Newsletter AMERICAN ASSOCIATION
OF
PHYSICISTS
IN
VOLUM E 24 NO. 3
MEDICINE MAY/JUNE 1999
AAPM President’s Column The AAPM as a National Influence Reference Values
Our Relationships with Other Organizations
There were several themes of this meeting, indicating the interest on the part of all three organizations in several topics in particular. The development of Reference Values was one such topic. This is being a d d ressed by AAPM Ta s k Group 7 chaired by Joel Gray, under the Radiation Protection Committee chaired by Chuck Kelsey. Reference Values are levels of dose considered rep-
by Geoffrey Ibbott Lexington, KY The central theme of this column is the relationships the AAPM has with other organizations. The AAPM has identified liaisons to nearly three dozen organizations whose missions and purposes in some way coincide with ours. Our liaisons are responsible for maintaining contact with these organizations, either by attending their meetings or through c o r r espon dence, and ar e expected to report on their activities to an AAPM committee or council, or directly to the board or Excom. In the next paragraphs, I will highlight a few of these relationships, and will discuss additional interactions in future columns.
Trilateral Committee The Trilateral Committee is composed of the leadership of the three medical physics organization s; th e AAPM, the A C M P, a n d th e AC R’s C omm i ssion on M ed ic al Physics. Each organization provides three members, making nine altogether. The Committee meets three times each year, with each meeting being hosted by a different
organization. The Trilateral Committee met over two days in March of this year, at an airport hotel in Los Angeles. This meeting was hosted by the ACR-CMP, which had prepared an agenda to which all three organizations contributed. The ACR also provided handouts for several of their agenda items. Attending on behalf of the ACR-CMP were Commission Chairman Don Tolbert, Dave Vassy, and Jim Hevezi; for ACMP were chairman J i m Smathers, Bhudatt Paliwal, and Larry Reinstein; while the AAPM was represented by P r e si de nt -el e ct Ken H o g s t r o m , P ro f e s s i o n a l Council chair Mike Gillin, and myself.
INSIDE TABLE OF CONTENTS President’s Column……………p. 1 EFOMP…………………………p. 4 Executive Director’s Col…..p. 5 New ACR Accredidation Prog…p. 6 AAPM Professional Council....p. 6 Delegates to AIMBE…………p. 8 R.T. Equipment Standards....p. 9 Summer Schools Change…........p. 11 ACR Comm. on Med Phys…..…....p. 12 Notice of I-125 Guidance…....…p. 14 Announcements……………p.14 Letters to Editor……………..…p. 14 Residencies & Fellowships……p. 15 Web Page Update…………..…p. 15
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resentative and appropriate for diagnostic radiological procedures. The Task group is determining suitable values by conducting surveys of current practice for selected procedures. The ACR has already d ec id e d t o i ncor p ora te R e f e rence Values into new standards of practice, and standards that come up for routine review. The ACR is also planning an educational program for their members. It has been empha s iz ed b y the Ta s k Group that the intention of reference values is not to set levels se p ara tin g d ose s considered acceptable from those that aren’t. Instead, reference values should be used as indicators of typical dose levels; excursions from the reference values are not prohibited, but warrant explanation and justification. This work is ongoing, and more details will be available later. The collaboration between the AAPM’s development of re f e rence values and the ACR’s development of standards which advocate their use is not only evidence of a healthy relationship between the two associations, but also an important synergism that benefits the members of both organizations.
Health Care Reimbursement Reimbursement issues are often present on the Trilateral agenda. Again during this meeting, reimbursement issues occupied a great deal of our time. Chief among these was a proposal from the Health Care Fi nanci ng A dmi ni strat io n ( H C FA) for a Ho spital Out pati ent Pro s p e c t i v e
Payment System (HOPPS). (See March i ssue of the Newsletter) This pro p o s a l would group CPT codes into Ambu latory Pa tient Classifications (APCs), assigning a reimbursement value to each. The AAPM has written several letters to HCFA criticizing this proposal, and arguing that the classification of CPT codes is inappropriate, and that the resulting reimbursement is inadequate. The ACR and the ACMP have likewise contacted HCFA, and have voiced concerns similar to ours. It is critical that medical physicists also write to HCFA, as government agencies like HCFA respond most to letters from individual practitioners. See the messages from Mike Gillin regarding the importance of contacting HCFA and your senators and congressmen.
European Federation of Organizations for Medical Physics While attending a re c e n t meeting, Don Frey, our liaison to the EFOMP, met with severa l of t he lead ers of the E u rop ean Fe der ati on of O rganizations for Medical Physics (EFOMP), to discuss collaboration on educational programs for European and American medical physicists. Don and his counterparts are considering ways of improving the input of Europeans to the RSNA educational programs, through the AAPM Education Council. At the same time, they are exploring ways of encouraging participation of US medical physicists in educational programs to be offered in Europe, as was done in conjunction with the IOMP meet-
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ing in Nice in 1997. A meeting under consideration is an EFOMP Summer School to be held in the summer of 2000.
International Organization for Medical Physics Two well-known medical physicists presently hold positions of importance in the International Organization for Medical Physics (IOMP); Colin Orton is President, and Gary F u l l e r t o n i s S ec re t a r y General. The re l a t i o n s h i p between AAPM and IOMP will be strengthened next year through the World Congress o n M edi c al P hy si cs a nd Biomedical Engineering, to be held in Chicago in July.
Intersociety Commission Our relationships with the various Radiology organizations are enhanced by the attendance by representatives of the AAPM at the annual I n ters oc i ety S u mmer C o n f e ren ce ( fo rmerly the Radiology Summit). This summer Larry Rothenberg and I will attend as the AAPM’s representatives. At last year’s meeting, the preparation of residents for practice was discussed. This summer, the to pi c of th e m ee ti ng i s “ S urv iv al o f E xc elle nce ”. Discussions will center around how radiology societies and radiology practices can be structured or changed in the n e w mi l len niu m to hel p patient care.
