AAPM JULY/AUG
7/28/99
7:38 PM
Page 1
Newsletter AMERICAN ASSOCIATION
OF
PHYSICISTS
IN
VOLUME 24 NO. 4
MEDICINE JULY/AUGUST 1999
AAPM President’s Column A Successful Annual Meeting
will expire in about two years. The AAPM is acting proactively, and has for some time had a committee on Headquarters Rel oc at io n, ch aire d by Tre a s u rer Melissa Martin. The committee is considering all of the possible options, i nc lu d ing s ta yi ng a t th e American Center for Physics in College Park. Other options include leasing or purchasing sp a ce el se whe re i n t he Washington DC area, or mov-
by Geoffrey Ibbott Lexington, KY By the time you read this column, our 41st Annual Meeting will have come and gone. At the time of this writing, our m eet in g pr o mis es to b e a r es oun di ng s uc c ess. Registrati ons are runn in g somewhat ahead of predictions, and the exhibit hall space has sold very well. The program will meet our customary high standards, thanks to the work of the Pro g r a m Committee, particularly chair David Pickens, Scientific Program Director Maryellen Giger, and Scientific Program Co-Director Eric Klein. The ve nu e, o f cou r se, is t he Opryland Hotel, which is said by many who have visited to be spectacular. The previews we’ve been provided on the AAPM web page are certainly t ant a li z in g. T he L oc al Ar rangements C ommi ttee , chaired by Ron Price, have already outdone themselves with the preparations. Our headquarters staff are all working hard to make sure the meeting is a success. In particular, the successful exhibit hall is due to the work of Lisa
R o se S u l l i v a n , a nd th e Tec hn ic al E xhi bi ts Subcommittee, chaired by Jim Marbach. Again this year, our electronic abstract submission system p e rf o rmed flawlessly. The number of abstracts submitted this year was comparable to the number submitted last year. This is important for several reasons; it indicates that participation in our annual meeting remains high, even in this time of cost-cutting by hospitals, and reductions in time and funding for professional development. The AAPM membership has grown slightly since last year and is expected to increase almost 3% from 1998.
Headquarters Relocation As many of you know, the AAPM’s lease in College Park
1
INSIDE TABLE OF CONTENTS President’s Column . . . . . . . . . p. 1 Call for Awards. . . . . . . . . . . . p. 3 Executive Dir. Col. . . . . . . . . . p. 4 Balanced Budget Act. . . . . . . . p. 5 Draft Standards Comments. . . . p. 6 ABR Physucs Update. . . . . . . . p. 7 ACR Physics Com. Link . . . . . . p. 11 Reference Values. . . . . . . . . . . p. 9 Letter to Editor . . . . . . . . . . . p. 11 Announcements . . . . . . . . . . p. 12
AAPM JULY/AUG
7/28/99
7:38 PM
Page 2
AAPM NEWSLETTER
JULY/AUGUST 1999
ing to a no th e r lo c at i on entirely. AAPM has hired The Staubach Company to study our needs and help negotiate for this new space. Updates will appear in the newsletter as this work progresses.
Our On-Line Presence Our journal, Medical Physics, is continuing to maintain high standards under the leadership of Editor Colin Orton. After going on-line earlier this year, a number of members have subscribed to the electronic edition. As of May 1, approximately 10% of full members were subscribed to the on-line service. This number appears to be growing, as more members learn the benefits of electronic access. Members who have visited recently have seen changes and new features on the AAPM web page. Thanks to Michael Wo o d w a r d a nd Sean Benedict of our Headquarters s t a ff, members and guests now have access to more information and news than ever before. Related to this is the discovery that, as of this spring, 79% of our membership has email. This is based on the proportion of members who have provided their email addresses to Headquarters for inclusion in the on-line and printed directories. This is a 29% increase from two years ago, when then-President S t e v e T h o m a s reported that the 1997 directory indicated 50% of the membership had email.
