AAPM Newsletter May/June 2001 Vol. 26 No. 3

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Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 26 NO. 3

MAY/JUNE 2001

AAPM President’s Column Coffey Break Charles W. Coffey, II Nashville, TN

Annual Meeting By the time you receive your copy of this Newsletter, only two months will remain until the Annual Meeting. My hope is that you have made arrangements to join your fellow AAPM colleagues in Salt Lake City. In addition to the scientific and educational programs offered, I want to remind you of four important events. On Monday afternoon from 1:30 – 3:20 PM a special diagnostic and imaging physics plenary session on the topic of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) has been scheduled.

Our special guest speaker for this session is Dr. Donna Dean, Acting Director of NIBIB. Following her presentation on the present status and future direction for the Institute, Dr. Dean and a panel of AAPM imaging scientists will be available for discussion and to answer questions concerning the AAPM’s role in this new Imaging Institute. On Monday evening I urge you to attend the Annual Awards Ceremony and the wine and cheese reception that follows to honor our awardees. I am privileged to introduce this year’s award winners who were recommended to the Board for approval by the Awards and Honors Committee, chaired by Mary Martel. Remember, AAPM members nominate the Fellows and the Coolidge Award recipient. The Awards and Honors Committee evaluates the nominees and forwards the selected names to the Board for final approval. If you know of someone that you consider a nominee for next year, please provide the name and necessary materials, including CV, to a member of the Awards and (See Coffey - p. 3)

CPT, APC, and Medical Physics Services Michael Gillin, Chair AAPM Professional Council In 2001 there have been important developments with respect to reimbursement for medical physics services for hospital outpatients. This article is an attempt to summarize these changes. CPT: Services provided to an individual patient by a medical physicist, e.g. a review of a (See CPT/APC - p. 2)

TABLE OF CONTENTS President’s Column CPT, APC, & ... Ed. Council Rep. LRP Comm. Rep. Exec. Dir.’s Col. Gov’t Rel. Col. Attrition Clauses AAPM/IOMP Rep. Announcements Annual Meeting Letter – AAPM Accompls. Letter – Merge?

p. 1 p. 1 p. 7 p. 8 p. 9 p. 11 p. 14 p. 16 p. 18 p. 19 p. 20 p. 22


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CPT/APC

(from p.1)

patient’s chart or a report addressing a specific issue, can be billed using either 77336 or 77370, respectively. A physician must write a request for a physics consultation in the patient’s medical record in order for a physicist to bill for a special physics consultation, 77370. The request for a physics consultation is NOT limited to radiation oncology. Imaging physicists can also use this code for services provided to an individual patient, e.g. fetal dose calculation, provided there is a written request in the medical record. As is the case for any service, there must be documentation in the patient’s medical record that this service has been provided. One mechanism to document a special physics consultation is for the physicist to write, sign, and date a report that becomes part of the patient’s medical record. Physicists also contribute to other CPT codes, in the 772XX, 773XX, 774XX, 777XX, and other series. However, 77336 and 77370 are used only by medical physicists for their support and consultative services. APC: Medicare, in response to a congressional mandate, created an Ambulatory Patient Classification system which took effect in 2000. APCs apply to hospital, outpatient technical charges for Medicare patients only. The net effect of the APCs is to bin the CPT charges to a limited number of catego-

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ries, which in theory provide similar services using similar resources. Congress defined a factor of two rule relative to similar resources, such that services whose mean cost differed by more than a factor of two should not be included in the same APC. The original HCFA proposal created approximately 350 APC codes, while the final rule had approximately 450 APC codes to describe all hospital outpatient services. APC code 0311 contained CPT codes 77336, 77370, and 77399. HCFA acknowledged that its data in establishing the reimbursement amount for these codes was flawed. The AAPM, the ACR, and ASTRO wrote separate letters to HCFA, which among other issues, noted that there was an independent study from Abt Associates, which concluded that the resources required for 77370 were more than a factor of two greater than the resources required for 77336. The Abt survey is the best data that the AAPM has to describe the cost of providing medical physics services. HCFA was required by Congress to appoint an Advisory Committee to provide recommendations relative to its implementation of the new APC system. This Advisory Committee was appointed in January, 2001 and met in February, 2001. The AAPM was represented at this meeting by its government relations specialist, Angie Furcron. Despite

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the fact that medical physics was not on the agenda, Angie was able to present our concerns relative to the amount of reimbursement for both 77336 and 77370 and note that the cost of providing these two services differed by more than a factor of two. ACR and ASTRO supported the AAPM’s concern and suggested a specific solution, which would move 77336 into APC 0304 and 77370 into APC 0305 and increase the payment for 77336 to approximately $75 and the payment of 77370 to approximately $200. This recommendation would result in the elimination of APC 0311. Some medical physicists have expressed concern over the potential elimination of APC 0311. It is my opinion that the elimination of APC 0311 is not important. Patient charges are still billed in terms of CPT codes for Medicare and nonMedicare patients. Non-Medicare patients will continue to be billed using the historical system. Administrators will still be able to track the number of 77336 and 77370 charges and the total amount billed. (Hospitals generally do not know that they have collected from Medicare on an individual charge for a specific patient service.) Physicists should confirm that in their departments charges are still being generated in terms of CPT codes. In the event that HCFA accepts the recommendations of its Advisory Committee, hospitals will


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be able to increase their charges for 77336 and 77370. The AAPM and the ACMP are funding an updated Abt survey for radiation oncology. New data should be available next year. The ACR has created a survey instrument relating to imaging physics. Data from that survey may be available later this year. The Medicare rules will change over time. In addition, the CPT system is scheduled for a major change with the introduction of CPT V within the next year or two. Medical physics will need to remain vigilant as the billing systems continue to evolve. ■

Coffey (from p. 1) Honors Committee for consideration. On Wednesday evening at 5:30 PM, the Annual Business Meeting will be held. This year two topics of concern will be initially introduced to the Association; membership dues and diagnostic physics and medical imaging reorganization within the AAPM. Your attendance and input are welcomed as the Association plans for the future. Last, I want to inform our younger AAPM members of the New Member Reception from 4 – 5:30 PM, immediately preceeding the Annual Business Meeting. This reception is an opportunity for our student and junior members to meet the leadership of the Association and to be introduced to the AAPM’s organization and committee structure. It is, additionally, an opportunity for the present leadership to begin to cultivate our younger members as leaders for the future.