ABR Over the past couple of months, the AAPM has developed a new process for submitting nominees to the ABR
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to fill vacant trustee positions. The new process was developed following the indication of serious concerns by a small group of medical physicists, after the submission of trustee nominees last fall (see the March issue of the Newsletter). The new process requires the AAPM Board to propose candidates, then conduct a vote to select the names to be submitted to the ABR. Three names are to be submitted, unless there is a tie vote, in which case four names are submitted. This process was conducted in February, March, and April of this year, and resulted in a tie vote leading to the submission of C o l i n O r t on , J am e s Purdy, Bhudatt Paliwal and Geoff Ibbott as the AAPM’s nominees for the trustee position. We expect to hear of the ABR’s decision shortly after their meeting at the end of May. Related to this is the result of the ACMP’s application to become a sponsor of the ABR. At this writing, it appears that th e app li c ati on wa s not endorsed by all of the other sponsoring organizations of the ABR, hence the ABR cannot act on the proposal. The AAPM did express its support for the nomination, both at the time it was submitted and more recently. It is my understanding that the ACMP has elected not to pursue sponsorship further at this time.
Alliance for Quality Medical Imaging and Radiation Therapy An issue of the ACR Bulletin reported recently that the American Society of Radiologic Technologists (ASRT) had
developed an Alliance for Quality Medical Imaging and Radiation Therapy. Several other organizations, including the American Association of Medical Dosimetrists and the Society of Radiation Oncology Administrators have joined with the ASRT. The purpose of the Alliance is to support th e Co ns um er- P a t i e n t Radiation Health and Safety Act. This Act contains provisions for licensure of radiologic technologists, but because the provision is voluntary, it has not been enforced. The AAPM has consistently supported licensure for medical professionals, including radiographers, radiation therap is ts , an d ph ysi c is ts . Consequently, we are investigating the goals of the Alliance and will consider in the future whether or not its purpose and goals coincide with ours.
Centennial Meeting of American Physical Society As your president, I attended the Centennial meeting of the APS in Atlanta in March. This was billed as the largest meeting of physicists ever, with more than 10,000 scientist attendees and over 8,700 oral and poster presentations over six days. The meeting was indeed impressive, and gave me opportunities to compare their organizational structure to ours. The Atlanta convention facilities were well suited to the conference, and for the most part the program flowed well. However, some presentations had to be cancelled or rescheduled, as they were dependent upon the appearance of dignitaries
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including the President and Vice President. The escalation of the Kosovo crisis preve nt ed th ei r att e nd an ce , although a number of representatives of other government agencies were present. There were also a number of Nobel Laureates in attendance, and several curre n t a nd f o r m e r P r e s i d e n t i a l Science Advisors. The meeting gave me the opportunity to meet with the leaders of several scientific societies, in cl ud in g t h e P h y s i c a l S oc ie t y , th e A m e r ic a n Mathematical Society, the AAAS and the AAPT. In a pleasant, informal setting, we discussed recent decisions in Washington that will aff e c t f u nd i n g f o r r e s e a r c h i n science and medical fields. ■
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European Federation of Organizatons for Medical Physics by Prof. Dr. Fridtjof Nsslin, President EFOMP EFOMP - The Euro p e a n Federation of Organizations for Medical Physics The European Federation of Organisations for Medical Physics (EFOMP) was founded in May 1980 in London as an umbrella organization covering the National Member Organisations for Medical Physics (NMO). So far 32 National Member Organizations have joined EFOMP. In addition to the NMOs, EFOMP has corporate members-but individuals belong to their respective NMO. Altogether, EFOMP represents about 5000 medical physicists working in clinical and/or research environments. These are mostly in radiotherapy, radiodiagnostics and nuclear medicine. However, due to the increase in medical physics, quite a few are involved in magnetic resonance, ultrasound, hyperthermia, and laser physics, etc. The main bodies of the Federation are the Council, which comprises two delegates appointed by each NMO, and the Officers Board consisting of the Pre s i d e n t , Immediate Past Pre s i d e n t , Honorary Treasurer, Secretary General, and Chairpersons and Secretaries of the Committees. Purpose - The main aims and purposes of EFOMP are fostering and coordinating the activities of the NMOs, collaborating with national and international organizations relevant to medical physics, encouraging national activities in education and training, promoting research and
development and disseminating professional information in medical physics. Considering the widely varying roles and qualifications of medical physicists in Europe, one of EFOMP’s key issues is to achieve harmony in education and training. Since high level education and training cannot be provided unless it is based on a solid scientific ground, EFOMP has a vigorous scientific program. Thus, much of the work of the EFOMP is done by the Committee for Education and Training and a Scientific Committee. G u i d e l i n e s - EFOMP has issued a number of Policy Documents and Guidelines. These are published in Physica Medicanisation harmonization throughout Europe, EFOMP recommended guidelines for creating schemes for education and training, for establishing registration schemes, and most recently for setting up schemes for continuing professional development (CPD). The latter issue came into focus with the new Medical E x p o s u re Dire c t i v e , 43/97/EURATOM, which particularly demands such education schemes and CPD to be set in force before May 2000 in all European Union Member States. This Directive strenghtened significantly the position of the Medical Physics Expert in the clinical environment. EFOMP is expecting real benefit in the areas of education and training since EFOMP is now going to create Guidelines for a credit-point system. An example for the professional is at the Staffing Levels in a Medical
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Physics Department where depending on equipment and work load minimum staffing levels have been specified for routine clinical work in radiotherapy, radiodiagnostics and nuclear medicine. EFOMP is certainly proud of the cooperation with AAPM. In particular the Education and Training Committeee has benefitted from its liasion with the AAPM Education Council. Furthermore, EFOMP appreciates the input of AAPM to our jointly operated Summer School programme in 1997. We are also appreciative of the cooperation in the forthcoming EFOMP congress to be held in Patras/Greece in September 1999 and are certainly looking forward a continued partnership with the AAPM that will benefit medical physicists in North America and Europe. ■ Prof. Dr. Fridtjof Nsslin, president EFOMP Algeria, Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Eire, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom www.efomp.org ÃAlgeria, Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Eire, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom European Federation of Organisations for Medical Physics (EFOMP) General Office: 4 Campleshon Road, York YO2 1PE, United Kingdom Telephone +44 904 610821 Telefax + 44 904 612279 internet: http://www.efomp.org