Relationships with Other Organizations • ASTRO Maintaining re l a t i o n s h i p s
and facilitating interactions with other organizations occupy a fair amount of time for the Association’s off i c e r s . Some of these interactions are largely scientific, as are our interactions with ASTRO. I recently appointed an ad hoc c omm i tte e, c ha ir ed by President-elect Ken Hogstrom, to review our participation in the ASTRO annual meeting. The charge to the committee is to develop a strategic plan for strengthening the presence of the AAPM at the meetings. • RSNA As President, I was invited to the June meeting of the RSNA Board of Directors. I took advantage of this opportunity to express the gratitude of the AAPM for several generous contributions made by the RSNA. In particular, the RSNA has contributed a large sum to our Development Fund, and is responsible for helping to launch the fund-raising efforts. The RSNA more recently has funded a medical physics fellowship in imaging. I used the opportunity to report to the RSNA on some discussions held recently between the AAPM and two non-radiology medical societies, concerning the qualifications of physicians who are doing radiological imaging and therapy. Finally, we plan to participate with the RSNA as an endorser of a project being conducted jointly with the Disney Corporation at their Epcot Center. The exhibit will likely b e entitled “RadiologyExploring New Horizons” and wi ll be part of Epcot’s Millenium Celebration. The Education Council, chaired by Don Frey, is staying in contact with the RSNA on this project.
2
• HPS We will be represented at the HPS annual meeting by Jean St. Germain, who will wear her AAPM hat at an Intersociety Luncheon. At the luncheon, information describing several invited organizations will be shared, and areas of common interest will be explored.
Alliance for Quality Medical Imaging and Radiation Therapy In the last Newsletter, I described the development of an Alliance for Quality Medical I ma gin g a nd R a di ati on Therapy by the American S ocie ty of R adi ol ogi c Technologists (ASRT). Several other organizations, including the American Association of Medical Dosimetrists (AAMD) and the Society of Radiation O n co lo gy A dmi nis t ra to r s (SROA) have joined with the ASRT. The purpose of the Alliance is to support the C o n s u m e r-Patient Radiation Health and Safety Act of 1981. This Act contains provisions for licensure of radiologic technologists, but because the provision is voluntary, it has not been enforced. At present, 33 states have some form of licensure of technologists but the regulations vary considerably from state to state. The AAPM has consistently supported licensure for medical professionals, including radiographers, radiation therapists, and physicists. To learn more about the Alliance, and to indicate the interest of the AAPM in this issue, I recently attended a meeting of the Alliance in Chicago. The other participants in the meeting included representatives of the
AAPM JULY/AUG
7/28/99
7:38 PM
Page 3
AAPM NEWSLETTER
ASRT, AAMD, SROA, as well as several of the training program accreditation organizations, and the technologist certification org a n i z a t i o n s . The majority of time was spent in drafting a bill to revise the Act, adding specific requirements for regulations addressing the quality of training programs and procedures for assessing the competence of technologists. Some additional effort went into cleaning up some ambiguities, and adding provisions to enforce the requirements. We are still investigating the ways in which the goals of
the Alliance coincide with ours and will consider in the future whether or not to join as a sponsor.
Interactions with Government Medicare As reported recently, we have commented several times to the Health Care Financing Administration (HCFA) concerning their proposal for a Ho sp it a l O u tp ati ent Prospective Payment System (HOPPS). Through the efforts of the Professional Council, chaired by Mike Gillin, it is hoped that many medical
JULY/AUGUST 1999
physicsts have also commented. Presumably, the comment period will have ended by the time you read this, although it was extended several times.
Congress With the assistance of several members of the Professional Council, particularly I v a n B re z o v i c h , cha i r of t he R eim b ursem en t P a tt er n s Subcommittee, I wrote to Representatives Rick Lazio and Anna Eshoo to support House Bill 1070. This bill would enable assistance to cancer patients whose financial circumstances may compromise their options for care. ■
AAPM Awards and Honors Committee Call for Awards and Call for Competitive Applications for 2000 Travel Grants Deadline Note: Nominations for awards and applications for travel grants must be received by October 15, 1999 at: AAPM Awards and Honors Committee One Physics Ellipse College Park, MD 20740-3846 Award winners and nominators, and applicants for grants, will be notified by June 15, 2000. Awardees and recipients will be honored at the AAPM Award and Honors Ceremony and Reception during the Chicago 2000 World Congress.
Categories for Awards • William D. Collidge Award - for distinguished career in medical physics • AAPM Award for Achievement in Medical Physics - members whose careers have been notable based on outstanding achievements • AAPM Fellows - for distinguished contributions by members
Categories for Grants • AAPM-IPEM Medical Physics Travel Grant - for U.S. AAPM member who shows evidence of an active scientific career in medical physics. The purpose is to promote communications and professional partnerships between U.S. AAPM members and IPEM members from the United Kingdom. • AAPM Medical Physics Travel Grant - to a U.S. AAPM member to travel to a foreign country of recipient’s choice. The grant is to assist in the career development of the recipient and to promote communications in medical physics between nations. Please contact Headquarters, Nancy Vazquez, at nvazquez@aapm.org for more information.
