AAPM Newsletter September/October 2001 Vol. 26 No. 5

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 26 NO. 5

SEPTEMBER/OCTOBER 2001

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

Annual Meeting Arrangements The Annual Meeting in Salt Lake City was a tremendous success. Our thanks go to the Salt Lake City Local Arrangements Committee under the leadership of Grant Gullberg and Pegge Stanley for their hospitality and social events planning, to the Scientific Program Director and Co-Director Eric Klein and Andrew Maidment, and Education Program Director Bob Gould for an excellent scientific and educational program, and to our AAPM Headquarters staff for the advance planning and on-site coordination and problem-solving that contributed to an excellent meeting. I am reminded again of the significant number of volunteers and the countless volunteer hours that are required to make our Annual Meetings successful. We thank you and salute your efforts. Clear you calendars now and plan to join us for next year’s Annual Meeting in Montreal, July 14-18, 2002.

ABR/ABMP Working Agreement During the President’s Report at the Annual Board of Directors Meeting on July 26th, I was given the exciting opportunity and special privilege to announce the ABR/ABMP Working Agreement. This agreement document (available on the AAPM Web site) was the culmination of many weeks and months of negotiations between physics representatives of the two certification boards.

The chief negotiators included from the ABR, Bill Hendee, Bhudatt Paliwal, and Guy Simmons, and from the ABMP, Ben Archer, Ken Hogstrom, and Larry (See Coffey - p. 5)

Ravinder Nath Receives William D. Coolidge Award AAPM’s highest honor is presented to a member who has exhibited a distinguished career in medical physics, and who has exerted a significant impact on the practice of medical physics.

This year’s William D. Coolidge Award goes to Ravinder Nath, Ph.D. Ravinder Nath received his Ph.D. degree from Yale University in 1971. He came to the (See Award - p. 4)

TABLE OF CONTENTS President’s Column p 1 Coolidge Award p 1 ABR/ABMP Agreement Letters pp 2,3 Treasurer’s Note p 7 Chairman’s Column p 7 Exec. Dir’s. Column p 10 Gov’t Rel. Column p 11 Awards, & . . . pp 12-13 Announcements pp 14-16 New Members pp 17-19 Letters pp 20-24

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The following letters announce the Working Agreement between the ABR and the ABMP. A copy of the agreement is currently available on the AAPM Web site at http://www.aapm.org/announcements/abrabmp.pdf. A copy of the agreement will also be printed in the next issue of the Newsletter.

–Allan F. deGuzman, Editor

ABR Announcement of the Agreement Between the ABR and ABMP William Hendee Bhudatt Paliwal Stephen Thomas The Physics Trustees The American Board of Radiology The American Board of Radiology (ABR), in keeping with its mission and that of one of its sponsoring organizations, the American Association of Physicists in Medicine (AAPM), has entered into an agreement with the American Board of Medical Physics (ABMP). This agreement embodies and describes the intent of the ABR and ABMP to eliminate competition in the board certification process and to work cooperatively to achieve shared objectives with regard to certification of medical physicists. Specific terms described in this agreement represent the initial objectives of cooperation between the parties; cooperation will continue towards the goal of continually improving the certification of medical physicists after the initial objectives have been achieved. The parties acknowledge that the spirit of cooperation evidenced in this agreement represents a long-sought

goal that supports the public interest and the professional standards of medical physics.

Specifically, the following related items are addressed in the agreement: ·Certification of new candidates in traditional fields of medical physics ·Certification of candidates in traditional fields of medical physics who are currently in the process of obtaining ABMP certification ·Certification in non-traditional fields of medical physics ·Certification equivalency for ABMP Diplomates ·Recertification of ABMP Diplomates ·Formation of a Medical Physics Certification Advisory Committee with equal representation by ABMP and ABR The agreement between the boards has been the outcome of a long and often challenging negotiation process. During the last six years several senior members of the two boards, and officers of the AAPM and ACMP, tirelessly pursued the goal of reconciliation to establish non-competing certification. The existence of competing certification boards often 2

created division in the medical physics community and diverted energy from the pursuit of professional, educational and scientific activities.

The final agreement is a result of several meetings and communications between the ABR Trustees and representatives of the ABMP Board. It also has the approval of the entire membership of the two boards. The ABR physics Trustees wish to recognize the ABMP physics representatives for their cooperation throughout the negotiating process. We also thank the AAPM and its president, Charles Coffey, for hosting the meetings of the two boards’ representatives and for continued encouragement and support throughout the process.

The ABR Physics Trustees sincerely believe that the agreement is a fair and very thoughtfully articulated document. This agreement is an important major step forward in establishing a constructive methodology to deal with issues (if any) in the future between the ABR and the ABMP. We also believe this achievement paves the way for greater and unified support for strengthening the credentialing ■ of medical physicists.

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ABMP Announcement of ABR-ABMP Working Agreement at AAPM Board of Directors Meeting ABMP Board of Directors: L. Reinstein, Chairman K. Hogstrom, Vice-Chairman K. Miller, Secretary B. Archer, Treasurer K. Steidley, E. Klein, L. Rothenberg, & M. Gillin The American Board of Medical Physics (ABMP) is pleased to announce that it has entered into a Working Agreement with the American Board of Radiology (ABR) effective July 9, 2001. This agreement was approved unanimously by both the the ABMP and the ABR, and it creates an environment in which the two medical physics certification boards can work closely together for the benefit of medical physics. The ABMP believes this agreement will unify the medical physics community and eliminate the confusion among entry-level medical physicists resulting from the two-board system.

Furthermore, it will strengthen the certification process in traditional fields of medical physics by uniting the resources of both boards.

Under the terms of agreement, the ABMP will continue to exist but will no longer offer to new candidates, certification examinations in the traditional fields of medical physics (namely radiation oncology physics and diagnostic imaging physics). The ABMP will focus

its future certification efforts in the non-traditional fields of medical physics, currently MRI physics and medical health physics, and in the development of subspecialty certifications such as cardiovascular physics and neuro-irradiation physics.

The ABMP will also retain its ability to rapidly expand into areas of new certification to meet changing needs in the medical physics environment.

Although the ABMP will no longer participate in certification in the traditional areas for new candidates, the two boards will participate jointly in the certification of medical physicists. The composition of the certification oversight committees will be equally divided among members appointed by each board. The ABMP will recommend three voting members to be appointed to the ABR Radiological Physics Examination Committee, and the ABR will recommend an equal number of voting members for appointment to an ABMP MRI Physics Committee.

The agreement allows candidates currently engaged in the ABMP certification examination process the option of completing their examination with the ABMP or the ABR. ABMP certified diplomates may apply for and receive an ABR letter of certification equivalence.

This letter allows them the op3

portunity to become members of the American College of Radiolgy (ACR) and to be recognized as equivalent to the ABR diplomates in all guidelines, standards, regulations, and privileges of scientific, professional, and regulatory bodies. The ABR will issue full certification and listing in the American Board of Medical Specialties to any ABMP diplomate having an ABR letter of certificate equivalence and having satisfied all conditions of its future Maintenance of Certification program.

The ABMP invites and expects the American Association of Physicists in Medicine (AAPM) to become a sponsoring organization. In the near future, the ABMP will modify its by-laws and develop future goals to meet its new strategic direction and role as established with this agreement. At the AAPM Board of Directors meeting during the 2001 annual meeting of the Radiological Society of North America (RSNA), the ABMP will invite the AAPM to become a sponsoring organization and will request moderate funding assistance for its new mission.

The ABMP wishes to recognize the ABR physics trustees for their persistence and constructive demeanor throughout the negotiating process, which (See ABMP - p. 4)

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ABMP (from

p. 3)

began at last year’s AAPM Annual Meeting. We also thank the AAPM and its president, Charles Coffey, for hosting the meetings of the two boards’

AWARD

representatives and for continued encouragement and support throughout the process.

This agreement is an extraordinary event in the history of medical physics. It is the sincere hope of the ABMP that the

spirit of cooperation and goodwill that prevailed during these negotiations will infuse the medical physics community so that we can all work together toward the advancement of our profession.

