9-2245 AAPMNews NOV/DEC 99
12/3/99
3:14 PM
Page 1
Newsletter AMERICAN ASSOCIATION
OF
PHYSICISTS
IN
VOLUM E 24 NO. 6
MEDICINE NOVEMBER/DECEMBER 1999
AAPM President’s Column Approaching the Conclusion of an Eventful Year
challenges of the past year. I look forward to serving the association as Chairman of the Board of Directors during 2000, and pledge to provide my strong support to the incoming president Kenneth Hogstrom and president-elect Charles Coffey.
by Geoffrey Ibbott Lexington, KY It has been a great honor and a privilege to have served the organization as President during the past year. It has been an eventful year, but a thoroughly enjoyable and challenging experience. I will always remember this year as a high point in my career and in my involvement with the AAPM.
Acknowledgements I would like to use a portion of this column to acknowledge the contributions and support of many colleagues and associates. First, I want to express my gratitude to EXCOM and the AAPM Headquarters staff, all of whom have worked diligently and enthusiastically during my term. Thanks also are due to the council, committee, and task group chairs and their members, the editors and staff of our numerous publications, our liaisons to other organizations, and all of the members who volunteered their time and effort to the association. Through their contributions, we have had several outstanding meetings and a number of excellent publications, and
Major Events During 1999 Annual Meeting our impact has been felt in Washington, by numerous state governments, and internationally. I could not have made it through the year intact without the generous support of my colleagues in Lexington: the c h a i r ma n o f R adi a tion Me d ic i ne, Moh amm ed Mohiuddin, M.D., my physicist co ll ea gue s , an d t he fin e dosimetry and technical staff at the University of Kentucky. My assistant, Heather Green, endured frequent long days, last minute deadlines, and endless demands for her creative, organizational, and te chn ic al s ki ll s, all w ith unflagging enthusiasm and a sense of humor. She has earned a long vacation. To my wife, Diane, goes my gratitude for her support, understanding, and counsel during the many
1
As always, our annual meeting was one of the significant highlights of 1999. This meeting was attended by 2,835 physicists, exhibitors, and companions; the greatest attendance at any meeting so far. The facilities were excellent, and while there
INSIDE TABLE OF CONTENTS President’s Column…………p. 1 CAMPEP Structure………….p. 5 ACR Councilor’s Report…….p. 6 Medical Physics/ACR Meeting.p. 8 Executive Directors Column..p. 10 World of Congress 2000……p. 11 Upstate NY Report…………p. 12 Letters to Editor……………p. 13
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:14 PM
Page 2
NOVEMBER/DECEMBER 1999
were some concerns expressed (which have been noted and will be acted upon) the overall reaction from attendees was highly positive. The scientific program and the social events were all judged to be first class. Again this year, the sale of booth space increased over previous years. The AAPM is grateful to our exhibitor colleagues for their support of our annual meeting.
Headquarters Relocation Our Headquarters Relocation Committee, chaired by treasurer Melissa Martin, is considering a variety of options, one of which will be implemented when our lease at the American Center for Physics expires in 2001. One option, of course, is to stay where we are, with additional space allocated for AAPM. However, the committee is considering competing options including alternate space in Washington, DC, and moving to another city entirely.
New Calibration Protocol The long-awaited report of Task Group 51 of the Radiation Therapy Committee was published in September. The TG-51 protocol replaces the TG-21 publication as the AAPM’s recognized calibration protocol. Members are encouraged to change to the new calibration protocol as soon as practicality and safe clinical practice permit. As implementing the new protocol will re q u i re that an institution’s instruments be calibrated in terms of dose-to-water, many physicists will likely implement the TG-51 protocol following
the next regularly scheduled calibration of their instruments. The ADCLs are accredited to calibrate ionization chambers in terms of dose-to-water, as was reported in a previous issue of the Newsletter.
Certification Boards Shortly before the annual meeting, we learned that past president Bhudatt Paliwal had been selected by the ABR to fill the radiation therapy physics trustee position vacated by Ed Chaney. I believe this appointment is good news for medical physicists for several reasons. First, Dr. Paliwal will be in a strong position to contribute meaningfully to the ABR certification process as well as the ABR restructuring initiative. In addition, with his long-time experience with the ACMP and his leadership of the 1996-97 ad ho c Board Unification Committee, Dr. Paliwal is highly qualified to help with efforts leading to unification of the medical physics certification boards. I believe that the medical physics community will benefit greatly from progress on this front.
Intersociety Commission Two AAPM representatives, Chairman of the Board Larry Rothenberg and myself, participated in this year’s meeting of the Intersociety Commission.
Ad hoc Committees Several ad hoc committees w e re appointed this year, including one chaired by President-Elect Ken Hogstrom which will address our relationship with ASTRO, and another
2
chaired by Gary Fullerton to develop and promulgate the AAPM position on a new National Institute of Biomedical Imaging and Engineering.
Conversations with the American College of Cardiololgy Earlier this year, EXCOM met with re p resentatives of the American College of Cardiology, at their request, to discuss the education and training of cardiologists who use radiation or radioactive materials in their practices. EXCOM agreed to this meeting because we felt medical physicists were morally obligated to respond to such a request, and because we felt that we had an opportunity to contribute to the quality of medical procedures and the safety of patients. This was not an easy decision, as we are very well aware of the concerns voiced by our radiology colleagues. Our conversations with the cardiologists, and our reasons for agreeing to talk with them, have been discussed with representatives of ASTRO, the ACR, and the RSNA. At the moment, we have agreed to continue the discussions with the cardiologists. Related to this, we have contributed to, and indicated our approval of, an ASTRO Round Table document entitled "Roles of Various Specialists in Intravascular Brachytherapy."
American Heart Association Council on Cardiovascular Radiology Earlier in the year, I was contacted by Richard White, MD, chairman of the American Heart Association’s Council on Cardiovascular Radiology. He
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:14 PM
Page 3
AAPM NEWSLETTER
explained his plan to restructure the Executive Committee of the Council, and has invited the AAPM, as well as a number of other radiological organizations, to hold a seat on the Executive Committee. The AAPM accepted this invitation, and I will attend a meeting of the Executive Committee as the AAPM representative in early November.