3
AAPM JULY/AUG
7/28/99
7:38 PM
Page 4
AAPM NEWSLETTER
JULY/AUGUST 1999
Executive Director’s Column By Sal Trofi College Park, MD AAPM Website AAPM Online has Members Only sections of the Website where you must enter your username and password. In the past, forgetting your passw o rd mea n t c al li ng Headquarters or requesting a new one, but now you can retrieve your username and p a s s w o rd, se cur el y a nd i ns t an t ly. Fr om the “G et U s e rn a m e / P a s s w o rd” link http://www.aapm.org/register.html,
you can enter your email address into a form to have the information emailed to you. The system will only send the username and password if the email matches your email in the database, therefore it is critical that you keep AAPM Headquarters updated when your email address or other contact information changes. Email is becoming increasingly important as more of our members go online, and we appreciate that some AAPM Members may not be interested in announcements fro m Headquarters. You now have the ability to limit any or all emailings that are sent to your email a d d ress. From the “Change your Profile Online” http://www.aapm.org/memb/ad dress-change.html, you may log in and specify what emailings you do/do not wish to receive. AAPM will continue to send you dues and payment information as well as meeting registration confirmations via email in an effort to reduce costs.
AAPM Online will soon have a searchable database of the AAPM Bo ar d and Annual Business Meeting minutes for the past 41 years. We are missing the 1964 Annual Business Meeting, the 1968 and 1969 Annual Meeting and 1972 RSNA Board Minutes. If you have a copy of the missing minutes, please let me know by email at strofi@aapm.org. I would like to add them to our database to complete the set.
Awards and Honors Included in the mailing with this Newsletter are the “Call for Nominations” and the “Call for Applications” for the 2000 Awards Program. Please make a note that the deadline to submit the necessary information is October 15, 1999. For additional information about the Awards Program, contact N an cy Va zqu e z at nvazquez@aapm.org
Chicago 2000 World Congress, July 23-28, 2000 P reparations for the next World Congress on Medical Ph y si cs a nd B i ome di ca l E ngi nee ri ng c on tinu e on sched ul e w ith in cre a s i n g e xc ite men t a s a d di ti on a l d e tai ls ar e an n o unce d . Following are important dates to remember: November 1, 1999 - Web site activated to receive elect ronic abstract submissions and meeting registration. J a n u a r y 14 , 2 00 0 Deadline for receipt of abstract April 3, 2000 - Authors notified of paper disposition
4
April 7, 2000 - Invited speakers notified of assigned session May 15, 2000 - Registration Deadline to receive discounted registration fees May 26, 2000 - Chicago 2000 Scientific Program available on wc2000.org June 2, 2000 - Short papers a nd hand outs d ue f ro m authors June 19, 2000 - Deadline for housing reservations and advance meeting registration July 1, 2000 - No refunds g iv en f or c a nce ll a t ion s received after this time
Staff News Becky Bible is leaving the A AP M fo r a new li fe in San dw ich , Mass ach us etts, which is on Cape Cod. Becky worked as our Accounting Assistant and her very fine efforts and accurate work is very much appreciated. She gave us a two-month notice of her pending relocation, which allowed her to train her replacement, Kysha Marshall. Kysha has over five years e xp er ie nce wo r ki ng in accounting departments. She is currently going to night classes at Montgomery College to further her studies in accounting. She also has skill with software
AAPM JULY/AUG
7/28/99
7:38 PM
Page 5
AAPM NEWSLETTER
packages, which will come in handy at audit time. Getting documents notarized fro m now on will be a bre e z e ; Kysha is a Notary for the State of Maryland. I n pr ep ar at i on fo r th e Chicago 2000 World Congress, we have added a full time temporary employee, Farh a n a Khan. Farhana is a Spring `99 graduate of the University of Maryland, where she received a B.S. degree in Biology. She has worked on a part-time basis for AAPM over the past year, assisting with various projects. Plans are for her to work through the end of 2000, easing the increased workload ge n er ated by t he Wo r l d Congress. M icha el O ’Do no van Anderson has been hired as a Programmer/Analyst. This is a new position approved by the AAPM Board to help headquarters deal with their everchanging automation needs. Mike has a B.S. Degree from the University of Notre Dame, w h e r e he ma jo red i n Integrated Science Pro g r a m (primarily physics and mathematics). He earned a Ph.D. in Phi l oso ph y fr om Ya l e University in 1996. Mike has work experience as a software engineer, tutor/assistant professor, and programmer. ■
JULY/AUGUST 1999
