AAPM Newsletter March/April 2000 Vol. 25 No. 2

Newsletter AMERICAN ASSOCIATION

OF

PHYSICISTS

IN

VOLUME 25 NO.2

MEDICINE MARCH/APRIL 2000

AAPM President’s Column For the Good of Medical Physics

By Kenneth Hogstrom Houston, TX I trust this newsletter finds each of our members doing well. I spent a reasonable amount of time during January continuing to make nominations for liaisons or appointments in organizations interested in AAPM participation and finding members to represent the AAPM in various meetings and activities. I appreciate all who have been so willing to help our association for the good of medical physics.

On February 11, your Executive Committee (EXCOM) had a productive conference call that marked our first of five meetings during the year. We discussed a variety of topics that indicate that the year should be productive and beneficial to our membership.

Many items are premature to present at this time, but I wanted to share a few with you, particularly those related to other societies and organizations with which we interact.

CAMPEP and Medical Physics Residencies

the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), which I am pleased to report, is serving our profession well.

Chair of its board, Bhudatt Paliwal, recently provided me with minutes of its November 28 meeting, and I would like to share some of the highlights.

CAMPEP received a request from L. John Schreiner, President of the Canadian College of Physicists in Medicine (CCPM), requesting that CCPM becomes a full sponsor. The AAPM Executive Committee fully supports this and has so informed CAMPEP. Also, CAMPEP has been requested to develop an appropriate arrangement to have CAMPEP medical physics continuing education credits (MPCEC) issued to medical physicists attending the American Society

The AAPM is a sponsor of

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for Therapeutic Radiology and Oncology (ASTRO) annual meeting. Last, CAMPEP is currently evaluating three medical physics residency education programs for accreditation and is expecting several new applications for accreditation this year. As our profession moves toward residency requirements, the future at some point will be dependent upon having an adequate number of programs and their being required.

This will likely come by the medical physics certification

INSIDE TABLE OF CONTENTS President’s Column…...…...p.1 Legislation&Regulation…...p.3 Announcements……………p.4 ACR Commmission………p.6 Executive Directors Column.p.8 Letters to Editor………...p.10 Mortimer Heller Obituary....p.12 Institute of Medicine Reportp.13 To Err is Human ABR Written Exam Report...p.15

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boards requiring successful completion of an accredited medical physics residency program prior to sitting for examination. It has been suggested that certification boards be encouraged to incorporate such requirement at a set time in the future, e.g. 2010. I would appreciate your individual opinions regarding this.

ASTRO At the invitation of American Society for Therapeutic Radiology and Oncology (ASTRO) Chairman of the Board, Chris Rose, M.D., I attended ASTRO’s strategic planning session and board meeting on January 29 in Los Angeles.

Other AAPM members in attendance were George Chen, ASTRO board member, and Randy Ten Haken, chair of ASTRO Radiation Physics Committee. The three of us represented medical physics, each participating in one of three strategic planning breakout groups: Education, Workforce, and Integration with Non-Physicians. My presence as representing the AAPM was well received as was the entire medical physics contingency.

The board was very interested in medical physics participation in the ASTRO annual meeting and other society issues. In response to a recent letter from me to President David Hussey, M.D., I had the opportunity to present the AAPM’s offer to form an ASTRO Education Coordination Subcommittee under our Continuing Education Committee. ASTRO enthusiastically encouraged us to proceed, and the following day, November 29, Randy Ten Haken partici-

pated in a meeting of the ASTRO Annual Meeting and Program Committee at the invitation of its Chair, Kenneth Russell, M.D. The board acknowledged the recent formation of our Medical Physicist Workforce Subcommittee and encouraged it to interact with the ASTRO Human Resources Committee. As part of the ASTRO ef fort to improve integration with nonphysicians, the board encouraged medical physicists to join ASTRO. This is something I strongly encourage of medical physicists in radiation oncology. I believe that we are in a good position to make significant progress in any ASTROAAPM matters of mutual interest with the current ASTRO and AAPM initiatives.

Trilateral Committee The Trilateral Committee is a joint committee of the American College of Medical Physics (ACMP), the American College of Radiology Commission on Medical Physics (ACR CMP), and the AAPM. Our profession is served well by each of these organizations, and our meeting three times each year is indicative of the effort to coordinate professional activities and to place service to our profession as the primary goal.

Each organization benefits our profession, and I urge those who are eligible for membership in ACMP and ACR to support your profession by becoming members, if not already so.

Each organization hosts one of three meetings annually.

The previous meeting, hosted by the AAPM, was held on October 13-14 in Chicago.