RSNA/Disney Exhibit In previous newsletter articles, I have described a project being conducted by the RSNA in collaboration with the Disney Corporation at their EPCOT center. The exhibit will be entitled "Radiology-Exploring New Horizons" and will be the only medical exhibit in the "Innoventions" exhibit. The AAPM has officially endorsed this project, and will be identified as one of the supporting organizations at the exhibit. This exhibit opened in October, and will be on display until at least 2003. For more information, see http://www.rsna.org.
Medicare Several articles in re c e n t Newsletters have discussed the conversations between AAPM representatives and a staff member at HCFA, regarding the M e d i c a re proposal fo r a Hospital Outpatient Prospective Payment System (HOPPS). More recently, I have had several conversations with Norbert Goldfield, MD, the developer of the orig inal pro posal for Ambulatory Patient Gro u p s (APGs). During the past few months, Dr. Goldfield has been consulting with HCFA regarding the current incarnation of the proposal and its scheme of
Ambulatory Patient Classifications (APCs). During these conv ersations, Dr. Goldfield described to me recommendations he had made to HCFA regarding the physics and dosimetry APCs; recommendations which, I believe, would generally benefit medical physicists. However, there is no assurance that HCFA will adopt Dr. Goldfield’s recommendations. During these conversations however, Dr. Goldfield made it clear that HCFA has intentions of developing a DRGlike scheme for outpatient payments. He advised me, and the AAPM, to begin developing a diagnosis-related scheme for reimbursement. Professional council chair Michael Gillin and I have discussed ways in which the AAPM, through its P rofessional Council and Committee on Reimbursement might respond. We have also stayed in close contact with representatives of ASTRO on this issue. I have learned that HCFA received a very large stack of letters regarding the radiology and radiation oncology APCs. I have also been told that a large proportion of the mail (30-40%) was from medical physicists. This is an outstanding response by the physics community; one that H C FA has surely noticed. Thank you all for responding.
ACR Political Action The American College of Radiology recently formed an o rganization called the Radiology Advocacy Alliance, the goals which are to influence legislation to the benefit of radiology. The RAA is not a political action committee; it was
3
NOVEMBER/DECEMBER 1999
f o rmed for the purpose of developing a political action committee. Recently, the RAA developed RADPAC, the Radiology Political Action Committee. Medical Physicists are encouraged to join the RAA, and contribute to RADPAC, to help heighten the awareness of Congress to the needs and contributions of radiology, radiation oncology, and medical physics.
NRC and FDA Advisors During the past year, I provided the NRC and the FDA with the names and biographies of a number of medical physicists who might be called upon by these agencies when consultants are needed. Both agencies prefer to have a list of potential consultants whose credentials have already been evaluated, to be called when consultants are needed. I’m grateful to these people for permitting me to forward their names to these agencies.
Support for Legislation During the last year, the AAPM has formally notified a p p ropr iate members of Congress of its support for several pieces of important legislation. We supported House Bill 1070, which would provide Medicaid coverage for certain cancer patients. In addition, we supported House Bill 1090, which wo uld exempt chemotherapy and "biologic" therapy from HCFA’s HOPPS proposal. Our letter also urged the Congressional sponsors of this bill to include radiation therapy as a modality to be excluded from the HOPPS proposal. My thanks to Ivan Brezovich for his assistance in preparing these
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:14 PM
Page 4
NOVEMBER/DECEMBER 1999
letters. Finally, through an ad hoc committee mentioned earlier, we have gone on record as supporting legislation to create a new Natio nal Institute of Biomed ical Imaging an d Engineering. In addition, we have provided our members with information to notify their congressmen of their support for this legislation.
Radiology Alliance During 1999, the AAPM joined with the ASRT and several other organizations as an active member of the Alliance for Quality Medical Imaging and Therapy. The goal of this alliance is to introduce legislation modifying the Consumer Patient Radiation Health and Safety Act of 1981 to strengthen the requirements for licensure of radiological technologists. As of this writing, it is expected that representative Rick Lazio of New York will introduce the bill.
CRCPD The CRCPD symposium, directed by Charles Kelsey and Richard Lane, was conducted by the AAPM at this year’s meeting of the Council of Radiation
C o n t rol Program Dire c t o r s (CRCPD). The topic of the symposium was Quality Assurance in Medical Facilities , and talks were delivered by ten medical physicists. The symposium was well received, and plans are well underway for a symposium at the 2000 annual meeting of the CRCPD. The CRCPD has appointed a liaison to the AAPM, Jill Lipoti, of New Jersey. Dr. Lipoti’s report of her participation in the AAPM 1999 Annual Meeting appeared in the September/October issue of the newsletter.