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(from p. 1)

United States in 1967 after receiving B.Sc. (Honors) and M.Sc. in physics from St. Stephen’s College at Delhi University in India. After postdoctoral training in experimental nuclear physics and in radiological physics, both at Yale University, he joined the Department of Therapeutic Radiology at Yale University School of Medicine where he is currently Professor of Therapeutic Radiology (radiological physics). Since 1992, he has also served as Chief of the Radiological Physics Section at Yale New Haven Hospital.

Ravi has served in many capacities in the AAPM. He was president of the AAPM in 1994 and chairman of the board in 1995. He has chaired numerous AAPM task groups, which have led to standardization of medical physics practice in the United States and abroad. His reports of Task Group 43 on Interstitial Brachytherapy Dosimetry and Task Group 60 on Intravascular Brachytherapy have received wide acclaim in the community. He chaired the AAPM Radiation Therapy Committee from 1982 to 1986 and has chaired the AAPM Sci-

William D. Coolidge Award winner Ravinder Nath with his family during the award ceremony in Salt Lake City, UT.

ence Council from 1997 to 1999. Ravi has also served extensively in many other national organizations dealing with medical applications of radiation. He has been chair of the Physics Committee of the American Brachytherapy Society and participated in various committees of the Inter-Society Council of Radiation Oncology, the American College of Radiology, the American Brachytherapy Society, the Radiation Research Society, the National Cancer Institute, the Radiation Study Section of National Institutes of Health and the National Council of Radiation Protection. Ravi has served on editorial boards of many journals, including Medical Physics, Endocurietherapy Hyperthermia, the Journal of Brachytherapy, Cardiovascu4

lar Radiation Medicine, and the Journal of Medical Physics.

Ravi has published over 180 articles in peer-reviewed journals. He has contributed many significant advances in radiation dosimetry, nuclear instrumentation, Monte Carlo simulations, magnetic field effects, dose rate effects, radiosensitization, photodynamic therapy, and, above all, in brachytherapy, with outstanding contributions second to none. He made many original contributions in the early development of radioactive seeds such as palladium-103 seeds, for permanent implantation of prostate cancer. More recently, he played a key role in the development of a new application of radiation in the prevention of restenosis following coronary

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artery angioplasty. His contributions to radiation oncology literature have brought him international recognition as a leading scientist in cancer research. He is also recognized as a leading expert in the physics of brachytherapy in coronary artery disease. Ravi received the Medical Physics

COFFEY

(from p. 1)

Reinstein. This group met twice, once in July and again in November, 2000. These meetings were hosted by the AAPM with myself as an invited participant/observer. The resulting Working Agreement effectively ends the competition between the two certification boards and affords the medical physics community an opportunity to obtain professional certification in the traditional fields of medical physics by the ABR and certification in the non-traditional fields and subspecialties of medical physics by the ABMP. Both ABR and ABMP representatives read announcement statements before the Board concerning the Working Agreement. Both announcement statements can be found elsewhere in this issue of the Newsletter. This agreement represents a significant unifying event within the medical physics community. Members of the Board of Directors joined me that day in a standing ovation in honor of the two certification boards for this longawaited achievement.

Award from the AAPM in 1975, the Henschke Award from the American Brachytherapy Society in 1994, the Association of Indian Medical Physicists in the U.S.A. Award in 1994, the JM Paul Memorial Lecture Award in 1995, and the Edith B. Quimby Lecture Award in 1997 from the New

Annual Meeting Highlights One of the personal honors of being President this year was to assist in the hosting of the Salt Lake City Annual Meeting. I want to thank all of the scientific presenters and acknowledge, in particular, the excellent scientific presentations given during the President’s Symposium entitled, “Molecular Imaging and Radiation Therapy Treatment Planning.”

For those of you who could not attend the Annual Meeting, the President’s Symposium lectures and, in addition, most of the refresher course and continuing education presentations will be available for viewing via the AAPM/DigiScript Webbased education program (contact Education Council representatives or the AAPM Headquarters staff for specifics).

I want to congratulate all of the Association’s award recipients who were honored at the Awards and Honor Program on Monday evening of Annual Meeting week. Of special note is this year’s William D. 5

York Chapter of the AAPM. He is a fellow of the AAPM and a fellow of the American College of Radiology. He has led a distinguished career in medical physics, which has highlighted the important role medical physicists play in radiation medicine for cancer and coro■ nary artery disease.

Coolidge Award winner, Ravi Nath. Certainly Ravi’s contributions to the science of medical physics and his leadership and service to the Association qualify him as recipient of the AAPM’s highest achievement award. Our sincere and heartfelt congratulations to Ravi and his family.

Additionally, the Association granted AAPM fellowships to 21 of its members in recognition of their contributions made to the Association and to the field of medical physics. A special thanks to the Awards and Honors Committee and its chair, Mary Martel, for this year’s successful program. I want to extend a personal thanks to Mike Gillin, chair of the professional council, for his efforts in hosting the New Members Reception on Wednesday of the Annual Meeting. The purpose of this reception is to introduce recent new members of the Association to the members of the AAPM Executive Committee and to the chairs of the Education, Science, and Professional (See Coffey - p. 6)

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Coffey (from p. 5) Councils. During the program, EXCOM members and council chairs were given time to explain the roles and responsibilities of their office. The meeting concluded with an opportunity for new members to interact one-on-one with Association leaders in an informal social setting.

Also, as President, I had the opportunity to moderate the Annual Business Meeting held on Wednesday afternoon.

Members of EXCOM were delighted by the number of members in attendance. During the Annual Business Meeting each year, officers of the Association, council chairs, and various committee chairs give informational reports to update AAPM members concerning matters of importance to the Association. At the conclusion of the reports, time is given for members in attendance to ask questions or discuss materials within the individual reports or to discuss other matters of individual interest and importance.

One item of significant interest was the discussion led by Melissa Martin, treasurer, on the topic of membership dues increases. Due to the rising cost of doing business and the increasing services provided to our members by the Association and HQ staff, a membership dues increase at this time is being considered. This topic was introduced only after careful deliberation by EXCOM

and members of the Finance Committee. Much effort has been given to maximizing our profit centers and minimizing our expenses; however, if programs and services are to continue to increase, then we as members must give consideration to a dues increase. Should a dues increase action item go to the Board of Directors at the Winter RSNA Meeting and be approved, a membership vote will be taken at the next Annual Business Meeting. Should a membership dues increase be approved by members present at the Annual Business Meeting in Montreal, then a dues increase would go into effect beginning January, 2003.

Deceased Members For the last few years, the Awards and Honors Program has allowed time for the president to honor our deceased AAPM members. This year’s list included the names of Victoria Castro, Jimmy Fenn, Douglas Jones, Jack Krohmer, Gregory Lawson, and D. John Wright. In years past, the names of deceased members have come forward only as a result of an individual member calling or submitting a short note to HQ. This year the History Committee has agreed to name a Necrology Subcommittee to maintain an official updated list of deceased members and to provide, when possible, an obituary on each deceased member. This is in response to the need to recognize 6

and honor our deceased medical physics colleagues. It is never my intent to recognize a contribution of one over that of others; however, I would be remiss not to mention the passing of Jack Krohmer in July.

Jack was a charter member of the AAPM, a member of the Board of Directors, served as president, and was the William D. Coolidge Award winner in 1985. Jack’s contributions and tireless dedication to the Association and to the profession of medical physics will not be forgotten.

Conclusion My sincere thanks also to our many vendors who exhibited this year in Salt Lake City. Of the 117 exhibitors this year, there were twelve first-time vendors (or first-time vendors with a new company name).

APPM leadership realizes that vendor support at our Annual Meetings contributes to the overall success of our Summer Meeting. I encourage members to acknowledge the contribution of vendors at our Annual Meeting by telling them you visited their booth or that you read their advertisement in an AAPM publication. Last, I want to thank HQ staff for another excellent job well-done.

The success of the registration process, the exhibition hall space layout, scientific meeting room preparations, and committee and the Board of Directors meeting accommodations are due to the preplanning, co-

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ordination, and active participation of our HQ staff. Our hats off to Sal Trofi, executive director, and Angela Keyser, deputy executive director, and the great staff at AAPM Headquarters.

