Newsletter
AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE NOVEMBER/DECEMBER 2001
VOLUME 26 NO. 6
As indicated in the previous issue, we are including a printed version of the ABR/ ABMP agreement in this issue of the Newsletter. An electronic copy is also available on the AAPM Web site. —The Editor
AAPM President’s Column Coffey Break Charles W. Coffey, II Nashville, TN
WORKING AGREEMENT WORKING AGREEMENT AMERICAN BOARD OF RADIOLOGY and THE AMERICAN BOARD OF MEDICAL PHYSICS, INC. June 4, 2001
Difficult Days We, as Americans, were saddened by the tragedies of September 11, 2001. We, too, as medical physicists, extend our condolences and sympathy to those families, friends, and acquaintances affected by the events of that most tragic September day. Also, our hats are off to those heroes and volunteers who served and continue to serve their communities, cities, and nation during these difficult days. I want to also personally thank our many international medical physics officials and friends who have sent their condolences and expressions of support to our American citizens. We may pause and ask if there is something to learn in all of this tragedy. Please allow me to share the following personal insights: Life is fragile. Tomorrows are not certainties. Selfless service to and for others is one key to joyous living. Hug your kids often. And, in the words of Lee Greenwood who sang his signature song at the 1999 Annual Meeting Night Out in Nash-
01_2140_AAPM_NovDec.p65
1
ville, “I’m proud to be an American… and I’ll gladly stand up next to you and defend her today, because there is no doubt I love this land, God Bless the USA.” Mike Gillin suggests that as medical physicist professionals, we can show our patriotism and serve our communities and country by becoming informed and observant citizens, by volunteering within our local communities as members of disaster relief teams, and by reporting to hospitals and local state emergency relief officials that we can serve, when appropriate, as radiation protection emergency professionals. So… stand up, volunteer, and make a difference in the lives of others.
This agreement is effective as of this 9th day of July, 2001 by and between the “parties” herein defined as the American Board of Radiology (ABR), a not-for-profit corporation with principal offices located at 5255 E. Williams Circle, Suite 3200, Tucson, Arizona 85711-7409 U.S.A. and The American Board of Medical Physics, Inc. (ABMP), a not-for-profit corporation with its principal office c/o Dr. Herbert Mower, Lahey Hitchcock Medical Center, 41 Mall Road, Burlington, MA 01805. WHEREAS ABR and ABMP each certify medical physicists; WHERAS ABR and ABMP mutually agree that the
(See Coffey - p. 2)
11/1/01, 2:49 PM
(See Agreement - p. 4)
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Coffey (from p. 1) Special Recognition Our special recognition, thanks, and appreciation go to Ken Hogstrom, chairman of the board, who completes three years of service on EXCOM as of December 31st. Ken, thanks for the excellent leadership, enduring friendship, and unselfish service that you have shown to the Association. Join me in congratulating Ralph Lieto on his selection to the medical nuclear physicist position on the Advisory Committee of the Medical Use of Isotopes (ACMUI). He joins fellow AAPM members Jeff Williamson and Richard Vetter on this prestigious national advisory panel of the NRC. Also, join me in thanking Allan deGuzman and his wife, Susan, on the completion of their first year as Newsletter editors. TABLE OF CONTENTS President’s Column p. 1 Working Agreement p. 1 Exec. Dir’s. Column p. 7 ABMP Testing Sched. p. 8 Gov’t Rel. Column p. 10 Summer Undergraduate Fellowship Prgm. p. 11 ACR Council Report p. 13 Travel Grant Report p. 15 Pediatric CT p. 17 Memorial Funds p. 18 Jones Memorial p. 19 Letters p. 20, 23 Chapter News p. 22
DigiScript and Webbased Continuing Education Opportunities Don Frey, Education Council chair, has announced that the DigiScript/AAPM virtual library is now available on the Web. Many of the educational presentations from this year’s Annual Meeting are posted there for your review. To visit the virtual library, go to http:// medphys.digiscript.com. I personally have partially reviewed the Web site and was impressed with the quality and varied subject materials of these educational presentations. Additionally, many of these presentations have been approved for CAMPEP credit through the AAPM RDCE program. I will join the RDCE program for 2002 and I encourage you to do so as well and take advantage of this CE credits program. The Association’s thanks go to Chuck Kelsey and the RDCE Subcommittee for their work on this project and for the many members who served as reviewers of these presentations at the Annual Meeting.
