPTEMBER / OCTOBER 1998

p hy si cs b e tw e en t h e A B MP a n d ABR in the same issue of the AAPM New sl etter. Thi s i s a st ep in the r ig ht d ir ec ti o n a n d t h e AA P M should support the ACMP proposal.

I could not support AAHP sponsorship of the ABMP on the eve of its possible dissolution, or until it is known which categories the ABMP would continue to offer certification.

I would not supp ort duplication between the ABHP and the ABMP in that regard. Regrettably, this does n ot p r o v id e a so l u t io n to M r .

Tonry’s quandary. Since he identif i e s so st r o n gl y w i t h me d i c a l physics, why not go for the ABR? Fi nal ly , I app la u d t he ACR C MP interactions with the CRCPD. Since CRCPD recommendations are often reflected in regulation, it is inportant for medical physicists to provide input to help guide us out of the regulatory morasses d e s c r i b e d above.

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Announcements Northwest AAPM Spring/Fall Meetings

by Carolyn Brand Tacoma, WA The Northwest AAPM is sponsoring two meetings on “The 3D Treatment Planning System Selection Process: A ‘Team’s’ Eye View”. Selecting a Tre a t m e n t Planning System is a very involved process! These meetings were designed to help the attendees develop skills to aide them in their selection prcess.

Th e Spring Meeting was held March 27-28, 1998 at the Skamania Lodge on the Columbia Gorge.

There were approximately 80 participants at this meeting.

ADAC, CMS, RAHD, Theratronics, and Varian each presented a “Team” (physician physicist, and dosimetrist) presentation of a case from their facility on their treatment planning system.

Meeting attendees were encouraged to interact with each “Team” during their presentation and questions were also addressed at the end of each 1 hour 30 minute pre s e n t a t i o n .

Attendees were also able to visit the vendors in the exhibit hall during the course of the meeting. Jack Cunningham, Dennis Leavitt, and Peter Rosemark were among the additional speakers. Topics discussed, in addition to the presentations, w e re calculation algorithms, new areas of treatment, imple-

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mentation and commissioning, and the devdopment of a selection process. Other vendors present were Barker+, IMPAC Medical Systems, Picker International and ROCS. Support was provided by Best Industries and Med-Tec. The Fall Meeting will be held November 13-14, 1998 at the Skamania lodge once again. Electra, Helix, Nucleatron, Prowess, and ROCS will each sponsor a “Team’s” Eye View of their Treatment Planning System. Bill Harms and Geoff Ibbott will be among the guest speakers. Topics will include the development of the selection process, a look at the financial considerations to present to administration, and other issues that we must

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SEPTEMBER / OCTOBER 1998

address once Pandora’s “3-D” Box is opened. In addition to the systems listed above, ADAC, CMS, RAID, Theratronics, and Varian will return to participate in an afternoon of System Workshops.

A full program will be available on the National AAPM webpage the end of August.

Please call Carolyn Brand for additional information at 253-351-6051.

AAPM Awards and Honors Committee Call for Nominations Deadline—all nominations must he received by October 15, 1998. Further information i n S ec tion 3.9 of R ul es of AAPM (see AAPM 1998 Membership Directory, page 45).

A d d ress Aw a rds and Honors nominations to: AA PM Aw a rd s and Ho nors Committee One Physics Ellipse College Park MD 20740-384 Award winners and nominators will be notified of decisi on s by Ju ne 1 5, 19 99 .

Aw a rdees will be honored at the Awards and Honors Ceremony and Reception during t h e An n ual Me eti ng in Nashville.

William D. Coolidge Award This award recognizes an AAPM member for a distingui she d c ar ee r in me d ic a l physics.

Primary Criteria • Exerted a significant impact upon the scientific practice of medical physics

• Significantly influenced the professional development of the careers of other medical physicists • A leader in national or international organizations, with specific emphasis on AAPM activities Nomination Procedur e • Submission of nomination including information regarding comprehensiveness and the criteria outlined above • Letters of support from three other AAPM members

AAPM Award for Achievment in Medical Physics This award, approved by the AAPM Board at the July, 1994 meeting, was given for the first time in 1996. It re co gni ze s A APM me mbe rs wh ose c ar ee rs ha ve bee n notable based on their outstanding achievements.

