AAPM Newsletter November/December 1998 Vol. 23 No. 6

Newsletter AMERICAN ASSOCIATION

OF

PHYSICISTS

VOLUM E 23 NO. 6

IN

MEDICINE

NOVEMBER / DECEMBER 1998

AAPM President’s Column Farewell Address

by Lawrence Rothenberg New York, NY Thanks This is my final opportunity to write this column as your president. It has been a great h on or for m e to ser ve th e AAPM, an organization which I ap pr ec i at e s o muc h a n d have participated in with so much pride and dedication for almost 30 years. I want to thank all of you who have provided input and insight, as well as splendid efforts during the past year. In particular, I would like to thank the m emb e rs o f E XCO M, th e Headquarters staff, the Council Chairs, all of the Committee and Task Group Chairs, the editors and staffs of our pu bl ica t io n s, ou r sp eci al liaisons, and the additional a rmy of member volunteers who worked so diligently to mak e our Annual Meeting, the RSNA physics pro g r a m , and all the other AAPM activities so excellent this year.

Finally, heartfelt thanks are due to a special few at home w ho ha ve pr ov id ed gr e a t support (sometimes inadvertently) which enabled me to s e rve you: m y M SK CC D epa rt me nt of M edi cal

Physics Chairman C l i f t o n Ling, my colleague Jean St. G e rm a i n, the members of my Diagnostic X-Ray Quality Ass ur anc e La bo ra to ry Richard Fleischman, Barry F r e e d , I rw i n L ev y , a n d Peter Shendero v, and last, but not least, my wonderf u l wife Laura. I pledge to provide whatever strong support I can muster to your future Presidents Geoff Ibbott, Ken H o g s t ro m, and those who follow. I am looking forward to s e rvin g you in 1999 as your Chairman of the Board of Directors.

Board Unification Proposal I had the opportunity to participate in a meeting, organized by American College of Medical Physics (ACMP) Chair Alex T u rn e r and hel d in

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P i t t s b u rgh in mid-September, concerning the Board unification propos al from ACMP which was strongly supported by your AAPM Board of Directors. Those present were the three American Board of Radiology (ABR) Physics Trustees Ed Chaney, Bill Hendee, and Gu y Si mm on s, A m e r i c a n B o a rd of Medical P hysics (ABMP) Chai r Faiz Kha n , AAPM past President and chair of the 1996-97 Ad-Hoc Board

INSIDE TABLE OF CONTENTS President’s Column………………p. 1 Online in '99…………..…………p. 3 Coolidge Awards-Bjarngard…..…p. 5 Executive Director………….……p. 6 Reseidences and Fellowships..…p. 7 CIRMS…………………………..…p. 9 CRCPD………………………...…p. 11 I-125 Notice…………………..…p. 14

Harold Johns……………...…p. 15 1997 Travel Award……….…p. 16 RSNA Plenary Session……...…p.

Achievement Awards………...…p.

Letters to the Editor……………p.

Endovascular Brachy………...…p.

Chicago 2000……………………p.

Accredited Dosimetry..…………p.

Upstate New York Lecture……..p.

Announcements…………………p.

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NOVEMBER / DECEMBER 1998

Unification Committee B h udatt Paliwal, and myself. At the meeting the ACMP proposal was discussed: the ABMP will cease to examine in competing areas of radiological physics if the ABR will include ACMP, the professional college of medical physicists, as one of its Sponsoring Organizations. In addition there w e re mutually agreed upon plans for ABR to re c o g n i z e those already certified by A B M P, and those who are partway through the ABMP certification process. The ABR Physics Trustees agreed to “su pport the proce ss� of ACMP attempting to become a Sponsoring Organization of the ABR. They will insure that the ACMP proposal, which has b een sent to the ABR President Dr. William Casarella, is forwarded for consideration and possible approval to the eight current ABR Sponsoring Organizations: the American College of Radiology, the American Radium Society, the American Roentgen Ray Society, the Association of University Radiologists, the American Medical Association, ASTRO, RSNA, and AAPM.

How Can You Help Achieve Unification?

How can each of you help in the effort to achieve Board unification, and to heal the c u r rent split in the medical physics community?

1. Contact those radiologists, radiation oncologists, other physicians, administrative personnel, and medical physicists whom you know to be influential in the eight Sponsoring Organizations and tell them of your strong sup-

port for and great interest in a chiev ing su cces s f or this unification proposal. If you are a member of their organizat io n, be s ure t o inf or m them of that fact.

2. Contact our current ABR P hysics Trus tees to assure them of your support for this B o a rd unification pro p o s a l and make known your willingness to help in any way possible to arrive at a successful result.

3 . Con tac t your A APM Chapter Board Representative, the AAPM Board Members-at Large, and your AAPM Executive Committee to show them your continuing support for this effort.

Special AAPM Activities for 1998 1998 was a good year for A APM f rom the sc ient if ic , educational, professional and financial (Wall Street excluded) points of view. AAPM has had many successful interactions with a variety of scientific, professional, and governmental organizations during 1998, some in new areas for most medical physicists: 1. AAPM has maintained its s t rong ties to the American Institute of Physics thro u g h attendance of its officers at the AIP Assembly of Scientific O fficers, and by having re presentatives on various AIP Committees and two re p resentatives on the AIP Board of Governors (C. Marshall and J. Smathers).

2. An excellent symposium was presented by AAPM at the Annual Meeting of the Conference of Radiation Cont ro l Pr ogra m Di re c t o r s (CRCPD). In addition, Steven

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Collins, the CRCPD Chairman attended our Annual Meeting with support from AAPM. 3. AAPM representatives (S. Balter and R. Nath) participated in the ASTRO Round Ta ble o n I n trav asc u lar Brachytherapy Procedures.

4. AAPM has appointed a liaison (M. Holland) to the American Society of Echocardiography.

5. AAPM Repre s e n t a t i v e s participated in the Conferenc e on Gradu ate Med ical Education hosted by the ABR. 6. An AAPM Representative ( F. Khan) attended a health physics round table at the HPS Annual Meeting.

7. AAPM Representatives (S. T homas, L . Ro thenbe rg ) participated in the Intersociety Summer Meeting.

8. The AAPM has maintained its strong relationship with RSNA through its many liaisons to RSNA, and by having the RSNA President David Fraser attend and address our Annual Meeting in San Antonio.

9. AAPM had re p re s e n t atives on the podium for three recent meetings sponsored by NRC to discuss revisions to Part 35 (M. Martin, R. Lieto, M. Fox).

10. The Trilateral Committee composed of leaders of the A AP M, the AC MP, a n d the ACR Commission on Medical Phy s ics ha s c on tinu e d t o meet to discuss professional, education al, and scientific matters of mutual intere s t .

Th e co m mit te e met thre e times in 1998, once by conf e rence call, and at Summer and Fall meetings in Virginia and Maryland.

11. AAPM through its 1999 P resident (G . Ib bot t) a n d

AAPM NEWSLETTER

P re si dent-Elect (K. H o g s t ro m ) will be pursuing efforts to have AAPM officially involved in the scientific program of the ASTRO Annual Meeting (similar to the current relationship with RSNA).

12. AAPM has initiated discussions with the American College of Cardiology to have more medical physicist/cardiologist involvement in ACC and AAPM educational and scientific programs.

My personal thanks to all of y ou who ha ve w or ked diligently and sacrificed your leisure time to be involved in t hes e ma ny ac tiv iti e s. We look forward to expanding our horizons even farther as we prepare to enter the new millennium.

Holiday Greetings My best wishes to you and your loved ones for a joyous holiday season. I look forward to my interactions with you in 1999.

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NOVEMBER / DECEMBER 1998

On-line in ’99 Medical Physics should become accessible over the Web* in 1999

by John Boone Sacramento, CA The Journal Business Management Committee (JBMC) oversees the business operation of the Medical Physics Journal, and has been in existence since 1996. The JBMC functions to insulate the Editor and the Editorial Board from the burden of managing the financial and contractual matters of the journal.

The Editor of Medical Physics, Colin Orton, is a full voting member of the JBMC and has a strong voice on the committee.

The JBMC has taken some recent steps to help the Editor to maintain Medical Physics as the premier journal in our field, and some of these steps will be outlined in this communication.

Since 1996 we have monitored very closely the advantages, challenges, and pitfalls that electronic publication presents. Our publisher, the American Institute of Physics (AIP), has been proactive in this area and has successfully launched on-line versions of 34 journals for itself, other member societies, and other organizations.

The term “on-line” should be clarified here. An on-line journal is one which is accessible over the Internet, and log-in procedures with passwords (or other access protection mechanisms) are implemented to allow only authorized subscribers to read and download manuscripts. The JBMC recently voted unani-

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mously to recommend to the Board that Medical Physics go on-line starting January 1999, in addition to distributing the print copy of the journal to regular AAPM members as usual. Some of the reasons for this decision are discussed below.

T h e re is little question that most scientific journals are headed toward electronic publication, the only decision to be made is “when?” Readers should know that our primary competition, Physics in Medicine and Biology, is already on-line for libraries. In addition, the ACMP will be producing it’s own, completely electronic journal in 1999. Medical Physics On-Line should not be thought of as a duplicate of the printed copy of Medical Physics.

Medical Physics On-Line will carry scientific articles in exactly the same layout as the printed journal, and each article with its figures can be printed out from the member’s own computer using high quality PDF format (Adobe Acrobat). However, the electronic version of the journal will also allow the horsepower of the computer to be exploited: The entire text of the journal can be searched for words, phrases, or author’s names.

Most re f e rences will be hot-

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NOVEMBER / DECEMBER 1998

linked, which means that if you click on a specific re f e re n c e , your Web browser will take you to the electronic version of that referenced article, if available. A given issue of Medical Physics On-Line will be accessible approximately 3 to 4 weeks before the print version comes in your mail, due to the time required for printing and mailing the hard copy journal.

Most members of the AAPM may not realize that the Journal is very dependent on the sale of advertisements, and the income derived from library subscriptions, for financial viability. Without these important sources of revenue, the cost of the journal to members would be quite high (~$215/year instead of $40). How will going on-line affect the look and feel of advertisements, and very importantly, how will our advertisers perceive the value of placing and paying for electronic advertisements? These a re important fiscal issues which the JBMC has seriously considered. In 1999, funds are budgeted to allow advertisers a presence in the on-line Journal, free of charge, assuming that they pay as usual for ads in the print version of the Journ a l .

This is so that our advertisers can become comfortable with the concept of electronic advertisement, and so that we can generate statistics concerning e l e c t ronic ad impact. After a trial period (1999), and once the value of on-line ads becomes evident to our advertisers, on-line advertisement fees will be implemented (in 2000). This, incidentally, will coincide with the World Congress meeting in Chicago (an important advertising opportuni-

ty), and this played a role in our deliberations.