Challenges for 2000 Several important challenges are looming on the horizon and require our attention in the year 2000. I have already mentioned several of these, including threats to Medicare reimbursement, our involvement with cardiology procedures including intravascular brachytherapy, and the prospects for unification of the certification boards. In addition, we are presently experiencing a shortage of trained personnel. This is quite unexpected given the surplus of medical physicists that was evi-
dent just a few years ago. However, the number of notices in our placement service has increased dramatically this year, and those of us who tried to fill vacant positions this year experienced much more difficulty than in the recent past. In particular, the shortage of trained dosimetrists has been intense. The reasons for the shortage are not clear, but it is thought that the MQSA legislation, the introduction of prostate implants in new centers, the rapid expansion of IMRT procedures, and the developing role of intravascular brachytherapy all may have contributed. A joint committee with the AAMD, ASTRO and the ACMP has been developed, chaired by Carolyn Brand of Auburn, Washington, to address the supply and training of dosimetrists. I am looking forward to working with incoming president Ken H o g s t rom, pre s i d e n t - e l e c t Charlie Coffey, secretary Jerry White, treasurer Melissa Martin and our Headquarters staff, during the next year. May I wish you and your loved ones an enjoyable Holiday Season, and best wishes for a successful Y2K. ■
RULES UPDATE The Rules Committee is undertaking a review and revision as necessary to the By-Laws and Rules of the Association. The Committee is conducting a survey on the AAPM Web Site. Members are invited to vote on the questions presented. The survey will be used to assist in the decision on changes to the By-Laws, if any, during the next year. – Jean St. Germaine
4
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:14 PM
Page 5
AAPM NEWSLETTER
NOVEMBER/DECEMBER 1999
CAMPEP Structure CAMPEP Structure by Bhudatt Paliwal Chair, CAMPEP Madison, WI T he Commission on Accreditation of Medical Physics Education and Tr a i n i n g Programs (CAMPEP) is continuing to provide the accreditation and continuing education services. Currently the Board con sists o f the following officers: Bhudatt Paliwal, Chair Jon Trueblood, Vice Chair Lawrence Rothenberg, Secretary/Treasurer Donald Frey Edward Sternick Charles Kelsey The Commission carries out its various functions by working closely with the following three review committees: Graduate Education ProgramPaul DeLuca, Jr, Chair; Residency Education ProgramRichard Lane, Chair; Continuing E ducation Credit- Russell Ritenour, Chair. To date, the following institutions have been accredited: University of California Los Angeles University of Colorado Health Sciences Center* Rush University Wayne State University University of Oklahoma Health Sciences Center* University of Kentucky Medical Center McGill University
M.D. Anderson Cancer Center University of Texas HSC San Antonio University of WisconsinMadison *renewal temporarily delayed at the institutions’ request A c c redited Programs:
Residency
Washington University School of Medicine Barnes-Jewish Hospital
Other Issues In its meeting on Sunday, July 25, 1999, the CAMPEP Board met with Peter Dunscombe, Past President, and Bre n d a Clark, Vice President, of the Canadian College of Physicists in Medicine (CCPM) to discuss i n f o rmation on the CCPM, which would like to become a sponsor of CAMPEP. Dr. Dunscombe indicated that the Canadian Provincial governments would be funding residencies in medical physics, mainly in radiation oncology. Ontario may have as many as 10 residencies. These residencies will have to be accredited, possibly by CAMPEP, in which case the CCMP would like to be involved in the process. After some discussion, the Board decided to proceed with soliciting a request for sponsorship from CCPM. The submitted information will be reviewed by CAMPEP and also submitted to the three current sponsoring organizations for further comment. HCFA has indicated possible approval of appropriate medical
5
physics residency programs. E. Klein is preparing an article for the relevant medical physics newsletters, to be reviewed by the CAMPEP Board, which will provide information on interacting with HCFA for residency funding. CAMPEP Inc. has formally requested ACR to suspended ACR’s review of the CAMPEP’s continuing education cre d i t awarding process. The review process will be held at a later date. Don Tolbert, chair, ACR Commission on Medical Physics, has contacted the legal affairs staff to review CAMPEP Guidelines and Bylaws for further advisory to ACR. CAMPEP MPCEC credits will be distributed to medical physicists attending the 1999 RSNA Annual Meeting. This program is approved through 2004. A similar program is in effect for the Society of Nuclear Medicine meetings. An effort, spearheaded by K. Hogstrom, will be made to obtain similar credit awards for the ASTRO Annual Meeting. A summary of continuing education credits by CAMPEP, Inc. is given in Tables 1 and 2. ■
by Gary Barnes Houston, TX As the AAPM’s designated ACR Councilor, I attended the 75th Anniversary Meeting of the ACR,
September 25-29, 1999 in Washington, DC. In attendance were more than 500 Councilors, A l t e rnate Councilors, State Society Officers and the 25 members of the Board of
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:14 PM
Page 6
NOVEMBER/DECEMBER 1999
Table 1 Inquiries
Applications Approved
Pending
Declined
Table 2
Educational Programs 1998 42 1999 24
19 18
4 0
3 1
Societies 1999
4
0
0
0
Total number of certificates issued: Societies 1114 Educational Courses 4905
ACR Councilor’s Report Chancellors. The majority of the Councilors and Altern a t e Councilors are State Representatives. Included are 23 Society Councilors and 8 Medical Physics Councilors-atLarge: Charles Kelsey, Goeffrey Ibbot, Rich Geise, Jim Hevezi, Richard Morin, Guy Simmons, Steve Thomas and David Vassy. Additional Medical Physics representation consisted of myself (AAPM Councilor), Michael Gillin (ACMP Councilor) and Donald Tolbert (Chair of the Physics Commission and member of the Board o f Chancellors). During this and last years meeting I served on Reference Committee II and for the past several years Michael Gillin has served (and will continued to serve for 2000 and 2001) on the influential Council Steering Committee. Reference Committee II’s responsibilities were standards, reports and resolutions involving Nuclear Medicine, Medical Physics, Radiation Oncology, Task Force on Breast Cancer, and Task Force on Vascular Restenosis.
Procedures In addition to the main Council Meeting which consists of reports (of of f i c e r s , Nominating Committee, AMA and ABR representatives, and Reference Committees), invited talks and voting on Standards and Resolutions, there are Open and Closed Refere n c e Committee Sessions. There are four Reference Committees, each with a different set of standards and resolutions to review and make recommendations on to the ACR Council. The resolutions and drafts of standards assigned to each of the Reference Committees are sent to all Councilors and Alternate Councilors, and given to all meeting attendees. During each R e f e rence Committee Open Session oral (and written) testimony, recommendations and suggestions on any and all items on the Committee’s assignments are heard from all meeting attendees, Councilors and A l t e rnative Councilors who wish to comment. During the
6
Closed Reference Committee Sessions, the presented testimony is reviewed and appropriate changes made to the resolutions and drafts of standards. The revised resolutions and drafts of standards along with those that required no revision and associated recommendations make up the Committee’s Report. The Reports are distributed to Council prior to the oral reports of the Chairmen o f the R e f e rence Committees. The revisions made by the Reference Committees are clearly indicated as are all previous changes made during the evolution of the standard and/or resolution. Recommendations made by each of the Refere n c e Committees are voted on by Council, either together or individually if there is controversy.