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Many of the items discussed at this meeting have been disc us s e d in th e p r e v i o u s newsletter. One item that remains of concern to the Trilateral Committee is the lack of action by the U. S. Nuclear Regulatory Commission (NRC) in filling one medical physicist and two radiation oncologist vacancies on the Advisory Committee for the Medical Uses of Isotopes (ACMUI).

The AAPM submitted nominations for the medical physics vacancy in late 1998. In December 1999, AAPM president Geoff Ibbott sent a letter to Kathy Haney of the NRC expressing our concern and requesting that the NRC’s timetable for filling these vacancies be communicated to us. At the time of the February 11 EXCOM meeting, Geoff had not received a response.

ACR Commission on Medical Physics Chair The ACR will select a new Chair of its CMP later this spring. This position is important to medical physicists as it can have a significant influence on how the ACR impacts our profession. Don Tolbert, whose term ends this June, has served effectively and conscientiously in this position.

Because of the importance of this position, the AAPM has offered its assistance in the selection process to W. Max Cloud, M.D., Chairman of the ACR Board of Chancellors, who has encouraged our input. Our goal is to recommend outstanding AAPM individuals for the appointment.

Our selection process, superv is e d by p r e s i d e n t- e l e c t

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Charles Coffey, II, will follow that utilized last year for selecting nominees for ABR trustee.

In this process, each of our board members has the opportunity to nominate up to two AAPM members who are qualified and willing. From those nominees a ballot will be distilled on which board members will vote for their top three choices. From the results of the election, the top three candidates will be recommended to Dr. Cloud.

Because the process is highly representative of medical physicist opinion, we are hopeful that the ACR Board of Chancellors will select one our recommended individuals.

Public Education How many times have you pondered how to answer the question, “What is a medical physicist?” If you are like me, your first reaction is that this will be difficult and that I may as well be trying to explain quantum mechanics. This is where our Public Education Committee, chaired by Nick Detorie, can help us help educate the public. We need to educate the public for many reasons, for having patients and referring physicians appreciate the benefit of good medical physics, for having the government appreciate our benefit to society, for recruiting physicists into our profession,

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etc. Recently, I had the opportunity to work with a writer at M. D. Anderson whose purpose was to write an article explaining “what is medical physics” in a monthly publication aimed at referring physicians. I found the project interesting and rewarding, and I shared it with Nick. I hope to continue to work with the Public Education Committee, as I believe that we all benefit from having others understand who we are and what we do.

Legislation & Regulation Committee

by David Keys, Chair St.Louis, MO All of us are affected in one way or another by the rules and regulations set down by the various Radiation Control Programs found in each state.

The sources of many of these rules and regulations are the Suggested State Regulations (SSRs) produced by the Conference of Radiation Control Program Directors (CRCPD).

While we cannot be Voting Members of this organization per se (unless we become head of our state radiation control program), we can become affiliate members of this organization. At $75 for an affiliate membership, the price is certainly right. I have been attending these meetings over

the past eight years. I have seen a gradual growth in mutual respect between the regulators and the physicists who attend these meetings. This is due in part to the influence of the ACR, which has regularly held a Healing Arts session at the meeting each year, the AAPM which has instituted training sessions for the regulators over the past few years, and the ACMP which has periodically contributed to the meeting.

Like other professional organizations, the CRCPD has formed numerous committees to study and recommend potential rules and guidelines for the use of all forms of radiation and radioactive materials under their jurisdiction. Jill Lipoti, the CRCPD liaison to

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the APPM, is interested in physicists who may want to contribute to these committees.

The committees and some areas of interest (not all) are as follows: SR- 1 Part C - Licensing of Radioactive Material SR – 2 Part D - Standards for Protection Against Radiation SR - 4 Part F - X-rays in the Healing Arts SR – 6 Part G - Radionuclides in the Healing Arts SR –8 Part X - Medical Therapy (including linear accelerators) SR – 12 Part T - Transporta-

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tion of Radioactive Material Part M - Licensing Requirements for the disposal of radioactive material Part O - Decontamination and Decommissioning Other committees, such as the Committees on Medical Practice, Nationwide Evaluation of X-ray Trends (NEXT), Mammography, and Quality Assurance in Diagnostic X-ray, are

also looking for membership This is your opportunity to "participate in the process.”

Your knowledge and energy could have a positive effect on the practice of medicine long after you retire because of the work you do on these committees. The first step (and a requirement) is to become an affiliate member. This is simple. Go to www.crcpd.org and join on line or contact Sue Smith (ssmith@crcpd.org) and obtain an application. Once

your membership application has been approved, you will be notified and provided an interest form for joining CRCPD working groups as an advisor (limit of two per member).