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Executive Director’s Column By Sal Trofi College Park, MD Annual Meeting-July 24, Nashville, TN Time is of the essence! Register for the upcoming AAPM Annual Meeting before June 15 to receive discounted registration fees. Remember the official dress code for the meeting is casual. Leave those suits and heels at home. The N ashvil le Local Arrangements Committee has arranged for an AAPM Golf Tournament at the Springhouse Golf Club at Opryland on Saturday, July 24. The cost will be $100.00 per person and will include green and cart fees, a box lunch and the award s reception. Sign up Early! Play is limited to 144 golfers. Starting in 1999, registrants may purchase an unlimited number of social function tickets to attend the Icebreaker, Aw a rd s C ere mon y an d Reception and Night Out. You do not need to be registered for the meeting to attend t he I ce bre a k e r, Aw a rd s Ceremony and Reception or Nig ht Ou t. NO TE : Companions must be registered to enter the Hospitality Suite and participate in the organized tours. If you have not yet done so, check out the full meeting program including abstracts on the AAPM web site. You will also find a list of exhibitors with their product descriptions and links to their web sites.
Membership Information Two years ago, AAPM HQ, in preparation for Directory production, created a huge paper mail merge of all 4,000+ mem-
ber’s database information and hand keyed the re s p o n s e s . This process took over three months to accomplish each year. Starting last year, we introduced “Webvalid”, a webbased address change system that allows members to log in and interactively change their i n f o rmation in the AAPM Membership Database. As a precaution, these changes are queued and inspected for postal regulation by staff before accepting the change. As there is no re-keying of information, information accuracy went up to 100% and the time to complete all the updates only took a few weeks. In 1998, we began updating this information quarterly for m em ber s w ith an e ma il address and yearly for those without. Beginning in April of 1999, we made modifications to the system to make it much more user friendly to both the AAPM Member and the AAPM employee confirming changes. On April 12, 1999, we sent a mass emailing to 3,349 members. Within 24 hours, over 5 00 A AP M Me mbe rs h ad entered the system to make changes to their information. We anticipate all changes will be made in under a week.
Medical Physics Journal The number of research artic le s p ubl is hed in 1998 increased by 28% over 1997 (245 vs. 190 articles). The number of re s e a rch article pages printed increased by the same percentage (1970 vs. 1540 pages). Even with the extra expense of publishing these extra pages, the Journal’s 1998 financial results were positive by a little over $200,000. Much of the credit for this
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financial success is due to the excellent publication services p rovided by the American Institute of Physics (AIP). A IP h a s c ont in ue d to i n c r e as e ou r ad ver tis in g income and reduce the unit cost to produce and distribute a page in the Journal. They have made substantial investments in both paper and electronic publishing capabilities. AAPM, as all member societies of AIP, has benefited by receiving lower prices and state of the art products. It may not be known by the AAPM membership, but AIP is now able to offer their publication services to organizations other than member societies at competitive prices. If you have an interest in knowing more, contact me and I will put you in touch with the proper person at AIP.
Audit The 1998-year audit of the financial records of the AAPM is now complete. I am glad to say that we were able to add to the reserves again this year. Factors that made 1998 a good year include gains on investments, greater number of jobs advertised in the Placement Bulletin, sale of more exhibit space at the annual meeting, more advertising revenue for Medical Physics J o u rnal, and reduction of expenses in many accounts. The Treasurer will report on this in more detail later. ■
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Medical Physics Continuing Education Credit (MPCEC) by Rus Ritenour, Chair, CAMPEP/MPCEC Committee Minneapolis, MN Jon Trueblood, Vice Chair Augusta, GA Physician Category 1 CME (Continuing Medical Education) is only obtained from educational activities which meet the guidelines established by the American Council for Continuing Medical Education (ACCME). The analog of physician CME for medical physicists is MPCEC, which can be granted for participation in continuing education activities that meet the guidelines established by CAMPEP. The CAMPEP guidelines for obtaining MPCEC approval for educational activity can be downloaded fro m www.campep.org. Some medical physicists have complained about the work involved in completing an application for MPCEC. The CAMPEP MPCEC Committee agrees that it takes a significant effort on the part of the activity director to complete an acceptable MPCEC application. However, the MPCEC program is designed to meet the standards established by the ACCME, which represents the defacto industry quality standard for CME, specifically, and for continuing education in general. It is the goal of the MPCEC Committee that the quality of continuing education be assured. To assist in drafting acceptable MPCEC applications, several sample applications are available on the CAMPEP web page or can be obtained from Lisa Rose Sullivan at AAPM Headquarters. â–
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New ACR Accredidation Programs by Robert Dixon Winston-Salem, NC The American College of Radiology, in order to broaden as well as s treamlin e its a c c reditation programs, has decided to develop a global a c c re d it a ti on pr o g r a m . Facilities may select from a menu of modalities in which they wish to be accredited. Current programs granting accreditations are mammography, stereotactic breast biopsy, ultrasound guided breast biopsy, ultrasound, and MRI. The ne w acc r edi tat io n pr ograms being developed, with the assistance of ACR members in physics, are in radiography, fluoroscopy, interventional, and CT. These programs are not
exam-specific but encompass the entire modality. They may, however, emphasize certain of the most important clinical exams such as the barium enema for fluoroscopy (see the recently published ACR Barium Enema QC manual for recommended physics/technologists tests). A modular phantom is being developed which can serve as an R/F phantom as well as the phantom for the interventional program. The CT phantom will be separate. While these a c c reditation programs are voluntary, it is anticipated that third party payers may require this accreditation as an indicator of quality and also that deemed status will be granted by the JCAHO for accredited facilities. â–
AAPM Professional Council by Michael Gillin Chair, Professional Council Milwaukee, WI The Medicare Issue The future of Medicare, which is currently having problems, is a looming social/economic/political problem in the U.S. For more than three decades, Medicare has covered the cost of health care for those over 65 and for those who are disabled and the children of the disabled. 72% of all beneficiaries are women. 80% of all Medicare dollars are spent on those whose incomes are less than $25,000 per year.