The Balanced Budget Act (BBA) of 1997 by Michael Gillin Chair, Professional Council Milwaukee, WI The enactment of the BBA of 1997 was a historic bi-partisan effort to balance the federal budget. It was signed into law on August 1, 1997, and is set to balance the federal budget by 2002, which would be the first balanced budget since 1969. The federal budget is divided into mandatory spending, which includes entitlement programs such as Medicaid, Supplemental Security Income, and Veterans Programs, and disc retionary spending, which includes Defense and Head Start among other programs. The 104th Congress reduced entitlement programs by $65.5 billion over the period from 1996-2002. The BBA of 1997 reduces overall spending on Medicaid by $14.6 billion over five years. The BBA slows the growth of Medicare spending by $115 billion over five years. It also includes funds for preventive benefits, such as annual mammography and prostate and colorectal cancer screening. The BBA allows beneficiaries to choose between the traditional fee-for-service Medicare program and a Medicare Choice plan which will offer coordinated care plans with HMO’s, PPO’s, and PSO’s, private fee for service plans, point of service plans, and Medicare medical savings accounts. Hospitals, through their professional organizations, are cal-
5
culating the reductions that they can expect to receive as a result of the BBA. There are at least four major areas that will have an effect on hospitals, namely the hospital prospective payment system (PPS) updates, indirect medical education payments, the transfer rule, and the conversion to an outpatient prospective payment system. The BBA hospital PPS updates means that updates will be based upon inflation minus a set percentage. This will have a cumulative effect over time. Medicare reimburses hospitals for indirect costs associated with medical education by using an IME add-on. The BBA lowers the IME adjustment factor. The transfer rule involves payments to hospitals for the ten high volume DRG’s which are reduced for short-stay patients receiving pos t-acu te care in other p rovid er settings. HCFA ’ s expanded transfer rule definition reduces hospital payments by approximately $450 million nationwide. According to MedPAC, Medicare payments to hospitals for outpatient services d ropped from 90% of cost before the BBA to 82% of cost after the BBA was enacted.
AAPM JULY/AUG
7/28/99
7:38 PM
Page 6
AAPM NEWSLETTER
JULY/AUGUST 1999
Once the new hospital outpatient prospective payment system (HOPPS) is implemented in 2000, payments are expected to cover only 78% of costs. Recently, there have been newspaper articles which discussed the $1,500 annual cap on physical and speech therapy combined and a second $1,500 limit on occupational therapy, which was part of the BBA of 1997. It is estimated that in 1999 approximately 200,000 elderly or disabled patients (one of every seven Medicare beneficiaries) will be forced to either pay for these services or to stop receiving this type of therapy. Hospitals are aware of these upcoming reductions and should be taking steps now to
adjust for this loss of revenue in the future. Medical physicists should make themselves aware of what their institution is doing to adjust to these changes. Physicists are well advised to take the initiative and discuss this with your hospital administration, if they have not come to you. The pressure from hospitals will increase to be more efficient and to do more with less. Hospitals will becom e increasingly reluctant to create new positions or to fill vacant existing positions. If you are hoping to add staff, now is the time to do it. There will be adjustments made in various aspects of the Medicare spending slowdown. Most of these adjustments will be
the result of various special interest groups lobbying Congress. Since the BBA is focused on technical charges, physician groups are currently closely monitoring developments. Organized medical physics, in conjunction with other organized professional groups, have addressed specific issues, such the HOPPS, and will continue to address specific issues when the opportunity presents itself. Individual medical physicists should establish ongoing relationships with their representative in Congress and provide information on how these spending reductions are effecting patients at their institutions. â–
Three Draft Standards Reposted for Physics Community Comments by Mark Bruels Chairman, ACMP Standards Committee Greenville, SC Three proposed standards are being re-posted on the A CMP web s ite ( h t t p : / / w w w . a c m p . o rg) for comments from the entire physics community. These were passed by the ACMP standards committee and posted to the web last year. Only one comment was received. A standard implies consensus of community opinion. Due to the lack of evidenced consensus and the possibly controversial nature of parts of the standards, the ACMP Professional Practice Commissioner, Larry Reinstein,
requests that more physicists send concise comments about these to him at ler@radonc.som.sunysb.edu. If you do not have web access, these standards are available through Rick Guggolz at ACMP headquarters, 703-481-5001 ext 4070. The three proposed standards are: 1) ACMP Standard for Telemedicine as it Pertains to the Practice of Medical Physics in Radiation Oncology; 2) ACMP Standard for External Beam Radiation Oncology Physics; and 3) ACMP Standard for Diagnostic Imaging. Please note that if you are a member of the clinical physics community, your comment is requested whether or not you are an ACMP member.