Medical Physics Standards New Standards that were voted up by Council relevant to medical physics practice included the ACR Standard for the Diagnostic Medical Physics Performance Monitoring of Real Time B-Mo de Ultrasou nd Equipment and ACR Standard for the Diagnostic Medical
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:14 PM
Page 7
AAPM NEWSLETTER
ed: 1114 4905
Physics Performance Monitoring of MRI Equipment. These standards, along with the existing ACR Standards for Diagnostic Medical Physics Performance Monitoring of Radiographic and F l u o r oscopic Equipment, Diagnostic Medical Physics P e rf o rmance of Computed Tomography Equipment, and Medical Nuclear Physics P e rf o rmance Monitoring of Nuclear Medicine Image Equipment, form a comprehensive set of standards covering all types of medical imaging equipment and are referenced in the relevant clinical medical imaging standards. Also important to medical physics practice was the existing ACR Standard for Radiation Oncology. The final revision of this Standard was voted up by Council. Noteworthy in the initial revision was that important wording on the role of the medical physicist was deleted. Based on discussions with radiation oncologists prior to the meeting and testimony presented at the Open Refere n c e Committee Session this wording was reinstated by the Reference Committee and accepted by Council. Standards are reviewed every four years and voted up or down by Council. The process results in either the existing standard or a revision of the existing standard being presented to Council. Dated Standards that are no longer relevant are voted down. Occasionally new Standards are voted down by Council and also occasionally new and existing Standards are modified on the Council floor and accepted. Any ACR Councilor can be heard on any resolution or
S t a n d a rd on the Council’s agenda. If a Councilor’s c o n c e rn is meaningful and he/she can garner a majority of support, he/she can effect a change in a resolution or Standard, or result in a resolution or Standard being voted down. However, the majority of work is done in the Open and Closed Sessions of the Reference Committees prior to the resolutions and Standards being presented to and voted on by Council. Currently there are nine ACR Standards concerned with radiation oncology. Several of these deal primarily with radiation oncology physics and the remainder have sections on radiation oncology physics. It is important for all clinical radiation oncology medical physicists to be familiar with these standards. Similarly it is important for diagnostic and nuclear medicine physicists to be familiar with the standards relating to their activity. P hysics sta ndar ds ar e developed by the Physics Commission Committee on Standards and Accreditation chaired by David Vassy. This Committee also reviews and comments on the clinical standards. The ACR has or is developing Accre d i t a t i o n P rograms modeled on the Mammography Accreditation Program for all areas of radiology, nuclear medicine and radiation oncology practice. The ACR Standards are the underpinnings of these Programs and medical physicists have an important role.
Political Actions A focus of the Meeting was political action and how to
7
NOVEMBER/DECEMBER 1999
influence legislation. This was discussed by Michael Dunn who made a compelling argument for the importance of radiology to have a well funded political action committee. Mr. Dunn heads up RAD PA C (Radiology Political Action Committee) which is a separate entity and not funded by ACR. As with any political action committee RADPAC fees and don ations are not tax deductible.
ACR Fellows A formal and important part of the Annual Meeting is the ACR Fellowship Convocation. At the Convocation the 1999 ACR Gold Medalists, Honorary Fellows and Fellows are presented. Nine of the new ACR Fellows inducted were medical physicists and members of the AAPM: Robert Chu Panos Fatouros Donald Frey Richard Geise John Kent David Keys George Oliver Subhash Sharma James Smathers I was glad to represent the AAPM and felt that my time was well spent. ■
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:14 PM
Page 8
NOVEMBER/DECEMBER 1999
Medical Physics and the Annual Meeting of the American College of Radiology by Don Tolbert, Chairman Commission on Medical Physics Honolulu, HI The annual meeting of the ACR Council was held on September 25 through 29 in Washington, D.C. There were a total of eight medical physics AtLarge Councilors representing the medical physics ACR membership. These individuals are appointed by the Speaker of the Council upon recommendation by the Chairman of the Commission on Medical Physics (CMP). The eight At-Large Councilors in medical physics were Richard Geise, James. Hevezi, Geoffrey Ibbott, Charles Kelsey, Richard Morin, Guy Simmons, Jr., Stephen Thomas, and David Vassy, Jr. In addition, there is one medical physics Councilor each representing the AAPM and ACMP. These individuals were Gary Barnes, and Michael Gillin, respectively. There were a total of 283 Councilors attending the meeting. There was one representing each ACR Chapter, affiliate organization (e.g., AAPM and ACMP), plus At-Larg e Councilors. Four Reference Committees, each with an agenda of Resolutions which relate to the expertise of the Reference Committee members, conducted hearings on Monday. Gary Barnes was a member of Reference Committee II where most of th e Resolutions involving medical physics were
heard. When each Reference Committee agenda was completed, Reference Committee members retreated to a room for deliberation of the testimony heard. These deliberations can be arduous if there are controversial issues. Refere n c e Committee recommendations w e re then printed and the Resolutions were available on Tuesday morning before the entire Council heard recommendations by the Chair of each Reference Committee. The Council members have the opportunity to vote up, down, make amendments, or refer it to the Board of Chancellors. The medical physics At-Large Councilors, and medical physics Coun cilors co mprise the Medical Physics Caucus at the annual meeting. As the Agenda book containing pro p o s e d Resolutions is in the hands of all Councilors a few months prior to the meeting, there is the opportunity and responsibility to review Resolutions, in order to know concerns prior to the meeting. Prior to this meeting, there were three Resolutions of c o n c e r n to the Medical Physics Caucus. Two originated from the CMP Standards and Accreditation Committee and one from the Commission on Radiation Oncology Standards and Accreditation Committee. They were entitled “ACR Standard for the Diagnostic Medical Physics Performance Monitoring of Real Time BMode Ultrasound Equipment,”
8