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Report from the Chairman of the Board Kenneth Hogstrom Houston, TX

Board of Directors Meeting Treasurer’s Clarification of the July/August Newsletter Column Melissa C. Martin, Treasurer Bellflower, CA In my last column entitled “2000 Year Summary of Financial Results,” I wrote that the World Congress had a disappointing financial result. This could lead one to assume that the World Congress had a financial loss, which is not the case. The World Congress made a substantial profit and the meeting was a success in all aspects.

The major reason why the World Congress did not achieve its targeted profit was because of unexpected penalty payments to some hotels due to meeting attendees booking sleeping rooms in hotels other than those with which we had signed agreements. As I mentioned in my last column, you can help in the future by staying at hotels designated by the AAPM when attending the ■ AAPM Annual Meeting.

I am pleased to report that the AAPM had a productive meeting of its Board of Directors (BOD) from 1 to 7:30 p.m. on Thursday, July 26, 2001 at the end of our Annual Meeting in Salt Lake City. The BOD meeting consists of reports from your elected officers, from chairs of the education, professional, and science councils, from chairs of administrative committees, and from our executive director. The reports include past, present, and future activities of the committees, as well as action items necessary to implement new programs and policies for effective operation of our society. Based on BOD reports and actions, I am pleased to report that our Association is hard at work for its members, that we are financially responsible, and that members are working constructively and wisely for the benefit of medical physics.

Since the officers and chairs of councils will discuss much of their information in this and subsequent newsletter articles, I will mention only a few generic items of interest.

The meeting began with an announcement at the beginning

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of President Charlie Coffey’s report that the American Board of Medical Physics (ABMP) and the American Board of Radiology (ABR) had adopted a Working Agreement. As vicechair of the ABMP, I read a statement on behalf of the ABMP, and Bhudatt Paliwal, ABR physics trustee, read a statement on behalf of the ABR. These statements and a copy of the Working Agreement were received into the minutes of the AAPM BOD meeting. This agreement demonstrates how individuals have compromised to work together for the benefit of medical physics, and I envision this action will serve as a catalyst to allow medical physicists to continue to become a stronger force through such future actions.

Several items have significant impact on future operations of the BOD. During President Coffey’s report, Consultant Jim Dalton discussed with the Board the opportunity it has to (See Hogstrom - p. 8)

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Hogstrom (from p. 7) become more involved in the strategic planning of the AAPM in addition to its current role focused more on oversight of AAPM operations. Board members will have an opportunity to experience that process in a special half-day workshop to be held the Thursday morning following our BOD meeting at the RSNA Annual Meeting. Second, during my report to the Board, a motion was passed that approved a policy for “Procedure of Board of Directors Online Voting.” This policy was developed with considerable input from EXCOM, Rules Committee, HQ Information Services, and your BOD. The Rules Committee, chaired by Chris Marshall, will begin developing the rule changes necessary to enact this policy. We hope this will allow the BOD to be more timely and functional when major issues outside of normally scheduled BOD meetings occur. Third, the Rules Committee will be evaluating the American Institute of Physics Conflict of Interest Policy for its appropriateness for members of the AAPM Board of Directors.

The Rules Committee brought forth a motion on behalf of the Journal Business Management Committee that Section 3.24.6 of the Rules become 3.24.7 and that 3.24.6 state, “In the penultimate year of each term of office of the Editor (of Medical Physics), the Committee shall initiate a

formal review of editorial operations and related issues, and shall present a report to the Board of Directors with a recommendation to either offer a further term of office to the Editor, or to initiate the process to seek a new Editor. The Committee will develop and maintain written guidelines for this purpose.” This rule change was approved and will provide the AAPM with the flexibility it needs to maintain the most effective editor of Medical Physics on an ongoing basis.

During my report, I was able to comment on a few items of continued interest. I was pleased to report that progress continues towards the radiotherapy accelerator engineers forming a professional society with assistance from the AAPM. Jim Galvin, chair of the AAPM ad hoc committee that supports that effort, had reported to me that there was a meeting of key individuals on March 24-25, 2001 in Philadelphia, in which a rough draft of the Radiotherapy Service Engineers Association (RSEA) Bylaws were developed. Jim has advised me that he expects RSEA to incorporate in the near future and that he hopes RSEA can meet with the AAPM in Montreal next year.

Also, I was pleased to have written recently a letter of support on behalf of the AAPM for Art Boyer’s NIH R25 grant proposal, “Web-based Computer-aided Instruction for Medical Dosimetrists.”

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ACR Summer Conference The ACR Intersociety Commission sponsors a Summer Conference each year for leadership from approximately 50 radiological societies. This year’s conference was held from July 27-29 in Banff, Canada, and the focus was on Maintenance of Certification.

The Conference attendees are mostly radiologists, but medical physicists were very much a part of this year’s activities.

President-elect Bob Gould had the opportunity to present a demonstration of our AAPM Web-based continuing education, which is operated by our Remotely Directed Continuing Education (RDCE) Subcommittee, under the leadership of Chuck Kelsey. Bob also worked with Rick Morin (chair, ACR Commission on Medical Physics) and others in providing medical physicist input into the passage of a “Resolution on Radiation Dose and CT Scans” that would encourage radiologists and manufacturers of CT scanners to take actions necessary to minimize the dose to every patient. Last, I gave the invited lecture at breakfast on Saturday morning entitled “The Evolution of Medical Physics Residency Training Programs.” The lecture was aimed at educating the radiologists on our goals, efforts to date, and our need for their assistance at the society ■ and individual level.

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AAPM NEWSLETTER SEPTEMBER/OCTOBER 2001

Executive Director’s Column Sal Trofi College Park, MD At the AAPM Annual Business and Board Meetings in Salt Lake City, questions were raised regarding the size and work assignments of the Headquarters staff. This is a valid concern and should be investigated periodically. When the AAPM Headquarters moved from New York to College Park, Maryland in November 1993 there were five full time employees (FTEs). The New York staff consisted of six FTEs, but when the decision was made to move to the ACP, the AAPM elected to contract with the American Institute of Physics for accounting services, therefore reducing the AAPM staff size. It was later determined that the accounting function needed to be come back to Headquarters, so we reorganized the workload to accommodate this with the original five FTEs. The current number of staff is 16 FTEs. Almost all of this increase of eleven FTEs in eight years is attributable to the demands of the membership for new or enhanced services.

First let me say that the current Headquarters’ staff is a hardworking group of professionals eager to respond to the needs of the AAPM. Many AAPM committee members have acknowledged the efficiency and enthusiasm of our

staff over the past eight years and the most recent Headquarters Site Visit Committee (HSVC) affirmed this. This committee reviews the Headquarters operation in great detail every three years. Their latest visit took place in February of this year. They had three specific charges from AAPM President Charles Coffey: 1) Is the AAPM Headquarters efficiently carrying out its current charges?; 2) What services should Headquarters be providing to the Association for the next three years?; and, 3) What resource changes need to be made to accomplish those services? The HSVC reports are available on the AAPM Web site.

Seven of the eleven added FTEs were the result of specific major programs that were added to Headquarters responsibilities. These are of two types: existing programs which were taken over by Headquarters only after a cost analysis indicated a savings, and new programs specifically requested by the membership. Existing programs that migrated to Headquarters accounted for three employees (the Medical Physics Editorial Office and the membership database). New programs that the membership assigned to Headquarters accounted for four employees (a strong technical and Web presence and government relations). This leaves four employ10

ees that were added for other reasons. What are these other reasons besides the general increase in the activities of the AAPM? The following is a partial list of significant functions: we now perform the entire accounting function through the financial audit, we provide staff support to the Journal Business Managing Committee, we support the CAMPEP program, we have increased support for the Executive Committee and Board of Directors and provided increased general support to many AAPM committees.

I have briefly explained the changes in staffing levels over the past eight years, but how does AAPM staffing compare to similar organizations? Data supplied to the HSVC from a leading nonprofit organization of association executives indicates that we rank very favorably when compared to other organizations of the same budget size and Internal Revenue Service classification. The latest survey indicates that the average staff size of other orga-

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nizations is 22.4 FTEs vs. 16 FTEs for the AAPM. The ratio of staff costs to total expenses for other organizations is 28.2% and AAPM’s is 12.4%.