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Recently, a presidentally appointed national bipartisan commission on Medicare reform was unable to reach consensus on changes in the system which would postpone the anticipated Medicare crisis. It is predicted that the Medicare trust fund will be bankrupt in 2008, when the aging 77 million baby boomers are eligible for Medicare. The next step will probably be a f i e rce congressional debate between those who wish to expand the program to include prescription drugs and a secure, affordable benefit package and those who think that it is necessary to decrease benefits in order to contain costs. The current HMO-
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Medicare developments are but the first steps in this reform debate. Separate funds finance the operations of the two parts of the Medicare program. The Hospital Insurance (HI) program, or Medicare Part A, helps pay for inpatient hospital, home health, skilled nursing facility, and hospice care for the aged and disabled. The HI program is financed primarily by payroll taxes paid by workers and employers. The taxes paid each year are used mainly for benefits for the current beneficiaries. The AMA has called this pay-as-you-go financing of Part A a “pyramid” scheme. “The similarity lies in the promise of future benefits to those who now fund services for current beneficia-
Thus from 1994 to 1997, there was a 29.6% increase in total Medicare outlays. The Part A increase was 33.4%, while the Part B increase was 22.8%. Controlling this rate of increase is the highest priority issue for the federal health policy makers. (The Health Care Financing Administration’s, HCFA’s, highest priority issue is solving their Y2K problems. After that, HCFA will focus its attention on controlling the rate of growth of Medicare outlays.) The above is background information which helps explain the current HCFA Hospital Outpatient Prospective Payment System (HOPPS) proposal. This proposal, which is essentially an outpatient DRG scheme, would transform the
Year Total Medicare Outlays HI Trust Fund Units: $10 6 Units: $10 6 1994 1995 1996 1997
$164,862 $184,203 $200,337 $213,600
SMI Trust Fund Units: $10 6
$104,545 $117,604 $129,929 $139,475
$60,317 $66,599 $70,408 $74,125
(Reference: http://www.hcfa.gov/stats/indicatr/backgrnd.htm)
ries, and the need for a growing number of new contributors to fund the growing number of beneficiaries.” (Reference: Rethinking Medicare: A Proposal to Reform Medicare. A Statement of the American Medical Assoication to the National Bipartisan Commission on Medicare , September 8, 1998) Medicare Part B, the Supplementary Medical Insurance (SMI) program, pays for physician, outpatient hospital, and other such services. The SMI program is financed primarily by monthly premiums paid by beneficiaries and from the general fund of the U.S. Treasury. The following table describes the growth in Medicare outlays in millions of dollars from 1994 to 1997.
current cost-based payment system into a prospective payment system. This scheme would impact on all health care providers. With this or any other such scheme, there will be winners and losers. HCFA estimates that urban non-teaching hospitals will suffer a one percent reduction, that teaching hospitals will suffer between a nine and 12 percent reduction, and that cancer hospitals will suffer a 29 percent reduction in Medicare funds if this proposal as it is currently constructed is adopted. Major social economic groups, e.g. the AARP, the AHA, etc. have formed their positions relative to this proposal. Medical professional societies, e.g. ASTRO and ASCO,
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have also submitted their official positions. The AAPM has sent three letters, outlining AAPM concerns. These letters are available on the AAPM web site. HCFA has for a fifth time extended their comment period until June 30, 1999. Organized medical physics is a very small player in a game played with very large and powerful players. Organized medical physics, (the AAPM, the ACMP, and the ACR CMP), have been active and will continue to be active in addressing the Medicare issue. There are at least two actions that individual medical physicists should take. The first is to contribute your own written response to this proposal (and every other proposal for which written responses are requested). The political system is sensitive to the concerns of both the well organized interest groups and the individual citizens. The comment period has been extended, so please send your comments, especially if you have not already done so. The second is to develop a relationship with the staff of your senators and member of Congress. Phone their offices and request to speak to their health aides. Engage in conversation with them on issues that you have an interest in. Listen to their concerns and suggest compromises or alternative solutions. It is also important, but not necessary, to contribute to their campaigns. Even small contributions are welcome and will be remembered. Difficult choices will eventually be made relative to the funding for Medicare. These choices will impact upon our professional interests. The political system tends to seek compromises between the multiple agendas of the various interest groups. It is important that medical physicists become and remain active to insure that our interests are considered when these difficult choices are made. ■
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Report of AAPM Delegates to AIMBE by Gary Fullerton San Antonio, TX This is the annual report of t he t wo A APM del egat es (William Hendee and myself) t o t he A IMB E (A meri ca n Insti tu te for Medical and Biological Engineering) concerning our attendance at the AIMBE meeting from March 12-14, 1999 in Washington, D.C. at the National Academy of Science. As many of you know Bill served as President of AIMBE for the past year as well as one of two AAPM delegates to the Council of Societies. In the position of AIMBE President, Bill has played a key role in promoting cooperation between the bioengineering and biomedical imaging communities to the advantage of both. Both Bill and I attended the AIMBE Sessi on s on ‘T hera peu ti c Delivery: Opportunities and Ch a lle nges for Bioengineering’, business sessions of the College of AIMBE Fellows and the Meeting of the Council of Societies. In addition both of us participated as AAPM representatives at the O rganizing Committee for Chicago 2000. The report will focus on the issues of greatest potential influence on AAPM interests. Both of us continue to be pleased by the growing influence of AAPM on national science policy and re g u l a t o r y change through AIMBE cooperation. A number of AAPM members recently took advantage of the method created by
the AIMBE Council of Societies to allow comment on federal rules and regulatory interpretations. We have not and will not win all the battles but we will have an increasingly effective voice in issues that effect AAPM members. A new Council of Societies web page (http://www.biomaterials.org/ aimbe.html) was created to facilitate AIMBE society member input. There are plans to continue this process and make it more effective through better distribution of information to AIMBE Society delegates and hopefully through them to concerned society members. We will try to use this method with good judgement, as too many such requests will, in our opinion, not be productive. As AIMBE President Bill Hendee reported at the meeting of the Council of Societies, progress has been made at NIH to make grants more accessible to investigators working on development of technology and devices. NIH is creating methodologies to consider what they refer to as non - hyp ot hesi s d r iven research. In addition the NIH has provided a report as requested by congress under a letter of transmittal of HEW S e c re ta ry Do nna Sh al al a (http://fairway.ecn.purdue.edu /BME/societies/AIMBE/ amsuprt1.html ).