“ACR Standard for the Diagnostic Medical Physics Performance Monitoring of MRI Equipment,” and “ACR Standard for Radiation Oncology,” respectively. The modus operandi over the past few years has seen the Chairman of the CMP (who also chairs the medical physics caucus) contacting key physicians/medical physicists prior to the meeting regarding concerns and/or suggestions pertaining to Resolutions. This is done far enough in advance of the meeting to hopefully reach agreement prior to the meeting. If agreement is reached, someone recommends the change during the Reference Committee hearing, then someone representing the caucus with which concerns were raised affirms that this is a g reeable to their caucus. Assuming the Refere n c e Committee itself has no problems with it, the Resolution with recommended changes is then presented to the entire Council the following day. A week or so prior to the meeting, the CMP Chair contacted Harvey Wolkov, M.D. (Chair of the Commission on Radiation Oncology Committee), Chris Merritt, M.D. (Chair of the Commission on Ultrasound), and William Bradley, M.D. (Chair of the Commission on Neuroradiology and Magnetic Resonance). In the Radiation Oncology Standard, wording was a concern in several places. In particular, the original Standard stated that
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:14 PM
Page 9
AAPM NEWSLETTER
“Practices without a full-time physicist must have regular onsite physics support during hours of clinical activity, at least weekly.” The portion “. . . support during hours of clinical activity, at least weekly” had been deleted in the revised Standard. This was objected to and there were other suggestions to bring the Standard closer to a consensus standard. All the changes we recommended were supported by CARROS (the radiation oncology caucus) and the Resolution was passed as amended. In previous years we weren’t able to place the desire d medical physics involvement into the ultrasound Standard because of concern about the availability of the qualified medical physicist. In previous years we encountered the same problem (availability of the qualified medical physicist) as with ultrasound, in trying to involve medical physics in the MRI Standard. Additionally in the MRI Standard, there was an effort to substitute “MRI Scientist” for the qualified medical physicist. Much has been accomplished
to provide medical physics training programs for both ultrasound and MRI. One such training program in MRI came out of a discussion held on the e-mail network for ACR medical physics membership. As a result of this, the medical physics ultrasound Standard was supported as written and a compromise was accepted for the medical physics MRI S t a n d a r d. The change amounted to using either a qualified medical physicist with three years of documented clinical MRI experience, or an MRI scientist with the same requirement for documented clinical experience. There is no certification recommendation for the MRI scientist but both the qualified medical physicist and MRI scientist will have to satisfy the ACR Continuing Medical Education Standard for continuing education. This compromise was accepted by the Medical Physics Caucus. Throughout the process of expressing concern, seeking support, and negotiating compromise, the interaction was characterized by respect, professionalism, and pro-
NOVEMBER/DECEMBER 1999
ductivity. The result of this effort before the meeting and prior to the deliberations of the entire Council on Tuesday and Wednesday, was a vote for approval without an objection. The design of the CMP, with leadership from the Committee on Standards and Accreditation, has been to have a basic medical physics Standard for all the major modality equipment, (e.g., CT, Ultrasound, MRI, etc.). This was realized with the two Standards mentioned above. All the clinical Standards that require the use of this equipment may now reference one of these medical physics Standards. This of course is important to image quality improvement, treatment quality improvement, and continued protection of staff and patients. ■
.We Apologize The September/October issue of the newsletter experienced it’s share of problems and we apologize for any errors, especially for the numerous gremlins on our end that invaded the NCRP article by Dr. Ed Webster. The errors were not his. In addition, we regret that two more items were cut from the final proof: • Ge Wang was awarded the 1999 Medical Physics Travel Award • The following AAPM Fellows are also announced: Daniel Bednarek, Satish Prasad and Claudio Sibato.
9
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:14 PM
Page 10
NOVEMBER/DECEMBER 1999
Executive Director’s Column by Sal Trofi College Park, MD Education Endowment Fund The Education Endowment Fund was established in 1989 and over the years generous contributions from the RSNA, AAPM Chapters, and individual members coupled with investment gains has grown this Fund to slightly over one million dollars. The original goal was to raise two million dollars and to use the investment revenues to fund Fellowship s and Residencies. Steve Goetsch, Development Committee Chair, is developing a Planned Giving Campaign to help to make up the shortfall. The Campaign will be launched this winter, and will concentrate on raising funds for the Education Endowment Fund as well as other purposes defined by the donor. The AAPM Board has made $300,000 available to be added to the Endowment Fund in $3,000 portions for each Planned Giving commitment made by individual members. Currently, the AAPM is funding $45,000 per year from general operations for two fellowships and one residency because the endowment fund is not yet at the two million dollar level. Details of the campaign will be mailed from headquarters this winter.
Fellowships and Residencies Funded by AAPM The AAPM Fellowship is offered to individuals and is being offered for the first time
this year, to commence in July of 2000. This is a 2-Year PreDoctoral Study in Medical Physics that begins in even numbered years. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP). The AAPM/RSNA Fellowship is offered to individuals and is a 2Year Pre-Doctoral Study in Medical Physics that begins in odd numbered years. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by CAMPEP. Th e AA PM I ma gin g Residency is offered to institutions to sponsor a clinical residency. This is a two-year grant to support a Clinical Residency in Imaging. The residency program must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding.
Fellowships and Residencies Funded by Others The ASTRO Clinical Residencies are off e red to institutions to sponsor two, TwoYear Clinical Residencies in Radiation Oncology. The residency program must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. The Elekta Oncology Systems Clinical Residency is offered to institutions to sponsor one, TwoYear Clinical Residency in Radiation Therapy. The residen-
10
cy program must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. The RSNA Research and Education Fund is offered to institutions to sponsor two, TwoYear Clinical Residencies in Diagnostic Medical Physics. The residency programs must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. The Varian Oncology Systems clinical residencies are offered to institution’s to sponsor two, Two-Year Clinical Residencies in Radiation Oncology. The residency programs must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding.