To summarize, the AAPM has a group of professional staff members who are busy doing the work of the membership as directed by the membership.

The staff size is just right for the current functions and programs. Our staff size and cost compare favorably to other similar organizations.

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Government Relations Column Angela L. Furcron Government Relations Manager The Health Care Financing Administration (HCFA) is being reorganized and is now called the Centers for Medicare and Medicaid Services (CMS).

The Secretary of Health and Human Services, Tommy Thompson announced that the new acronym would be CMS instead of CMMS, because the former is easier to say. CMS will be divided into three primary lines of service: the Center for Medicare Management, the Center for Beneficiary Choices and the Center for Medicaid and State Operations.

The Center for Medicare Management will focus on the traditional fee-for-service Medicare program. The Center for Beneficiary Choices will focus on providing beneficiaries information on Medicare programs including Medicare Select, Medicare+Choice and Medigap options. The Center for Medicaid and State Operations will focus on programs administered by states, such as Medicaid, the State Children’s Health Insurance Program (SCHIP), insurance regulation functions, survey and certifica-

tion and the Clinical Laboratory Improvements Act (CLIA).

The following press releases contain more detailed information on HCFA’s reorganization: http://www.hhs.gov/news/ press/2001pres/20010614.html and http://www.hhs.gov/news/ p r e s s / 2 0 0 1 p r e s / 20010614a.html.

The AAPM is in the beginning stages of organizing a grassroots political network and would like the home addresses of members to determine in which congressional districts AAPM members live and vote. When issues of importance to the AAPM go to a specific government committee to be discussed and voted on, it is important to contact members of that committee. AAPM members who live in specific districts will be contacted, at their default (usually business) 11

address and asked to write a letter to their congressperson.

A sample letter, stating the AAPM position, will be provided to you. If you specify that you prefer to receive mail at work, we will not send information to your home address.

You can add your address by going to the AAPM Web site, where a pop-up box will appear if your membership profile does not include your home address.

If you have included your home address and you would like to make sure it is correct, click on “Update Your AAPM Profile” on the middle of the right side of the AAPM home page.

There is a newly created AAPM Presidential Ad Hoc Committee on Government Affairs Coordination. The acronym for this committee is GACC. The purpose of GACC is to: provide oversight and direction for the government affairs effort and government affairs manager, establish educational/informational programs to inform and involve AAPM members in government affairs issues, coordinate the government affairs effort within the AAPM and sister societies to establish a united AAPM voice (See Gov’t Rel. - p. 12)

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Gov’t. Rel. (from p. 11) and united medical physics voice, respectively. There are representatives from the following councils and committees on the GACC: Professional Council, Education Council, Diagnostic X-ray Imaging Committee, Legislation and Regulation Committee, Nuclear Medicine Committee, Radiation Protection Committee and Radiation Therapy Committee. There is an Executive Committee representative, as well as three staff ex-officio members and an American Institute of Physics government affairs consultant.

Congress came back from summer recess on September 4 and is scheduled to adjourn on October 5. Between their return from recess and adjournment, Congress needs to pass the remaining appropriations bills and continue confirmation hearings. Also, the CARE bill may be introduced in the Senate soon; I will keep you posted.

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Awards, Honors & Grants Honorary Membership

2001 AAPM Fellows

Honorary Membership was granted to Hans Svensson, Ph.D., Emeritus Professor Umea University, Sweden.

Dr. Svensson is known for his pioneering work in Radiation Dosimetry and the clinical development of Microtron. For over four decades he has served as a leader of the European Physics Community through the European Society for Therapeutic Oncology. Internationally he has served the developing countries through the Atomic Energy Agency, Vienna.

Jerry D. Allison, Ph.D. Morris I. Bank, Ph.D. Dev Prasad Chakraborty, Ph.D. Indra J. Das, Ph.D. Carlos E. de Almeida, Ph.D. Bruce J. Gerbi, Ph.D. Maryellen L. Giger, Ph.D. Michael T. Gillin, Ph.D. L. Stephen Graham, Ph.D. Thomas N. Hangartner, Ph.D. Walter Huda, Ph.D. Andrew Karellas, Ph.D. Eric E. Klein, M.S. Dennis D. Leavitt, Ph.D. Charles Lescrenier, D.Sc. Ernest L. Madsen, Ph.D. Mary K. Martel, Ph.D. Renate Muller-Runkel, Ph.D. Thomas R. Nelson, Ph.D. Ronald Price, Ph.D. E. Russell Ritenour, Ph.D.

Farrington Daniels Award The Farrington Daniels Award for the best paper on Radiation Dosimetry published in Medical Physics in 2000 is presented to Iwan Kawrakow, Ph.D. for his paper entitled “Accurate condensed history Monte Carlo simulation of electron transport. I. EGSnrc, the new EGS4 version,” Med. Phys. 27 (3) 2000, pp. 485 -498.

Sylvia Sorkin Greenfield Award (This year two papers were selected to receive this award) The Sylvia Sorkin Greenfield Award for two of the best papers (other than Radiation Dosimetry) published in Medical Physics for 2000 is presented to Marc Kachelriess, Ph.D., Stefan Schaller, Ph.D., and Willi A. Kalender, Ph.D. for their paper entitled, “Advanced single-slice rebinning in cone-beam spiral CT,” Med. Phys. 27 (4) 2000, pp. 754 - 772. and David A. Jaffray, Ph.D. and Jeffrey H. Siewerdsen, Ph.D. for their paper entitled, “Cone-beam computed tomography with a flat-panel imager: Initial performance characterization,” Med. Phys. 27 (6) 2000, pp. 1311 - 1323.

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AAPM NEWSLETTER JANUARY/FEBRUARY AAPM NEWSLETTER SEPTEMBER/OCTOBER 20012001

Awards, Honors & Grants AAPM-IPEM Medical Physics Travel Grant Indra J. Das, Ph.D., FAAPM

AAPM Medical Physics Travel Grant Aldo Badano, Ph.D.

Pictured (l to r) are S.A. Nehmeh, Anita Berndt and Jason Safford, winners of the Young Investigator Competition.

John C. Cameron Young Investigator Competition 1st Place Award - R. Jason Safford of the University of Texas M.D. Anderson Cancer Center for his paper entitled “Real-Time MR Temperature Imaging of Ultrasound Thermal Therapy Using EPI.” 2nd Place Award - Anita Berndt of CancerCare Manitoba, Winnipeg, MB, Canada for her paper entitled “An 192Ir CT Scanner for High-Dose-Rate Brachytherapy.”

3rd Place Award - S. A. Nehmeh of Memorial Sloan-Kettering Cancer Center, New York for his paper entitled “Grated Positron Emission Tomography In Lung Cancer: A Novel Technique To Reduce Lung Tumor Motion Effect for Radiotherapy.”

Other Young Investigator Competition finalists included: F. Lerma of Washington University School of Medicine E. Ford of Memorial Sloan-Kettering Cancer Center K. Welsh of the State University of New York at Stony Brook M. C. Lee of Stanford University School of Medicine J. Dai of St. Jude Children’s Research Hospital C. Hua of Memorial Sloan-Kettering Cancer Center L. Li of the University of Pennsylvania 13

AAPM NEWSLETTER SEPTEMBER/OCTOBER 2001

Announcements RSNA/ARR/AAPM Workshop N.I.B.I.B. Update for Radiological Scientists

ACR E-mail Survey

The RSNA Research Committee, with the assistance and co-sponsorship of the Academy of Radiology Research and the AAPM, is spearheading the presentation of a workshop to communicate to the radiological sciences community the current status and evolving opportunities of the new National Institute of Biomedical Imaging and Bioengineering (N.I.B.I.B.).

The workshop will be held November 9, 2001 from 8 a.m. – 5 p.m. at the Hyatt Regency Bethesda.