The Shalala letter and the report will be of interest to a number of research oriented
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members of AAPM. An important indicator of the willingness of NIH to focus on physical science and bioengine er ing to pi cs is th e ‘B i omed ic al I ma gi ng Symposium’ that is planned for June 25-26 at the Natcher C o n f e rence Center at NIH. This BECON symposium is intended to create a document to focus on potential needs for future NIH funding in medical imaging. This is of course an area of critical importance to AAPM members. In listening to Dr. Wendy Baldwin, Deputy D i r e cto r fo r Ext r am ural Research, it is clear that a s t rong turnout at the last BECON conference played a large role in raising the visibility of technology developers at NIH. AAPM should encourage interested members to attend this symposium to make sure our voice is heard on medical imaging. More information, including registration, is availa b le a t http://www.capconco rp.com/grants/becon/meeting 99/index.asp
You should note that RSNA and AIMBE (including AAPM of course) cosponsor this symposium. Dr. Rita Colwell, Director, National Science Foundation gave the Plenary address for the AIMBE College of Fellows. The recent effort of OMB to make funded federal research results available was raised by her as an issue of grave concern to the medical research community. It is clear that constant vigilance is necessary a nd AAP M me mber s ar e encouraged to submit comments on this issue.
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Finally, AAPM members should all know they are welcome to participate in the annual AIMBE meeting. In
addition, it is in the best interests of AAPM to have more members nominated as fellows of AIMBE College of Fellows.
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Both Bill and Gary are fellows and can assist in the nomination of appropriately qualified individuals. ■
Radiation Therapy Equipment Standards From the International Electrotechnical Commission by Geoffrey Ibbott Lexington, KY In the US, many of the requirements addressing the safety of radiation therapy equipment are published by the FDA or the NRC, or are p romulgated by the states t h r o u gh t h ei r H e al t h Departments. In many cases, specific requirements for performance and QA originate in standards published by the International Electrotechnical Commission. The design of equipment for radiation therapy is likewise impacted a great deal by the IEC standards. The AAPM participates in the development of these standards, and this is a report of attendance at a re c e n t meeting at which such standards were discussed.
The I.E.C. T he I n te r n a t i o n a l Electrotechnical Commission is a standards-setting organization of approximately 50 member nations, with headq u ar te r s in G en e v a , Switzerland. Its role is to develop standards for safety and performance of electrical devices ranging from toasters and shavers to bullet trains and power plants. The IEC consists of 200 technical committees and subcommittees
but it is in the working groups that the actual development of standards takes place.
Subcommittee 62C Of the many IEC committees, subcommittee 62C is responsible for equipment for radiation therapy, nuclear m e di c in e , a n d r a di at i on dosimetry. It has three “working groups,” of which WG-1 is responsible for radiation therapy equipment. Each member nation participates in the IEC through its National Committee. The US National Committee is located at the offices of ANSI, in New York. The USNC Technical Advisor and representative to SC62C is Peter Paras, of the US FDA. The USNC established a technical advisory group (TAG) associated with each of the three working groups. I presently chair the TAG to WG-1, and as such am a member of the working group. The TAG consists of a number of medical physicists, of whom Frank Bova and G e o rge Starkschall are the other AAPM delegates. The Working Group itself consists primarily of representatives of m a n u f a c t u rers of radiation therapy equipment. Participation on the Working Group is an important responsibility, as the decisions made by the WG,
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and ultimately adopted by the IEC, influence the design of radiation therapy equipment sold all over the world. In many countries, particularly the European Community, the decisions of the IEC carry the weight of law. The formation of the EC has created a much larger customer for radiation therapy equipment than is the U.S., and can potentially dictate the design of the equipment.