Intravascular Brachytherapy (IVB) Roles Document Several years ago, representatives from ASTRO and AAPM wrote a roles document for intravascular brachytherapy (IVB) team members. In March, 2001, a meeting was
held in Washington, DC with participants from ASTRO, American College of Cardiology (ACC), Society for Cardiac Angiography and Interventions (SCAI) and AAPM for the purpose of writing a multi-discipline roles document. As president, I appointed Ravi Nath and Stephen Balter as the official AAPM representatives to this roles document working committee. Beginning in late spring, representatives from the organizations combined to write a draft document. At this time the draft document is still undergoing final revision. When the roles document is completed, the four participating organizations plan to publish the document in the International Journal of Radiation Oncology, Biology, and Physics. When completed, the roles document will also be posted on our AAPM Web site. For those of you who are not as yet participating in IVB, I encourage you now to become proactive team members in your local hospitals and medical centers in the procedures writing for the safe, effective use of IVB. Our thanks to Ravi and Stephen and the IVB Subcommittee members who assisted in the writing and review of this important document.
Electronic Media and Communications Leadership of AAPM shares in the enthusiasm that has been created by the introduction of electronic media and commu-
2
01_2140_AAPM_NovDec.p65
2
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
nications within the Association by Headquarters Information Services staff and the Electronic Media Coordinating Committee (EMCC). Examples of such include the aforementioned DigiScript Web-based learning opportunity and the Annual Meeting Call for Papers and Registration via the Internet. The recent dues notice statements that were sent electronically offer a substantial savings to the Association’s budget in postage and administrative support dollars. Several AAPM standing committees are now conducting virtual committee meetings via e-mail and the Internet. These virtual meetings keep committee members informed and allow for more timely reports and publications without the costs of additional member travel and time outside the normal Annual Meeting and RSNA committee meetings. Next year, look for officer and board member at-large balloting to be done via e-mail and the Internet. As a cost-savings measure, AAPM leadership encourages, to the extent possible, council and committee chairs to conduct committee business including meetings, report writing and revisions, member surveys, etc. via electronic media.
a close. Let me say that it has been a genuine honor to serve you as president this year. I appreciate the confidence that you have shown to allow me this opportunity of a lifetime. As I have indicated in previous columns, I am indebted to many individuals for this year of service. My thanks to my departmental chairman and to my excellent staff who have covered the clinic for me and allowed me the time to serve. My thanks to EXCOM, Ken Hogstrom, chairman of the board, Robert Gould, president-elect, Jerry White, secretary, Melissa Martin, treasurer, and Sal Trofi, executive director for their leadership, support, and cooperation. My thanks to the many of you who have answered my calls to service and assisted me with writing letters, deliberating policy statements, and making decisions. My thanks to Headquar-
The American Association of Physicists in Medicine Cordially invites you to attend the AAPM Cocktail Party during the 2001 AAPM / RSNA Meeting Sponsored by Siemens Medical Systems, Inc. Tuesday, November 27, 2001 6:00 pm - 8:00 pm Waldorf Room Chicago Hilton and Towers Chicago, Illinois
Thanks By the time you read this column, the Winter Board Meeting at RSNA may have passed and the year will be drawing to
ters leadership and staff who have taken my phone calls for assistance and completed the assignments well before the agreed deadline. And last, thanks to my family who has endured this year’s additional workload and challenges with patience, understanding and love. In closing, the Association, led by an extraordinary volunteer leadership corps and an excellent Headquarters staff, is strong, united, and active in a multitude of scientific, educational, and professional efforts. The days ahead will be uncertain for our nation but our nation is also united and its faith is strong. I urge you to do your part in keeping our Association and nation strong through participation, cooperation, and volunteer service. My best wishes to you and your families for a joyous and peaceful holiday season. ■
light hors d’oeuvres
3
01_2140_AAPM_NovDec.p65
3
11/1/01, 2:49 PM
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Working Agreement (continued from p. 1)
process of certification of medical physicists should be defined and administered by board-certified medical physicists; WHEREAS ABR and ABMP mutually agree that having a single certification board for each field and subspecialty of medical physics will reduce confusion of medical physicists and the public; WHEREAS ABR and ABMP agree that having a single certification board for each field and subspecialty will increase efficiency of the process of certification of medical physicists; WHEREAS ABR and ABMP also agree that having a single certification board for each field and subspecialty will increase the stature of certification to individuals obtaining it; and WHEREAS ABR and ABMP mutually agree to work together from the date of this agreement forward to achieve and maintain a single certification board for each field and subspecialty of medical physics; NOW, THEREFORE, for and in consideration of the mutual covenants set forth in this agreement, it is agreed by and between the parties as follows: ARTICLE 1 – Purpose of the agreement 1.1 1.2
1.3
This agreement embodies and describes an intent of ABR and ABMP to work cooperatively to achieve shared objectives with regard to certification in medical physics. Specific terms of cooperation 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.