60 participants are anticipated, including radiology chairs, vicechairs for research, research center directors, and radiology center directors. Topics will include: •Overview and History (C. Douglas Maynard, MD, Ruth L. Kirschstein, MD, Acting Director of NIH, Donna J. Dean, PhD, acting director of N.I.B.I.B.) •Referral Guidelines and Future Strategies •Collaborative Research Opportunities •Future Directions and Strategic Frontiers •NIBIB Opportunities: Views from the Chair •Summary and Proposed Action Plan for Excellence in Image Dependent Research Directed by C. Leon Partain, MD, PhD and co-directed by Roderic I. Pettigrew, MD, PhD, the workshop will result in publication in paper and posting of the RSNA Link (Web site) of proceedings, recommendations, and a roster of attendees.

Registration will be $100 for RSNA and AAPM members. For more information, please contact Brad Schlichting (630)571-7889 at RSNA Headquarters, 820 Jorie Blvd., Oak Brook, IL, 60523■ 2351. His e-mail address is bschlich@rsna.org.

The ACR is sending out a follow-up survey e-mail form to a selected sample of AAPM members in an effort to establish base line data on the activities of medical physicists outside radiation oncology. These “Non-Radiation Therapy” activity data will be useful in establishing current time and effort levels and can serve as initial data in establishing CPT codes for payment of these activities.

It takes about 30 minutes to fill out the form. If you’ve been selected to receive the survey please fill it out and return it as soon as possible. The results will be reported in a future issue of the AAPM Newsletter.

If you have any questions about the survey contact Chuck Kelsey at ckel@unm.edu. ■

ABMP 2001 Oral Exam Results Discipline Radiation Oncology Diagnostic Imaging Health Physics MRI

Takers 66 14 5 3

Pass (%) 27 (41) 6 (43) 3 3 14

Condition (%) 18 (27) 7 (50) 1 0

Fail (%) 21 (32) 1 (7) 1 0

AAPM NEWSLETTER JANUARY/FEBRUARY AAPM NEWSLETTER SEPTEMBER/OCTOBER 20012001

Announcement 29th Annual Meeting of the American Healthcare Radiology Administrators (AHRA) Walter Huda Syracuse, NY The 29th Annual Meeting of the American Healthcare Radiology Administrators (AHRA) meeting was held at the MGM Grand in Las Vegas from July 30 to August 3, 2001. This meeting is held in conjunction with the Association of Educators in Radiological Sciences (AERS), which attracted some 1,200 participants and approximately 140 exhibitors. The opening ceremony featured a one-hour show by a singing group (Knudsen Brothers) as well as an informative and amusing talk entitled “Humor in the Workplace” by a ‘board certified’ comedian (Mary Feeler Fisher). Two hours of entertainment were supplemented by about 30 minutes of ‘business’ which may help to explain the excellent attendance at the Grand Opening of the meeting. The AHRA president welcomed the AAPM liaison at this session, together with liaisons from half a dozen other organizations including the Society of Nuclear Medicine (SNM) and the Society of Computer Applications in Radiology (SCAR).

The major concern of the AHRA today is the serious shortage of technologists in most regions of the United States, and the decline in the number of radiological technologists’ training programs.

The shortage of technologists is an issue that also impacts on medical physicists working in radiology departments. As such, any political support that the AAPM may have to offer to rectify the severe shortages currently encountered in many departments would be welcome. One item of interest was an announcement made at the AHRA meeting of the introduction of a formal certification scheme for radiology administrators. With a generous donation of $1,000,000 from Kodak, the AHRA plans to launch the initial examination to certify radiology administrators (CRA) at the 2002 meeting to be held in New Orleans.

The AHRA meeting is very different to the one adopted by scientific societies such as the AAPM and the RSNA. Most of the talks are between 60 and 90 minutes, with limited attendance. To qualify for CME credits, one must be present no later than five minutes after talks begin, and once the room has been filled no additional persons are permitted to enter the room. As to be expected, administrative issues are of primary importance with few scientific issues or topics being 15

discussed. At this year’s meeting of the AHRA, Dr. Ben Archer gave a talk on the topic of “High Dose Fluoroscopy: The Administrator’s Responsibility.” This one-hour talk, sponsored by the American College of Medical Physics, was extremely well received by the full capacity audience. Future interactions between and the AAPM and AHRA are likely to be directed to sponsoring talks of interest to an audience composed of Radiology Adminis■ trators.

Minutes of Annual Business Meeting Available A draft of the minutes from the July, 2000 Annual Business Meeting of the AAPM is available for review and download on the AAPM Web site: http://www.aapm.org/ org/07_17_01_ABM _2000_07-26__Draft_ .pdf. Members who would prefer a paper copy by mail should contact Sharon Cohen at the AAPM Headquarters office at sharon@aapm.org, or by calling (301)2093392.

AAPM NEWSLETTER SEPTEMBER/OCTOBER 2001

Announcement Practical Considerations for an IMRT Program, ACMP Therapy Workshop Michael G. Herman Rochester, MN At the recent annual meeting of the American College of Medical Physics, held this past June in Hershey, Pennsylvania, the traditional workshop format was divided into concurrent, two-day therapy and diagnostic sessions. The therapy workshop on IMRT was organized and co-chaired by Dr. Stan Benedict and Dr. Tim Solberg. The workshop addressed a number of practical issues for assisting the clinical physicist in the implementation of a clinical IMRT program. A number of the presentations are available on the ACMP Web site (www.acmp.org) in pdf format.

The symposium began with keynote presentations on the clinical rationale for IMRT. Drs. Michael Zelefsky from MSKCC and Brian Butler from Baylor University shared clinical experiences over the past several years from their respective institutions. Dr. Steve Lee from UCLA provided an enthusiastic and stimulating discussion on biological rationale for IMRT. An overview of planning and delivery systems for IMRT was presented by Drs. Ping Xia, Mark Arnfield, and Gary Luxton. Pros and cons of vari-

ous commercial inverse planning solutions, MLC capabilities and limitations, and delivery techniques (fixed gantry SMLC, fixed gantry DMLC, tomotherapy) were discussed.

Beginning with the first afternoon session, various aspects of IMRT commissioning and quality assurance were discussed by Drs. Jim Galvin, Tom LoSasso, and Walter Grant. A very useful presentation on film and polymer gel dosimetry was given by Dr. Larry Reinstein.

The first day concluded with presentations from two physicists, Kevin Rogers and Chet Ramsey, who have successfully implemented IMRT in their smaller, community-based practices. They provided valuable advice on how IMRT could be performed with limited resources; evidence that IMRT is increasingly finding its way into non-academic centers.

Tuesday morning opened with a presentation on specification, evaluation and reporting of dose/dose distributions

by Dr. Radhe Mohan of the Medical College of Virginia, issues that many of us take for granted with more traditional techniques.

Then, as many of the technical details of IMRT planning and delivery are becoming well understood, the topic turned to what many believe to be the 16

weak link in the radiotherapy process, that of patient positioning and organ motion. Drs. Stanley Benedict and John Wong provided the audience insight into these difficult problems. This was followed by a thought-provoking presentation by Dr. Howard Amols from MSKCC on what the future of therapy physics holds.

The symposium concluded with a discussion on the requirements of record and verify systems in supporting IMRT treatment, given by Annemarie Ison of IMPAC, and topical presentation on the status of billing and reimbursement for IMRT given by James Hugh from AMAC. Tuesday afternoon was made available to vendors who wished to share information on their particular systems/products. Presentations were made on behalf of BrainLAB, Radiological Imaging Technology, Inc., Varian, Med-Tec, Elekta Oncology Systems, and MDS Nordion.

Collectively, the experience of the speakers and their colleagues represented at the IMRT workshop accounted for a significant portion of the overall IMRT experience. Presentations and handouts were well received by the capacity â– crowd in attendance.

AAPM NEWSLETTER JANUARY/FEBRUARY AAPM NEWSLETTER SEPTEMBER/OCTOBER 20012001

New Member List Welcome to the following new members who have joined the AAPM since August 1, 2000. Henceforth, the New Member List will appear in alternate issues of the Newsletter.