6
The regulatory community has developed an unfortunate tendency to place scientific s t a n d a rds into re g u l a t i o n s . Consider this tendency in formulating your comments and suggestions. Thank you for your time and efforts. â–
AAPM JULY/AUG
7/28/99
7:39 PM
Page 7
AAPM NEWSLETTER
JULY/AUGUST 1999
ABR Physics Update Restructuring of the ABR Physics Written and Oral Examinations by Ed Chaney Chapel Hill, NC Written Examinations All True/False questions will be eliminated beginning with the 1999 exam based on ABR psychometric analysis which shows that True/False questions do not always discriminate well between high- and lo w- s co r ing c andi da te s. True/False questions will be replaced with Type A questions (multiple choice, one best answer), which discriminate very well. The 1999 exam will comprise 50 “simple” Type A questions, and 25 “complex” questions. A “simple” question requires the candidate to recall a fact or perform a simple calculation. A “complex” question requires the candidate to perform a higher level of analysis of factual information or to perform a multiple step calculation. The complex questions will be weighted more heavily (3:1) than the simple questions. The ABR has acquired computer-based testing software developed by Assessment Technologies, Inc. in association with the American Board of Family Practice. Anthony G e rd e ma n, Ph. D., AB R Psychometrician, constructed a demonstration physics exam for review by the Physics Trustees and the Written Exam Subcommittees. The Physics Trustees established the fall of
2000 as the target date for offering Parts 1 and 2 of the physics written exam on computer, contingent upon timely resolution of administrative a nd l ogi st i ca l de ta il s. A demonstration of this computer- based exam can be seen at the ABR booth at the AAPM N as hvi ll e m eet in g. T he Trustees are working closely with the Exam Subcommittees and ABR headquarters to prepare for the transition.
Oral Examinations Three important changes for the 1999 oral exam were reviewed during the winter meet ing of the Board of Trustees and plans for their implementation were discussed. The changes are 1) restructuring of the exam categories, 2) reduction in the number of examiners from six to five, and 3) requiring examiners to use a more structured scoring form based on a form designed by Chris Merritt, M.D. for the diagnostic radiology oral exams. 1. The old and new exam categories are described in the table below. The changes were motivated by 1) the fact that the old categories over-
emphasized radiation protection (3 of 5 categories included radiation protection questions), and 2) the old categori es d id not exp lic itl y encompass the full breadth of current practice in the clinical setting. The current question pool will be reclassified for the 1999 exam according to the new categories, but few immediate changes are planned for question content. Questions will be gradually changed and new questions will be added over the next several years. 2. Historically the exam panels included five physics examiners and one clinical examiner. When the oral clinical exams were eliminated, the clinical examiner was replaced with another physics examiner. Retrospective analysis of score sheets shows that the scores are highly correlated and that the sixth examiner adds little if any additional reli-
OLD CATEGORIES
NEW CATEGORIES
Design of Radiation Installations Calibration of Radiation Equipment Radiation Hazard Control
Radiation Protection and Patient Safety Patient-Related Measurements Image Acquisition, Processing and Display Calibration, Quality Control, Quality Assurance Equipment
Radiation Dosage Equipment
7
AAPM JULY/AUG
7/28/99
7:39 PM
AAPM NEWSLETTER
Page 8
JULY/AUGUST 1999
ability to the exam. 3. New score sheets allow grades to be assigned in four categories associated with a c and id a te ’ s r esp on se: 1 ) understan din g/context, 2) analysis/deduction, 3) explanation clarity, and 4) clinical context. Notes can also be recorded. The final score for each question will be the average of the four categories.