ARTICLE 2 – Certification of new candidates in traditional fields of medical physics 2.1
2.2
Traditional fields of medical physics include the areas of radiation therapy physics (therapeutic radiological physics), diagnostic radiology physics (diagnostic radiological physics), and nuclear medicine physics (medical nuclear physics). After the July 21, 2001 examination, the ABMP will no longer offer the Part I Written Examination for new candidates in the traditional fields of medical physics. All new candidates for certification in these areas must apply to the ABR.
ARTICLE 3 – Certification of candidates in traditional fields of medical physics who are currently in the process of obtaining ABMP certification 3.1
Candidates engaged in the ABMP certification process after the July 22, 2001 ABMP examinations may continue the ABMP certification process. 4
01_2140_AAPM_NovDec.p65
4
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
3.2 Candidates engaged in the ABMP certification process, who have passed Parts I or II, may transfer into the corresponding stage of the ABR certification process. 3.3 ABMP oral examination candidates who have conditioned in one or more areas and transfer to the ABR oral examination process must take the full ABR oral examination. ARTICLE 4 – Certification in non-traditional fields of medical physics 4.1 Non-traditional fields of medical physics include independent areas of medical physics certification other than traditional fields of medical physics. 4.2 The ABR will not examine medical physicists in non-traditional fields of medical physics in which the ABMP offers certification by examination, and similarly the ABMP will not examine medical physicists in non-traditional fields of medical physics in which the ABR offers certification by examination. 4.3 The ABMP presently certifies medical physicists in three non-traditional fields of medical physics: hyperthermia physics, medical health physics, and MRI physics. In exception to 4.2 the ABR may offer certification by examination in MRI physics five years after the effective date of this agreement. 4.4 The ABMP will provide the ABR with equal participation in its non-traditional certification examination in MRI physics. Equal participation is defined as providing the ABR with equal representation of voting members on an ABMP committee, which is responsible to the ABMP for conducting examination for certification. The ABR members will be selected by the ABMP from nominees submitted by the ABR. The ABR will submit 2 nominees for each member to be selected by the ABMP. ARTICLE 5 – Certification in medical physics subspecialties 5.1 Subspecialty certification examinations shall require certification by the ABR or by the ABMP in a traditional or non-traditional field of medical physics. 5.2 The ABMP retains the right to develop subspecialty certification examinations (e.g. in cardiovascular or neuro-irradiation physics). The ABR will not certify in subspecialties of medical physics. ARTICLE 6 - Certification equivalency for ABMP diplomates 6.1 Medical physicists certified by the ABMP in a traditional field of medical physics will, upon written request, receive a letter of certification equivalence from the ABR stating that ABMP certification is equivalent to ABR certification in the same field. The letter of certification equivalence will be available for 5 years from the date of this agreement. 6.2 The ABR acknowledges that ABMP diplomates with a letter of certification equivalence in a traditional field of medical physics should be recognized as equivalent to ABR diplomates (in the same traditional field) in all guidelines, standards, regulations, and privileges of scientific, professional, and regulatory bodies. 6.3 The ABR has been informed by the American College of Radiology (ACR) that medical physicists receiving a letter of certification equivalence will be eligible for membership in the ACR on the same basis as medical physicists certified by the ABR. (See Agreement - p. 6)
5
01_2140_AAPM_NovDec.p65
5
11/1/01, 2:49 PM
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Working Agreement (continued from p. 5)