This form should then be forwarded to Sue Smith at the Office of Executive Director, 205 Capital Avenue, Frankfort, KY 40601 or faxed to (502) 227-7862. This year’s CRCPD annual meeting will be May 1417 in Tampa, Florida. Hope to see you there.

Announcements Society for Computer Applications in Radiology June 3 - 6, 2000 Philadelphia PA "The Electronic Practice: Radiology in the Enterprise" As a profession, medical physicists are often looked to for guidance in establishing the introduction of new technologies in diagnostic and therapeutic departments. As digital imaging moves beyond the local confines of the radiology department, and integrates with enterprise-wide information systems, medical physicist input will likely be sought to help plot that course.

The 17th annual meeting of the Society for Computer Applications in Radiology (SCAR) will be a valuable "navigational aid" for physicists at all levels of digital

imaging experience.

The Philadelphia 2000 meeting of SCAR marks the 20th anniversary of the society. The keynote speaker is Ronald Arenson, M.D., speaking on the history of PACS and the challenges and future of imaging informatics in the new millennium. SCAR 2000 will also be a meeting of many firsts: • the induction of the first group of SCAR fellows • the introduction of SCAR University containing 12 course tracks with 100, 200, 300 and graduate level courses (including digital imaging, storage and networking, PACS purchasing, teleradiology, medical legal issues, security, workflow, quality control, etc.)

• a 20th anniversary celebration to commemorate prior SCAR chairs -- a judged scientific poster session with cash awards.

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In addition, eight scientific presentations covering state-ofthe-art research (including gital radiography, computeraided diagnosis, etc.) will be offered. Technical exhibits will be offered by numerous vendors and tours of digital imaging activities at the University of Pennsylvania, Thomas Jefferson University, and Temple University will be available.

For more information on the SCAR 2000 meeting (including how to register), visit the SCAR WebSite at HTTP://WWW.SCAR.rad.washington.edu or phone the SCAR office at 703-757-0054.

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RDCE Update

ACR Annual Meeting

As of Feb 1 there are 27 quizzes available for coninuing education credits at the RDCE section of the AAPM web site. More quizzes are on the way. Access to the RDCE site is limited to those who have paid the $20 RDCE fee.

Even though the AAPM grants a 3 month grace period before AAPM membership lapses, there is no grace period for the RDCE program. This is another good reason to pay your dues before the first of the year.

July 28-29 2000

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Chicago The American College of Radiology is holding a dual track Physics Symposium - “Ultrasound Physics” and “Magnetic Resonance Imaging Physics” - to be held concurrently at the Hotel Inter-continental Chicago, on July 28-29, 2000, immediately following the AAPM Annual Meeting. The Symposia are targeted to physicists, radiologists and residents in diagnostic radiology and radiation oncology. A complete registration brochure will be included with the May issue of the AAPM newsletter. For further information, or to request a registration brochure, please call the ACR at (800) 227-5463, Ext. 4245 or email edu@acr.org

If you have any questions please contact Chuck Kelsey at ckel@unm.edu

Equipment Needed Apology To All AAPM Members The AAPM Headquarters apologizes for an unfortunate error we made in the Jan/Feb 2000 Newsletter. We incorrectly listed Thomas P. Mitchell, Gainesville, FL as being a deceased member during 1999. President Ken Hogstrom phoned Tom Mitchell and apologized for the mistake.

The AAPM headquarters has now put in place a procedure that will minimize the chance of this happening in the future.

Sincerly, Sal Trofi AAPM Executive Director

Dr. Marginean Claudiu has a medical foundation setup in Romania and badly needs the equipment mentioned below.

If someone can donate the old equipment to his clinic, IOMP will be pleased to ship them to Romania. Romania is a poor developing country with very limited resources and IOMP Professional Relations Committee want to help them to get some equipment.

1. Ultrasound system - Echograph - with sectorial transducer (3.5 and 5 MHZ), one for endovaginal and the others for obstetrics and gynecology with printer.

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2.

3.

4.

5.

Surgical Aspiration System Gastroscope Cardiotocograph Micro-analyzer for blood, urine and biochemistry 6. Electro-cardiograph and Holter system 7. Stomatology parts - right piece, bend piece and turbine.

If you need more information, please contact M. Zaidi, IOMP Equipment Donation Program at 208-526-2132.

Thanks.

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SUMMARY OF 1999 ACR COMMISSION ON MEDICAL PHYSICS ACTIVITIES

By Don Tolbert, Chairman Tripler AMC, HI

Description of CMP There are seven operational and eight specialty commissions in the ACR. The operational commissions are for Education, Economics, Research and Technology Assessment, Government and Public Relations, Human Resources, Standards and Accreditation, and Intersociety.