Libraries around the world a re feeling the pre s s u res of soar ing journal costs and reduced library budgets. In addition, the number of electronic journals being launched is increasing almost exponentially. In some foreign countries, long delivery times for h a rd copy journals translate into significant delays in accessing the literature. There is also a move afoot to develop digital library consortia in large university systems and at the Federal level, and electronic journal subscriptions will play an important role there.

The move to place M e d i c a l Physics On-Line in the hands of librarians next year will better position ourselves (by giving added value) to reduce the loss of subscriptions that all scientific journals, including Medical Physics, have experienced in recent years. Note that library subscribers will be able to provide the electronic journal only to their traditional, limited clientele (access is limited to cer tain re g i s t e red IP addresses), and therefore this will not open up the journal to be free to everyone on the Internet. Journal subscriptions follow a supply and demand curve like anything else, and therefore it is necessary to limit supply to survive financially.

In considering the needs of our advertisers, we are nevertheless not willing to compromise the professional look and feel of Medical Physics OnLine: There will be absolutely no advertisements (zero) in the scientific articles within the Journal. Tasteful vendor logos with electronic links to their

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ads will be visible in the “service areas� of the Journal - (i.e. the cover, the masthead, the table of contents, the calendar, etc), but flashing and otherwise cavorting ads will not be seen unless the user clicks on an advertisement. While 1999 will be an opportunity for our advertisers to become comfortable with electronic ads, we encourage our members to also become familiar with electronic advertisements. Many of us b rowse the ad pages in the print journal; members should also develop the habit of browsing the electronic ads in the on-line version. Because hit rate statistics may someday be useful in establishing advertisement fees, browsing these elect ronic ads may ultimately be beneficial to the Journal’s bottom line.

All members of the AAPM were sent a CD ROM of Medical Physics last spring, and this was really our first foray into the world of electro n i c publishing. If you have not tried it out, I encourage you to do so. The electro n i c p reparation (and associated cost) of the Journal for the CD ROM has significant redundancy with the p re p a r a t i o n required for placing it on-line.

After the membership has experience with the Journ a l on-line for a year or so, we will probably institu te the option for interested members to only get the Journal on-line (and n ot receive the prin t copy of Medical Physics) .

For 1999, we have re c o mmended that the subsidy of providing the print Journal to student members be eliminated, and instead all student members will be given fre e

AAPM NEWSLETTER

access to Medical Physics O n - L i n e . All AAPM members will continue to receive a CD ROM at the end of each year for their archives. Once we get to the point where we can further reduce the number of print journals that are produced, significant fiscal savings may be realized. There f o re , our decision to invest some of our profits in the short term for electronic publication may pay off in the future.

While the future of electronic publication is uncertain, there is no question that there is a huge momentum in that dire c t i o n .

This paradigm shift has important ramifications in terms of how scientific literature will be delivered to the scientist, but does this mean that scientists will become incre a s i n g l y chained to their CRTs? Probably not. How many articles do you actually read in-depth each month in Medical Physics?

P robably not that many, but certainly we all read different articles because of our differing interests, so all articles are read in-depth by somebody. Wi t h Medical Physics On-Line, we can print out the couple of articles that we are interested in reading in-depth, and carry these to the bathroom or to the b e d room or to the jetliner, where most in-depth scientific reading really gets done. In this mode, your briefcase will be several pounds lighter next year, and you may have already read several articles in the journal before you even receive the hard copy Medical Physics in the mail. *assuming that the AAPM Board approves the recommendations of the JBMC

NOVEMBER / DECEMBER 1998

1998 Coolidge Award Winner advisor to NCI, NRC, FDA, and Bengt Bjarngard received his IAEA. He has served AAPM in graduate training at the Univermany capacities, e.g. as the sity of Lund, Sweden. His thechair of the Committee on sis in radiological physics in Training of Medical Physicists 1962 was on spectra of scatwhen it was formed in 1973. tered x-rays and on doses in He was President of the AAPM dental radiography. He worked in 1979. He has also been in the nuclear power industry 1961-65 on solidstate dosimetry and the consequences of reactor failure and joined a commercial company in the US in 1965 as manager of a radiationinstrument division. He became the Director of President Lawrence Rothenberg awards medal Physics of the Harto Bengt Bjarngard of Philadelphia, PA. v a rd Joint Center for Radiation Theractive in ASTRO, ACR and apy when it was established RSNA. He was the first Physics in 1968.

Editor of International Jour nal He organized (with others) of Radiation Oncology, Biology, graduate training in radiological P h y s i c sl974 - 1988 and is curphysics at Harvard (1970) and rently an Associate Editor of postdoctoral training in physics Medical Physics. of radiotherapy (1973). The His 150 publications span physics re s e a rch work at the many subjects and emphasize J C RT pioneered in 1974-86 thermoluminescence dosimetry, resulted in the computer conc o n f o rmal therapy, and data t rolled techniques which are for description of now called conformal and x-ray beams. â– intensity-modulated radiation therapy. Dr. Bjarngard was promoted to Professor of Radiation Therapy in 1980 and served at Harvard Medical School until 1989. He held similar positions at Brown University 1989-1995 and has since 1995 been Vice Chair, Director of Physics and Professor of Radiation Oncology at the University of Pennsylvania.

D r. Bjarn g a rd has been an

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NOVEMBER / DECEMBER 1998

Executive Director’s Column

By Sal Trofi College Park, MD

Staff News

Membership Directory We plan to mail the paper versi on o f th e 1 999 Memb ersh ip Directory ear ly in January.

This year, in an effort to automate the update p rocess to the membership database and reduce maili n g co s t s , w e s e n t t h e majority of the requests for updated information via Email. The count was 3,058 E-mail messages and 1,346 via the traditional method of mailing a paper printout.

Memb ers rec ei vin g th e Email version were asked to make demographic changes t h rough the AAPM web site.

The on-line version of the Membership Directory is by far the most popular information on our web site.

Members can submit changes to their demographic information via the AAPM web site at any time.

T h e st a f f s tr i v e s t o m a k e the changes received on a daily basis so that addresses a r e corr ec t. T he M ember ship Directory on the AAPM web sit e is updated every w o r k d ay a t n o o n a n d 5:00pm.

Chicago 2000 P l a n n i n g f o r t h e Wo r l d C o n g ress Meeting in Chicago has be en go in g on fo r five years. The budget for t his mee tin g co ntin ues to be adjusted, as better infor-

mation becomes available.

The final budget should be ready for approval by July of 1999. It is anticipated the total dollar amount of budget for this meeting will be in about the same range as the entire AAPM budget ($3.5 million).

The Biomedical Engineers, because of contractual agreements, need to publish short papers (1-4 pages) t h a t w i l l a c co m p a n y t h e abstract s ubmissio ns. This publication is known as the IEEE Proceedings and must be published in a paper v e r s i o n to sa t i s f y l i b r a r y commitments. Our abstracts database system can accommodate this need with little or no e xpe nse . An a gre e ment was reached that all registrants of the Congre s s wi ll rec eiv e a CD-ROM i n their onsite packet. The CD w il l con ta in al l ab st ra ct s, sh or t pa p e r s, a n d r e v i e w course hand outs, pro g r a m sessions and other inform ation. The same inform a t i o n will be available on th e Chicago 2000 web site before the Congress starts.

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K at h y Bu r r o u g hs wa s h i r e d t o r e p l ac e A n d r e a D e G i rolamo. Kathy’s title is “Membership Representative” and she began work on Se p t e m b e r 1 5 . K at h y h a s tw o c hild re n (t win s) w ho a re f i v e y e a r s o ld . K a t hy w or k e d f or t h e A m e ri c a n Association of Retired Person s (AAR P) f or 12 yea rs , d o i n g m e e t i n g pl a n n i n g , a d m i n i s t r a t i v e s u p po r t , acc ounts p ayabl e, pa yro l l and benefits, and interacted wi t h v ol un te e r m e m b e r s .

She is currently studying for a B.S . Degree i n Info rm ation Systems Management at the University of Maryland.

K at h y w i l l w o r k a t t h e RSNA meeting in the headquarters office.

Sean Bened ict was hire d to replace Janie Steplowski.

S e a n ’ s ti t l e i s “ D a t a b a se Support Technician” and he began work on August 21.

He earned a B.A. Degree in Radio, Television and Film, from the University of Maryland in 1994. Sean worked with media companies producing short and long video p r e s e n t a t i on s f o r c a b l e , b roadcasts and other media.

He has experience in purchasing and integrating new equipment into existing systems, and assembling an d c o n f i g u r in g P C s y s t e m s .

S e a n w a n t s t o f o cu s h i s c a reer in Information Te c hnology. He will work at the RSNA meeting in the headquarters office.

AAPM NEWSLETTER

Closing The office will be opened all regularly s cheduled workday s during the holiday seas on, bu t will be clo sed on Fr iday, December 25 and Friday, January 1. Some st aff wi ll t ake va ca t io n d ay s du rin g t hi s period, but sufficient help will be available to service your needs.

This is my last column for t h e 1 9 9 8 y e a r. I w a n t t o ta k e t h i s o p p o r t u n i t y , speaking for all the staff, to w i sh y o u a n d yo ur l ov e d ones a happy and healthy holiday season.

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NOVEMBER / DECEMBER 1998

AAPM Residencies and Fellowships— A Brief History

by Steven Goetsch Chairman, Development Commitee San Diego, CA Jean St.Germaine Founding Chair, Development Commitee San Diego, CA This article is to provide a comprehensive review of the Residencies and Fellowships s p o n s o r e d by t he A APM since 1992. Selected AAPM members will soon be asked to participate in a Planned Giving program to benefit the Education Endowment Fund, and it seems appropriate to inform members of what has been achieved so far.

Th e AA PM D evelopmen t Co mmit tee w as f o rm ed i n 1989 with the intent of identi f ying wo r th y pro g r a m s which required funding. The Committee’s original membership consisted of past officers of the Association, including fou r Pa st Pres id e nts. Th e Committee identified educati on as on e of th e ar e a s which would re q u i re longt e rm funding, and the Committee asked the Board of Directors to create the AAPM Education Fund. A five year p rogr am w as l a unch e d t o raise the endowment for the fun d, wit h a goa l of $1,000,000. A Membership Campaign under the leadersh ip of J osep h B lin ic k encouraged AAPM members to donate at the Silver, Gold

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and Pl ati nu m le vel . T hi s e f fo rt rai sed $ 340 ,000 i n pledges. A Past Pre s i d e n t ’ s campaign under the leadership of Peter Almond raised ov er $10 0,0 00 in pl edges .