Ibrahim Shakib Abdulhay Flint, MI Salahuddin Ahmad Houston, TX Ergun Emin Ahunbay Detroit, MI Abderrazzak A. Ajaja Montreal, QC, CANADA Parham Alaei Minneapolis, MN Brent Albertson Columbus, OH Andrew L. Alexander Madison, WI Ali Kassim Alkaissi Ypsilanti, MI Scott J. Alleman Shreveport, LA Abdalmajeid M. Alyassin Niskayuna, NY Amanda L. Anderson Norfolk, VA Tim H. Anderson White Plains, NY Stefanie Beate ApeldoornRassow Hochdorf, SWITZERLAND Gary M Arbique Dallas, TX Michael John Bailey Victoria, AUSTRALIA Robert S. Baker Flagstaff, AZ Maria Carmen BanosCapilla Valencia, SPAIN Shannon Carole Barlow Sarasota, FL Timothy Mark Barry Rochester, NY Leslie W. Barton Matthews, NC E. Richard Bawiec Fort Smith, AR Michael L. Beach Houston, TX Stewart J Becker Madison, WI Arup Bhattacharya Buffalo, NY

Nader Binesh Los Angeles, CA Peter Justin Binns Cambridge, MA Timothy J. Blackburn Dallas, TX Candance D. Bletscher Los Angelas, CA Douglas E. Boccuzzi Amherst, NY Scott Francis Borzillary Silver Spring, MD Satya Ranjan Bose Longview, TX Beth Bradshaw Lilburn, GA James Michael Brindle Gainesville, FL Karen D. Brumley Knoxville, TN Angela P. Bruner Dallas, TX Nicholas I. Burriesci Chicago, IL Carlos Alberto Caballero Scottsdale, AZ Marie-Laure A. Camborde Montreal, QC, CANADA Michael Jeffrey Cariveau Greenville, NC Frank Cerra Rockville, MD Sankar Chakraborty MIRAMAR, FL Gordon H. Chan Ottawa, ON, CANADA Rosita U. Chang Los Angeles, CA Nicolas Charest Windsor Ontario, CANADA Edmuth K Chau Cherry Hill, NJ Gang Cheng Rochester, NY Chih-Yao Cheng San Antonio, TX Indrin J. Chetty Ann Arbor, MI Lim Cheung Concord, MA

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Rajiv Chopra North York, ON, CANADA Edward A. Christman Princeton, NJ Archie C. Chu Detroit, MI Suzanne J. Chungbin Scottsdale, AZ Alexei V. Chvetsov Calgary, AB, CANADA Alan B. Cohen St Louis, MO Jeremy F Cole Madison, WI William H. Collins Johnstown, PA Maria J. Corsten St. John’s, NF, CANADA Jeremy L. Corwin Centralia, WA Mike Coughlin Sudbury, ON, CANADA Andrea Crespi Monza, ITALY Charles Alan Curle Greenville, NC Mark W. Davidson Pocatello, ID William Earl Davidson Philadelphia, PA William W. De Forest Cary, NC James F. Dempsey Gainesville, FL Gary D. Dillon Dyer, IN Andreea Dimofte Philadelphia, PA Wim Dries Eindhoven, NETHERLANDS Yiping Peter Du Chicago, IL Weiliang Du Chicago, IL Ronald D. Edwards Naperville, IL Maribelle G. Elesango San Gabriel, CA

David Carsten Ellerbusch Madison, WI Bruce P. Emmer Brooklyn, NY Darell B. Faldyn Bellville, TX Ning Yuan Feng St Johns, NF, CANADA Michael Fix Waldkirch, GERMANY Michael Ryan Folkert Cambridge, MA Eric Cassel Ford New York, NY Liliya Fridman Staten Island, NY Lisa Ann Fromme New York, NY Eli E. Furhang Staten Island, NY Keith M. Furutani Winnipeg, MB, CANADA Hani Ezzat Gaballa New Hyde Park, NY David Stewart Gaede Mississango, ON, CANADA Steven Anthony Gasiecki Tonawanda, NY Kaundinya S. Gopinath Gainesville, FL Michael S. Gossman Memphis, TN Bhanu Prasad Gottipati Placentia, CA Peter A. Goyer White House Station, NJ Crockett L. Grabbe Iowa City, IA Edward J. Grant Little Rock, AR James E. Grebe Valrico, FL Heath L. Hanshaw Whitmore Lake, MI Laura Happersett New York, NY Kamran U Haq Las Vegas, NV

(See Members - p.18)

AAPM NEWSLETTER SEPTEMBER/OCTOBER 2001

Members (from p. 17) Marissa Hernandez Morristown, NJ David R. Hintenlang Gainesville, FL Ellen Hochheiser Tucson, AZ Joseph Dempsey Hodges DeQuincy, LA Roger Joseph Holst Camden, NJ Murshed Hossain Philadelphia, PA Victor Lyle Howard Brooklyn, NY Kimberly A. Howell La Crosse, WI Rebecca Maureen Howell Tucker, GA Joseph Leonard Howley Orlando, FL Kevin Kai Huang Baton Rouge, LA Chulhaeng Huh Gainesville, FL Tobin C. Hyman Florence, SC Khalil Ibrahim-Ashford Summit, NJ Nisy Elizabeth Ipe San Carlos, CA Adnan Nasher Ismail Flint, MI Helmar S. Janee Santa Barbara, CA Jens Jensen New York, NY Steve B. Jiang Boston, MA Jose Ignacio Jimenez Alarcon Santa Cruz Tenerife, SPAIN Kevin RA Johnson Montego Bay, JAMAICA Dan T. Jones Faure, SOUTH AFRICA Deborah Kaminsky Long Grove, IL Dennis John Kehoe Flushing, MI Gerrit Kemerink Maastricht, NETHERLANDS Robin L. Kendall Houston, TX

Joseph William Kettner Holly, MI Harjinder Singh Khaira Cincinnati, OH Sultan F. Khalil Amman, JORDAN Delsin Khan-Boney Littleton, NC Maksud G. Khatri Macomb, MI Ki-Hwan Kim Taejon, KOREA, REPUBLIC OF Jeomsoon Kim Lowell, MA Stephan Robert Kloeck SWITZERLAND Tooru Kobayashi Osaka, JAPAN Shuji Koyama Nagoya, JAPAN Michelle Kritzman Ann Arbor, MI Stephen F Kry Houston, TX Jong Hyun Kung Boston, MA Vadim Y. Kuperman Tampa, FL Mark Langer Indianapolis, IN Catherine C Large Heiskell, TN Sandra C. Larson Ann Arbor, MI Wolfram Laub Royal Oak, MI Jean-Charles Laxague San Diego, CA Ricky Robert Layman Cleveland, OH Lawrence H. Le Edmonton, AB, CANADA Tae Kyu Lee West Lafayette, IN Richard V. Lehmkuhl Little Rock, AR Fritz A Lerma St Louis, MO Lance J. Levendowski Marshfield, WI Ives Levesque Montreal, QC, CANADA Craig S. Levin San Diego, CA Loretta A. Lewandowski Minneapolis, MN

Donald A. Lewis Los Angeles, CA Sicong Li St Louis, MO Lin Li Philadelphia, PA Xiaolin Li Scranton, PA Alexander N. Li Los Angeles, CA Zhimin Li Madison, WI Chung Y. Lin Lubbock, TX Ho-Ling Anthony Liu Taoyuan, TAIWAN Jessica R. Lowenstein Houston, TX Anh My Ly Loma Linda, CA Lijun Ma Baltimore, MD James T MacKenzie West Seneca, NY Dennis Mah Philadelphia, PA Sadiq R. Malik Lancaster, PA Peter Manser Affoltern am Albis, SWITZERLAND Jerry Markman St. Louis, MO Leonid Massarski Sierra Vista, AZ Christopher G Matthews Lyndhurst, OH Michael J. McCullough Baldwin, MD Kiaran P. McGee Rochester, MN Paul M. Medin Minneapolis, MN Elizabeth C. Mele Louisville, KY Pedro Mendez-Correa Temple, TX Richard Bryan Meyer Jeffersonville, IN Brett M. Miller Southfield, MI Rebecca Jane Milman Houston, TX Satoshi Miyajima Suita Osaka, JAPAN Joseph M. Modrick Ann Arbor, MI