The specialty commissions are for General and Pediatric Radiology, Interventional and Cardiovascular Radiology, Neuroradiology and MR, Nuclear Medicine, Medical Physics, Radiation Oncology, Small and Rural Practices, and Ultrasound. There are six committees under the Commission on Medical Physics (see below). The Chair of each Committee is a member of the respective Commission.

Action items brought forth from a Committee under the Commission on Medical Physics (CMP), for example, are considered by the CMP. Upon approval, the action item is placed on the agenda for the appropriate operational commission. If approved by the Commission, the action item is presented to the Board of Chancellors (BOC).

Depending on the action item, it is either placed on the agenda for the Annual Council meeting (in the form of a Resolution), or it is enacted via

the Staf f.

Resolutions approved by the Council become ACR policy. The Staff is often consulted, and frequently provides expert guidance, along this path of development.

Highlights of 1999 Activities Following is a highlight of 1999 activities, by committee, carried out under the leadership of the ACR Commission on Medical Physics.

Economics - James H e v e z i , C h a i r . Geof frey Ibbott has been nominated for membership on the Practice Expense Advisory Committee.

A long-term goal of the Committee is to develop a technical user’s guide for reimbursement, which would be directed by the Commission on Economics.

The Committee maintains currency on the Ambulatory Patient Classification (APCs) and is developing new codes for Intensity Modulated Radiation Therapy (IMRT) in conjunction with the new Joint Economics Committee of ASTRO and ACR. The Committee has discussed compliance reviews, and the ACR has a model compliance plan for correct CPT coding.

Education - Jon Trueblood, Chair The Committee has organized an ACR symposium to be held at the 2000 World Congress of Medical Physics and the annual meeting of the

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AAPM. It will be entitled “Physics Symposia on Ultrasound and Magnetic Resonance Imaging.”

The Committee continues work on the physics syllabus for radiation oncology residents, and it is almost completed. The Committee is also ready to publish a brochure on radiation effects and protection for medical students.

The Committee will look into the possibility of having the ACR develop physics Continuing Performance Improvement programs.

Government and Public Relations - Richard Morin, Chair The Committee continues to monitor proposed revisions to the Nuclear Regulatory Commissionís Part 35 - regulations on the medical use of licensed radioactive materials.

The Committee, in conjunction with approval from the ACR Commission on Government and Public Relations, is looking into purchasing software, which would allow ACR members to communicate directly with their congress-

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men and senators.

The Committee is compiling and organizing radiation safety material pertinent to public awareness. This awareness is focused toward exposures, safety, and risks for x-ray procedures.

Standards and Accreditation - David Vassy, Jr., Chair The Committee has finished the “ACR Guide to Medical Physics Professional Practice.”

The CMP has approved the revision, the ACR has placed it on the ACR Web site (members only) and versions will be available to non-members for $10 per copy.

Two standards were adopted at the 1999 Annual Meeting: ACR Standard for Physics Performance Monitoring of BMode Real Time Ultrasound Equipment and ACR Standard for Physics Performance Monitoring of MRI Equipment.

With the adoption of these standards there is a comparable physics standard for each diagnostic and therapeutic modality.

For the 2000 cycle, the committee will propose a new standard Brachytherapy Physics for After-loaded HDR Sources. The 1995 Brachytherapy Physics: Manually Loaded Temporary Implants Standard is being revised. In addition, the committee participates in the review of Radiation Oncology and Nuclear Medicine standards that have implications for physics. A draft of a standard for Physics Performance Monitoring of Positron Emission Tomography Equipment is being prepared for the 2001 cycle. The 1997 Diagnostic

Medical Physics Performance Monitoring of Radiologic and Fluoroscopic Equipment will be reviewed.

At the request of the chair of the Commission on Standards and Accreditation Commission, the committee will develop, in cooperation with the General and Pediatric Standards and Accreditation Committee, standards for Radiation Safety and Fluoroscopy.

Human Resources - Joel Gray, Chair A membership recruitment ef fort was developed, approved by the CMP, and implemented by the Staff. A brochure entitled “Why Should a Medical Physicist Join the American College of Radiology” was mailed to the AAPM membership with a cover letter encouraging ACR membership.

At the request of the CMP, the Committee is drafting a survey of diagnostic medical physicists. This survey will define tasks expected of diagnostic medical physicists.

The purpose of the survey is to determine the time and intensity associated with each. Such information will be used by the Practice Expense Advisory Committee.

Research and Technology Assessment - Perry Sprawls, Chair The Committee continues to develop STAR, which will be part of the ACR web site in January. STAR is a web based information resource for the ACR membership on the issues concerning the science and technology of medical imaging.