Financial News The news for the 1999-year is very good. For the sixth consecutive year the finances of AAPM are in a positive position. The main reasons for the 1999-year success are: better investment p e rf o rmance, more re v e n u e from dues, more revenue from the Medical Physics Journal non-
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:15 PM
Page 11
AAPM NEWSLETTER
member subscriptions and advertising revenue, and more exhibit space sold at the AAPM Annua l Meeting. On the expense side, I am glad to say, we were substantially under the budget allowance. The Treasurer will report the final 1999 financial results in greater detail in a subsequent issue of the AAPM Newsletter. The 2000-year in all likelihood will end the streak of positive financial results. The Chicago
2000 World Congress meeting is a joint meeting with two engineering groups and profits must be split. This, combined with new program spending requests, results in a budget prediction that we will give back this years’ gain. The last World Congress in the United States was held in 1988 in San Antonio. That year was a deficit year for the AAPM also, but that meeting accounted for a substantial increase in the number of exhibitors in subse-
NOVEMBER/DECEMBER 1999
quent years. This years’ positive re s u l t when added to the cumulative gains brings our undesignated reserves to about one-years operating budget. The AAPM Board approved the recommendation of the Investment Advisory Committee, Chaired by John Kent, to engage a professional investment advisor to manage our investment funds. ■
Chicago World Congress 2000 Time is drawing near for the Chicago 2000 World Congress on Medical Physics and Biomedical Engineering to be held July 23 - 28, 2000 in Chicago. On November 1, 1999, the wc2000.org web site was activated to accept meeting registrations, abstract submissions, and housing reservations. Many of the aspects of the Chicago 2000 World Congress will be different than a typical AAPM Annual Meeting. Please take a few moments to review some important instructions regarding the Chicago 2000 World Congress. ABSTRACT SUBMISSION Abstract submission will be available via the Internet only. The deadline for submission is January 14, 2000. In order to submit an abstract, you must first register for the Chicago 2000 World Congress on-line. You may only be the Presenting Author on 2 papers. Accepted papers are subject to a $50 abstract submission fee which will be applied as a deposit on your meeting registration. At the time you submit your abstract, you are invited to submit a 1 - 4 page short paper. This paper will replace supporting documents that were allowed in the past for AAPM’s sub-
missions. PLEASE NOTE: These 1 4 page papers will be published along with the abstract. Abstracts and short papers will be available via the Chicago 2000 web site on May 26 and will be published on a CD Rom that will be distributed to all meeting attendees. Abstracts will not be published in the Medical Physicsjournal. REGISTRATION Meeting Registration will be available via the Internet only. Once you register, you will be given a Registration ID that will be required during the abstract submission process. Register and pay in full by May 15, 2000 in order to receive discounted registration fees. Deadline for advance meeting registration is June 19, 2000. After that time, only on-site registration will be available. PAYMENT OPTIONS You may pay your full balance on-line via Visa, MasterCard or American Express. You may send a check to pay your full balance. You may defer payment until you are notified on April 3 about the disposition of your paper. Remember, registration must be paid in full before May 15, 2000 in order to
11
qualify for discounted registration fees. HOTEL RESERVATIONS A $150 deposit will be required for each reservation. This means that you must either provide a credit card number so that the $150 can be charged to your card at the time the registration is made, or you must send a $150 check to reserve your room.There are nine hotels in the downtown Chicago area that are participating in the Chicago 2000 World Congress. Shuttles will be provided from the hotels to Navy Pier. The Deadline for housing reservations is June 19, 2000. We urge you to make your reservations early! AAPM AWARDS CEREMONY & RECEPTION Because this is a World Congress and not a typical AAPM meeting, a ticket to the AAPM Awards Ceremony and Reception IS NOT included in any of the meeting registration categories. You must purchase the ticket separately. The Awards Ceremony and Reception will be held on Tuesday, July 25, 2000.
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:15 PM
Page 12
NOVEMBER/DECEMBER 1999
Upstate New York Chapter Report By Stephen Rudin Buffalo, NY The Upstate NY Chapter of the AAPM Annual Meeting including 6th Annual Scientific Program and Kodak Memorial Lecture in Medical Physics was held October 8, 1999 at Rochester General Hospital, Rochester NY. Nick Szeverenyi of Upstate Medical Center discussed quality assurance in functional MR, Ian Yorkston of Kodak reviewed the current status of digital flat panel recep-
tors, and Dan Bednarek of U. Buffalo presented an extremely accurate and practical method of computer-aided bootstrap sensitometry. The radiation therapy presentations were clinical applications of IMRT by Mazen Soubra of RAUNY in Syracuse, a review of current efforts in the use of radiation for prevention of stenosis by Mike Schell at U. Rochester, and prostate cancer afterloading treatments by L. Liu of Upstate Medical Center. After presentations by Varian and MDS Nordion, t h e K o d a k Memorial Lecture dedicated
in honor of Lionel Cohen was given by Colin Orton, who spoke on the relationship between cell survival and clinical response. Colin indicated that Lionel Cohen was an investigator who was ahead of his time in establishing these relationships many of which are still used today in essentially the same form. Following his lecture Colin was presented with a memorial plaque and the audience and speakers retired to a fine dinner to conclude this successful meeting.
Letters to the Editor Response to Bushong from ABR President By William Casarella, MD President, American Board of Radiology D r. Stewart Busho ng's letter in t he September/October AAPM Newsletter contains areas of confusion and misunderstanding that should be addressed. First, any action to change s p o ns o r s h ip of t he A m e r ic a n Bo a r d of Radiology (ABR) must be approved unanimously by
all eight sponsoring societies. This is a part of the ABR by-laws that is very difficult to change. It has always been problematic to i n c rease the number of sponsoring societies when all of the existing ones must agree. The ABR did not reject the American College of Medical Physics (ACMP) proposal. Before it began discussion the ABR needed to determine if there was unanimous support from the 12
sponsoring societies. The Executive Committees of six of our eight sponsors voted against the proposal or abstained - an action which has the same effect as a negative vote. The American Association of Physicists in Medicine (AAPM) has chosen to support the ABR. In the American Board of Medica l Specialties (ABMS) structure, societies are limited to sponsoring one board.