Undergraduate Physics Students Per my column in the March/ April Newsletter, I am concerned about the approaching manpower shortage in medical physics. At a recent meeting with American Institute of Physics (AIP) officials at the AAPM Headquarters, I learned about a subset of one hundred and twenty undergraduate Society of Physics Students

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(SPS). Each of these students has already indicated an interest in medical physics as a potential career path. I have asked the Regional Organization Committee Chair, Rene Smith, to divide this list of students into geographical area and assign local AAPM chapter members to become medical physics mentors for each of the students. The concept would be for the mentors to take these students to lunch, invite them to visit their clinics and/or laboratory areas, and to discuss with them the many benefits of a professional career in medical physics. This should not be a onetime courtesy meeting but a series of ongoing interaction and dialogue until the student completes his/her undergraduate degree. My firm intuition is that an interested undergraduate student will become an excited graduate student. This mentoring would be an effort to impact our profession one student at a time. Stay tuned for more information concerning this program beginning in fall, 2001.

HQ Site Visit On March 1-2, the Headquarters Site Review Committee visited the newly remodeled and expanded AAPM Headquarters office in College Park, Maryland. The Site Review Committee, chaired by Bruce Curran, will submit its final report to the Executive Committee; EXCOM will submit the (See Coffey - p.4)


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Coffey (from p. 3) committee report and subsequent recommendations to the Board at the Annual Board Meeting in July. As an ex-officio member of the Site Review Committee, the committee’s and my opinion is that the HQ staff, operations, and facilities are under excellent management by Sal Trofi, executive director and Angela Keyser, deputy executive director. As AAPM members you should be proud of our Association’s Headquarters operations and its services offered to the membership. Take the opportunity to express your appreciation to our excellent staff at the Annual Meeting.

Long Range Planning On April 7-8, selected leadership of the AAPM met in Washington, DC for the annual Long Range Planning (LRP) Meeting. This year’s meeting followed the structure and format initiated last year by thenPresident Ken Hogstrom. This year the LRP meeting was led by a consultant facilitator, Jim Dalton. Mr. Dalton led those in attendance in several “think tank” sessions to consider who the Association seeks to serve. The answers included AAPM members (diagnostic and therapy and clinical and research), our patients, local and national health care colleagues, administrators and regulators, and our industry and technology representatives. Through-

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out the weekend, Jim challenged us to continue the implementation of last year’s objectives and to also determine the top five issues that will face the organization in the next three to five years. Those issues, as determined by the attendees, include economics (clinical and research funding dollars), increasing regulatory issues, new technological advances in the medical sciences, medical physics manpower issues, and medical physics professional concerns. In an afternoon meeting, the group was split into five breakout sessions that included the three Councils – Science, Education, and Professional, the Administrative Committee chairs, and an ad hoc group interested in the new biomedical imaging institute (NIBIB). Each breakout group was given the assignment to define the strategies and objectives it wanted to specifically pursue for the Association in the next two to three years. Members of each breakout group were further challenged to establish programs and opportunities to carry out the strategies and to complete the objectives that would result in the AAPM reaching its stated mission. (The AAPM Mission Statement can be found in the Membership Directory on pages 4647.) The LRP Report will be presented to the Board by EXCOM at the July Board Meeting. Look for the creation of two presidential ad hoc com-

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mittees before summer, 2001: Promotion of Diagnostic Imaging Physics within the AAPM and the Recruitment of Undergraduate Physics Students into Medical Physics.

Intravascular Brachytherapy A recent intravascular brachytherapy (IVB) summit meeting was held with the executive leadership of the American College of Cardiology, the Society for Cardiac Angiography and Interventions, ASTRO, and the AAPM in attendance. Items of discussion included the roles and responsibilities of the intravascular brachytherapy team members, the content and format of training for IVB team members, and the continuing need for IVB research on the radiation response of cardiovascular tissues to radiation. The four represented societies agreed to publish a white paper on the roles and responsibilities of the intravascular brachytherapy team members by mid-year. A task group with representatives from each discipline will prepare a document on the scope, course content, and financial concerns necessary for the introduction of educational and training materials for intravascular brachtherapy. Three AAPM members from the Intravascular Brachytherapy Subcommittee will be appointed to serve on this cooperative task group effort.


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At the recent Trilateral Meeting in Washington, DC on April 7-8, committee members discussed the recommendations resulting from the summit meeting and other issues associated with intravascular brachytherapy clinical procedures. As your president, I was asked to remind AAPM members and the medical physics community of the following issues: (a.) the medical physicist is a recognized member of the intravascular brachytherapy team, (b.) the medical physicist is re-

sponsible for the radiation safety and source calibration, storage, and inventory and must be present for each IVB procedure, and (c.) the clinical application of an IVB device must be for “Labeled Use Only.” With regard to (c.), the intravascular brachytherapy medical physicist should read and understand the interpretation of “Labeled Use” versus “Off-labeled Use” documented in the radiation license for IVB device use. The medical physicist should further determine the applicability of any specific

Place Standard Imaging Ad Here (You have received new film directly from them.)

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IVB treatment procedures associated with site-specific institutional Investigational Review Board (IVB) approved clinical research protocols.

Capitol Hill Visits On April 9-10, the AAPM initiated what is hoped to become a continuing effort – the medical physics influence on Capitol Hill. This initial government relations meeting was led by Michael Gillin , chair of the Professional Council and Angie Furcron, the AAPM (See Coffey - p. 6)


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Coffey (from p.5) government relations manager. The meeting was concluded with its twenty attendees visiting the congressional aides and staff persons in the offices of their representatives and senators. Realizing that a visit only is not sufficient, each attendee was asked to write follow-up letters to their respective senators and representatives. You ask, “Can so few affect a change?” We are hopeful that this is just the beginning and that we can solicit a majority of Association members to participate in similar efforts. You ask, “Need I visit DC to be effective?” You can be effective by meeting with your congressmen and/or representatives in your home district. Additionally, letter writing (not e-mail) is very influential in getting the AAPM message heard. Quality assurance in medicine was the message that each of us presented to our congressional representatives. Our quality assurance concerns were echoed in three legislative areas: the Consumer Assurance of Radiologic Excellence Act (Care Act), the Assure Access to Mammography Act of 2001, and 2002 appropriations support for the newly created National Institute of Biomedical Imaging and Bioengineering. Contact Angie Furcron at AAPM Headquarters for further information concerning these quality assurance in medicine concerns.