Committee on Radiation

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Units, Standards, and Protection (CRUSP) Fred Mettler, Jr., M.D., Chair The Committee supports having the ACR to encourage physician participation through the Council of Radiation Control Program Directors(CRCPD) in drafting suggested state regulations.

CRUSP is working on a contribution to the combined ACR/RSNA web site. This contribution will address radiation safety issues for the public.

RSNA Executive Director Dies Suddenly Del Stauffer, 60, Executive Director of the Radiological Society of North America for more than 10 years, died suddenly March 1, 2000. He apparently suffered a heart attack as he played recquetball near the society’s Oak Brook, IL headquarters.

Memorial contributions may be made to the Research and Education Foundation, RSNA, 820 Jorie Boulevard., Oak Brook, IL 60523.

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Executive Director’s Column

by Sal Trofi College Park, MD

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Chicago 2000 World Congress

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The scientific program for the upcoming World Congress is taking shape. The abstract submission process was entirely electronic and went very smoothly. Over 2,500 abstracts were submitted, which exceeded our expectations by roughly 500 abstracts. During the month of February, 400 abstract reviewers conducted their work via the Internet. In March, the World Congress Scientific Program Committee and staff held a meeting at AAPM headquarters to put together the scientific program. Authors will be notified about the disposition of their paper during the first week of April.

In February, over 2,300 scientific registrants had completed the on-line registration process.

Remember, you must register before May 15 in order to receive discounted registration fees.

During the World Congress, AAPM functions will be held at the Sheraton Chicago. AAPM members are urged to make their housing reservations early as rooms at the Sheraton are selling fast. Reservations must be made by June 23. For housing reservation instructions and the most up-to-date information, please visit the Chicago 2000 web site at http://www.wc2000.org Important dates approaching: • First week of April, Authors will be notified

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about paper disposition.

May 15, Registration deadline to receive discounted fees.

May 26, Chicago 2000 Scientific Program available on the web June 19, Deadline for advance meeting registration June 23, Deadline for housing reservations

2000 Summer School "General Practice of Radiation Oncology in the Next Century" The 2000 AAPM Summer School will be held July 29 August 1, 2000 immediately following the World Congress.

The Summer School will be held at Northern Illinois University in Dekalb, Illinois. The Preliminary Program and Registration information were mailed to you in your April monthly mailing. Register by June 15 to receive discounted registration. You can access all this information on line via AAPM On-line at http://www.aapm.org. If you need additional information, please contact Nancy Vazquez at nvazquez@aapm.org or phone 301-209-3390.

SQL Conversion At the 1999 AAPM Meeting in Nashville, the BOARD approved funds for the conversion of the AAPM Membership Database backend to MS SQL Server. This conversion was completed on the weekend of February 12, 2000. This change to Membership Database

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enables AAPM HQ to integrate all of our databases onto the same platform allowing universal data access from one database to the other.

SQL Server is a highly connective database that allows access to data from multiple sources, from our Paradox Membership Database client to an ad-hoc Access query window, to a web page on AAPM.ORG. All of these clients can view data directly from the SQL database in real time. The immediate effect of this is an improved Online Membership Directory which allows members to query on far more fields, much faster than was previously possible (try this, it is awesome!). It is our goal to customize the AAPM.ORG website to provide information specific to the member using it; for instance logging into the AAPM website and being reminded that you have only two weeks left to register for discounted meeting fees, or better yet, not seeing this message if we note that you have already registered. We can also take you to specific areas of the AAPM website based on your committee memberships where you

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will be able to converse with other committee members. All this will be possible from one login.

Partners in Physics The AAPM Partners in Physics Program is a sponsorship of qualified medical physicists in developing countries. Some full time medical physicists living in developing countries whose education and experience meet the requirements for AAPM Full Member status cannot afford to pay membership dues - for some of them, it is more than their salary! These individuals can apply to the AAPM to be a "Partner" in the

Partners in Physics program.

To make this program work, some individual AAPM Members and Chapters offer to act as a "Sponsor" of a Partner and pay half of the amount of the Partner's dues, which, in 2000, is $92.50 US. The Partner and Sponsor have a chance to have an active relationship and share information, and the Partner receives all twelve monthly issues of the AAPM peerreviewed scientific journal, Medical Physics, Physics Today Journal, a Membership Directory, and a few mailings each year with pertinent information about upcoming events and meetings.

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At this time, about threedozen Partners do not yet have Sponsors. If you are interested in becoming a Sponsor, please contact Kathy Burroughs, Membership Representative, at the HQ Office. We ask that Sponsors make a three-year commitment to support a Partner. You may request an individual of a particular gender from a particular country and we will do our best to accommodate your first choice. Partners who are currently waiting for Sponsors live all over the globe, from Brazil to Zambia, and Medical Physics occupies an important place in each of their offices.