Final ly, a Corpora te C ampaign under the leadership of Ned St e r nic k re ce ived a major gift from the Radiological Society of North America totaling $250,000. The overall ca mpa i gn wa s cha i re d b y Jean St. Ger mai n w it h t he assistanc e of Al Smi th, Ed McCullough and other members, assisted by a pro f e ssional fund raiser, Bob Pierpont. A total of $700,000 was pledged.

In order to jump start the p rogram before pledges for the endowment fund were fulfilled, funding for residencies was sought. Funding for the first residencies in radiation oncology physics was received from the American Society for Therapeutic Radio lo gy and Onc ol og y an d began in 1992 (see Table 1).

Support for two additional resi de nci e s i n ra di at io n on colo gy ph ysi c s we re received from Varian Corporation, beginning in 1993 and continuing to this day. The graduate fellowship program fo und e d b y th e Bo ar d i n 1987 was also placed under the direction of the Development Committee, as well as funding for graduate student travel awards. All awards of the Development Committee are granted by a subcommittee of the Development Com-

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NOVEMBER / DECEMBER 1998

m i tt e e, c h air ed fro m it s inception by John Laughlin, until last year, when Bhudatt Paliwal became the chair. In 1997, Elekta Oncology was asked by the present Development Committee Chair to sponsor an additional re s idency in radiation oncology physics and they have agreed to a two year commitment beginning in 1998.

The Development Committ e e sou ght t o ba l anc e the c om mi tme n t t o ra d ia t io n oncology physics by seeking sponsorship of one or more residencies in imaging. The first imaging residency was s p o n s o red directly by AAPM o pe ra ti ng f un ds in 1 991 .

Under the leadership of Steve T homas, the AAPM sought and received generous support for imaging re s i d e n c i e s from the Radiological Society of North America.

The Board of Directors has followed a policy to this date of reinvesting into the Fund a l l int er est and div id e nds received from investments of the Endowment Fund. Wi t h careful stewardship and a rising stock market, the fund stood at $970,810 as of July 31, 1998. No te that by the t e r ms of it s c re at i on, t h e principal of the fund CAN NEVER BE SPENT. S in ce 1 99 0 a t o tal of 12 residencies and three fellows h ip s h av e been a wa rd e d (listed in Table 1). Each of these residencies and fellowsh ip s h as be en pa id for directly by sponsoring organizations or by the AAPM General Fund. G e n e rous sponsors include the Radiological Society of North America, the American Society

ASTRO Residency Awards

Chris Scarfone Vanderbilt University

Siyong Kim University of Florida

for Therapeutic Radiology a n d On c o l o g y , Va r i a n O n co l og y Sy s t e m s , a n d Elekta Oncology Systems, I n c . Each residency is funded by a grant of $15,000 per year for two years from the AAPM, and this fu nding is mat c hed by a gr ant of $15,000 more from the institution supervising the re s idency. In addition, a travel grant of $1,000 to attend the A APM a nn ual m ee ti ng is gr an te d to e ach C AMP EP accredited graduate program and residency program, independent of other grants, paid for by the General Budget.

At present seven re s i d e n c i e s a n d on e f ell ow sh ip ar e a d m i n i s t e red by the AAPM Development Committee.

A APM fe l lo ws hi ps ar e restricted to those nine graduate programs which have been accredited by the Commission on the Accreditation of Medical Physics Education P r ograms, Inc. (CAMP EP ).

AAPM residencies, however, are not restricted to residency p r ogra ms ac c redi t ed by C A M P E P. At pres ent , onl y on e resi de ncy p rogr am is

a c c re d it e d b y CAM P EP. CAMPEP programs are listed o n p a ge 2 4 of th e 199 8 AAPM Membership Directory.

This year three re s i d e n c y a w a rd s hav e b e en announced. The two awards i n R a d i a t i o n O n c ol o gy Ph y si c s s p on s o re d by ASTRO have been made to Siyong Kim, Ph.D. at the U n i ve r s i ty o f F l o r i da ( u n de r t h e d i r ec t i o n of Jatinder Palta) and to Chris Scarfone at Vanderbilt University (under the dire cti on o f Cha rle s C of f e y ) .

The first Radiation Oncology Physics residency sponsore d

by Elekta Incorporated has been awarded to Mallinckrodt Institute of Radiology (under t he di re ct io n of J am es Purdy). The RSNA Diagnostic Medical Physics Residency is also about to be announced.

To summarize, four graduate students have re c e i v e d fellowships and 19 graduates have received residencies at 12 different institutions since 1 990 , w ort h a t ot al of $630,000, without diminishing the Education End owment Fun d by a s in g le d ol lar,

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AAPM NEWSLETTER

thanks to the generosity of sponsors and support fro m the AAPM General Budget.

We feel it is important fo r A APM me mbe rs t o b e i n f o rmed of the steward s h i p of all gifts made to the Education Endowment Fund, as wel l a s a ddi tio na l g rant s made by corporate sponsors and other non-profit org a n izations. Th e Develop ment Committee intends to begin an important new fund-raising campaign in the next few months, and we hope that members can appreciate what has been achieved so far.

We feel it is important for A APM me mbe rs to be i n f o rmed of the steward s h i p of all gifts made to the Education Endowment Fund, as w ell a s a dd iti ona l g rant s made by corporate sponsors and other non-profit org a n izations . The Develop ment Committee intends to begin an important new fund-raising campaign in the next few months, and we hope that members can appreciate what has been achieved so far. â–

NOVEMBER / DECEMBER 1998

Table 1. AAPM Residencies and Fellowships Sponsor

Term

Institution

Recipient

Supervisor P.M. DeLuca, Jr.

A. Fellowships RSNA/AAPM

1990-92

U. of Wisconsin

Jason Polzin

1992-94

U. of Wisconsin

Eric Niendorf

P.M. DeLuca, Jr.

1995-97

U. of Wisconsin

Mike Schuler

P.M. DeLuca, Jr.

1997-99

McGill University

Martin Lachaine

G. Fallone

1992-94

U. of Wisconsin

Rebecca Kitchen

T.R. Mackie

B. Residencies ASTRO

Varian

AAPM

1992-94

U. of Rochester

Fang Yin

M. C. Schell

1992-94

Wayne State

S. Chungbin

C. Orton

1994-96

T. Jefferson Hospital

Jeff Yue

T. Suntharalingam

1994-96

Mallinckrodt Inst.

Steen Madsen

J. Purdy

1996-98

Wayne State

Mark Rivard

C. Orton

1996-98

Univ. Cal SF

Jenny Hai

L. Verhey

1998-00

Univ. of Florida

Siyong Kim

J. Palta

1998-00

Vanderbilt Univ.

Chris Scarfone

C. Coffey

1993-95

Mem Sloan Kettering

John Willens

C. Ling

1993-95

Univ. of Minnesota

Anil Sethi

F. Khan

1995-97

Mem. Sloan Kettering

Ken Forster

C. Ling

1995-97

Univ. of Minnesota

L. Lewandowski

F. Khan E. Podgorsak

1997-99

McGill University

Belai Moftah

1997-99

Mallinckrodt Inst.

S. Marty Goddu

J. Purdy

1996-98

Mayo Clinic

Kalpana Kanai

J. Felmlee

Imaging

1998-00

Not announced yet

Elekta

1998-00

Mallinckrodt Institute of Radiology

RSNA

1998-00

Not announced yet

J. Purdy

Diag Med

Activities of the Council on Ionizing Radiation Measurements and Standards (CIRMS)

by Larry DeWerd AAPM liaison to CIRMS Madison, WI T he C oun c il on Io ni zing Radiation Measurements and Standards (CIRMS) represents us ers of i onizi ng radiatio n a nd r ad io a ct i ve so ur c e s engaged in medical radiation, industrial radiation processing and sterilization, and worker radiation protection programs.

CIRMS provides a forum for discussing ionizing radiation issues; identifying, defining and prioritizing needed work for standards; disseminating information on standards; and o rganizing worksh op s and meetings to advance ionizing ra di ati on te ch nol og y. T he National Institute of Standards and Technology (NIST) interacts wi th th is org a n i z a t i o n with respect to the needed

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standards and measurements.

CIRMS is divided into four a reas: Medical Applications, Radiation Effects, Public and Environmental Radiation Protection (PERP), and Occupational Radiation Pro t e c t i o n (O RP) . T he org a n i z a t i o n accomplishes these goals in t h re e wa ys: 1 . An annu a l meetin g, 2. Per iodic worksho ps an d 3. A r e p o r t “National Needs in Ionizing

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NOVEMBER / DECEMBER 1998

R ad iati on Mea su re m e n t s , ” t e rmed the Needs report. A number of AAPM members h ave ta ken p a rt i n t hes e activities.

CIRMS annual meetings of the past have addressed topics in Medical Physics such as Absorbed Dose to Wa t e r : S t a n d a rds and Tr a c e a b i l i t y , P r o to n B ea m Dos im et ry , Polymer Gel Dosimetry, TLD 2-Dimensional Dose Mapping, a n d Re ac tor P ro d u c e d Radionuclides. As part of the a n nua l m ee ti ng , p ost er papers are accepted for presentation. Poster papers of the past included Scattere d Fractions of Dose from Megavoltage Linear Accelerators, New Standards (Mammography and ISO beams) for Ionizing Radiation Measurements a nd R esp on se of R a d i o c h r o mic Fi lms a ft er E l e c t ron Irradiation. By the t i me th is is pub li sh e d the annual meeting of October 1 9- 21 , 1 99 8 w ill h a ve occurred. It covered the topic The Role of National Agencies in Ionizing Radiation Measurements and Standards and International Standard s Activities.

CIRMS has appro x i m a t e l y three to four focused topical worksh ops each year. The medical applications subcommittee has been active in the workshops given. In particular, some topics very pertinent f or the AAPM, su ch as intravascular brachytherapy, Interstitial Brachytherapy with 125 I and Absorbed Dose Standards for Photons have been topics in the last two years.

The r ecen t work shop o n “Radiation Protection Dosime-

tr y: New Developments in R e f e rence Radiation Sourc e s and Proficiency Te s t i n g ” included the measurement of beta particles and new radiation sources, which may be important for future intravascular brachytherapy applications.

In 1995, CIRMS published its first document of Measurement Prcgram Descriptions (MPD), entitled “Report on National Needs in Ionizing R adiati on Meas ure m e n t s . ” T hi s re p ort , t e rm ed t h e Ne eds repo r t, has b een updated and is expected to be published in January 1999.