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Watch for future articles in the Newsletter for letter writing format and content.

Committee Appointments for 2002 Bob Gould has requested that I remind you of his call for volunteers for AAPM committee appointments for 2002. Those of you who are interested in serving the Association in this manner are asked to contact HQ and complete a volunteer information sheet. Last year approximately 50 committee appointments were made through this process. If you have not previously served on an AAPM committee, I would highly suggest that you attend your committee(s) of choice this year at the Annual Meeting, introduce yourself to the chairperson, and inform him/ her of your interest to serve on the committee. I personally look forward to the opportunity to meet and greet each of you at one of the many great scientific and social events planned at the Annual Meeting. See you in Salt Lake ■ City.

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Education Council Report G. Donald Frey, Chair Charleston, SC I am pleased to report that the AAPM has signed an agreement with DigiScript to host AAPM continuing education activities on the Web. Representatives from DigiScript will attend our annual meeting in Salt Lake where they will capture many of our refresher courses, continuing education courses and the presidential symposium. Shortly thereafter these educational materials will be available on the Web for viewing and for continuing education credit. The AAPM Board approved this program at the RSNA meeting in December 2000. An ad hoc committee reviewed the various offerings and recommended to EXCOM that the AAPM should select DigiScript. Following EXCOM’s approval, the contract was signed. The AAPM content will be available without charge to the members through the end of 2001. Continuing education credit will be available through the AAPM’s RDCE program. If you want a taste of DigiScript’s work, visit their Web site at www.Digiscript.com. I wish to that thank the members of the ad hoc committee (Charles Coffey, Melissa Martin, Russell Ritenour and Martin Weinhous) for their efforts. I also appreciate the efforts of

the many members of the AAPM staff that worked to support the program. The program will put extra strains on Education Council Task Group 1 and the RDCE Subcommittee. Please consider volunteering as a reviewer for these two committees. Are you struggling with getting your radiography, therapy or dosimetry students to understand physics concepts? Are you tired of seeing students nod off during your lectures? Are you fed up with trying to reach students that just don’t “get it,” even after they’ve attended your lecture? If you are facing these same problems that many of us have to deal with, you should be sure to attend the Education Council Symposium at the Annual Meeting. The title for the symposium is: “Techniques for Teaching Medical Physics to Allied Health Professionals.” Beth Schueler is organizing it. The objective of the symposium is to provide physicists who teach allied health professionals with an introduction to two current teaching methodologies: active learning and WWW distance learning. The session will include specific examples of the application of these methods to teaching medical physics principles as an alternative to a traditional lecture format. Speakers include Eugene D. Frank, RT(R) FASRT, director of the

Mayo Clinic Radiography Program and Arthur L. Boyer, Ph.D., Stanford University School of Medicine. Mr. Frank will discuss active learning strategies, including justification for the technique and specific applications to teaching physics principles to radiologic technologist students. Dr. Boyer will discuss distance learning by the Web for dosimetrists. Because of the new schedule at the Annual Meeting the symposium will run from 9:00 until 10:30 AM on Sunday. Another important new program for your society is the summer fellowship program. The AAPM discussed the problem of attracting promising new students into medical physics at the Long Range Planning Meeting in 2000. It was decided that a summer fellowship program for undergraduate students could be helpful. The Board approved the program at the RSNA (See Educ. Council - p. 8)

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Educ. Council (from p.7) meeting. A subcommittee of the Education and Training of Medical Physicists Committee administers the program. Ken Hogstrom and Paul DeLuca have worked very hard to get this program operational in a short time. Check the AAPM Web site for more details. This year’s Summer School, “Accreditation Programs and the Medical Physicst,” will be held from June 24-28 at the University of Washington – Seattle. Summer School registration is ahead of projections and the school may sell out. If you are planning to attend you should register as soon as possible. Another service the AAPM provides for the membership is the Annual Physics Review Course. This one and a half day educational track is presented just prior to the Annual Meeting. It is a wonderful vehicle for newer physicists to review and refresh their medical physics education. For the more experienced physicist, the review is a way of staying current in areas that we are less active in. By the time you receive this newsletter you should have received a mailing about this year’s course. There are diagnostic and radiation oncology tracks. Mark Rzeszotarski is the overall director. The Education Council and its many committees and subcommittees are always looking for AAPM members would are willing to help us with our en-

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deavors. If you have any interest in educational issues I would encourage you to attend any of the committee meetings at Salt Lake. If you like what you see, introduce yourself to the chair of the committee and

tell him/her that you would like to help with the committee work. It is only because members volunteer for committee work that the Association can serve the needs of the members. ■

Long Range Planning Committee Report NIBIB Breakout Session Paul Carson Kresge, IL The Long Range Planning breakout group on AAPM responses to the formation of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) met in three sessions on April 7-8. The interests of the AAPM in imaging sciences were the major topic. We are in a good position to contribute to a successful initiation through our unique involvement in each of the umbrella organizations that led to the establishment of the NIBIB. Immediate issues in the NIBIB formation period include: •Solicitation of nominations for a NIBIB director, search committee, advisory council, and other potential NIBIB staff. John Boone will head the nomination/enlistment effort. •The inclusion of NIBIB funding issues in the congressional lobbying/advocacy workshop on April 9-10 was applauded.

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•Communication with membership will include NIBIB-related sessions initiated by Phil Judy for this summer’s Annual Meeting. •Training needs for imaging science should be addressed, as training is part of NIBIB’s existing mandate. A proposed white paper was drafted by Geoffrey Clarke. A science council, NIBIB Initiation Task Group, was recommended to address the above broad range of tasks. In the long term we need an AAPM structure and effort that can better address the issues of imaging research and clinical practice, as well as grow to support scientific meeting and training initiatives. We recommend that the president appoint an ad hoc committee to review an Imaging Sciences Council and other approaches and recommend changes to achieve the above mentioned goals. ■


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Executive Director’s Column Sal Trofi College Park, MD

immediately proceeding the 2001 AAPM Annual Business Meeting. This session is intended to introduce any interested member to both the organization of the Association, and to its officers and representative senior members.