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Letters to the Editor Einstein; and the Valley of Death

by Robert Dixon Winston-Salem, NC Albert Einstein Way to go Albert Einstein - Time Magazine Person of the Century.

All physicists (real or imagined) should be proud. I recently saw some boys racing battery-powered, radio-controlled cars and thought of a fun relativistic problem which I think Einstein would have appreciated. One hears the argument that when electrons are accelerated in a linac, as their velocity approaches the speed of light c, their mass approaches infinity, hence they cannot be accelerated past c. For a battery powered car, however, there is no increase in the mass of the car with velocity since the energy is supplied from within (in fact, when the car stops after depleting its battery, its rest mass is less than its original rest mass ). Then why can’t we theoretically accelerate a battery-powered car past c?

Solve the problem for the car’s velocity as a function of its rest mass at any instant, and you will see why. Send me your solution, and those of you who get it right will be identified in the next issue.

(Hint: 4-vectors may prove useful, but use as many as you like). If you don’t believe the original premise, then “flame” me on that.

the premise that medical physicists should assert their independence from organized medicine - indeed one such pronouncement stated it as our patriotic duty. I applaud such bravery much as Alfred Lord Tennyson chronicled a similar brave effort long ago in the Crimea.

Half a league, half a league, Half a league onward, All in the valley of Death Rode the six hundred.

“Forward, the Light Brigade!”

Charge for the guns, he said: Into the valley of Death Rode the six hundred.

My message to our present day “light brigade”: be brave and independent if you must; just don’’t take the rest of us with you. The activities of the medical physicists working within the ACR, (as

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Charge of the Light Brigade There have been numerous pronouncements and “breast beating” of late in the newsletter supporting

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chronicled in a recent newsletter issue) and within ASTRO (as described by Ken Hogstrom in this issue) make it clear that much more can be accomplished for medical physics by working within the medical organizations than by taking a separatist position.

The argument for an ACR/RSNA model for medical physics, in order to divide professional and educational activities, does not really apply, since we are not 30,000 members strong and have limited financial resources. In fact Ron Evans, ACR president, recently stated (Dec 99 ACR bulletin) that Radiology was splintering into too many organizations, despite their 30,000 person strength! He says, “So what is the problem with a specialty that has many organizations? One could argue

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that the more diversity in a specialty the better. However, when a specialty cannot focus the appropriate amount of energy and resources on its major challenges, it runs the risks of not meeting these challenges.”

A proper strategy for medical physics, considering our small number, is to leverage our influence by working within and utilizing the resources of these larger medical organizations.

AAPM has done this quite successfully with RSNA. Don Tolbert as chair of the ACR Commission on Physics, together with his able lieutenants, have also accomplished much for medical physics, aptly illus-

trating that diplomacy with our Radiological colleagues is much more fruitful than an “in your face” confrontational attitude. I am proud of the accomplishments of the AAPM in the professional arena in the past under the leadership of Don Tolbert, Geoff Ibbott and now Mike Gillin. The effort has been redoubled it seems to me, and wisely so, to the credit of the AAPM leadership.

If an organization wishes to control my professional destiny, it’s not enough to say that I should trust them to do so (by some sort of birthright) they will have to show me some significant positive results where they have advanced our profes-

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sional interests. Then I will listen. We will accomplish much more united under one commander (as in Desert Storm) rather than having separate commands with significant duplication of efforts and sharing of limited resources. (Martial music here with slow fade).

“Forward, the Light Brigade!”

Was there a man dismayed?

Not tho’ the soldiers knew Someone had blundered: Theirs not to make reply, Theirs not to reason why, Theirs but to do and die: Into the valley of Death Rode the six hundred.

Serving on the AAPM board of Directors: A Privilege and Responsibility

By Cynthia McCollough Rochester, MN During the 1998 AAPM Annual Meeting in San Antonio, Texas, I learned that I had been elected by the AAPM Membership to serve on its Board of Directors as a Member at Large. While I was honored by this vote of confidence and looked forward to serving the AAPM in this capacity, I was not overly enthusiastic about the additional time commitment, particularly the need to attend the five-hour Board of Director meetings at the end of both the AAPM and RSNA Annual Meetings.

I have now had the opportunity to take part in two meetings of the AAPM Board of Directors, at the annual meeting in Nashville and most

recently at the RSNA in Chicago, and would like to express my sincere appreciation for this opportunity. I would also like to let others in the AAPM know that serving in this capacity is indeed time well spent.