Of particular interest to the medical physics community is a recently completed MPD for national air- k e rma stand a rd s for ma mm ogra p hi c be am s. Th is MP D is n ow included as an appendix of the new Needs report. The contents of the Medical subcommittee part of the report will have the following Meas u rement Program Descriptions (MPDs) which addre s s m e a s u rement and standard s needs in medical applications of ionizing radiation: A.2.1 Radio activ ity Stan d a rds a nd Tec hn iqu es f or Nuclear Medicine A.3.1 High Spatial Resolution Solid State Dosimetry for Radiation Therapy A.4.1 Absorbed-Dose-toWater Standards for Photon E x t e r n al B eam Rad ia tio n Therapy A . 5 A ir Ke r ma Nat io na l S t a n d a rds for Diagnostic Xray Beams A .6 Na ti ona l A ir Ke n na S t r eng th S ta nd ar ds f or Brachytherapy Sources

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A7 Standardized Dosimetry for Intravascular Brachytherapy Sources To pi c A. 1 Na tio na l Ai rK e rma Standards for Mammography has been complete d and i s i ncl ude d in th e Appendix with results of the M PD .

MPD A .4. 1 A b s o r b e d - D o s e - t o - Wa t e r Standards for Photon External Beam Radiation Therapy is almost compl ete . This has been accomplished thro u g h the cooperation of the AAPM, particularly TG 51 and CLA TG 1 an d NIS T. M PD A .5 and A.6 are also in progress.

The AAPM subcommittee for the ADCLs is being informed o f th e p ro g r ess of th e se activities. T his new Needs r ep ort , p re p a re d b y th e CIRMS science and technology c omm i tt e e, s ho ul d be a va ila b le i n Jan u ary 199 9 f rom C IR MS a t P. O. B ox 3 418 , Ga i the rsb urg, MD 20885-3418.

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NOVEMBER / DECEMBER 1998

Conference on Radiation Control Program Directors (CRCPD)

by Keith Strauss Chicago, IL Introduction The 30th annual meeting of the Conference of Radiation C o n t rol Program Dire c t o r s (CRCPD) was held in Mesa, Arizona. The program consisted of the following sessions: 1. Opening 2. Healing Arts 3. Radioactive Materials/ Emergency Planning 4. Environmental 5. Science and Program Management The CRCPD is taking steps to respond to change. As an exam ple, Blu e Cr oss Bl ue Shield (BCBS) of New Jersey s ent ou t a su r ve y a ski ng about the age and condition of imaging equipment and about quality assurance programs within individual facilities. Will future standards by insurance companies have to be met to insure re i m b u r s ement? The CRCPD received requests from the regulated c o m mu n it y to b ec o me involved to help establish a national standard for third party payers like BCBS. The tension between State and Federal Regulatory Programs has diminished. The l ea der sh ip of th e C RC PD understands that partnerships with Federal Regulatory Programs, with other professional orga n iza tion s lik e th e AAPM, and with other members of the regulated community need to either be created

or stre ngthened. Shrinking b udget s w i th in sta te p rogr ams hav e f orc ed the i r d i rectors to seek eff i c i e n c i e s and limit “over” regulation, Among the training programs of f e r ed the AAP M Symposium on Image Quality and Pati ent D os e was designed to acquaint CRCPD members with the concept of image quality, factors affecting image duality and their relationship to patient dose. The topics of conventional radiography, digital radiography, film screen systems, fluoroscopy, and CT were covered. The 62 participants who would like to see the symposium continue in future years.

The relationship between the Medical Physicists who attend the CRCPD meeting and the CRCPD continues to improve. All imaging physicists, however, need to establish a non adversarial re l ations hip wi th the Pro g r a m D i rector of their state. This re lat i on ship i s n e ede d t o allow the exchange of information necessary for state personnel to better understand the broad spectrum of factors which make it impossible to write regulations on image quality and entrance skin exposure rates without restricting the proper use of X-ray s in no n sta nd a rd or “cutting edge” applications within the healing arts. Medical physicists also need to become more aware of the “political” pre s s u res on their Program Director so equitable

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compromises can be reached.

Opening Session T he c hai r pers on of th e CRCPD, Jill Lipoti, summarized the past year’s highlights. She encouraged members to be open to change, be willing to try new things, and become more involved.

She outlined her three broad objectives: 1. Create flexibility within the C RCP D to re sp on d t o rapid change. a. Develop more “Quality Assurance Guideline” documents. b. Rad io a ct i ve Mat er ia l “Orphan Source” initiative to address storage problems. c. Training videos on “Stray Ra di oac tive Ma te rial ” a nd “Emergency Preparedness” d. Support of MQSA re a uthoriztion. e. Radiation safety issues associated with irradiation of food.

2. Discover common goals wit hi n a b r oad r an g e of agencies and groups. a. Pr ovi de t ra ini ng programs for members using the knowledge and expertise of othe r gro ups. Th e A AP M Symposium on Image Quality and Patient Dose pre s e n t e d by members of the AAPM, ACMP, and ACR is one example. b. Relationship with ACR was s tren gthen ed. ACR is now providing significant funding in support of the NEXT (Nationwide Exposure Trends surveys) Pro g r a m .

The liaison to the ACR fro m

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NOVEMBER / DECEMBER 1998

t he CRCPD is no w a thre e year appointment to develop more continuity.

3. Allow the CRCPD to be a more effective service organization to its members. a. Pr o g r a m s w it h in t h e CR CPD w ere e val ua te d t o assess their effectiveness. A report on “Criteria for Adequate Programs” will soon be published. b. Administrative changes h a v e b e e n c o m p l e te d t o p r o v id e m o r e s u p p o r t t o chair persons of “Suggested S t a te R e gul a ti on Co m mit tees” in an effort to stre a mline the approval and publication process. c. Amplify the “voice of the states” to Federal agencies, e.g. CDRH, EPA, FEMA, etc. d. Create new web sites.

Ci ndy Cardwell of Te x a s reviewed the 30 year history of the CRCPD in recognition of its 30 t h anniversary. The CRCPD was establis hed in 1968 to allow state regulatory p rograms to speak with one voice, encourage partnerships with Federal regulatory agencies, and provide a re s o u rc e in the field of Radiation Protection. She challenged the m e mb er s hi p t o ge t mo re i nvo lve d an d t a p n e w re s o u rces. She also encouraged everyone to stay current with emerging technologies because “you can’t fairly r e g u l at e wh at y ou d on ’t understand.”

C harl es Meinhold of t he NCRP presented a nice review of radiation risk models. He commented that “everyone agrees that the linear model is t oo conservat ive”, but we should use it for small radiation doses until better scientif-

ic data becomes available.

Steve Collins of Illinois asked during discussion, “At what level (mrem/yr) should we stop regulating to conserve our limited funding?”

While he did not get a specific answer, it is comforting to know that some regulators a re asking these questions.

Kathleen Kaufman of Calif o rnia expressed concern about the delay in the publication of the Rewrite of N CR P R e po rt N o . 4 9 on D i a gn o s ti c S h ie l di ng Design Criteria. Bill Dornsife of Nuclear Affairs discussed “Risk Based Decision Making.” He commented that the public understands and d e s i res the concept of risk management. While the public does not understand risk a ss ess m ent , t oo of te n t he public’s incorrect assessment o f ri sk dri ve s r e g u l a t o r y p rocesses. Mr. Dornsife provided a list of “cost per risk avoided” associated with the us e of x- ra ys i n me d ic i ne and in the use of radiation in industry. Regulatory gro u p s ne ed t o f o cu s l imi ted re s o u rces where the actual risks are sizable.

H a ro ld Fin ger f rom t he National Academy of Public Administration concluded the session discussing the needs to balance risks fairly acro s s generations . H e p ro p o s e d that society needs to: 1. Fix past actions 2. Anticipate future pro blems an d start fixing them now 3. Impose costs on current generation to safeguard long term future.

H e u se d th e l o n g t e r m high level radioactive waste

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dispo sal issue to illustrate his premises.

Healing Arts Session A panel presentation and discussion re p resenting the views of the CDRH, states, an d u sers w i th r esp ect to Mammography initiated the session, Ruth Fischer of the CDRH discussed the voluntary interventional mammography accreditation program. The goal is to accredit 100% of the 1207 upright and 1692 prone stereotactic mammography units and their facilities by the year 2000. Digital mammography will re q u i re eight hours of modality specific training for personnel prior to first clinical use of this modality. Stanley Marshall of Nevada provided a perspective of problems with the MQSA program in rural and sparsely populated areas. Pam Wilcox-Buchalla of the ACR discussed the results of a phone survey of n facilities in 12 states and New York City. The average time spent testing a unit during inspections was 1.5 hours while inspectors averaged 4.1 h our s r ev ie w ing r e c o rd s .

Inspection times at a facility ranged fr om 3 - 16 hours!

Walid Mourad of the CDRH discussed the development of new inspection pro c ed u r es f or u s e w i th t h e MQSA final rules which go into effect on 4/28/99. The current three levels of n o n c o m p l i a n c e w i ll b e r e du c e d t o tw o l e v el s .

E fforts are being made to shorten inspection times.

During the discussion, the reduction of levels of noncompliance was questioned.

AAPM NEWSLETTER

Some regulators fear that this will confuse the tracking and follow up of noncompliances.

Pam Buchalla was also questioned about the ACR lobbying the CDRH for a reduction of inspection frequency. She responded that the reduction would only apply to facilities with no violations. Ruth Fisc h er cl os ed t he t op ic o f Mammography by re v i e w i n g personnel (radiologist, physicist, and technologist) qualification changes effective with the final rules.

Th oma s S h ope o f t h e CDRH initiated a panel discussion on “high dose fluoroscopic procedures.” He commented that the newer x-ray tubes with larger heat loadin g, d ig it a l i mag in g tec h n iq ues , and ne w di gi tal image receptors all contribute to the large patient exposures associated with interventional procedures. In the majority of cases involving patient radiation injuries, lack of training and awareness by the operator, not malfunctioning equipment, is the primary problem.

This problem is compounded by the increased use of fluoroscopic equipment by nonradiologists with little or no specialized training.

Dennis Angelo discussed a study conducted by Pennsylvania on high level cine and f l u o roscopy. He concurre d w it h M r. Sh op e th a t mo r e operator training was needed, and called for more collaboration between the states and federal agencies.

D r. John Cardella, Chief of Cardiovascular-Interventional Radiology at Penn University Hospital discussed the use of C - a rm fluoroscopes outside

the Radiology Department.

He noted that 25% of interventions and 18% of all fluoroscopy is perf o rmed at his institution by non-radiologists outside the Radiology Department. He noted that th ese “ o ff site” cas es tend to be less complex with shorter fluo roscopy times than cases p e rf o rmed within Radiology.