2001 AAPM Annual Meeting The 43 rd AAPM Annual Meeting will take place July 2226, 2001 in Salt Lake City, Utah. Registration and housing information is available on the AAPM Web site. Register by June 15 to receive discounted registration fees. Make sure to visit the AAPM Web site to review the most up-to-date Annual Meeting information. Abstract submissions for the 2001 meeting were up approximately 7% from the 1999 year. Scientific Program Director Eric Klein, Co-Director Andrew Maidment and Education Director Bob Gould have put together an excellent scientific and educational program. The full program, including abstracts and supporting information, is available online. Over 100 companies have contracted for exhibit space. The AAPM appreciates the continued support from our Corporate Affiliate Members and other vendor companies. A searchable 2001 Annual Meeting Buyer’s Guide is available on the Web that allows you to view the floor plan, search for specific product lines and product focuses and view a description of each exhibiting company. Please schedule time to

2001 Summer School visit the exhibit show floor. The AAPM will be using seven hotels in Salt Lake City. Make your hotel reservations via the Web by June 18. The Headquarters property is the Salt Lake City Marriott Downtown. The Companions’ Hospitality Suite will be in the headquarters property. The headquarters office, all committee meetings, sessions, and exhibits will all be held in the Salt Palace Convention Center, 100 S. West Temple, directly across from the headquarters hotel. NEW THIS YEAR – The exhibit hall will open on SUNDAY from 12:30 – 5:30 PM. Also, the therapy poster sessions will be held on Sunday afternoon in the exhibit hall poster area from 1:00 – 5:00 PM. Make plans to arrive by Sunday to take advantage of the extra time to meet with the exhibiting companies and participate in the poster sessions. The Professional Council will be sponsoring a New Member Symposium on Wednesday, July 25 from 4:00 – 5:30 PM,

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The 2001 Summer School is scheduled for June 24-28 at the University of Washington in Seattle. The University of Washington is conveniently located about three miles north of downtown Seattle, on the northern shore of Lake Washington. Program Co-Directors Bob Dixon, Penny Butler and Wlad Sobol have organized the program entitled “Accreditation Programs and the Medical Physicist.” Local Arrangements Committee Co-Directors Sherry Connors and Steve Langer have organized a wonderful Night Out at Tillicum Village on Blake Island. Details and registration are available via AAPM Online at www.aapm.org. Registration closes on June 1. Housing reservations are being handled directly with the University of Washington and must be made by June 1. If you are unable to attend and would like to purchase the proceedings, contact Medical Physics Publishing at 800-442-5778. (See Trofi - p.10)


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Trofi (from

p.9)

Membership Directory While the printed version of the Membership Directory is easy to carry, unfortunately it is out-of-date soon after it is published. In a typical twelvemonth period, 24% of AAPM members change their mailing address, and another 26% change other demographic information. This means that about 50% of the membership changes some information in the directory between printings. I encourage you to visit the online AAPM Membership Directory when looking for your colleagues for the most accurate information. We recently added the ability to upload your photo to be included in your listing, and we are currently experimenting with ways to allow the export of data into popular address book formats. We are always interested in suggestions for improvement; please e-mail any suggestions you have to our new webmistress, Farhana Khan <farhana@aapm.org>. Over the past few years, we have made an effort to collect e-mail addresses from the membership. I am glad to report that we now have 91% of our members listed in the directory with an e-mail address. It is our thought that most of those without e-mail addresses on file have e-mail but have not informed Headquarters of their address. Headquarters plans to reach out to this population

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with a mail and fax campaign in an effort to raise this percentage. In some cases, correspondence between the Headquarters and members is less costly, quicker, and more efficient. Headquarters is very sensitive to the abuse of e-mail and understands that it could become a nuisance if overused. We have a policy of reviewing mass emails to members to insure against abuse.

Member Insurance Benefit The American Physical Society (APS) Insurance Trust was established in 1969 and began by offering Term Life Insurance to members of AIP member societies, including AAPM, in February 1970. Since then the program offerings have been expanded to include: Long Term Care, Term Life Plan, Hospital Indemnity Plan, Personal Accident Plan, Catastrophic Insurance, Medicare Supplement Insurance, Disability Insurance, and most recently 10 Year Level Term. The Insurance Trust continues to examine new programs to meet the long-term needs of its members. The official insurance broker for the APS Insurance Trust, HVF, Inc., works with insurance companies to provide the best possible combination of coverage, pricing and access. The HVF, Inc. staff is available to serve you from 9:00 AM to 5:00 PM (EST) by phone at 516-764-0050/800-272-1637.

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Other contact information follows; 119 North Park Ave., Rockville Centre, NY 115704179, fax: 516-764-0839, http:/ /www.hvfinc.com/, or e-mail: apsit@hvfinc.com.

Information Services (IS) News After the Chicago 2000 World Congress, a significant effort went into updating the AAPM Annual Meeting Online Submission system (AMOS). AMOS is a complete rewrite of the system used in 1999, which was an e-mail-based submission system. AMOS is a Webbased document upload system. Wait times for conversion dropped to 30 seconds, a significant drop from the five to ten minute times we saw in the previous system. AMOS worked flawlessly this year to accept the 562 regular abstracts submitted. The new system was easier to use by eliminating the e-mail component and adding an HTML upload function. Headquarters received only a fraction of the calls for help compared to those in 1999 or 2000.

Headquarters Site Visit (HSV) Every three years the AAPM president appoints a committee to study the Headquarters operations. The 2001-year HSV took place on March 1-2. The members of the committee representing AAPM were Bruce


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Curran, chair, Charles Coffey, John Hazel, Maryellen Giger, and Chris Marshall. As usual, an executive director from a related organization was also a member of the HSV team. This year that person was Frank Malhouff from ASTRO. The HSV Committee is in the process of writing their report and they plan to have the report ready for the Annual Meeting.