Recent Work Probably the most comprehensive, far- reaching and influential recent publication of WG-1 is the second edition of IEC 60601-2-1 known as t h e A c c e le ra t or S a f e t y S t a n d a rd. This document dictates the design of important safety features of medical linear accelerators, including t h e fu n c t io ni ng o f t h e dosimetry system, the testing of interlocks, permitted levels of radiation leakage, and certain important characteristics of the radiation beams. This document was completed and published in 1998. Similar standards have been published to address safety requirements of simulators, cobalt units, and lower-energy t r e at m e n t u n i ts . P e rf o rmance standards also
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h ave been p ub li sh ed, to address minimum levels of acceptable perf o rmance of radiation therapy equipment. Current work that was discussed at the most-re c e n t meeting of the Working Group includes the following: IEC 62083, Safety of Radiotherapy Treatment Planning Systems. Now nearing completion, this document has been drafted by Ed M a r t e ll of Nordion/Theratronics, with a great deal of input from US TAG members. The standard addresses features of software design intended to reduce the likelihood of incorrect data entry and misinterpretation of results. Amendments to IEC 609 76 and 60977, Performance Standards for Radiotherapy Accelerators. R ay M c I nt yr e of Va r i a n Oncology Systems has drafted new language to address the performance of multi-element beam limiting devices (MLCs, for those unaccustomed to IEC-speak). Previous drafts had been commented upon heavily, and these amendments are now nearing final form. Amendment to IEC 61217, C o o rdinates, Movements and Scales. This standard, published by the IEC in 1996, s t a n d a rdizes the coord i n a t e systems and scales to be used for radiation therapy equipment. Todd Steinberg of Siemens Oncology Systems has written new language defining a patient coordinate system, together with matrices to enable transformation of coordinates to and from the
DICOM coordinate system. Some mi nor s ugg est io ns were made at the meeting, but it i s l ikely that the amendment will be voted upon soon. Guidance document for implementation of DICOM-RT. Some years ago, the IEC made the commendable decision to cease work on its own standard for elect ronic data exchange, and officially adopt the DICOM standard. Several meetings were held at which a number of issues believed critical by WG-1 members were discussed with the members of t he D IC O M - R T wo r k i n g group, and consensus was reached. Now, the IEC wishes to publish guidance for the implementation of the DICOM-RT objects, to familiarize readers with the origins of the objects, explain the meaning and interpretation of a conformance statement, and raise issues to consider when specifying and purchasing equipment. I have been asked to lead the development of this document. A first draft was reviewed, comments were received, and a second draft will be produced for review at the October meeting of the WG. Revision of 60601-2-17, Safety of RemoteC o n t rolled Afterloading Equipment. I am leading the effort to update this document to address modern developments in remote cont r o l led a f t er l oa di n g brachytherapy. A number of comments were received on a first draft, and a second draft
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will be pre p a red for the October meeting. Finally, the WG has agreed that the two accelerator perf o r ma nc e s tan da rds , I EC 60976 and 60977, are due for updating. The US TAG is undertaking the responsibility for preparing drafts, under the leadership of Frank Bova. This work is just beginning. AAPM members who wish to contribute to the publications of the Working Group a re encouraged to contact me. Be warned, however! These documents are complex, and are necessarily written to be both unambiguous and understood by people of many cultures and backgrounds. Review is not easy, but it is rewarding work, as one is aware that the result will have significant and longlasting effects. â–
AAPM NEWSLETTER
MAY/JUNE 1999
AAPM Summer Schools Rotating Format Proposed by Lee Goldman, Chair, Summer School Subcommittee Hartford, CT Anthony Seibert, Chair, Continuing Education Committee Sacramento, CA Donald Frey, Chair, Education Council Charleston, SC The AAPM has conducted college campus-based summer schools since 1969. These annual, week-long schools emphasize instruction: they strive to provide in-depth coverage of selected topics important to the work of the typical medical physicist. Although limited amounts of researchoriented material may be included to round out topic coverage, summer schools do not deal with science frontiers. Scho ol pro ceed ings are
published as bound volumes
weeks and
within a few
P ro p o s e d :
Adopt a three-year topic cycle: a broad therapy topic (year 1); a broad imaging topic (year 2); and concurrent specialized therapy and imaging topics (year 3). suitable for future re f e re n c e use. Past schools pre s e n t e d therapy and imaging programs on a four-year ro t a ting schedule: a bro a d therapy topic (year 1); a b road imaging topic (year 2); a specialized therapy topic (year 3); a specialized imaging topic (year 4). The campus enviro n m e n t complements the collegial a t m o s p h e re of the schools. With both faculty and attend e e s l i v i n g on c a m pu s , extensive and informal interactions occur naturally, a p rocess which enhances the summer school experience. Un til 1995, summer schools were (linked) to the AAPM annual meeting: they w e re held on consecutive
hours ground travel of each o t h e r. Due to concerns that two weeks away from work made it difficult to attend both the school and meeting, the school was “delinked� in 1995, and held at the end of June and in a separate location. Summer schools have been a popular and valuable re s o u rce for continuing medical p hysics education. H o w e v e r, decreasing travel budgets and increasing time p re s s u res forced a re - e v a l u ation of how they might better meet the needs of AAPM members. To aid in this evaluation, an email survey was conducted in September 19 9 8 . T he s u r ve y a sk e d respondents to indicate their
More or less likely to attend school if it is:
Linked to annual meeting
Linked and shorter (3.5 days)
Linked/abutting to eliminate lost days
More likely to attend Less likely to attend No difference: % More likely to attend: % Less likely to attend:
95 44 80 43% (68%) 20% (32%)
129 24 66 59% (84%) 11% (16%)
103 46 68 47% (69%) 21% (31%)
22 129 64 10% (15%) 60% (85%)
Primary reason for non-attendance at School:
Cost
Time
% of Respondents
20%
29%
Interest in Topic 49%
Conflicts with Other meetings 2%
Numbers in parentheses exclude the diff e rences in re s p o n s e s .