Bu t the off s it e st ud ies in general do not involve imaging physicists, good radiation protection practices, or operators which have had specialized training, Steve Baiter discussed the manufacturer’s perspective of high dose nuoroscopic proced u re s. He sta rt ed b y d is cussin g so me of the other (non radiation) safety issues associated with interventional p ro c e d u res, e.g. CPR rated ta bl es, spla sh pr o t e c t i o n , e ffects of power loss in the midd le o f an gi oplast y. He pleaded with the audience to overlook their rules for radiation interlocks on the doors of interventional rooms. He stressed that higher radiation exposure rates to the patient ma y ac tu all y red u ce t o tal radiati on exposure due to shortened total fluoro s c o p y time, Jeanne Crosby of California and David Spelic of CDRH reported on the status of the NEXT Surveys. F o r lack of training funds, a survey was not cond ucted i n 1997. The survey for 1998, tha nk s i n par t t o f un di ng provided by the ACR, will be a PA chest for a 15 mon th old child using a phantom of plastic, aluminum and an air gap. Scheduled su rveys in the future are: Dental ’99, CT

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NOVEMBER / DECEMBER 1998

’00 , Adult Chest ’01, Adult Abdomen ’02. Data dumps f r o m p r e vi o u s s ur v e ys through 1995 are available on the CDRH Web site.

A variety of topics concluded the Healing Arts Session.

Kathleen Kaufman of Californi a reported on escalat ed e n f o rcement pr o c e d u re s which were needed at two mammography facilities which refused to cease practicing.

Susan McClanahan of Minnesota discussed radiation c o n t rol concems associated with osteoporosis. Dr. Sander Pellet from Budapest presented exposure data and associated effective doses associated with photofluorography used for mass chest screening in Hungary. He proposed a reference skin dose level of 7.5 mGy; surveyed values ranged from 0.7 - 35.9 mGy! Dwight Shearer reported on a survey of dental panographic units in Pennsylvania. Among other p roblems, too many dental facili ties ar e still guilty of underprocessing their films.

R i c h a rd Wa rner discussed beam cut-off from the use of improper focus film distance wit h f o cu sed grid s. He believes that radiation dose to patients nationwide could be reduced up to 25% if all grids were focused properly.

Mr. Warner questions whether the states should write a regulation concerning this problem! Joanne Barton of the CD RH di sc us sed ch ange s within the CDRH Radiation P rogram designed eliminate b u re auc ra cy a nd im p ro v e efficiency. Judith Ball of Minne sot a re sp on ded o n her experience dealing with the issue of improperly trained

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NOVEMBER / DECEMBER 1998

technologists operating x-ray equipment. After numero u s failures at licensure and other approaches, potential operators of x-ray equipment must n ow pas s a n exa m. Wh ile this has led to better training, i t cam e at th e e xpen se o f registered technologists feeling undermined.

During discussion, concern was expressed concern i n g the use of a non transmission radiation device to scan for contraband concealed on the surface of visitors in prisons.

Will this type of device find it’s way into airports?

Next year’s CRCPD meeting will be in Atlanta, Georgia in late April or early May. Typically, approximately at least a doz en m edic al ph ysicist s a tt end r e p resen ti ng loca l AAPM and ACR chapters. The AAPM cannot be over represented at this meeting. Thank you for the opportunity to re p resent you at this year’s meeting. The published proc eedi ng s sh oul d b eco me available prior to the new year. Copies of these can be p u rchased by contacting the CRCPD’s executive office: 205 Capital Avenue Frankfort, Kentucky 40801 (502) 227-4543 ■

Notice to I-125 Sealed Source Users

by Dale Kubo Chair of ad hoc committee of AAPM Radiation Therapy Committee Sacramento, CA This notice is to inform you that in January 1999 the Natio nal In stitute of St andards and Technology (NIST) expects to implement a revised air- k e rma stre n g t h s t a n d a r d f or I - 1 25 s eal ed s o u r c e s . H ow e v e r, I - 1 2 5 s o u r ce s b e i ng s h i pp e d a t this time have been calibrated using the NIST air- k e rm a s t a n d a rd t hat ha s be en in u s e f o r m a n y y e ar s . Yo u w i l l b e n ot i f ie d o n c e t h e new calibration standard is implemented.

T h is n o t i ce i s a l s o t o advise you, if you have not already done so, to convert your I -125 sealed sourc e dosimetry pro c e d u res to t h e TG 4 3 p r o t o c o l . I n addition to conforming with the AAPM standard of practice, you will also simplify the future adoption of the r e v i s ed N I S T a ir- k e rm a s t rength standard. There are several areas that can cause potentially large dose discrepancies during the course o f TG 43 imp lementat io n.

Users are strongly advised to become familiar with the TG 43 protocol [1] so that there i s no confu si on re g a rd i n g the prescribed dose. Consider your institution’s conver-

14

si on proc es s ste p by st ep using your institution’s parameters. You are encouraged to a sk s om e o n e wh o i s familiar with the conversion to examine your conversion p ro c e d u re before initiating actual treatmen ts with the TG 43 protocol.

Suggested procedures both f or ado pt in g t he TG -4 3 dosimetry protocol and for imp le men t in g th e re v i s e d NIST air-kerma strength stand a r d w ere des cr ib ed in a r ece nt is sue o f th e AA P M Newsletter[2]. A detailed scientific approach to the same goal was pu blished in the I n t e rna ti o n a l J o ur n a l o f Radiation Oncology, Biology and Physics [3] In the latter publication, a simplified stepby-step procedure for several scenarios is presented.

However, the reader is cautioned to fully understand the manuscript. Please pay attention to the values of the parameters you have been using i n c om parison to t ho se in Ref. 3. Note that several new s o u rce models have become available since the publication of Ref 3 and the TG 43 protocol [1]; users are advised to i nco rpor ate t he av ailabl e do sime try da ta and use a similar approach to conform with the TG 43 protocol.

Certain treatment planning systems do not incorporate the TG-43 protocol for dose calculation, and others do not allow a simple change f rom an “apparent” sourc e activity to air-kerma strength.

A procedure for dealing with

AAPM NEWSLETTER

these limitations was re c o mmended in Ref. 3. The adhoc committee urges vendors of treatment planning systems who have not already done so to adopt the TG-43 protocol for dose calculation.

References 1. AAPM Report No. 43.

Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. Med. Phys. 22:209234; 1995.

2. Kubo, H. D.; Preview of 125I sealed source dosimetry implementation. AAPM Newsletter. 22:9-11; 1997.

3. Kubo, H. D.; Coursey, B. M.; Hanson, W. F.; Seltzer, S. M.; Shu pin g, R. E.; and Williamson, J. F. Report of the ad hoc committee of the AAPM Radiation Therapy Committee on 125I sealed source dosimetry.

Int. J. Radiation Oncology Biol.

Phys. 40, 697-702; 1998 ■

NOVEMBER / DECEMBER 1998

Harold Johns Dies Developed Co-60 Teletherapy

by Clive Greenstock Canada I re g ret to inform you that P r of. H arol d E. J oh ns, Ph D FRSC DSc LLD OC, the first t o d e velo p t he C ob alt -6 0 radiotherapy machine for cancer treatment, a radiation pioneer, an eminent scientist and teacher, and a great Canadian M ed ic al P hys ic i st , d ie d in Ki ng st on O N C a nad a o n August 23, 1998.

Th e A AP M had h ono r e d hi m wi th t he W il li am D. Coolidge Award 1976, and he w a s t he H aro ld F. B at ho Memorial Lecturer 1980 and the Schultz Lecturer 1980.

Du r in g hi s pr o f e s s i o n a l career he served with distincti on a s Pro f esso r in th e Ph ysi cs Department at the University of Alberta, 19391945; jointly with the University of Saskatchewan and the Saskatchewan Cancer Commission, 1945-1956; and at the University of To ronto in the Departments of Medical Biop hy s ics , R ad io lo gy, an d Physics, 1956-1980. During his scientific career, he published o v er 20 0 pe er- re v i e w e d papers, trained over 100 graduate students, many of whom hold key positions in the field i n C anada and ar oun d t he world, won many prestigious a w a rds, and published four editions of “The Physics of Radiology”, the premier textbook in its field. His development in the late 1940’s of the Cobalt Therapy Unit led to a new career in the pioneering

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Prof. Emeritus Harold Johns 1915 - 1998 field of Medical Biophysics.

This in turn led to a national and international re p u t a t i o n among scientists. His many awards and accolades reflect the respect and admiration in whi ch h e was held by the ac ade mi c an d sc i ent ifi c world. His greatest pub lic a w a rd was his appointment as an Officer of the Order of Canada in 1976 and his final p rofessional honour will be his induction into the Canadian Medical Hall of Fame in October, 1998.

AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

Report on the 1997 AAPM Travel Award

by Rodica Alecu Sherman, TX First of all I would like to thank AAPM for the unique opportunity to travel, visit radiation oncology departments, meet physicists, learn about their activities and present our work in the five countries of Romania, Germany, Austria, Netherlands and Turkey.

I am grateful to Varian for making the arrang ements, accompanying me during the visits and sponsoring part of t he trip; Marius Alecu for helping me with the presentations, and Tim Ochran, PRN Vice President, for allowing us to leave and covering for our clinical duties. Marius helped me a lot by producin g the video tapes (a diff e rent one for each country!), handling the audio visual equipment during the presentations, givi ng par t o f the talk s and answering some of the quest ions when the p hysician s wanted more than a physicist’s point of view (His MD background was useful).

The first center we visited was the Nightingale Hospital in Istanbul. The local physicists and physicians invited us to give a two hour seminar (we had physicists and physici an s from several centers attending). We were als o asked to give an interview for the local newspaper. I presented the role of the High D ose Rate Br achyth erapy, HDRB, in a radiation therapy depar tment. We were very

surprised to find such a modern department in Turkey. The physicist was in the process of commissioning a Clinac 2300 CD with MLC, a Xi matro n Simulator and a Va r i S o u rc e HDR unit. They were hoping to open their department by the end of the summer. The physicians have a lot of interest in HDRB and I understand that this center will perf o rm all the HDR pro c e d u res for several million people. They w e re very excited about the idea of performing HDRB for head and neck and pro s t a t e cases, since until now it seems that they were perf o rm i n g brachytherapy only for gyn cases. They showed us the room where the HDR unit will be placed and we had some very constructive discussions.

We had dinner with Mr. Bilger Duruman, the owner of the hospital (and four other hospitals in Istanbul) and discussed the possibility of having the physicians an d ph ysicists trained at our Texas Oncology Cancer Centers and us returning to Istanbul for assisting the local team in treating the first HDRB patients.