Staff News Hadijah Robertson replaced Farhana as a programs assistant. Hadijah worked for us last year as temporary help. Her performance was so impressive

that we immediately thought of her when this position became available. Luckily, she was willing to make a job change and came to work for us on March 5. Our applications developer, Mike O’Donovan-Anderson, has accepted a research position at the University of Maryland. His last day was March 30. Mike did some great things for us and he will be missed. Zailu Gao was hired on March 16 to replace Mike. Zailu was born and educated in China. He received a B.A. degree in English in 1992 from the Shandong University in Jinn, China. He received an M.S. degree in Applied Computer

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Science in 2000 from the Illinois State University in Normal, Illinois. There was a twoweek overlap between Zailu’s first day of work and Mike’s last day, which was used to bring Zailu up to speed with projects in progress. Kysha Marshall, our accounting assistant, resigned as of March 2, 2001. We are still in the process of looking for a replacement. We have temporary help filling the position in the meantime. Magda Renaud-Durham, our receptionist, is relocating to Florida with her family. Magda’s last date of work will be May 31. A search for her replacement began in April. ■

Government Relations Column Angela L. Furcron College Park, MD The first AAPM Capitol Hill meeting on Monday, April 9 and Tuesday, April 10 was a success. The conference was in Washington D.C. and was attended by 24 AAPM members. The first day consisted of information sessions that prepared participants to go to Capitol Hill on the following day. April 9th was primarily made up of panel discussions. There were government relation’s representatives from the American College of Radiology (ACR), the American Society for Therapeutic Radiology and Oncology (ASTRO), the Ameri-

communicate effectively with Congress. There was also a role-play that showed participants the most and least effective ways to communicate with their congressperson. The message that the AAPM took to Capitol Hill was that:

can Institute of Physics (AIP), the American Physical Society (APS), and the Academy of Radiology Research (ARR). The government relation’s representatives discussed how they interact with Congress on behalf of their members. They also discussed how members

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1.) medical physicists help to ensure quality care for patients, 2.) Congress should support the “Consumer Assurance of Radiologic Excellence Act of 2001” (CARE Act), HR 1011, which requires state licenses for practitioners of medical imaging and radiation therapy (except ultrasound), (See Gov’t. Rel. - p.12


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Gov’t. Rel. (from p. 11) 3.) Congress should support the “Assure Access to Mammography Act of 2001”, S. 548/HR1354, which bridges the reimbursement gap to insure that facilities continue to provide mammography services, and 4.) adequate funding for the National Institute of Biomedical Imaging and Bioengineering (NIBIB) is essential. There were several articles on the NIBIB in the last newsletter. In my last column I mentioned the 13 Final Rules from the Health Care Financing Administration (HCFA) that the Bush Administration had placed under a 60-day moratorium. These Final Rules are regulations that have been published in the Federal Register, but have not gone into effect. I reviewed the list of 13 regulations and found that none of them have any impact on the AAPM. I attended the HCFA Advisory Panel on Ambulatory Payment Classification (APC) Groups meeting on February 27, 28 and March 1. This panel consists of professionals from different areas of medicine who meet yearly to evaluate the APC groups. I would like to explain some basic concepts that may not be evident: APC Groups are the larger classification groups that contain smaller classification groups called Current Procedural Terminology (CPT) codes. The three medical physics CPT

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codes under APC 311 are 77336, 77370 and 77399. During the HCFA meeting, a representative from ASTRO suggested to the Advisory Panel “that APC 311 should be eliminated, reassigning its current CPT codes 77336 Continuing physics consult and 77399 External radiation dosimetry to APC 304, and 77370 Special physics consult to APC 305. The panel concurred with these recommendations and will present them to HCFA (ASTROgram #251).” I asked the Advisory Panel if CPT 77336 could remain where it is currently so that APC 311 could be preserved, but the Advisory Panel did not accept this recommendation. Here is how the proposed changes will affect reimbursement levels: APC 0311 - $65.46 Current amount for 77336, 77370 & 77399 APC 0304 - $73.90 Possible new amount for 77336 & 77399 APC 0305 - $201.36 Possible new amount for 77370 HCFA can accept, reject or alter the Advisory Panel’s recommendation. As of this writing, these codes have not been changed. The Proposed Rule from HCFA is due to be published this spring. Everyone who delivers services would agree that an increase in funding for APC 311

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is the most acceptable outcome, but there are some fundamental problems within APC 311. All the codes violate the “times two rule.” The “times two rule” says that no CPT code can be two times more than any other CPT code under the same APC. Under the current APC 311, CPT 77399 has a median cost which is two times more than 77370, and 77336 has a median cost that is two times more than 77370. One or two codes need to be removed from APC 311 and placed in an APC with a higher reimbursement rate. As many of you know, 77370 takes approximately 4.0 hours to perform and 77336 takes approximately 1.5 hours to perform. It seems to be inappropriate to reimburse these two CPT codes at the same level. The Bush Administration’s detailed budget was released on April 9, I am still deciphering it. I will give you all the highs and lows in my next article. One known fact is that the National Institutes of Health did indeed receive a significant increase. Its budget was increased by $2.75 billion or 13.5%. ■


AAPM NEWSLETTER

MAY/JUNE 2001

Attrition Clauses How they Affect the Annual Meeting Attrition Clauses Bruce Curran,Chair Annual Meeting Coordination Committee Attrition Clauses? Probably not a term you have heard unless you were a member of the Organizing Committee for the 2000 World Congress. However, they now affect most of our upcoming AAPM Annual Meetings, as well as other scientific, educational, or professional meetings we are likely to attend. And the result of such clauses can significantly affect the balance sheets for the meeting and for the AAPM at-large.

What are Attrition Clauses? When HQ and the Annual Meeting Coordination Committee (AMCC) book a city for an Annual Meeting, we normally reserve a number of rooms at one or more hotels. The more rooms we book, the better the rates we receive, not just from the particular hotel, but also from the convention center and other facilities we might need during the meeting (bus service, etc.) Rooms are reserved for each night of the meeting, usually starting the Friday before the meeting starts and ending the Thursday evening after the meeting. We also try to book just enough

rooms so that all persons attending the meeting will be able to reserve rooms up to the registration deadline. In previous years, societies were not penalized for overbooking, as long as the rooms were freed by the society several months before the meeting (hence the advance registration deadline). In addition, hotels share information on the rooms booked and attributed to the society so that societies could not overbook a large number of rooms. The hotels knew what was a reasonable number. This “free� overbooking is no longer allowed by hotels today. At the end of the meeting, each hotel adds up the total of roomnights (the sum of the number of rooms used each night) and compares this to the number of room-nights promised by the society (usually four to seven years in advance). If the society has overbooked these nights, it is liable to pay the hotel for the nights unused. This fee can be quite large; be-

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fore negotiation, it was nearly $1,000,000.00 for the 2000 World Congress.