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:15 PM
Page 13
AAPM NEWSLETTER
R e g a rding selection of trustees, it must be remembered that trustees do not represent the interests of the societies from which they originate. Trustees have a fiduciary responsibility only to the ABR. This is how the ABR maintains its objectivity and independence from member-run organizations and allows it to exercise its powers of individual certification as a public trust and not a political process. The credibility of the ABR and the other ABMS boards is cru-
cia l to it s ce rt if ica tio n process. The physics trustees are essential to the function of the ABR, and are full partners with their colleagues in diagnosis and oncology. None of the groups control the ABR which is strengthened by the presence of all three disciplines. The ABR certification p rocess for physicists is developed solely by physicists nominated by the AAPM. The ABR is strongly committed to impro v i n g and maintaining very high
NOVEMBER/DECEMBER 1999
standards for the physics certification process. The physics trustees have equal access to all the fiscal and technical resources of the ABR to carry out this commitment.
Letters to Editor Bag the Orals by Stewart Bushong Houston, TX I was pleased with Bill Hendee’s report in the last issue of this Newsletter of the ABR Physics subcommittee. I am especially pleased to see the ABR remove Type B and Type X questions from the written examination and move toward computer-assisted examination. But they’ve missed a chance to do more. Currently the examination by both the ABMP and the ABR is a three-step process. Part I is a written examination covering general aspects of medical physics. Part II is a written examination covering the medical physics of a specialty - diagnostic imaging, radiation oncology, nuclear medicine physics, medical health physics and magnetic resonance imaging. Part III is an oral examination in the specialty area. I think it is time to abandon the Part III oral
exams and let me tell you why. The origin of our oral examination lies in the ABR oral examination of radiologists. The value of the oral examinations for radiologists is clear; they make their living interpreting images for their clients’ clinicians. We make our living collecting data, analyzing the results of measurements, making judgements of equipment performance, supervising treatment planning, and rendering reports of our findings for our clients - physicians and administrators. An oral examination is neither necessary nor appropriate for assessing our ability to do our job. Medical physics is a precise and objective science. An oral examination in this area is much too subjective. I have participated as an oral examiner for both boards and can relate so many instances when a candidate was found unqualified probably because of the scientific bias of myself and my fellow examiners or because
13
of the nervous state of the candidate. Although the format for the oral board differs somewhat between the AMBP and the ABR the judgement process is the same. A few examiners are asked to evaluate a candidate in less than two hours on the basis of just a few questions. The process is simply too subjective to be adequate or, in many cases, fair. Both boards are designed to establish minimum standards – not maximum competence – for the practice of medical physics. Both boards now require an upper level degree in order to sit for the examination. In most occupations that upper level degree would be sufficient evidence of competence. The Part III oral examination should be replaced by an expanded or at least more directed Part II written examination. Should either of the boards adopt this suggestion they would not be entering new territory. None of
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:15 PM
Page 14
NOVEMBER/DECEMBER 1999
the following pro f e s s i o n a l s e n d u re an oral examination before practice – lawyers, architects, professional engineers and professional accountants. None of the following physicians e n d u re an oral examination by their respective ACGME approved board before practice A l l e rgy & Immunology, Dermatology, Family Practice, I n t e r nal Medicine, Medical
Genetics, Nuclear Medicine, Pathology, Pediatrics, Preventive Medicine. Closer to home, the American Board of Health Physics abandoned its oral examination in 1984 with no indication that either the examination or the value of the diploma was weakened. Our use of an oral examination for radiologists seems appropriate. I believe it is unnecessary for
medical physicists and may be inaccurate in many cases. I will applaud that board - ABMP or ABR - which first removes the oral examination as a requirement for certification. However, I am afraid the ABMP is too conservative and reluctant to change and the ABR encumbered by the physician organization sponsors. ■
The Glover Brezovich, Glover and Amols Letters By Donald Herbert Mobile, AL As someone famously queried, “where’s the beef?” Our levels of pay and perks derive largely from the fact that we do whatever we do in a broad field of “‘high-stakes endeavor’” that the American public, bless them, has chosen to reward rather well (and according to some, perhaps a bit too uncritically) namely, medicine. Moreover, within that broad field, specialists are rewarded -
still more handsomely than generaists. It is not an idle distinction. Indeed, since World War II, most physicians have strenuously worked to obtain the credentials of a medical specialist (rather - than, say, just a general practitioner). “So what’s in a name?” Evidently quite a bit. As Willie Sutton famously remarked: “that’s where the money (and the parking etc.) is” Hence, it would seem that if one is going to participate in the medical field, it is better to be identified (with some slight
ambiguity perhaps) with the medical specialists. It seems to me that is all Dr. Brezovich was saying. It has very little to do with anything else. In particular, it would seem to have little to do with job satisfaction, job performance, justifiable pride in one’s profession, etc. ■ *The burden of harm conveyed by the collective impact of all of our quality problems is staggering M. Chaitin et al, The Urgent Need to Improve Health Care Quality JAMA vol 280 (11) pp 1000-1004. (1998)
Reply to Amols and Glover Letter By Ivan Brezovich Birmingham, AL I would like to thank Drs. Howard Amols and John Glover (Reply to Brezovich Letter, AAPM Newsletter Sep/Oct 1999) for their time and effort in responding to my letter to the editor It is vital for us to be medical specialists (AAPM Newsletter, Jul/Aug). Only frank and open discussions like these can resolve our differ-
ences, or, as in this case, make us realize that any disagreements are only on style, not on substance. I believe we all have the same goal, establishing medical physics as a respected, adequately reimbursed profession. I can assure you that I am not a wannabe physician. I had the opportunity to go to medical school, but opted for physics. I consider the preliminary exams required to get into the PhD
14
program as the most difficult exam I ever took! 75% of my classmates failed. I expressed my belief in physics by saying in my letter that our status as medical specialists does not diminish our status as physicists. I am happy to be a physicist, but we wear many more hats throughout the day. To the dentist we are patients, and in the restaurant we are guests. None of those titles diminishes our prestige as physicists, yet