On June 17 we arrived in Romania. Here we visited the two National Cancer Institutes (in Bucharest and Cluj) and the Radiation Therapy Department at the County Hospital in Baia Mare. At the Bucharest Cancer Institute (they have a Siemens dual energy linac, a Co-60 unit and a Nucletro n HDRB unit - which they use only for gyn applications) we discussed the AAPM/ IOMP

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Summer School for Central and Eastern Europe which will be organized in Romania in 1999.

In Cluj, Romania, we discussed the AAPM Summer School with Pro f e s s o r Ghilezan, the Chairman of the Radiation Department at the Cluj Oncology Institute, and th e Vice Presid ent of the Romanian Society for Oncology and Stefan Both, the Head of the Medical Physics Department. I invited Stefan to be the Secretary of the local organizing committee and we decided to organize the courses in Cluj and the calibration workshop at the Cluj Institute.

This Institute has a GE Saturne liniar accelerator, a simulator and a Co-60 unit. They also perform LDR gyn procedures.

I was told that they do not use the electron beams because neither the physicians nor the physicists have been trained (their only training being with the cobalt units).

With the photon beams, they had some bad late re a c t i o n s because the physicians are still prescribing the large fields, as they were used with the cobalt machines, do not perform conformal therapy, etc.

They hope to purchase in the next months a brachytherapy HDR unit, but nobody h as experience with HDRB procedures.

We made plans for the Summer School as well as for training Romanian physicists and physicians at our Te x a s Oncology Cancer Centers both

AAPM NEWSLETTER

for tele- and brachytherapy.

I am happy that Azam Niroomand-Rad, the chairperso n o f the ISEC of AAPM, approved my request to allow the physicians as well to attend the 1999 AAPM Summer School.

We, Marius and I, gave a 1.5 hour talk at the Cluj Cancer Institute on HDRB procedures, t reatment planning and QA issues. The talk was very well received by both physicists and physicians.

I have also talked with Profes sor Cozar from the Cluj University, Faculty of Physics: they are creating a Medical Physics Section and we will collaborate on this project.

Then we went to Baia Mare Hospital, the hospital where the Romanian Medical Physicists’ Association was founded in 1990 and where the first Medical Physics Confere n c e and courses were held. The radiation therapy department in this hospital is supposed to serve an area with a population of 3.5 million, but they can perform only orthovoltage treatments since their Rokus M Co-60 unit, 75 cm SAD, made in the former Sovi et Union, has a source with an activity of 1.5- 2 Ci. The problem is that the production of s o u rces for this type of machine (Romania has 10 of them) stopped a long time ago, so the only solution would be to get a new teletherapy machine. I would like to help them, therefore if you are aware of a center wishing to donate a cobalt machin e, I would gre a t l y a p p reciate if you could contact me at (903)892-9455 or by e-mail at rodicaa@aol.com and

raalecu@prninc.com.

T h e re are hopes for major chang es i n the Ro manian Health Care System: there is a national plan to have four major cancer centers with linear accelerators, HDR units, etc. and 12 smaller centers equipped only with a cobalt unit. Unfortunately, nobody knows when these “dre a m s ” will come true.

On June 25 we visited the Institute for Radiation Oncology, Kaiser Franz Josef Hospital in Vienna, Austria and I gave a talk on “The role of In vivo Dosimetry in HDR Brachytherapy.” The seminar was attended also by a g roup fro m Essen, Germany. This department is completely digitized, filmless, equipped with Varian machines: Clinac 2100 C/D with MLC, Ximatron simulator with XimaVision to transfer and save the flouro images, Va r i S o u rce H DR unit an d Varis. The clinical chief, Dr. S c h r a t t e r, was complaining that they are very busy and do not have time for special projects (7 physicians, 2 physicists, no dosimetri sts an d about 110-120 patients). It was i n t e resting to hear that the physi cians are per f o rm i n g their own treatment planning, isodose distributions and calculations, and the physicists are checking the charts. I was told that initially the physicists were performing the treatment planning, but it was not efficient because sometimes they will end up generating 7-8 plans until the physician will accept one of them.

On June 29 I gave a talk on “New and Future Developments in H igh Dose R ate Brachytherapy: A Physicist’s

17

NOVEMBER / DECEMBER 1998

Perspective” at the Radiation Oncology Clinic, University of Gottingen (known for quite a few Nobel Prize laure a t e s , physicists who have graduated h e re), Ger many. Pro f e s s o r Hess and Dr. Weiss were interested in gyn and prostate ap plicatio ns, as well as in endovascular brachytherapy. I l e a rned that they treat the cervix cancer only with tandem (instead of the traditional tandem and ovoids) and perf o rm optimization to get the desired shape of the isodose lines.

On June 30, we visited the Radiation Oncology Center, Ziekennhuis University, Amst e rdam, The Netherlands. I was very impressed with the dep artment: they have the whole package of the new Varian equipment. I presented “HDRB for Prostate Cancer” and the attendees, from the three major radiation therapy centers in Amsterdam, had lots of questions and comments.

D r. Meijer, one of the staff physicians attended one of our talks, Physician Reliance Network, courses on HDRB organized at Sherman, Texas.

He invited us to make this p resentation in their department since they in te nd to implement an HDRB program for prostate cancer. Dr. Slotman, the chair man of the department plans on sending the whole team to attend our training courses.

Dr. Ben Mijnheer, Director of the Medical Physics, Netherlands Cancer Institute, and some of his physicists have also attended our seminar.

During our visit in Amsterdam I also discussed with Ben Mijnheer our common project:

AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

a chapter on in-vivo dosimetry for patients with implanted high Z materials for the AAPM Task Group 63 report.

This trip was an excellent opportunity for me to make new friends, understand how physicists in different countries work and think, to pre s e n t our work and to get useful feedback and ideas. It also helped me and my colleagues f rom Romania to better plan the 1999 AAPM Summer School. I want to express my appreciation to all the people who made this trip possible. â–

Plenary Physics Session at RSNA 1998

by Stephen Riederer Rochester, MN In an effort to try to take advantage of physics specialists from many different subf iel ds o f m edi cal ph ysi cs attending the RSNA meeting, the RSNA Physics Scientific P r o gr am wi l l t hi s ye ar i nclude a plenary s ession.

Thi s w i ll be hel d M o nday m o r ni ng o f R SNA w ee k, November 30, from 10:30 AM to 12 noon in Room 401AB of the Mc Co r m ick P la ce South Building. The speakers 10:30 10:45 11:00 11:15 11:30 11:45

AM AM AM AM AM AM

Anthony Seibert Peter Burns Faiz Khan Andrew Karellas Sandy Napel Elliott McVeigh

will primarily be members of the Physics Program Subcommittee. Each will review the principal contemporary developments in his field, including previews of topics to be presented at the RSNA meeting later in the week. The overall purpose is to enable the RSNA attendee to go to a single scientific session and get some sense of the major developments across all areas of radiological physics. The speakers and topics are:

Computed X-Ray Tomography Ultrasound Physics Radiation Therapy Physics Diagnostic X-Ray Imaging Physics Image Processing Magnetic Resonance Imaging Physics

The session will be moderated by the Physics Subcommittee Chairman Stephen Riederer.

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AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

Medical Physics Achievement Award Winners

John Hale

Jon Trueblood

Ken Wright

Letters to the Editor Response to Jack Krohmer’s Letter

by Faiz Khan Minneapolis, Minnesota It is not at all clear to me why “the summary of Physics Certification by AAPM Members from the AAPM Director y ”, pr e p a r e d b y Ja ck K ro h m e r, was published in the July/August 1998 issue of th e Ne w sl e tt er. It i s n o t suprising that the ABR numbers, accumulated over far g r ea t er nu m be r of y ea rs , w o u ld e xc e ed t h e A B MP numbers of nine years. But wh at i s n ot ewo rt hy is the fact that a large number of me d ic a l ph ys i ci s t s h a ve sought ABMP certification, over 500 have received certification (200 by examination) and almost another 500 are i n v a ri ou s st ag e s o f t he

examination process. These numbers re p resent a stro n g support within the medical physics community for this B o a rd. This is certainly not the work of a fe w “Sen ior Ad vi so rs ” a s J a c k p u ts i t.

Th is is a sup po rt f o r th e Peer-Board at the grass roots.

I do not want to quibble with Jack’s numbers, taken from the AAPM directory, but I take issue with the intent of his letter and his editor ial comments. The AAPM members are not well served by such biased commentaries based on misinformation. If he had taken the trouble to veri fy h is fact s, he wou ld have found out that in the ABMP inaugural certification, no in di vid ua l was g r andfathered without prior certifi-

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cation and that subsequently no individual has been certified without examination.

F or t he ben e fit of t he AAPM members wh o want this “Battle of the Boards” to end amicably, let me state the following: 1. The ABMP is fully supportive of the ACMP Proposal fo r un if icat io n o f t he t wo b o a rds - because it values p r o fe ssio n al u nit y a mon g medical physicists and the recognition of ACMP as their professional society; 2. Until and unless the two boards are unified, the ABMP is committed to pro v i d i n g peer-board certification of the highest possible standards. ■

AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

Letters to the Editor Health Physics Certification - Response to Tolbert and Torny Letters

by Jean St. Germain New York, NY Th is le tt er is s ent in response to the corre s p o ndence from both Don Tolbert a nd L oui e To nry w hi ch appeared the AAPM Newslett e r. First, some backgound issues need to be clarified.

The American Academy of Health Physics (AAHP) is the bo dy of ce rt ifi e d hea l th physicists and was form e d less than 10 years ago. The American Board of Health Physics (ABHP) was form e d in the 1960’s and originally ha d th r ee sp ons ors : t he Health Physics Society (HPS), AAPM and the Conference of Radiation Control Pro g r a m Directors (CRCPD). Throughout its history the ABHP has c o n s i d e red that the portion of health physics specific to medicine is part of its examination pr ocess. The ABHP has continued to place on its B o a rd senior persons who can balance the other interests within the profession of health physics. The sponsorship structure was changed following the formation of the ABHP. The ABHP established one sub-specialty in power reactor health physics wh ich i t eli min ate d th re e years ago.

I have served on the ABHP which continues to give an examination in compre h e nsive health physics. I am also

the current Tre a s u rer of the A B H P. Both the ABHP and the AAHP have indicated that t hey h av e n o i nt ere st in sponsoring any sub-specialty exams. The code of ethics of t he AA HPco nt in ues to r e q u i re o f t h e Ce rt i fi ed Health Physicist (CHP) that s/he not hold themselves as experts in a field which is not their specialty. This ethical requirement is as binding as that of any other Board and both the Academy and the ABHP re g a rd violations of its Code of Ethics as serious issues. Formal processes have b een establ ished for persons wishing to pursue ethics complaints. There are CHP’s who have been practicing for a number of years in clinical settings. Some of these persons are distre s s e d to find that the value of their credentials have been steadily eroded by statements that their training and experience do not apply to the clinical s et ti ng. M any ph ysi c is ts choosing to practice radiation protection in a clinical setting have decided that they do not w is h to a tte mp t t he ABHP exam process because they are of the opinion that t he y l ac k su ffi cien t b ac k g round in nuclear engineeri ng and /o r envir o n m e n t a l m e a s u rements to complete the process.