What Causes Lost Room-Nights? Typically the AAPM sells out its booking for the Annual Meeting. What this means is that, as of the registration deadline, each hotel has received sufficient reservations to fulfill the quotas agreed to between the AAPM and the hotel. Often, in fact, we do not have sufficient rooms, and must negotiate for additional rooms, hoping that the hotels have not sold those rooms to non-AAPM guests. What happens, then, that results in attrition clauses being invoked? There are two common actions that can cause attrition clauses to become active. The first of these are people who cancel reservations after the deadline. While sometimes unavoidable, this may have forced other individuals to make reservations outside the AAPM room block, or to use an alternate hotel. In either case, the reservation then drops the number of credited room nights. If a sufficient number of individuals cancel, the attrition clause may come into play. The second type of attrition action results from individuals who


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book a room for the entire period, then leave early or arrive late. Although they have, in fact, used their reservation, they have reduced the number of room-nights booked which can result in attrition fees.

have normally ‘sold-out’ at the current number of rooms, many members will find themselves unable to reserve a room, particularly in some of the more popular cities.

As a society, the AAPM depends upon the Annual Meeting to produce a sufficient amount of revenue to support many of its programs. (The Annual Meeting is one of three significant revenue sources, the other two being dues and the Journal.) Obviously, a large attrition penalty could significantly affect the profitability of the Annual Meeting, and result in some programs being un- or under-funded for the year. To prevent attrition fees, the obvious answer is for HQ and the AMCC to reduce the number of room-nights booked for the Annual Meeting. Unfortunately, this can result in increased costs to the AAPM and to the attendees for the meeting, as well as some inconvenience. Based on the number of rooms in the block, other facilities in the hotel (meeting rooms, banquet space, complimentary rooms, etc.) are made available to the AAPM for little or no cost. As the number of room-nights is reduced, rates for that space, as well as the rates offered to attendees, will rise. Additionally, since we

to be successful in negotiating good contracts for the association for the Annual Meeting, and the AAPM will be able to maintain the programs and activities that you have requested. ■

How Can You Help? What Can the AAPM Do to Prevent Attrition Fees?

JANUARY/FEBRUARY 2001 MAY/JUNE 2001

There are a number of things you can do to help prevent the society from incurring attrition fees. These include: •Book your room reservation early and as accurately as possible. We recognize that unforeseen conditions may alter plans, but the earlier you let the hotel know of changes, the more likely it is that another member will be able to fill the nights you cannot be present. •Use the AAPM reservation service. The more individuals who book within the AAPM block, the better our rates will be, and the less we will be charged for use of meeting rooms, etc. In addition, Annual Meeting registration fees for each year are based on results from the past one to three years’ results. If we need to budget attrition fees and other costs into the registration fee, it will rise. The higher the percentage of attendees who use the hotel registration service, the better we will be able to accurately book room blocks for upcoming years. With your cooperation, the AMCC and HQ will continue

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AAPM NEWSLETTER

MAY/JUNE 2001

AAPM/IOMP Report International Scientific Exchange Program Workshop in Bangladesh Azam Niroomand-Rad, IOMP V.P. & ISEP Chair Washington, DC, and M. Saiful Huq Philadelphia, PA The 11th AAPM / IOMP oneweek Workshop in Radiation Therapy Physics was held successfully at Bangladesh University of Engineering and Technology (BUET) in Dhaka, Bangladesh, from January 29 – February 2, 2001. The workshop was sponsored by the AAPM International Scientific Exchange Programs (ISEP) and the International Organization for Medical Physics (IOMP) Education and Training Committee. The workshop was co-sponsored by the Bangladesh Medical Physics Association (BMPA), Bangladesh University of Engineering and Technology and Delta Medical Centre Ltd. The program was organized by the Department of Physics, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh. The objectives of this workshop were to discuss the fundamentals of the physics of radiation therapy, to present the current status of treatment of cancer patients using state of the art treatment technology to the clinical physicists and radia-

tion oncologists, to intercompare calibration of photon and electron beams using the IAEA and the AAPM TG-51 protocols, and to exchange information concerning the medical physics profession in Bangladesh. Dr. Gias uddin Ahmad, professor of physics, BUET and president of the Bangladesh Medical Physics Association, was the host director and codirector of this program. The AAPM faculty were: Drs. Faiz M. Khan, Bhudatt R. Paliwal, Nagalingam Suntharalingam, LeRoy J. Humphries, M. Saiful Huq and Theodore Thorson. In addition, two faculty members from Germany and The Netherlands (Dr. K.H. Hoever and Dr. P.H. van der Giessen, respectively) attended the workshop. There were 72 participants; 71 from Bangladesh and one from Nepal. The participants included medical physicists, radiation oncologists, teachers, scientists and researchers. The program began with a welcoming address by Professor Abu Hashan Bhuiyan, head of the Physics Department, BUET and was officially inaugurated by Professor Nooruddin Ahmed, vicechancellor, BUET. A total of 39 copies of the book, The Physics of Radiation

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Therapy, written by Dr. F. M. Khan, with author’s discount, were also donated for distribution among participants and institutions which officially sent participants to the workshop. Certificates of Appreciation and Certificates of Participation were presented to the faculty and the participants. The certificates were signed by Drs. Charles W. Coffey, AAPM president, Azam NiroomandRad, AAPM ISEP chair, and vice president of IOMP, Oskar Chomicki, president of IOMP, and Gias uddin Ahmad, president of the Bangladesh Medical Physics Association. In the closing ceremony Drs. Gias uddin Ahmad and M. Saiful Huq highlighted the main features of the workshop and discussed the future activities of the medical physics profession in Bangladesh. Dr. Huq discussed the possibility of establishing a state of the art cancer treatment facility in Bangladesh and asked the local radiation oncologists and medical physicists to assume leadership in the creation of such a facility. The closing speech was delivered by Professor Nooruddin Ahmed. After the concluding ceremony, the faculty and the participants were taken on a sight-seeing tour of the national memorial