9-2245 AAPMNews NOV/DEC 99
12/3/99
3:15 PM
Page 15
AAPM NEWSLETTER
they provide us with specific rights and privileges as warranted by the circumstances. As patients we get state of the art dental care, and the waitress makes sure we enjoy our meal. In a clinical environment, the hat of a medical specialist gives us tangible rewards like higher and more secure pay (hard vs. grant money), faculty rank, and tenure. This comes IN ADDITION to the deep admiration we typically get for being physicists, being the smart kids on the block. Insisting in a medical environment that we are not medical specialists will only alienate the people we work with, like saying to the waitress that we are not like the other guests, but physicists. I agree with Howard’s assessment that there are some physicians and administrators who consider physicists to be second class citizens, and that they are the ones who have the problem. Unfortunately, their problem becomes also our problem, when they are in a position to affect our careers and our livelihoods. Let’s be careful not to hand them any tools they can use against us. Our importance to the patient, that we are the ONLY people in a hospital who know physics is well recognized by the Health Care Financing Administration of the US government. Current reimbursement for the CPT Physics codes is among the highest. The problem is, there is no efficient mechanism for the money to reach the physicist. It is up to the physics community to suggest such a mechanism, but so far this has not been done. If we could keep the same fraction of the revenue we are generating as (other) medical
specialists, our income would reflect our unique role. We would be the highest paid individuals in the radiation oncology department. The magic word that activates the efficient payment mechanism is provide.r There is nothing unique about providers. All medical specialists, except medical physicists, are providers. Even pathologists are providers, although they have less patient contact than medical physicists. And so are some social workers and physician’s assistants who are not considered medical specialists. My involvement in reimbursement matters has given me the opportunity to talk to countless people: hospital administrators - often intervening on behalf of medical physicists, to government officials, and to politicians. Most of them are astonishingly well educated about the situation of the medical physicist, and trying to further educate them would be an inefficient use of our time. In a recent phone call, a hospital administrator was initially claiming that their radiation oncology department was losing money, and asked me to find inexpensive physics services for him. When I pointed the finger toward their poor billing practices, he admitted that their physics division was highly profitable, but that the profits were needed to cover losses’ leaders’ in areas unrelated to radiation oncology. I could feel he was under pressure from his superiors to keep it that way. Any word from me that we are not medical specialists would have been taken out of context, given the proper spin, and used as an excuse for another pay cut
15
NOVEMBER/DECEMBER 1999
for the remaining physicist at that institution. According to a recent article in Physics Today physicists are, after mathematicians, the second lowest paid group of scientists. To a large extent, we owe our higher pay compared to physicists in general, to our recognition by the American Board of Medical Specialties. Let’s not throw away this jackpot lottery ticket, simply because good fortune handed it to us. Lets keep and treasure it, even at the risk of being called ‘winners’ instead of physicists. Addressing the issue of low pay for physicists, I wrote countless letters to members of Congress and to government agencies. Politicians are quite aware of the low pay for physicists, but advised me of the difficulty to legislate ethics and morality, and the impossibility to enforce such laws. To help us, we would have to suggest specific, doable actions. The reason why I signed the letter as Chairman of the Reimbursement Pattern s Subcommittee is that I have been studying those issues for many years. I wanted to warn individual medical physicists of the risks they are taking if they distance themselves too far from the medical community. Preserving our current close association with the medical community is well in line with official AAPM policy. In conclusion, let me reaffirm my high regards for physics. The fact that my original letter to the editor could have been easily misinterpreted but actually was interpreted correctly shows how delicate the issues are. ■
9-2245 AAPMNews NOV/DEC 99
12/3/99
AAPM NEWSLETTER
3:15 PM
Page 16
NOVEMBER/DECEMBER 1999
Reply to Amols and Glover Letter By William Kowalsky Monroe, LA Several recent letters to the editor by Ivan Brezovich, John Glover and Howard Amols debated the position of medical physicists in the medico-scientific community. I would like to add some plain talk to the debate: Medical physicists have never come from a single scientific discipline called physics. We are composed of engineers, BSRTs with graduate degrees, biologists, physicists, etc. The relationship of many medical physicists to the scientific discipline of physics is through name only. Other than very specific questions related to our daily job functions, there are no graduate level general physics questions that every medical physicist could be expected to answer correctly. How many of us can intelligently discuss the standard model in a
non-superficial and quantitative way? How many of us could write down the Schwarschild solution of the field equations of gravitation, or the field equations themselves, or even recognize them if someone else wrote them down? Are our mathematical skills up to the level of nineteenth century mathematicians (or for that matter, nineteenth century physicists)? This again shows that many of us are physicists in name only. Let’s stop wasting space and time with pompous declarations of our intrinsic value as physicists when many, if not most of us, are not physicists. In truth we are more closely related to our physician colleagues than we are to traditional physicists. We use technology and our extensive training in medical physics to serve a patient population and we do it well. Its time we got behind members of our organization who have some vision. We need to support
the efforts of Dr. Brezovich and others not afraid to challenge the status quo and carve out a place for medical physicists among the medical specialists. After all, nurse midwifes are recognized medical specialists (providers) and pathologists are recognized specialists who rarely, if ever, have patients of their own. Our profession needs to set much tighter standards from within as well as to demand more respect and recognition from without. If we want to call ourselves physicists than lets all become Ph.D. physicists in the traditional sense before we do post doctoral training, (residencies), in medical physics. If we want recognition as a medical specialty then lets all support one board and contribute a non-trivial percentage of our income for the next five years to congressional lobbying efforts. There is no painless road to a more rewarding future. â–
AAPM NEWSLETTER 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 January/February, 2000
DEADLINE December 15, 1999
MAIL DATE January 15, 2000
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
16