Over a long period, clinical physicists have complained that some health physicists

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hired as radiation safety officers lack experience in the clinical setting. In many small hospitals and clinics, a variety of consulting firms have hired and employed persons trained primarily as nuclear mediclne technologists to fulf il l th e ra diat i on s afe ty responsibilities. These persons have, in general, a limited background in radiation o ncology, a nd th ere have been a number of “turf battles” over which portion of the radiation safety responsibilities properly belong to the radiation oncology physicist and which belong to the consultant or other gro u p s .

In still other settings, many radiation oncology physicists are only too pleased to turn ove r t o a me di cal hea l th ph ysic is t t he pr ob lem s o f dealing with regulators and administrators on radiation safety issues. In other areas, the RSO responsibilities are ass ig n ed to t he i ma gin g physicist who delegates some of his duties to the radiation oncology physicist.

There will never be a perfec t so lu ti on to all of t he p roblems d iscused above; h o w e v e r, the creation of a medical health physics subspecialty by the ABMP is an attempt to assure the medical health physicists who elect this sub-specialty will be able to function in the clinic setti ng an d wil l al so b e well

AAPM NEWSLETTER

g rounded in health physics.

D is cu ss io ns w ill c onti nue between the AAHP and the ABMP are ongoing on ways to improve the exam process.

While the number of persons seeking certification in the s ub- s pe ci al ty of me di cal health physics is momentarily small, the panel believes that these numbers will grow as t he exa mi na t io n p ro c e s s becomes better known in the health physics community.

The members of the examining panel in medical health physics are senior members of o u r p rof ess io n who believe that we are trying to improve the clinical environment. It is the re s p o n s i b i l i t y of the members of the medica l phy sic s pro fes si on to decide what sub-specialties are important to our practice and to develop the standards for that group. The members of the medical health physics examining panel are hopeful that this cooperative venture between the AAHP and the ABMP will meet the needs of both groups.

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NOVEMBER / DECEMBER 1998

Response to Jack Krohmer's Letter

by Lawrence Reinstein Stony Brook, NY I take issue with the implic ati on s of Ja ck Kro h m e r ’ s l et ter to the ed it or i n t he recent newsletter. As a medical physicist and an AAPM member I made a deliberate ch oice to b e “ABM P on ly” certified. I believe my reasons for this were sound and I am happy to discuss them another time. But, this is not the point of my letter. Rather, it i s t o say t ha t I ex pe ct my colleagues and my Society to respect my right to make this choice.

Is it reasonable that AAPM members should be subjected to a concerted effort to isolate and to eliminate the ir P ro fe s sion a l C e rt if i ca t io n B o a r d ? K ro hme r’ s l ett er a tta cks th e ABM P j us t because at the present time t hey a re i n t he m in or i ty .

Shouldn’t we value and protect the rights of the minority?

How significant is Jack’s listing of “pockets of ABMPo nl y c er ti fi ca ti on ? ” Th ese “pockets” represent 16 of the most populous states, and I b e li e ve a ma jori t y of t he AA PM mem bers hip. These AAPM members are simply written of f in a perjo riti ve manner as having been influenced by a small number of “S eni or Adv i so rs” . Us in g K ro hmer’s arguments I am tempted to suggest that the anti-ABMP campaign that has been given credibility an d high visibility in the AAPM newsletter is simply the result

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of a diff e rent “small number of senior advisors.”

None of these articles or letters is particularly helpful to th e A AP M m embe rsh ip .

They are divisive and lead n o w h e r e. I suggest th at in the future better judgement is shown by all. I hope for the day that I can enjoy re a d i n g the newletter again.

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AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

Endovascular Brachytherapy

by Stephen Balter New York, NY Ravinder Nath New Haven, CT Coronary artery disease is a leading cause of death. Fluoroscopically guided angioplasty includes a variety of p ro c e d u r e s f or r e o p e n i n g stenosed (partially closed) arteries. More than a half-million of these pro c e d u res are p e rf o r med i n the US e ach year. Unfortunately, a signific ant f ra cti on of th e tre a tments fail because the arteri es re ste n ose i n a f ew months.

Radiation therapy is being actively investigated for its ability to reduce the restenosis rate. Currently, there are about a dozen human-trials in various stages of progress.

The sh ort ter m results are very promising. There is a strong possibility that at least on e pro to co l w i ll be approved by the FDA before the end of 1999.

E ndo v asc ul ar tr e a t m e n t technologies involve activities from a permanently implanted ste nt con ta ini ng a f ew m i c roC uri e s o f P - 32 to removable applicators using several tens of milliCuries of Sr/Y-90 or hundreds of milliCuries of Ir-192. For re m o vable applicators, dose rates at the arterial wall are several grays per minute. In terms of patient safety, these are truly HDR treatments. Other potential delivery systems include radioactive gasses and liq-

uids. The physics and radiobiology of these tre a t m e n t s a re active areas of curre n t investigation. Moreover, clinical treatments are far from a routine cath lab procedure.

P re sent cli ni cal trial s all include a team including a cardiologist, a medical physicist, and a radiation oncologist. This level of staffing is essential at the research level.

Although staffing for routine t r eat ment s ha s n ot bee n established, medical physicist attendance at and participation in all removable pro c edures is a likely requirement.

The duties of the medical physicist include most of the ac tiv i ti e s as soc i ated wi t h i n t e roperative brachytherapy plus some additional duties that are unique to the work flow in an inteventional cardiac laboratory. Based on a consensus of medical physici st s i nvo lve d in c u rr e n t research, approximately onehalf person -day is needed per HDR procedure T h e re are more than 1,000 hospitals that currently off e r interventional cardiology services. All are likely to want to of fe r En dova s cu la r Brachytherapy (EVBT). Realistically, all hospitals with both a conventional brachytherapy p rogram and interventional c a rdiology will actually perf o r m EVB T. I f ev er yth in g stays on track, there will be a r oun d 20, 0 00 r e m o v a b l e procedures performed in the year 2000. This might escalate to 50,000 procedures per year by 2002. Meeting this

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initial workload re q u i res 50 FTE of medical physicists. It is evident that a very larg e fraction of the therapy medical physics community must be professionally prepared to meet this demand.

What can you do? Investigating your hospital's cardiology and radiation oncology plans might be worthwhile.

On the educational side, a categorical course for medical physicists on cardic cath is in this years' RSNA pro g r a m .

Portions of this course will serve as an introduction to th e ca th la b fo r th e rapy physicists. Other educational o ppo rt un it ies a re be ing planned for the 1999 annual meeting of the AAPM. Keep tuned. â–

AAPM NEWSLETTER

Scientific Program Plans Underway for Chicago 2000 World Congress

by Russell Ritenour Chairman, Scientific Program Executive Committee Minneapolis, MN The next World Congress of Medical Physics and Biomedical Engineering will be on July 2328, 2000 in Chicago. This triennial World Congress is a joint effort of six societies (International Union for Physics and Engineering Sciences in Medicine, International Federation for Medical and Biological Engineering, International Organization for Medical Physics, American Institute for Medical and Biological Engineering, American Association of Physicists in Medicine, and the IEEE Engineering in Medicine and Biology Society). The Congress also has collaboration commitments from 22 other scientific and educational organizations.

On the basis of these partnerships the Organizing Committee now predicts Chicago 2000 attendance in excess of 8000 at the first World Congress of this type in the USA since 1988.

The theme for the Chicago 2000 is “Global Inform a t i o n Networking for the Twenty-first Century.” The inform a t i o n technology theme includes uses and impact on research, education and patient care. The theme will be reflected in the opening session, plenary sessions, panel discussions, and other invited pre s e n t a t i o n s throughout the week. The Scientific Program will include a p p roximately 1500 scientific p resentations over a five day

period. International peer review committees will select presentations from submissions by physicists and engineers t h roughout the world.

Although several sessions of scientific presentations will be devoted specifically to information networking, presentations will cover the entire scope of c u r rent topics in medical physics, medical and biological engineering.

For the first time in Wo r l d Congress history, the submission, selection, and distribution of program information for the year 2000 meeting will be entirely electronic. An International Advisory Committee has been formed to ensure, among other objectives, that all submitters have access to the technology to use electro n i c submissions to the pro g r a m .

The Scientific Program Executive Committee wil l work closely with the International Advisory Committee to ensure that the needs and interests of Chicago 2000 participants from all countries are incorporated into the planning process.

Chicago 2000 Co-Presidents, Bill Hendee and Al Potvin, formed the Scientific Program Executive Committee in 1995.

It consists of two medical physicists, Russ Ritenour, and Bruce Thomadsen, and thre e Biomedical Engineers, John Enderlee, Joe Bronzino, and Morton Friedman. The Executive Committee has defined the overall scientific program and is working with the various o rganizing and collaborating

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NOVEMBER / DECEMBER 1998

societies to form a 30 member General Scientific Pro g r a m Committee (GSP C).

The GSPC, which will be hard at work by early 1999, consists primarily of the chairs and cochairs of the various program tracks, or subject areas. The track chairs and co-chairs have responsibility for re v i e w i n g and selecting proffered papers and subdividing the program tracks by detailed subject area as needed.

Russ Ritenour chairs the Scientific Program Executive Committee and reports directly to the Congress Co-Presidents.

He is an academic Medical Physicist since 1979 who has taught for the last nine years at the University of Minnesota.

A Preliminary Scientific Program along with a wealth of other information about Chicago 2000 and the participating societies is found on the official web site for the meeting www.wc2000.org .

Comments or suggestions for improvement are welcome. ■

AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

The AAPM Accredited Dosimetry Calibration Laboratory Program

by Geoffrey Ibbott Lexington, KY Safe, accurate, and effective radiology and radiation therapy depend in large part on reliable calibrations of ionization chamber and electrometers. To assure the availability of high-quality instrument calibrations, the AAPM developed a program of accreditation of dosimetry calibration laboratories. The role of the AAPMa c c red ited laboratories (ADCLs) is to transfer calibration factors from in-house s t a n d a rds calibrated at the National Institute for Standards and Technology (NIST) to a customer's instrument. The customer's instrument can then be said to possess a NISTtraceable calibration factor.