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at Savar, Dhaka. The drive through rural Bangladesh was quite enjoyable. The local expenses of the faculty were supported by the host institution and their travel expenses were financed by funds provided by the AAPM, the Medical Physics Foundation, and vendors. Corporate Sponsors (+$1,000) were Computerized Medical System (CMS), Elekta Oncology System, Medical Physics Foundation, Nucletron Corporation (USA), SSGI / Prowess Systems, Siemens Medical Systems, and Varian Oncology Systems. Contributors ($100-499) were DIACOR, HUESTIS, and Standard Imaging. Various institutions came forward with generous contributions to help meet the expenses for local hospitality. BUET led the way in this gesture by making a generous contribution to meet the local expenses of the faculty. Besides, it provided all the physical facilities needed to hold the workshop, including full-time transportation for the faculty. Professor Nooruddin Ahmed hosted a dinner on the evening of January 29, 2001 to meet the faculty and the participants. Delta Medical Centre Ltd. helped the organizers in a big way. It made a generous contribution and provided one day’s lunch for the faculty and the participants. It also placed its facilities at the disposal of the organizers for the practical session. Generous contribu-

tions were also made by Siemens Bangladesh Limited, Globex Marketing Company Ltd., Projukti Service Limited, Popular Diagnostic Center Ltd., Ad-Deen Hospital, Gono Bishwabidyalay, National Medicare, Xylia limited, AQ Chowdhury and Co. Pvt. Ltd., Natasa Corporation Ltd., Bangladesh Industrial X-ray, Mardel Agencies, Motherland Corporation, M/S. Gram Bangla Traders and Comfort Diagnostic Center. We are grateful to these organizations and companies for their generous support. We would like to place on record the total commitment and effort of Dr. Gias udddin Ahmad and the members of the organizing committee, particularly those of Dr. Abdus Sattar Mollah, Dr. S. R. Husain, Dr. Fatema Nasreen, Professor M.A. Zaman, and Mr. Jahangir Alam for organizing this workshop with such short notice. The workshop provided an excellent opportunity for interaction among the medical physicists and also among the physicists and oncologists. It also served to forge an unforgettable friendship among the faculty and the participants. We would also like to thank the AAPM faculty as they volunteered their time and effort in â– this endeavor.

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JANUARY/FEBRUARY 2001 MAY/JUNE 2001


AAPM NEWSLETTER

MAY/JUNE 2001

Announcements ACR Physics Symposium

The 18th Annual ACMP Meeting

The American College of Radiology (ACR) is holding a Physics Symposium entitled “Clinical Implementation of the AAMP TG-51 Protocol” on Friday, July 20th, immediately preceding the 2001 AAPM Annual Meeting. The Symposium will grant up to four hours of Category 1 or MEPS credit. The full program, faculty list, and registration form can now be downloaded via the internet. You can access the information on the ACR Web site at www.ACR.org, or <http:// www.ACR.org>. For further information, please call the ACR at (800) 227-5463, extention 4245.

The 18th Annual American College of Medical Physicists (ACMP) Meeting will be held in Hershey, Pennsylvania from June 2-7, 2001. “Practical Considerations for Establishing and Maintaining a Clinical IMRT Program” and “Digital X-Ray Imaging” are the topics. The workshops will be held June 4 and 5. Both will contain practical information for the practicing medical physicist. The Mammography Symposium, satisfying MQSA requirements for continuing education for medical physicists, will be held on the morning of June 6. The Professional Symposium on June 6-7 will include “Credentialling, Education and Billing for Medical Physicists.” 19 hours of MPCEC has been applied for. Program and registration materials are on the ACMP Web site: www.acmp.org.

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AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2001

Kennecott Copper Mine

43rd AAPM Annual Meeting and Technical Exhibition July 22 - 26, 2001 Salt Lake City, Utah Visit AAPM Online at http://www.aapm.org for information, registration and housing for the meeting – Register by June 15 to receive a discounted registration fee! The HOUSING RESERVATION DEADLINE is June 18.

Silver Lake at Brighton

New in 2001!! •The Exhibit Hall will be open on Sunday, July 22 from 12:30 - 5:30 PM. This is a dedicated time to visit the Exhibit Hall. •All Therapy Poster Sessions will be held on Sunday, July 22 from 1 - 5 PM. 19


AAPM NEWSLETTER

MAY/JUNE 2001

Letter to the Editor The Professional Accomplishments of the AAPM Don Tolbert Honolulu, HI and Geoff Ibbott Houston, TX The following is a response to an invitation by Bob Dixon (Nov/Dec AAPM Newsletter) to list some of the important accomplishments of the AAPM that have served the medical physics community. The authors served consecutively as chair of the AAPM’s Professional Council from 1986 through 1998 and feel qualified to respond. First, we should supply a little history: The AAPM was formed as a professional society within the American Institute of Physics in 1958. Warren Sinclair, the AAPM’s second president, recalled that “we had thought of the AAPM as primarily a professional body, serving the professional interests of its members in the now distinct role of medical physics in a hospital environment. Initially we believed that there were already enough other scientific and medical societies providing scientific meeting programs and journals. Therefore, AAPM did not need to serve this role by adding a new scientific program and journal.” In 1965, the professional activities of the AAPM were formulated in the articles of incor-

poration and included: “…secure and maintain high professional standards… represent professional interests…” and other language confirming the professional nature of the Association. Concerns were raised as to whether AAPM professional activities could jeopardize the tax status of the American Institute of Physics. In response, the AAPM articles of incorporation were amended to maintain its status as a “charity” and to delete references to professional activities. Soon afterward, however, the AAPM’s legal counsel determined that AAPM was permitted to conduct a reasonable level of professional activities. The articles of incorporation were not revised a second time in order to avoid drawing the tax authority’s attention unnecessarily to the AAPM professional activities. As many members are aware, recent advice from our legal counsel indicates that the AAPM can conduct a range of professional activities without jeopardizing its tax status. In 1973, the AAPM formed its Professional Council. The Quarterly Bulletin reported that “after a year of investigation and controversy, the AAPM Board of Directors at the San Diego Annual Meeting made the decision to deal more ex-

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tensively with professional matters within the AAPM. As a result, President Tanner appointed the Professional Council….” The committees of the Professional Council included Professional Information, Insurance, Legislation and Regulations, Clinical Relations, and Ethics. Now, to address Bob Dixon’s challenge, the professional activities of the AAPM during the last decade have included: 1.) Moving from partial to full sponsorship of the ABR; 2.) Participation in the Trilateral Committee, consisting of the AAPM, the ACR Commission on Medical Physics, and the American College of Medical Physics (ACMP) and involving three meetings each year; 3.) Publication of an annual professional (salary) survey; 4.) Regular and frequent comment on regulatory actions (these usually have been described in the AAPM Newsletter and on the Web page); 5.) ACMP and AAPM commissioning of a study of medical physics practice by Abt Associates. This study has been referred to widely and has been of great value to clinical medical physicists; 6.) Maintenance of a placement service, now available