Recertification Beginning in 2002, Physics Certificates will carry a time limitation of ten years. A Recertification Committee to identify issues and define the recertification process was est a blis he d in 199 8. Committee members include the Physics Tru stees and Daniel Bourland, Thomas P a y n e, Do n a l d F r e y , Rodney Wi m m e r, Russell R i t e n o u r, and Jon Trueblood. The Committee held its first meeting during
RSNA. The committee has agreed on the following general concepts: 1) Recertification should be an ongoing process, conceptually similar to certification maintenance. 2) Recertification should be a clinically oriented process. 3) Recertification re q u i rements should include a combin ati on of e xa min ati on s, continuing education, and if possible, practice review. 4) Three different computerbased take-home exams will be offered over the ten-year interval covered by the original certificate. The first exam will be offered 2-3 years after certification, and the other two exams will follow at 2-3 year intervals. Each exam will cover a well defined body of literature focused on a particular aspect of clinical practice. Diplomates will be advised of the literature covered by each exam. Exams, with complete
8
instructions, will be provided on a disk to diplomates. Diplomates will re t u rn the exam disks, with answers recorded, by a specified deadline for scoring. 5) Continuing education credits should be awarded and documented by independent organizations such as CAMPEP (Commission on Accreditation of Medical Physics Education Programs). 6) Practice review is desirable. Various options are being considered. External review by peers can be expensive, time consuming, and complex to implement. An alternative to on-site peer review is for the diplomate to complete a prescribed self evaluation protocol and submit the resulting documents to a panel of peers for evaluation. These and other options were discussed at the May 19 meeting of the Recertification Committee. â–
AAPM JULY/AUG
7/28/99
7:39 PM
Page 9
AAPM NEWSLETTER
Reference Values — What Are They? by Joel Gray, Chairman Task Group 7 Rochester, MN At the summer AAPM Meeting in San Antonio, the Rad ia tion P ro t e c t i o n Committee, chaired by Charles Kelsey established the “Task Group to Develop Reference Values for Diagnostic X-Ray Examinations,” Task Group 7. This task group was subsequ ently appro ved by the Science Council. Table 1 lists the member s of the Task Group. Table 1 AAPM Task Group 7
Task Group to Develop Reference Values for Diagnostic X-Ray Examinations Joel Gray, Ph.D., Chair Benjamin Archer, Ph.D. Priscilla Butler, M.S. Barry Hobbs, M.D. Fred Mettler, M.D. Robert Pizzutiello, Jr., M.S. Beth Schueler, Ph.D. Keith Strauss, M.S. Orhan Suleiman, Ph.D. Martin Yaffe, Ph.D.
Consultants to Task Group 7 include- Stephen Amis, Jr., M . D . , re p r esen tin g th e American College of Radiology John Crowe, M.D., representing the American Roentgen Ray Society Fred Mettler, M.D., representing the National Council on Rad ia tion Protection and
Measurements Keith Faulkner, Ph.D., a British colleague Donald McLean, Ph.D., an Australian colleague Detlev Richter, Ph.D., a European colleague Reference values, or reference levels, were first discussed by the International Commission on Radiological Protection in ICRP 60. More recently the ICRP has recommended the use of Reference Values (ICRP 73). Quoting from ICRP 73— “(100) The Commission now recommends the use of diagnostic re f e rence levels for patients. These levels, which are a form of investigation level, apply to an easily meas u red quantity, usually the absorbed dose in air, or in a tissue equivalent material at the surface of a simple standard phantom or re p re s e n t a t i v e patient... the diagnostic reference level will be intended for use as a simple test for identifying situations where the level of patient dose or administered activity is unusually high. If it is found that procedures are consistently causing the relevant diagnostic reference level to be exceeded, there should be a local review of procedures and the equipment in order to determine whether the protection has been adequately optimized. If not, measures aimed at reduction of doses should be taken. “(101) Diagnostic reference levels are supplements to professional judgement and do not p ro vid e a div idi ng li ne
9
JULY/AUGUST 1999
between good and bad medicine. It is inappropriate to use them for regulatory or commercial purposes. “(102) ...The values should be selected by professional medical bodies and reviewed at intervals that represent a compromise between the necessary stability and the longterm changes in the observed dose distributions. The selected values will be specific to a country or region.” The European experience with reference values has been encouraging. The European Community has published reference values and image quality criteria for a broad range of x-ray projections and these are being applied thro u g h o u t E u r ope. Th e Nationa l Radiological Protection Board of Great Britain and the Royal College of Radiologists have developed RVs for common diagnostic x-ray projections. A follow-up study showed a 30% decrease in patient exposures for these x-ray projections in England. The Conference of Radiation Control Pro g r a m Directors have already provided guidanc e re g a rding radiation exposures levels and some states have included maximum exposure levels in their radiation control programs. The F ood and D rug Administration’s Nationwide Evaluation of X-Ray Trends (NEXT) survey has been measuring radiation exposure s since 1973. However, there has been no active effort by any professional organizations to use the information provided by the FDA to reduce patient radiation exposures. This data clearly shows that there is sig-