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Belal Ali Moftah Montreal, QC, CANADA Michel Moreau Madison, WI Homeira Mosalaei London, ON, CANADA Dariusz Mroz Kanata, ON, CANADA Bryon A. Mueller Rochester, MN Florence Calaway Mullins Denham Springs, LA David Campbell Murray Middleton, WI Gwendolyn P. Myron Salt Lake City, UT Jayalakshmy Narayanaswamy Bellrose, NY Catherine L. Neath Surrey, BC, CANADA Elena Margareta Nes Corvallis, OR Bill C. O’Brien-Penney Chicago, IL Dan O. Odero Baltimore, MD Kent M. Ogden Syracuse, NY Bernard Odongo Okoth Alpena, MI Nigel P Orton Madison, WI Mi Young Paek Seoul, KOREA, REPUBLIC OF Harald Paganetti Boston, MA Stephanie Anne Parker Winston-Salem, NC Timothy John Paul Los Angeles, CA Todd A. Pawlicki Stanford, CA Martin Peter Petric Montreal, QC, CANADA Stanley V Phillips Greenville, NC Carmen Pinza-Molina Santa Cruz Tenerife, SPAIN Brett A. Poffenbarger Palo Alto, CA Brian D. Pomije San Diego, CA Sven Prevrhal San Francisco, CA

AAPM NEWSLETTER JANUARY/FEBRUARY AAPM NEWSLETTER SEPTEMBER/OCTOBER 20012001

Ramani Ramaseshan Toronto, ON, CANADA Abdul Rashid Baltimore, MD Paul S. Rezentes Bellflower, CA Jeff J. Richer Windsor, ON, CANADA Michael Randall Ringor Lafayette, IN Mark J. Rivard Boston, MA Duk-Woo Ro Washington, DC Douglas P. Rosenzweig Milwaukee, WI Francesca Rossetto Mountain View, CA Carl G Rowbottom Royal Oak, MI David Rozas Peabody, MA Iris A. Rusu Philadelphia, PA Kelly James Ryan Durham, NC Harith Saif Saginaw, MI Amir H. Sanjari Elkhart, IN John C. Sarafa St. Louis, MO David Nicholas Schaaf Beavercreek, OH Barbara U Schaffner Baden, SWITZERLAND Stefan G. Scheib Zurich, SWITZERLAND Eric C Schreiber Chapel Hill, NC Sumit K. Shah Los Angeles, CA Vijeshwar Kumar Sharma Windsor, ON, CANADA Kyo Chul Shin Cheonan Chungnam, KOREA, REPUBLIC OF Billy Jack Shirlen Taylor, MI Jileen Shobe Gaithersburg, MD Kapil P. Shukla Voorhees, NJ Kelli J. Silverstrim Fairfield, CA

Matthew Garrett Skinner Oshawa, Ontario, BC, CANADA Alan Paul Sliski Lexington, MA Debbie Michelle Smith Gatineau, QC, CANADA Edward L. Solem Solon, OH Archana Rajesh Somnay Detroit, MI Haijun Song Philadelphia, PA Ju-Young Song Seoul, KOREA, REPUBLIC OF Spiridon V. Spirou New York, NY Shiv P. Srivastava Harrisburg, VA Clayton E. Stablein Syracuse, NY Angela Marie Stam Baton Rouge, LA Kurt Edward Stump Madison, WI Francisca Sugiro Albany, NY Sandra D. Szendy Knoxville, TN Yuri Tabrizi North Chicago, IL Maurice Tajiran Houston, TX Mat M. Tamimi Knoxville, TN Russell B. Tarver Fort Worth, TX Michael S. Taylor Clayton, MO Robert T. Thompson London, ON, CANADA Sharon A. Thompson Stewart Manor, NY Frank Dorego Tierney Smyrna, GA Shidong Tong Richmond, VA Alberto Torresin Milano, ITALY Cynthia Amy Tozian Reading, MA Michael Aaron Tressler Malabar, FL Sugata Tripathi Lexington, KY

Guillermo Trujillo San Juan, PR Haifeng Tu Madison, WI Julius V. Turian Chicago, IL Nagarajan (Raj) Varadhan Fridley, MN Subrahmanya S. Vedam Richmond, VA Jagannath Venkatesan Naperville, IL Milos Vicic St. Louis, MO Kandavelu Vishwanathan Scarborough, ON, CANADA Thomas Von Der Haar Nuernberg, GERMANY Thomas H. Wagner Jacksonville, FL David S. Waid Muskegon, MI Lin Wang New York, NY Hui Wang East Amherst, NY Li Y. Wang Greenwood, IN Ruqing Wang Baltimore, MD Christopher J. Watchman Gainesville, FL Deborah L. Weber Middleton, WI Joseph A Webster Cincinnati, OH Sheri Mara Weintraub East Bridgewater, MA Edward Brian Welch Rochester, MN William Geoffrey West Atlanta, GA Matthew K. West Tulsa, OK Sharon L. White Birmingham, AL Brian D. Wichman Phoenix, AZ Brian P. Wilfley Los Altos, CA Joseph D. Wise Charleston, SC Matthew P. Wismayer Ottawa, ON, CANADA

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Michael F. Worman Flemington, NJ Yulong Yan Stanford, CA Chang-Ying J. Yang Rochester, NY Sung-Joon Ye Toledo, OH Pengpeng Zhang Cleveland, OH Sue Y. Zhou Galveston, TX â–

AAPM NEWSLETTER SEPTEMBER/OCTOBER 2001

Letter to the Editor Response to Coffey Ivan A. Brezovich, Birmingham, AL I wholeheartedly agree with the essence of Dr. Coffey’s proposal, the need “to become proactive and write your members of Congress and let them know of the important role(s) of medical physicists in radiology procedures and radiation therapy treatment delivery” (AAPM Newsletter, July/August 2001, page 1). However, before we contact members of Congress, the AAPM needs to do its homework. I don’t want other AAPM members to get burned like I did.

I once contacted a politically active lawyer friend of mine who is a close relative of one of Alabama’s U.S. senators.

During an extensive, pleasant conversation I explained the role of medical physicists in health care, and pointed out difficulties medical physicists are facing in terms of staffing, recognition and pay. He wanted to know if medical physicists had an organization. I said “Yes, the AAPM and the ACMP.” He then wanted to know the stand of these organizations on those issues, and what specific actions we wanted from Congress. I had to admit that neither the AAPM nor the ACMP had an official stand, like desiring to be recognized by

HCFA as professionals (providers). At that point, my friend simply said: “Get your organization to agree on a specific goal that you want Congress to achieve, and we can take it from there. Until this happens, I can do very little for you.” I felt like little Johnny being chastised by his teacher for not having done his math problems.

There are many medical physicists with even better connections, eager to use their personal assets for the benefit of our profession. But without some backing and recognizable direction by the AAPM or the ACMP, these dedicated members are just spinning their wheels. No matter how strongly a congressman or senator agrees with the importance of our role in health care, he can’t do anything for us until we tell him what we want.

Contrary to common belief, physicists are superb politicians once they put their minds to it.

Two of the U.S. congressmen are physicists by training, a high percentage considering the small number of physicists in the American population. The AAPM and the ACMP have achieved their stated political goals. Medicare pays for medical physics services, essentially at the requested rate. But patients and medical physicists rarely benefit from that. Medical physics has become the cash cow of the hospital, like no

20

other profession. The AAPM now needs to devise a mechanism by which money paid for physics services is used for the intended purpose. Medical physicists will then be able to use their considerable political influence to implement that mechanism, for the benefit of patients and the profession. ■

AAPM NEWSLETTER JANUARY/FEBRUARY AAPM NEWSLETTER SEPTEMBER/OCTOBER 20012001

Letter to the Editor Response to R.J. Schulz: IMRT Works!

Howard I. Amols New York, NY Bob Schulz writes in the July/ August Newsletter that IMRT is an unproven technology that unnecessarily increases health care costs. I must respectfully disagree with him on this important issue.

One useful criteria for judging the value of any new medical device is to ask the question; ‘How would I want to be treated if I were a patient?’ So I ask Dr. Schulz; If you had prostate cancer would you opt for 65 Gy using a 4-field box technique, or would you prefer 81 Gy IMRT? Or, perhaps; If you had been a patient in 1960, would you have opted for orthovoltage irradiation— megavoltage being (at that time) an expensive and unproven technology?!