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Held at conf. center
AAPM NEWSLETTER
primary reasons for nonattendance at summer schools, and if their attendance would be more likely under certain conditions. A summary of the 230 re s p o n ses is provided in the following table. Th e S u mmer Sch o ol S u bc omm it te e a nd C o nt in uing E d uca ti on Committee propose changing the summer school format, beginning in 2000, to address this feedback. Schools would adopt a three-year topic cycle: a broad therapy topic (year 1); a broad imaging topic (year 2); and concurrent specialized therapy and imaging topics (year 3). This allows popular broad topics to be presented more frequently, and allows less-well attended specialized schools to be conducted more cost eff e c t i v e l y . Schools would be linked to the annual meeting on alternating years (’00, ’02, etc.), with linked schools shortened to 3.5 days (beginning on Friday morning after the meeting and ending on Monday morning). This reduces the time commitment required to attend both the annual meeting and summer school to six work days. Future schools may also incorporate more hands-on learning opportunities. The planning process is also being improved to allow more lead time and provide more assistance to local arrangements committees. We believe these changes can improve the quality of summer schools and allow more members to take advantage of the educational experiences that summer schools o ff e r. We we lc ome your input. ■
MAY/JUNE 1999
Past Year Activities For ACRs Commission on Medical Physics by Don Tolbert Chair, ACR Commission on Medical Physics Honolulu, HI The Commission on Medical Physics (CMP) is comprised of the following individuals: John Cardella, M.D., George T.Y. Chen, Ph.D., Robert Dixon, Ph.D., Cassandra Sue Foens, M.D., Michael Gillin, Ph.D., Joel Gray, Ph.D., James Hevezi, Ph.D., Geoffrey Ibbott, Ph.D., Fred Mettler, Jr., M.D., Richard Morin, Ph.D., Perry Sprawls, Ph.D., Jon Trueblood, Ph.D., and David Vassy, Jr., M.S. The leadership experience includes two Chairs of Radiology Departments, one past Chair of ACMP, two past AAPM Presidents, Board member of ASTRO, and the present AAPM President. The following highlights the CMP activities and accomplishments during the past year.
Status of Projects We are in the final processes of a) developing a brochure entitled “What Does the ACR Offer the Medical Physicist” and b) developing an “ACR Guide to Medical Physics Professional Practice.” We received a presentation from the Canadian College of Physicists in Medicine and the Canadian Organization of Medical Physics during our San Antonio meeting. The purpose was to explore common goals of our organizations and establish the basis for ongoing relationships, including perhaps mem-
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bership in the ACR. During the 1999 meeting of the Board of Chancellors and Council Steering Committee, R e f e r ence Values were approved for incorporation into some ACR Accre d i t a t i o n P rograms and Standards of Practice. We continue to provide support to this important development. We also continue to play a leadership role representing the ACR to the Conference on Radiation Control Pro g r a m Directors (CRCPD). Several presentations were made at the 1998 annual meeting and several are planned for the 1999 annual meeting.
Committee Project Status Economics Committee - James Hevezi, Chair A coding article on codes 77336 (Continuing Medical Radiation Physics Consultation in Support of Therapeutic Radiologist) and 77370 (Special Medical Radiation Physics Consultation) was published earlier this year. Many discussions took place with physician counterparts in meeting with officials regarding the Practice Expense
AAPM NEWSLETTER
Study, third-party Carrier Advisory Committee initiatives, and HCFA proposals regarding Hospital Outpatient Prospective Payment System (HOPPS). The Committee is looking at new technologies and whether adequate coding is available to cover this work. The Committee is also working on a definition of diagnostic medical physics cost centers to aid in the development of costs using capitation.
Education Committee Jon Trueblood, Phd., Chair The Committee is organizing an ACR symposium to be held at the 1999 annual meeting of the American Association of Physicists in Medicine. It will be entitled “Medical Physics Consultation on Radiation E x p o s u re; Measuring, Calculating, and Reporting Radiation Risk.” Planning is in progress toward developing education programs tailored to the changing needs of medical physicists and upcoming Accreditation Programs. The Committee continues to work on the physics syllabii for radiation oncology and residents. The radiation oncology physics syllabus is nearing completion. Progress is also being made on updating the ACR’s Guidelines for the Teaching of Medical Physics to oncology and diagnostic residents and the Teaching of Radiation Protection to medical students. An initiative to develop lecture source materials for teaching non-radiologist physicians about the safe use of fluoroscopy has been undertaken.
Government and Public Relations Richard Morin, Chair The Committee continues to review proposed revisions to the Nuclear Regulatory Commission’s Part 35 (Medical Use of By-Product Materials) and monitor developments regarding MQSA regulations. The Committee continues to interact with the CRCPD to provide clinically relevant presentations of interest at the annual meeting of the Conference. Additionally, liasion activities continue to provide a mechanism for communication with the CRCPD.
Standards and Accreditation Committee David Vassy, Jr., Chair The Committee is working on the development of the following 1999 standards: 1) Diagnostic Medical Physics Performance Monitoring of Real Time B-Mode Ultrasound Equipment, 2) Diagnostic Medical Physics Performance Monitoring of Magnetic Resonance Imaging Equipment, 3) Perf o rmance of Brachytherapy Physics: Remotely-Loaded HDR Sources, and 4) Performance of LowDose-Rate Brachytherapy. Two 1995 standards are in the review stages: 1) Performance of Brachytherapy Physics: Manually Loaded Temporary Implants, and 2) Standard for Radiation Oncology.
Research and Technology Assessment Committee Perry Sprawls, Chair The Committee is providing
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MAY/JUNE 1999
oversight and guidance for a study on image compression. It is expected that the results will provide the ACR with data that can be used to develop recommendations and standards. The Committee is launching STAR on the ACR web site. STAR (Sci ence and Te c h n o l o g y Assessment Resource) is a web based information resource for the ACR membership on the issues concerning the science and technology of medical imaging.