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online as well as via the familiar “blue pages”; 7.) Development of a professional insurance program for AAPM members; 8.) Regular contact since 1978 with the Joint Commission on Accreditation of Health Care Organizations (JCAHO) to provide information on essential and scientific roles of medical physicists. Our efforts have resulted in the specific inclusion of medical physicists in a number of “examples of implementation,” published in the JCAHO comprehensive accreditation manual for hospitals. Medical physicists have significantly greater recognition by the JCAHO as a consequence. The AAPM has played a significant role in ensuring appropriate compensation for medical physics clinical practices. Medical physicists participated in the development of the first relative value scale for radiation oncology developed in the early 1970’s. Since then, medical physicists have participated in refining the RVS, and in contributing to the development and justification of new charge codes. Close and frequent collaboration between the AAPM and the American College of Radiology has ensured that medical physicists have been members of the various economics committees of the ACR, and have contributed to the maintenance and development of charge codes. In addition, medical physicists repre-

senting the AAPM have on several occasions visited the Health Care Financing Administration (HCFA) to ensure that our concerns are heard regarding the physics, radiology, and radiation oncology charge codes. Additionally, the AAPM has participated in AIP Society Officer meetings since 1965, and since 1973 has participated in the Council of Scientific Society Presidents. Both of these groups contribute to developing a constructive national science policy for the United States. Since 1976, the AAPM president has periodically formed ad hoc strategic planning task groups. In part, these tasks groups have addressed the professional interests of AAPM members. Recommendations from the 1995 strategic planning task group, and the outcomes, included: 1.) Develop and approve a mission statement for the AAPM (this has been completed); 2.) Re-evaluate the size and composition of the AAPM Board of Directors (completed); 3.) Ensure greater participation by younger members (several actions have been implemented to achieve this); 4.) Develop a strategy for increasing medical physicist participation in AAPM chapters (under way); 5.) Identify effective mechanisms for representing member

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JANUARY/FEBRUARY 2001 MAY/JUNE 2001

interest in the formation and promulgation of government policies and regulations (completed); 6.) Further develop professional activities and work cooperatively with other organizations to this effect (under way). In recent years, the ad hoc task group has been replaced by an annual strategy-making workshop, the most recent of which was held in early April. At this workshop, the leadership (consisting of EXCOM, selected council and committee chairs, and certain other members) meets to develop strategy for carrying the Association forward. The AAPM has made numerous other contributions in the scientific and educational arenas that are not addressed here. Bob suggested we list five professional accomplishments, and we have gone somewhat beyond that. Still, we hope we have made the point that the AAPM has contributed substantially to the professional needs of the medical physics ■ community.


AAPM NEWSLETTER

MAY/JUNE 2001

Letter to the Editor Time to Merge? Peter R. Almond Houston,TX Perhaps the time has come for the Medical Physics Community in the United States to take a cue from corporate America where mergers are constantly taking place. This is done to ensure stockholders a reasonable return on their investment and to provide better products and services at competitive prices. Mergers allow this to be done by increasing efficiency and effectiveness in a single organization as compared to two. In a merger, regardless of the relative size of the two companies, the best of both groups are combined to make an even better organization and often a new name for the combined company is used. Mergers don’t just happen, they come about after long periods of discussion and negotiation to ensure that the interests of both parties are considered. So perhaps the time has come for the American Association of Physicists in Medicine and the American College of Medical Physics to start talks about a possible merger. This could result in a better return for the members (stockholders) on their investment (dues) and in providing better products (service to the medical community). One of the main reasons for forming the ACMP was to have

an organization (run by medical physicists) aware of and to promote the professional concerns of medical physicists. Membership in the AAPM, as a scientific and educational society, was and is open to anyone with certain academic qualifications who is interested in medical physics. The ACMP has stricter membership requirements and is open only to those physicists who meet professional medical physics qualifications and who are actively engaged in the practice of clinical medical physics. At the time the ACMP was formed it was believed that these two activities of scientific and professional concerns could best be undertaken in separate organizations because of tax laws and other considerations. After 20 years it may be wise to revisit these issues and to see if a merger would be of benefit to all medical physicists. Some insight may be gained from recent actions by the In-

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stitute of Physics (IOP) in the United Kingdom. The IOP has just approved changes in its chartered physicist qualifications in order to separate it from ordinary membership. This was done to raise the professional status of the “chartered physicist” membership, which now requires a minimum of a master’s degree and five years’ professional experience. Approved chartered physicists may use the initials “CPhys” after their name. At the same time the IOP simplified the criteria of their member category “MinstP.” In order to recognize those medical physicists who for the majority of their time are actively engaged in clinical medical physics and who have appropriate board certification, a “Certified Clinical Medical Physicist” (CCMP) membership category could be established by the AAPM. It could further be required that the Professional Council and Professional Council Committee chairpersons be CCMP members and that a simple majority of the membership of the council and its committees be CCMP members. Such an arrangement would give a strong voice in the AAPM to those members who are most concerned about and qualified to speak on professional matters without denying the right of non-CCMP mem-


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bers to be heard. Such a set-up would go a long way, I believe, in resolving the ACMP’s concerns. A bilateral ad hoc committee, equally represented by the ACMP and the AAPM, could thoroughly review the possibility of such a merger. If it looks feasible and desirable, an agreement of “Intent-to-Merge,” to be approved by both organizations, could be drawn up with a set time limit (e.g. two years) to work out all the details. Such a proposal, I believe, merits serious consideration at this time. ■

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JANUARY/FEBRUARY 2001 MAY/JUNE 2001


AAPM NEWSLETTER

MAY/JUNE 2001

AAPM NEWSLETTER EDITOR Allan F. deGuzman MANAGING EDITOR Susan deGuzman Please send submissions (with pictures when possible) to the editors at: e-mail: deguzman@wfubmc.edu (336)773-0537 Phone (336)716-7837 Fax 2340 Westover Drive, Winston-Salem, NC 27103 The AAPM Newsletter is printed bi-monthly. Next Issue: July/August 2001 Postmark Date: July 15, 2001 can I work here

Deadline for the July/August issue: June 15, 2001

Editorial Board Arthur Boyer Nicholas Detorie Kenneth Ekstrand Geoffrey Ibbott C. Clifton Ling Richard Morin

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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