I found the meetings to be conducted in an efficient, democratic, and professional manner. The five hours which I had thought would seem long passed quickly, primarily because of the informative discussions on a wide range of topics. These topics covered the entire breadth of the AAPM’s professional, educational, and scientific activities.

I was particularly impressed by the manner in which members of the Board of Directors with significantly different opinions expressed themselves in a

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diplomatic and professional manner. The Board of Directors, all of whom are volunteering their time, energy and expertise to the well being of the AAPM, clearly were working on the behalf of the good of the organization. I saw no evidence of individual motives playing a key role in any of the discussions or decisions. I was proud and grateful that so many of our peers care enough to set aside personal agendas and differences of opinions to work towards the higher good of our profession in general and the AAPM in particular. It is indeed a privilege and a responsibility to be a member of the AAPM Board of Directors, and I humbly recant my previous unenthusiastic attitude.

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Mortimer B. Heller Obituary

by Shirley Vickers Rego Park, NY I am greatly saddened to report the death on January 4 of Mortimer B. Heller, at age 69. Having retired from practice of medical health and physics in New York, he had moved with his wife Gayle to the Seattle area about a year and a half ago.

Mort was a Charter Member and Fellow of the Health Physics Society, a member of the American Association of Physicists in Medicine, and a Fellow of the American Public Health Association. He had served as president of the local chapters of both the HPS and the AAPM, and had chaired the New York State Low-Level Waste Advisory Committee between 1988 and 1992. In addition to his scientific pursuits, Mort was a passionate devotee of sailing; and when ill health recently limited his activity, his “new boat” was an exquisite Japanese garden which he designed and saw executed.

Longtime members of the HPS and AAPM will fondly remember Mort as the string bass player in the singing group known facetiously as “The Mutants” (of which I was one). During the late

‘60’s and early ‘70’s, attendees at local and national meetings heard our humorous views of the professional, scientific, and legal issues facing health and medical physicists. Mort’s five children, now grown, can still sing with remarkable accuracy their favorite “Mutants” songs, learned during the interminable rehearsals in their home. At least one daughter recalls her own ambition to grow up to become a “Mutant.”

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Mort will be greatly missed by his friends and colleagues, who extend to his family their deepest sympathy. His wife, Gayle Heller, may be reached at 17034 Viking Way, Poulsbo, Washington 98370. Donations in his memory may be sent to “Gift to Life” (a project of Rotary International), 505 Northern Boulevard, Suite 102, Great Neck, NY 11021. This organization helps children around the world who need open heart surgery.

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MARCH/APRIL 2000

Institute of Medicine Report on Medical Errors

by Mike Gillin, Chair Professional Council Milwaukee, WI To Err is Human: Building a Safer Health Care System The National Academies consist of four organizations, namely the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council.

The National Academy of Sciences was created in 1863 by a congressional charter approved by President Abraham Lincoln. Under this charter, the National Research Council was established in 1916, the National Academy of Engineering in 1964, and the Institute of Medicine in 1970.

The National Academies have a web site, www.nas.edu.

The Institute of Medicine (IOM) identifies concerns in medical care, research, and education and secures the services of members of appropriate professions to examine policy matters relating to public health. (The IOM was the organization which was invited by the Nuclear Regulatory Commission to review the NRC's activities in medicine.

The recommendations contained in that report were basically ignored by the NRC and others.) The IOM is governed by an elected council. There are established committees that deal with specific categories of business. Recently, a

project initiated by the IOM, the Quality of Health Care in American Life, issued its first in a series of publications, To Err Is Human: Building a Safer Health Care System.

Pre-publication copies are currently available from the National Academy Press 1-800624-6242. This report will be published soon. The Committee on Quality of Health Care in America had 19 members and was chaired by William Richardson, President and CEO, W. K. Kellogg Foundation. The Committee was composed mainly of academic and business physicians. It did have one nurse, one health care administrator, and one representative of medical consumers.

To Err Is Human focuses on two large studies, one conducted in Colorado and Utah, and the other in New York.

The Colorado and Utah study found that adverse effects occurred in 2.9% of hospitalizations and that 8.8% of adverse effects led to death.

The New York study found that 3.7% of hospitalizations led to adverse effects and that 13.6% of adverse effects led to death. These findings are extrapolated to the 33.6 million admissions to U.S. hospitals in 1997 with the resulting implication that somewhere between 44,000 and 98,000 patients die each year as a result of errors. The report notes that these figures are higher than the number of Americans dying from motor vehicle accidents (43,458),

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breast cancer (42,297), or AIDS (16,516).

It is too late to wonder about the validity of the initial data or its extrapolation. Both the executive and legislative branches of the U.S. Government are now involved with this public health issue. The American public is becoming increasingly interested and concerned about this issue.