AAPM JULY/AUG
7/28/99
7:39 PM
AAPM NEWSLETTER
Page 10
JULY/AUGUST 1999
nificant room for improvement, i.e., for exposure reductions. The ratio of the maximum to minimum exposures measured in the NEXT survey (Table 2) range from 8.8 to as high as 126.7. This is compared with a ratio of 3.6 for mammography. One must ask, is it really justified for one facility to use 10, 20, or 126 times more exposure to produce an x-ray image than another facility? Maximum and minimums are e x t remes. However, even
exposure levels, and determine (BOC) and Council Steering the various choices that need to Committee (CSC) in early 1997 be made in developing RVs for by the Commission on Medical the various x-ray projections. Physics. The College feels that The goal is to conclude the it is important to implement development of RVs by the RVs for the improvement of 1999 AAPM meeting in patient care and to demonstrate Nashville and to present a list the ACR’s commitment to of x-ray projections and the patient safety and image qualirecommended reference values ty to third party payers (insurfor use at that time. In addiance companies) and the tion, two papers or publicapublic. The responsibility for tions are being prepared. One further development was given of these will be directed to the to the Commis sion on diagnostic imaging community Standards and Accreditation. at large and During their recent meeting in Table 2 will be submitJanuary of 1999, the BOC-CSC NEXT Survey Results (mR or R/min) ted for considvoted to incorporate Reference eration for Values into the accreditation Exam Min Max Max/Min publication in programs in radiography and PA Chest 2.4 81 33.8 R a d i o l o g y .The fluoroscopy (including chest xAP L. Spine 6.2 2,154 34.7 other will be rays), computed tomography, GI Exams for the assisand vascular- i n t e r v e n t i o n . Rate 0.7 16.2 23.1 tance of med(The ACR data will provide an Spot Film 38 4,815 126.7 ical physicists additional database to assist in CT Head 1,600 14,000 8.8 providing refining RVs in the future.) The details for the ACR will also include RVs in measurements their Standards as they come looking at the median, and first to assure that the medical up for routine review. and third quartiles, provides physics community is measurReference Values will provide some food for thought (Table ing the entrance exposures in a the benchmark to which we 3). The maximum exposure consistent, reproducible mancan compare x-ray exposures measured by NEXT for an AP ner. In addition, this paper will for all facilities. RVs will assist lumbar spine radiograph is include suggesti on s for us as professional medical 2,154 mR and the third quartile methods of decreasing x-ray physicists to optimize x-ray is 487 mR. This means that exposures. exposures to our patients and 25% of the facilities are using The concept of Reference image quality for the diagnostic exposures for AP lumbar spine Values were first presented to imaging community. ■images between 487 and 2,154 the ACR Board of Chancellors mR. If the RVs were to be set at the 75% level, it would be incumbent on the facilities repTable 3 resented in the exposure range NEXT Survey Results (mR or R/min) above that to justify their use of these higher radiation exposure Exam Med 1 Q 3Q levels. PA Chest (400) 11.6 9.2 16.0 Task Group 7 has been workAP L. Spine (400) 333 252 487 ing rapidly to review the literaGI Exams ture regarding patient exposure Rate 5.0 3.5 6.8 levels, determine what various Spot Film 268 175 398 states and governments have CT Head 5,100 4,500 6,600 done with regard to radiation
10
AAPM JULY/AUG
7/28/99
7:39 PM
Page 11
AAPM NEWSLETTER
Letter to the Editor It Is Vital For Us To Be Medical Specialists by Ivan Brezovich Chairman, Reimbursement Patterns Subcommittee Birmingham, AL “Why do we have to be med ical specialists? Why can’t we be happy just being physicists?” a sk s J o h n G l ov e r i n t h e May/June AAPM Newsletter. The answer is simple: Because we are being paid for our expertise in the medical field, i.e., for being medical specialists, and nothing else. In a clinical environment, physics by itself brings no monetary or other consideration. In our subspecialty physics is just a means for becoming a medical specialist. Being famous in quantum mechanics or astrophysics most certainly brings admiration from our coworkers, like a talent in music or playing