There are peer-reviewed clinical trials that show a clear benefit to IMRT prostate radiotherapy. At my own institution it has been shown that the five year actuarial PSA relapse free survival for unfavorable prostate patients (stage >T2) increased from 21% at doses of 66-70 Gy; to 43% for dose = 75.6 Gy; to 67% at 81 Gy. In addition, the incidence of grade 2 rectal bleeding was lower

(2% vs. 14%) in IMRT patients than in conventional 3DCRT patients (1,2). Are there confounding factors clouding these results, such as early detection, significance of PSA, effects of distant mets on overall survival, etc.? Of course! Are these trials definitive proof that IMRT is better than conventional therapy? Maybe not! On neither of these points do I disagree with Dr. Schulz. But I come back to my original question; How would I want to be treated if I were the patient?

Dr. Schulz also ignores other possible benefits of IMRT, such as normal tissue avoidance.

Even when treating tumors where conventional doses already provide good local control, IMRT can reduce the severity of normal tissue damage while maintaining the same local control, such as in the treatment of breast and pediatric tumors. Since Dr. Schulz chose breast as a prime example of the ‘wastefulness’ of IMRT, let’s look at this in more detail.

Conventional RT of breast suffers in three important areas: high doses to normal lung (sometimes resulting in radiation pneumonitis, and sometimes resulting in secondary malignancies); inhomogeneous dose to the breast itself (sometimes resulting in undesirable cosmesis); and measurable increase in long-term cardiac complications. IMRT can (may, if you prefer, since this is all 21

unproven) provide better clinical outcome in all three of these areas. Might the IMRT patient still die of distant mets? Yes, they might! Have any of these benefits of IMRT been proven definitively? No, they have not!

But again; If you were the patient what would you want?

Since cost appears to be the driving force in many of Dr. Schulz’s arguments, let’s examine the real costs of IMRT. The proposed new HCFA charge codes for IMRT (G0174 and G0178) will add approximately $10,000 to the total treatment costs for a typical patient receiving 30-35 fractions of IMRT. For want of a better estimate, let us assume that HCFA has carefully analyzed this problem, and that the proposed charge codes indeed represent the real costs of IMRT. Assuming 200,000 patients per year will be treated in the U.S. with IMRT (roughly 1/3 of all RT patients), this represents an incremental increase in national health care costs of about $2 billion. That is equivalent to approximately 0.05% of our Gross National Product, or the amount of money spent by the federal government every 17 hours, and less than the cost of a single B-1 bomber. I apologize for not having a good estimate on the cost of a Star Wars missile obliterating a harmless decoy ten miles from (See Amols - p. 22)

AAPM NEWSLETTER SEPTEMBER/OCTOBER 2001

Letters to the Editor Amols

(from p. 21)

its intended target, but I’ll hazard a guess that is also about two billion bucks a pop.

Coming back to my (and Dr. Schulz’s) prostates, if I were a patient I would rather have IMRT as opposed to being the proud owner of 0.0005% of a B-1 bomber ($10,000 incremental IMRT cost divided by $2 billion for the B-1). You can quibble with my figures and ridicule my politics, but the point is that the richest nation in the history of human civilization can easily afford IMRT if it chooses to do so. The argument that we should abandon IMRT now because it costs money and its benefits are unproven denies us the opportunity to test it definitively. With such logic there would never be any progress. Not too long ago megavoltage was expensive and unproven, as was CT imaging, computerized treatment planning, MR, PET, etc.

One would be hard-pressed to argue that IMRT, when administered by properly trained personnel, can be less effective than conventional RT. Indeed, if there are any published studies demonstrating this I hope someone will point it out in the next Newsletter. In short, IMRT has to be as good or better than conventional RT. I did add the caveat that IMRT requires additional training, and I am aware that training also

costs money. But training a B1 pilot also costs money, so again we come to defining national priorities. Hopefully Americans will vote with due concern for their prostates, breasts, and other cancer-bearing organs, and continue to support the development of IMRT and other innovations in health care.

On a personal note, I’d like to thank Dr. Schulz for providing me with this opportunity to write something controversial for the Newsletter. Lord knows, with the recent resolution of the physics certification board issue, and elimination of the Newsletter’s cartoon section, I have been hard-pressed to find things to write about!

1. Zelefsky MJ, Leibel SA, Gaudin PB, et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radi Onc Biol Phys 41; 491-500 (1998).

2. Zelefsky MJ, Fuks Z, Hunt M. et al. High dose radiation delivered by IMRT radiotherapy improves outcome of localized prostate cancer. J Urology, in press (2000). ■

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Response to Schulz Letter on IMRT Joseph Ting Atlanta, GA I read the “Letters to the Editor” on IMRT by Dr. R. J. Schulz (IMRT, RJ Schulz, AAPM Newsletter, 26:4, 2001,17-18) with great interest. Though I agree with many of the points made by Dr. Schulz in his article, I found that Dr. Schulz focused his discussions on the potential improvement of cancer cure using IMRT and did not address the proven benefits of using IMRT to reduce the treatment toxicity. Here are some of my findings: Emory, though an academic center, does not have the typical army of physicists for research and development tasks.

Most of our clinical day is well occupied by patient-related duties and QA tasks. However, we have been using IMRT for routine, clinical treatments since August, 1998.

Since Dr. Schulz brought up two specific sites (breast and prostate) for discussion, I will address these two sites with some detail.

First, at Emory Clinic we use IMRT for the treatment of the breast only as an electronic tissue compensator and we have not used IMRT with inverse planning for breast treatments.

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We consider breast is not suitable for IMRT with inverse planning because of target volume definition, organ motion during treatment, daily setup variations, and comparatively higher doses to healthy lungs and heart. Besides, current breast treatments using tangential approaches are well tolerated by most patients and the current clinical results are excellent. As my grandmother and many others would say, “If it is not broken, don’t fix it.” Therefore, we do not use inverse planning and IMRT for treatment of breast cancer.

Second, we use IMRT for prostate treatments. However,

we have not escalated doses beyond 81 Gy covering the prostate. And, we have no dose escalation plans for any other clinical sites using IMRT. Our doses are well in line with those practiced in our department using conventional treatment methods. As many other clinical sites, namely, head and neck, rectum, pancreas, we have used IMRT for the purpose of toxicity reduction and NOT for dose escalation. It does not require a large number of patients to prove that IMRT can reduce small bowel toxicity, for example. One can actually observe the result quickly as patients are going

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through the treatment. We have many IMRT patients who have survived two years or longer with advanced brain, head and neck, and abdominal lesions.

Many of these patients benefited from IMRT in a very direct fashion: “they were able to be treated using IMRT and could not be treated using conventional treatment methods without causing unacceptable toxicity.”

I am NOT in support of those commercial flyers containing “… happy, smiling faces of physicists …” But, one should look one step beyond and see the results of IMRT on patients (See Ting - p. 24)

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Ting (from p. 23) who have completed their course of treatment. It may require a thousand patients and a well-orchestrated double blind protocol study to prove IMRT’s efficacy. But, for that one patient who was able to go through the entire course of treatment without the common

toxicity, IMRT DOES MAKE A DIFFERENCE. Finally, I support Dr. Schulz’s viewpoint about managing the patient who has distant metastases. But, there may come a day that treating metastases with high dose radiation (IMRT or otherwise), call it hot shot, for the lack of a proper terminology at this time, is a way to

manage patients with metastases. Those patients may have improved quality of life and/or lengthening of productive life. Please notice, I did not say, improvement of cancer cure.

Again, I wish to thank Dr. Schulz for his contribution with a different viewpoint.

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AAPM NEWSLETTER EDITOR, Allan F. deGuzman MANAGING EDITOR, Susan deGuzman Editorial Board: Arthur Boyer, Nicholas Detorie, Kenneth Ekstrand, Geoffrey Ibbott, C. Clifton Ling, Richard Morin

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: November/December 2001 Deadline: October 15th Postmark Date: November 15

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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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