Primary Criteria • Outstanding career achievements in medical physics practice, education, or organizational affairs and professional activities Nomination Procedur e • Submission of nomination including supporting evidence of outstanding achievement in one of the three areas of medical physics • Letters ofsupport from three other AAPM members

AAPM Fellows AAP M F ellowship re c o gnizes distinguished contributions by AAPM members.

Primary Criteria

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• Distinguished achievement in medical physics practice, education, or leadership.

Nomination Procedur e • Nominated by either an AAPM Chapter or by two AAPM Fellows • Five years as Full Member of AAPM required for nominee • Use nomination form available from Awards and Honors Committee (address above)

AAPM Awards and Honors Committee Call for Competitive Applications for 1999 Travel Grants Deadline—All applications must he received by October 15 , 199 8. Ad dres s Tr a v e l Grants applications to: AAP M Aw a r ds and Hon ors Committee One Physics Ellipse College Park MD 20740-384 Applicants will be notified of decisions by June 15. 1999.

Recipients will be honored at the Awards and Honors Ceremony and Reception during t he An n ual Me et i ng in Nashville.

AAPM-IPEM Medical Physics Travel Grant This grant is made annually to a U.S. AAPM member who shows evidence of an active scientific career in medical physics. The recipient should be pre p a red to travel in the United Kingdom for 14 to 21 days between July, 1999 and July, 2000.

Primary Criteria • Practicing medical physics for at least 5 years

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Announcements • Travel to United Kingdom for 14 to 21 days between July, 1999 and July, 2000 • Submit report suitable for publication in AAPM Newsletter, and appropriate receipts, for reimbursement Application Procedure • Applicant sh ould send curriculum vitae and letter detailing anticipated pro f e ss io nal dev el op m ent as a result of this travel, and five suggested topics for lecture s to be presented during their vis it t o th e U. K., t o t he AAPM Aw a rd s and Honors Committee (address above) The grant is supported by a donation from Charles Lescrenier of up to $1,500. In addition, this grant will include £400 fro m th e Insti tu te o f Physics and Engineering in Medicine and £750 from Varian TEM Ltd. towards expenses incurred in the U.K.

AAPM Menical Physics Travel Grant This grant is made annually to a U.S. AAPM member to travel to a foreign country of the recipient’s choice. The purpose of this grant is to assist in the career development of the recipient and to p romote communications in m edi ca l ph y sics bet we en nations.

Primary Criteria Completed graduate training within the past ten years • Not be able to accomplish this travel without financial assistance • Travel for 14 to 21 days to a foreign country between

July, 1999, and July, 2000 • Submit report suitable for publication in AAPM Newsletter, and appropriate receipts, for reimbursement Application Procedure • Applicant should send curriculum vitae and letter detailing anticipated professional development as a result of this travel, and five suggested topics for lectures to be presented during their travel, to the AAPM Awards and Honors Committee (address above) This grant is supported by a donation not to exceed $1,500 from Charles Lescrenier.

Attention I-125 Seed Users:

by Geoff Ibbott Lexington, KY In the n ear fut ure, th e National Institute of Standards and Technology (NIST), the ADCLs, and seed manufacturers will implement a re v i s e d a i r- k e rma strength standard for I -125 se ale d so urc e s .

H o w e v e r, so urces be in g shipped presently are calibrated in terms of apparent activity based on the air- k e rm a standard that has been in use for many years. At this writing, implementation of the new calibration standard is expected to occur in January 1999. You will be notified once this date is finalized.

Should you have questions, please contact the seed supp l i e r, one of the ADCLs, or the AAPM Subcommittee on

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C ali bra t ion Accreditation.

La b ora tor y ■

AAPM NEWSLETTER

SEPTEMBER / OCTOBER 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.

NEXT ISSUE November/December

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October 15,1998

November 15, 1998

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

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.acp.org http://www.aapm.org