The ADCLs are supervised by a subcommittee of the Radiation Therapy Committee ( RTC). Accreditation is re commended only after a laboratory demonstrates, through submission of written materials and by successful completion of a site visit, that it meets guidelines for accre d i t a t i o n that were developed by the subcommittee. Conti nued accreditation requires that the laboratory pass periodic site visits, presently conducted at five year intervals. A major chang e at an AD CL may oblige the laboratory to undergo an additional site visit.

In addition to compliance with the accreditation guidelines and successful site visits, an ADCL is expected to

participate in annual meas u rement quality assurance t est s. Eac h y ear, on e o r more ionization chambers are circulated among the ADCLs, which compare the instrume nt s wit h their i n-hou se standards and assign calibration factors at selected beam qualities. During altern a t e years, NIST also participates in the intercomparison, and p rovides "re f e rence" calibration factors for each instrum ent circ ul at e d.

E ach " ro u n d - robin" interc o m p a r iso n, as t hey are c all ed, is analyzed to ensure that the calibrated standards maintained by each ADCL remain in agreement and that disc r ep anc ies in pr o c e d u re s have not evolved.

Th e r esu lt s o f s ev era l recent ro u n d - robins are presented here. In 1997, two ionization chambers were circulated among the ADCLs, with instructions to calibrate the instruments in beams of cobalt-60 radiation, and in xray beams re p resentative of the range of qualities available at the laboratory. As the x-ray qualities vary from on e ADCL to anot her, the dat a a re plot t ed i n t he attached figure as a function of H VL. A ctua l air- k e rm a calibration factors are plotted, and error bars corresponding to t he me an va lue + /- 1% have been superimposed to indicate the variation among similar measurements. Figure 1 indicates data measured at h ig h ene rg ie s w ith a n

24

Exradin A-12 chamber, while F i g u re 2 indicates the data obtained at lower energ i e s with a PRM MC-1 thin-window chamber. As the MC-1 chamber response varies with the spectrum of the beam, different symbols are used to distinguish between modera t e l y - f i l t e red, lightly-filtere d , and moly/moly beams.

Figure 1. A-12 chamber in gamma-ray and x-ray beams

Beam Quality [mm AI] Also in 1997, a re - e n t r a n t ionization chamber provided by the Radiological Physics Center was distributed among the ADCLs. Instructions were provided to determine a calibration factor for the instrument using the radioactive s o u rces for which the ADCL

AAPM NEWSLETTER

Figure 2. MC-1 chamber in low-energy x-ray beams.

HVL [mm AI] had calibration factors. The calibration factors obtained by the ACDLs are shown in F i g u r e 3. B ec ause o f t h e variation in calibration factor with radiation energy, the data points for each sourc e a re expressed in relation to the mean value. Ag ain, it can be seen that the variation among the ADCLs is extremel y sma ll, general ly o n the order of 1%. gure 3. Re-entrant chamber calibration actors for several radioactive sources

In 1998, in preparation for t he int rodu ction of a n ew dose-to-water calibration protocol (TG-51), a round-robin was conducted in collaboration with NIST. An ionization chamber was distributed a mo ng t he A DCL s, w it h instructions to determine a dose-to-water calibration fact o r. In addition, the ADCLs determined an air-kerma calibration factor. These data are presented in Table 1. As

NOVEMBER / DECEMBER 1998

and recalibration of ionization chambers.

Questions regarding the operations and policies of the ADCLs, or about this report may be directed to the author. â–

b e f o re , t h e ag r e e m e n t am ong t h e A DC Ls is exceptionally good.

Additional ro u n d - ro b i n s have been conducted for brachytherapy source calibra t io ns, bu t as of th is writing, the results are not yet available. The roundrobin was postponed to include the introduction of a new calibration standard fo r I -12 5 s our ce s .

T he results will be reported at a lat er da te .

S im il arl y , a

Table I ADCL

ND, W

NIST ADCL#1 ADCL#2 ADCL#3 ADCL#4

4.568 4.567 4.557 4.559 4.559

Percent difference -0.02 -0.24 -0.20 -0.20

ro u n d - robin proficiency test of x-ray beam calibr ations will be conducted later in the y e a r. T he t est ha s b e en delayed due to the availability of equipment at NIST. Finally, a number of ADCL customers submitting PTW i oni za ti on ch ambe rs h a ve received notifications that the c al i bra t io n f act o r of th eir instrument has shifted. Seve r a l o f t h e A D C L s h av e reported that the response of s o me P T W c h a m b er s c a n c h a n g e u p t o 1. 4% d u ri n g t h e f i r s t ye a r of u s e. Physi cists wi th PTW c h amb er s ar e a dvi se d to monitor the response of the instrument carefully during the first year of use. Users are encouraged to contact the ADCL at which the chamber calibration was obtained to determine the ADCL's policy for the return of instruments

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Nk 4.140 4.122 4.146 4.135 4.137

Percent difference -0.43 +0.14 -0.12 -0.07

AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

Upstate New York Chapter Holds Fifth Annual Memorial Lecture Program

by Daniel Bednarek Buffalo, NY Th e Ups tat e Ne w Yo r k Chapter of the AAPM held its Fifth Annual Memorial Lecture Program at the Rochester General Hospital in October.

Each year the chapter presents an award to honor past and present physicists who have made significant contributions to the field of medical physics.

This year the award was presented to Martin Ya ff e, of Sunnybrook Health Science Centre / University of To r o n t o i n m e m o r y o f H a rold Johns. Dr. Johns p a s s e d a w a y e a r l i e r t h is y e ar a n d l e ft a l e g a c y i n m e d i c a l p hy s ic s t h at w il l

live on. His many graduate s tu d e n t s , c o l l e a g u e s , t h e many individuals who learned medical physics f r o m h i s te x tb o o k “ T h e Physics of Radiology”, and everyone who has ever been t reated with radiation therapy owe him a debt of gratitude. Martin Ya ffe re c a l l e d fond memories of his d ays with Dr. Johns and pre s e n ted a talk entitled “Developm e nt a nd A p pl i c a t io n s o f D i g i t a l M a m m o g r a ph y .”

Martin studied at the Universi ty o f To ro n t o u n de r D r.

Johns receiving his Ph.D. in 1978. He has since published extensively in medical imaging and has served on AAP M Task Grou p 29 , the N C RP 7 2 S u b c o m m i t t e e ,

Assembled for the Memorial Lecture are (left to right): Neal Tobochnik Rochester General Hospital, Dan Bednarek, SUNY Buffa lo, Art Haus, S&A Medical Imaging Consultants, Martin Yaffe, Sun nybrook Health Science Centre, Andrzej Krol, SUNY Health Science Center at Syracuse

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n u m e rous ACR committees and is currently the chair of t h e IC R U C o m m it t e e o n Image Quality Assessment.

At this meeting Art Haus also was presented with the F re derick F aw Memorial Aw a rd in appreciation of his dedicated service to the c h a p t e r. Art has spent seventeen years of active participation in the chapter including the organization of many regional meetings. He recently moved from the Rochester area to be closer to his family in Ohio. Th is award comme mo r ates F re d F aw w ho was one of the charter members and first presidents of the Upstate New York Chapter and who died unexpectedly in 1984.

The memorial award lecture has been jointly sponsored by t he c hap te r a n d Eas tm an Kodak Company. Support for the scien tific program was received from Varian Oncology Sy ste ms, Th e ra tr o n i c s I n t e rnational Ltd, Nucletro n , Keithley Instruments, LACO and Frank Barker Associates.

Se ve ra l o f t h e ve ndo rs exhibited during the course of the meeting. The scientific program included seven additional presentations on MRI, PACS, t reatmen t plan ni ng, image intensifier distortion c o r rection, and mammography. The meeting was fo llowed by a congenial dinner w h e r e all h ad a chanc e to congratulate the award recipients.

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AAPM NEWSLETTER

NOVEMBER / DECEMBER 1998

Announcements Call for Abstracts Deadline for abstract submission is April 1, 1999.

International Conference on Med ic al I ma g in g, M edi ca l Physics, and Precision Radiation Therapy GUANGZHOU CHINA NOVEMBER 4 - 6, 1999 Co-Presidents: Nan-Zhu Xie Guangzhou, China, William Hendee Milwaukee, WI The evolution of medical imag in g ove r t he pas t 25 ye ars is y ie l di ng i m ag ing tools of intense power for medical applications. To d a y medical images are available in 2-, 3- and 4-dimensional re p r es e nta tion s t o re v e a l anatomic and functional relationships in every area of the human body.

P recision radiation therapy requ ir i ng hi gh ly ac c ura te anatomical information is also rapidly evolving.

The rapid developments in med ic al im ag in g, me dica l physics and precision radiotherapy are leading to a convergence of these disciplines in an effort to improve the curative potential of radiation fo r pa tie n ts w ith c anc er.

Th ese i mp r ove men ts a nd th e ir a p pl ic a tio ns ar e the focus of the First Intern ational Conference on Medi ca l I m a g i n g, Me d i ca l Physics and Precision Radiation Therapy to be held in Guangzhou, China in Novem-

ber 1999.

Abstracts of papers to be presented at the International C o n f e r enc e ar e cur re n t l y being solicited. Papers are encouraged on advances in medical imaging and medical p hy sic s, and o n ne w approaches to precision radiation therapy. Of particular interest are papers that examine the applications of imaging technologies and planning algorithms to pre c i s i o n radiation therapy, including the use of imaging in planning, implementing, guiding, monitoring, following and evaluating radiation therapy.

Also of particular interest are papers on quality control and quality assurance related to medical imaging and radiation therapy.

The deadline for abstract submission is April 1, 1999.

Authors will be notified by June 1 whether the abstract is accepted for pre s e n t a t i o n .

Abstracts should provide a succinct summary of the proposed presentation and must n ot e xc e ed 10 0 0 w o rd s , including bibliography. A biographical sk etch of the p r e se n ti ng a u th or, no t t o exceed 100 words, should be submitted with the abstract.

E -m a i l s ubm i ss io n of abstracts is encouraged; if faxed or mailed, please send 6 copies. Abstracts should be directed to: William Hendee Medical College of WI

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8701 Watertown Plank Road Milwaukee WI 53226 Phone: 414-456-4402 Fax: 414-456-6554 E-mail: HYPERLINK mailto:whendee@mcw.edu â– *Guan gzho u (C anton ) is a mainland city in the Peoples' Republic of China about two hours by train north of Hong Kong. It is a major cultural cen te r of Ch in a, a nd is known in particular for its culinary delights. An active spouses' program is planned for the meeting. â–

AAPM NEWSLETTER

NOVEMBER / DECEMBER 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 Email: rdixon@wfubmc.edu 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 January/February 1999

DEADLINE

MAIL DATE

December 15,1998

January 15, 1999

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

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