golf, but such expertise is irrelevant unless we work in these areas. Radiologists typically have degrees in the life sciences, but I have yet to meet one who would like to be recognized purely as a biologist. Hence, if we insist on being “just physicists” we will surrender the prestige, compensation and authority associated with being medical specialists. We will lose recognition gained from passing the demanding board exams, and the many years of training and experience. We will no longer be recognized for the enormous responsibility we have for our patients. Since we are using only a small fraction of our physics knowledge - many of our best and most successful medical physicists have their highest degrees in biology or biochemistry - we can expect compensation like college teach-
JULY/AUGUST 1999
ers, and experience pay cuts of $50,000 or more. We may lose some of our current fringe benefits, like the corner office or the close parking place, and the travel allowance for going to meetings. We may even lose the authority we need to safely carry out our work. In summary, by being just physicists we would give up much and gain nothing. At the same time, medical specialists receive special consideration from the Federal Government. Citing reasons of f a i rness, the Health Care Financing Administration (HCFA) in recent years raised reimbursement for family practitioners and internists by nearly 50%, so that their income would be more in line with that of other medical specialists. Physicists never received such caring treatment from the Fed. So we need to push for broader recognition as medical specialists, not less. Finally, we need to realize that our status as medical specialists does not diminish our status as physicists. It is an additional accomplishment to be proud of. ■
ACR Physics Com. Link Communications and Surveys by Don Tolbert Chair, ACR Commission on Medical Physics Oahu, HI The American College of Radiology’s Commission on Medical Physics (CMP) has recently begun an e-mail communication effort between the
CMP and the 43% of our membership on e-mail. If you are an ACR medical physics member having e-mail, but have not received e-mail from the CMP and would like to - please contact Don To l b e r t (DTOL1940@cs.com). Initially this will be utilized to keep that portion of the membership informed of ACR/ CMP activities and to benefit from feedback.
11
A survey instrument was developed some time ago out of the CMP’s Committee on Hu ma n Re s ou rces . T he
AAPM JULY/AUG
7/28/99
7:39 PM
Page 12
AAPM NEWSLETTER
JULY/AUGUST 1999
purpose of this survey was to determine practice profiles for our membership, attempt to find characteristics which distinguish the ACR membership from that of the AAPM as a whole, and gain insight into differences between those members on e-mail, members not on e-mail, and the membership as a whole. Philip Crewson of the ACR Staff converted the survey to electronic format and at this writing has e-mailed the survey to all ACR medical physics we have addresses for. A 55% response was attained and preliminary analysis did show small demographic differences between the entire membership and those 43% having e-mail (e.g., more Ph.D’s and fewer Masters level people having e-mail than the membership as a whole). The CMP is interested in not only keeping our membership informed, but to have feedback. Our ability to represent the needs and issues important to our membership depends on it. The Internet medium of course provides an excellent opportunity for that. This effort coincides with a drive to increase membership. We invite you to consider this and should you decide to join our ranks, we welcome you. ■
Announcements Quality Control In Magnetic Resonance Imaging by R Lerski, J De Wilde, D Boyce and J Ridgeway IPEM Report No.80 A new publication from the I n s ti t u t e o f P h ys i c s a nd Engineering in Medicine The efficient and effective use of any medical imaging equipment necessitates careful quality control. This is particularly true for the relatively new modality of magnetic re s onance imaging where the complexity of the equipment gives much scope for mal-adjustment and performance variation. Regular checking of performance is essential. The use of test objects allows a simple routine check that can be accomplished in minutes. Such testing leads to confidence in the clinical images obtained. T h is n e w p u b li c a ti o n f r o m t h e In s t i t u te o f Physics and Engineering in Medicine provides essential guidance for all involved in carrying out such quality control tests on magnetic re so na n ce s ca nn e r s. I t
includes a full description of the techniques and principles of MR quality control and gives a description of suitable test objects with a detailed guide to their application and the analysis of results. The test objects and procedures described may be used either for simple quality control of MR scanners in routine use or for a detailed acceptance test of the equipment. Both aspects are covered in this report, although with emphasis on routine QC. F o r M or e I nfo r m at i on, contact IPEM as above, or call: Dr Richard Lerski Department of Medical Physics Ninewells Hospital Dundee Tel: 01382 632177 Fax: 01382 640177 Email: r.a.lerski@dundee.ac.uk ■ Radiotherapy to Reduce Restenosis Sponsored by Scripps Clinic
January 14 & 15, 2000 Hilton La Jolla Torrey Pines Hotel Contact: 858-554-8556 or jhofmans@scrippscli.com ■
AAPM NEWSLETTER NEXT ISSUE September/Oct. 1999
DEADLINE
MAIL DATE
August 15, 1999
September 15, 1999
e-mail: rdixon@rad.wfubmc.edu 12