Committee on Human Resources Joel Gray, Chair The Committee has developed a survey instrument for medical physics members of the ACR. The purpose of this survey is to determine practice profiles, use of e-mail, and characteristics of members regarding e-mail. The Committee has also developed a mechanism and letters to recruit new ACR medical physics members.
Committee on Radiation Units, Standards, and Protection Fred Mettler, Jr., Chair The Committee supports ACR funding of the training of state employees to continue the National Evaluation of X-ray Trends (NEXT) study. In addition to the leadership experience noted above, the CMP strives to set a high standard of professionalism. I am proud to Chair this group and look forward to our continued work during 1999. ■
AAPM NEWSLETTER
MAY/JUNE 1999
Letters to the Editor
Announcements I-125 Guidance Notice “G ui dance to u sers o f Nyc om ed A mers ham a nd North American Scientific, Inc., I-125 Inters titial Sourc e s : Dosimetry, and calibration changes” is of importance to a large proportion of medical physcisists. Please see Med. Phys. 26, 570-573 (1999) for this information.
Medical Dosimetrists Meeting The American Association of Medical Dosimetrists will convene for their 24th Annual Meeting June 13-June 17,1999 at the Hyatt Regency Hotel, Minneapolis, MN. For more information, contact: Randi Weaver (612)927-0689 or Oaks Travel/Meeting Department (800)284-0679, Fax (713)430-1960, Email: meetings@oaksgroup.com ■
Define Board Eligible
Comments on Guy Simmons’ ABMS Article
by Joe Wong San Luis Obispo, CA Reading Robert Matthews’ letter in the July/August 1998 issue of the AAPM newsletter (I was just catching up on my reading), I cannot help but notice an often used term, “board eligible.” I think it is time for the AAPM forum to define that terminology. While in graduate school, we had a talk given by Dr. Jack Krohmer in which he defined “board eligible” as “someone who has received an invitation to take the board exam.” Nowadays, a lot of professionals to whom I spoke defined that as “having the qualifications to take the board exam,” and not necessarily having made an application or been invited to take the exam. If the latter is true, then anyone who has graduated from a physics program with at least two years experience is “board eligible” physicist. Or should we ask for the letter of invitation for the next exam as proof of “board eligible” just as we w ou ld a sk s omeon e fo r his/her board certificate if he/she alleges that he/she is board certified? Any thoughts from my peers?■
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by John Glover Plymouth, MA Thank you for the article in the January 1999 issue by Guy Simmons on the ABMS. It WAS informative. However, nowhere did Dr. Simmons indicate any tangible benefit to working medical physicists by the affiliation of ABR with ABMS. In fact it would appear that ABMS just suffers medical physicists via ABR (“hereafter the ABMS will not authorize Member Boards of the ABMS to certify non-physicians”) probably because of historical precedent. Why do we have to be medical specialists? Why can’t we be happy just being physicists? I understand the desire for a “unified Board.” But if that is the correct option, let’s do it for the right reasons. ■
AAPM NEWSLETTER
Residencies and Fellowships Announced
by Steven Goetsch Chair, Development Committee La Jolla, California Bhudatt Paliwal, Chairman of the Awards Sub Committee of the AAPM Development Committee, has announced the recipients of the two Clinical Residencies in Radiation Oncology. Va r i a n Oncology Systems sponsors each of these awards, as it has done since 1993. The awards were given to Barnes-Jewish Hospital of St. Louis (program director James Purdy) and to the University of Kentucky (program dire c t o r Geoff Ibbott). The individual recipients of the residencies will be named later. Dr. Paliwal also announced that Susan Richardson has received the Fellowship for Graduate Study in Medical Physics sponsored by the Radiological Society of North America and the American Association of Physicists in Medicine. R i c h a rdson will attend the University of Wisconsin this fall. The award will include a stipend and tuition support for the first two years leading to a doctoral degree in Medical Physics. The Development Committee of the AAPM now administers eight residencies and two fellowships, awarded on staggered years. The next issue of the AAPM Newsletter will give a list of the awards which begin July 1, 2000 and deadlines for application. ■
Susan Richardson, recipient of the Fellowship for Graduate Study in Medical Physics, will attend the University of Wisconsin for her doctorate.
Web Page Updates by Carter Schroy Columbus, Ohio The AAPM and Medical Physics web pages (homepages = http://aapm.org and h t t p : / / w w w . m e d p h y s . o rg ) have undergone extensive revision and updating over the past year. Please be sure to check them out if you haven’t done so recently; they contain a wealth of new information. Th e AA P M M ed ic al P hys ic s R e so urc e Page (http://aapm.org/medphys.ht ml) is a compendium of informative sites that contain informa ti on man y m edi cal physicists will find useful. These include many departmental pages and websites in all subspecialties of medical physics including DICOM (including NEMA), X-ray info servers, NIST standards, and
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MAY/JUNE 1999
even the Naval Observatory’s time-of-day page. It also contains a list of pertinent electronic mailing lists to which you may subscribe. Chief among these is the Medical Physics Mailing List which now has over 1650 subscribers in over 60 countries. The AAPM Medical Physics and Related Org a n i z a t i o n s page (http://aapm.org/orglist.html) contains links to many organizations and agencies of interest including ISO, IPEM, ABR, ACMP, ISMRM, etc., etc. Th e Med ica l Phys ic s Calendar (http://www.medphys.org/calendar/calendar.ht m), which is no longer published in the printed journal due to space constraints, has immediate update capabilities and hot links to events’ web sites and email contacts. It also links to the web calendars of many medical physics and related organizations. ■
AAPM NEWSLETTER
MAY/JUNE 1999
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 e-mail: rdixon@rad.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 July/August, 1999
DEADLINE
MAIL DATE
June 15,1999
July 15, 1999
Editorial Board Benjamin Archer Bruce Curran Marsha Dixon 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.org http://www.aapm.org
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