The IOM report has made this an important public issue and one that will have some impact on the health care delivery system. This issue should be viewed as an opportunity for medical physics, as patient safety is one of our raisons d'etre.

This issue should also inspire medical physicists to review our standards of practice, our training programs, and our board certification programs.

The IOM report defined safety as freedom from accidental injury. Error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. In his 1990 book Human Error, James Rea-

AAPM NEWSLETTER

MARCH/APRIL 2000

son noted that errors depend on two types of failures, namely an error of execution or an error of planning. The major causes of error in medicine are well known, namely medication errors, hospital based infections, and patient injury from falling. There have been a limited number of significant errors involving patients in radiation oncology, including mechanical and radiation.

In imaging, it can be argued that every image which must be repeated for technical reasons represents an error.

The recommendations in the IOM report are built on a four layer approach, namely: 1. Establishing a national focus to create leadership, research, tools, and protocols to enhance the knowledge base about safety 2. Identifying and learning from errors through the immediate and strong mandatory reporting efforts, as well as the encouragement of voluntary efforts, both with the aim of making sure the system continues to be made safer for patients 3. Raising standards and expectations for improvements in safety through the actions of oversight organizations, group purchasers, and professional groups 4. Creating safety systems inside health care organizations through the implementation of safe practices at the delivery level. This level is the ultimate target of all the recommendations.

The recommendations of the IOM report include the creation of a new federal organization, namely the Center for Patient Safety within the

Agency for Health Care Policy and Research. The recommendation is for initial funding for the Center, of $30 to $35 million, evolving to funding of $100 million per year. The recommendations also include a mandatory and a voluntary re p ort ing s y s t e m s .

T he mandatory system is viewed with considerable concern within the health care delivery system. Recommendation 7.2 states that “Performance standards and expectations for health professionals should focus greater attention on patient safety.� There are two subsets to this recommendation.

The first is directed to health professional licensing bodies, while the second is directed towards professional societies.

The recommendation directed to professional societies is as follows: Professional societies should make a visible commitment to patient safety by establishing a permanent committee dedicated to safety improvement.

This committee should: (1) develop a curriculum on patient safety and encourage its adoption into training and certification requirements; (2) disseminate information on patient safety to members through special sessions at annual conferences, journal articles and editorials, newsletters, publications and websites on a regular basis; (3) recognize patient safety considerations in practice guidelines and in standards related to the introduction and diffusion of new technologies, therapies, and drugs; (4) work with the Center for Patient Safety to develop com-

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munity-based, collaborative initiatives for error reporting and analysis and implementation of patient safety improvements; and (5) collaborate with other professional societies and disciplines in a national summit on the professional's role in patient safety.

It is my expectation that all of organized medical physics (AAPM, ACMP, and ACR) will seriously consider this report and implement some of these recommendations. The IOM report does provide medical physics, radiology, and radiation oncology an opportunity to emphasize the successful patient safety activities already in place. The Task Group reports of the AAPM in part address patient safety issues.

Task Group 35, Medical accelerator safety considerations, is devoted to safety. The ACMP standards and the ACR standards address patient safety.

The ACR practice accreditation programs include an element of patient safety. It is safe to predict that in the future there w ill be a n e v e n g r e a te r emphasis on patient safety issues. The medical physicists’ contribution to patient safety should be emphasized when discussing the role of medical physics in radiology and radiation oncology both for existing and new technologies. It is prudent to remind both physicians and administrators of our patient safety contributions.

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ABR Written Exam Results

by Guy Simmons ABR Physics Trustee Lexington, KY

191 candidates took the written ABR certification exams in physics last September. The pass/fail statistics are as follows:

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MARCH/APRIL 2000

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MARCH/APRIL 2000

AAPM NEWSLETTER MANAGING EDITOR Marsha Dixon

EDITOR-IN-RESIDENCE Robert Dixon Send information to: Marsha Dixon Broadcast News Public Relations 201 Knollwood Street Winston-Salem, North Carolina 27104 (336) 721-9171 Phone (336) 721-0833 Fax Email: rdixon@wfubmc.edu The AAPM newsletter is printed bi-monthly. Deadline to receive material for consideration is four to six weeks before mailing date. We welcome your entries, and encourage authors of articles to supply a photo. Please send material via e-mail, disks or mail. Faxes are encouraged as back-up, and are acceptable alone.

NEXT ISSUE May/June, 2000

DEADLINE April 15,2000

MAIL DATE May 15, 2000

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

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE One Physics Ellipse College Park, Maryland 20740-3846 (301) 209-3350 Phone (301) 209-0862 Fax e-mail: aapm@aapm.org http://www.aapm.org

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