ARTICLE 7 – Recertification of ABMP diplomates 7.1 Each medical physicist certified by the ABMP will be eligible to participate in the recertification program of the ABMP. 7.2 Those ABMP diplomates who attain the ABR letter of certification equivalence after December 31, 2002 will be required to participate in the ABR’s Maintenance of Certification program in order to maintain the letter of certification equivalence. 7.3 Any ABMP diplomate with a letter of certification equivalence is eligible for the ABR’s Maintenance of Certification program. If all conditions for maintenance of certification are satisfied, these physicists will be awarded an ABR certificate and placed in the listings of the American Board of Medical Specialties. ARTICLE 8 – ABR Radiological Physics Examination Committee 8.1 Membership: Consistent with Article VIII, Section 5 of the ABR Bylaws, this agreement establishes that the voting members of the Radiological Physics Examination Committee shall consist of the three ABR Physics Trustees and an equal number of members from the ABMP. The ABMP members will be selected by the ABR from nominees submitted by the ABMP. The ABMP will submit 2 nominees for each member to be selected by the ABR. ARTICLE 9 – Funding 9.1 Parties to this agreement recognize that termination by the ABMP of certification of medical physicists in traditional fields of medical physics will cause financial hardship to the ABMP for a 3-year transition period (July 1, 2002 to June 30, 2005). 9.2 The ABR agrees to provide transition compensation to the ABMP over three years for lost revenue caused by this termination of certification. 9.3 Compensation shall be as follows: a first payment of $15,000 by September 30, 2002; a second payment of $15,000 by September 30, 2003; and a third and final payment of $15,000 by September 30, 2004. 9.4 No other payment or compensation for any purpose shall be paid by the ABR to the ABMP. ARTICLE 10 – Continued Cooperation 10.1 The intent of both parties is to continue to cooperate to improve the process of certification of medical physicists after the specific terms of the agreement have been satisfied. 10.2 The intent of both parties is to continue to cooperate to improve the stature of certification of medical physicists. This shall include, but is not limited to, the ABR and ABMP encouraging the ACR, American College of Medical Physics (ACMP), American Association of Physicists in Medicine (AAPM) and other similar professional organizations’ inclusion of ABR and ABMP medical physics certification in appropriate standards and definitions of medical physicists.
6
01_2140_AAPM_NovDec.p65
6
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
10.3 The intent of both parties is to continue to cooperate to improve the unity of the process of certification of medical physicists. American Board of Radiology By: Robert R. Hattery, MD, President June 10, 2001
The American Board of Medical Physics, Inc. By: Lawrence E. Reinstein, PhD, Chairman July 9, 2001
■
Executive Director’s Column Sal Trofi College Park, MD
Fellowships and Residencies Last month your monthly mailing contained applications for a sponsored fellowship, two clinical residencies in radiation oncology and two clinical residencies in diagnostic medical physics. Residency applications must be received at AAPM Headquarters by February 1, 2002. Fellowship applications must be received by April 15, 2002. The AAPM Fellowship is offered to individuals and is a two-year pre-doctoral study in medical physics that will begin on July 1, 2002. Graduate study must be undertaken in a medical physics doctoral degree program accredited by CAMPEP. The amount of the award will be $18,000 per year for two years. This fellowship is funded through the AAPM General Operating Fund. The ASTRO Clinical Residencies will be awarded to two institutions. Each institution will sponsor one, two-year
clinical residency in radiation oncology. The residency program must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. ASTRO has supported these residencies since 1992. The RSNA Research & Education Fund will award residency funding to two institutions. Each institution will sponsor one, two-year clinical residency in diagnostic medical physics. The residency programs must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. RSNA has supported these residencies since 1998.
AAPM Web Site We now have e-mail addresses for about 92% of the AAPM membership. Those with bad or rejected e-mail addresses are about 2%, and the remaining 6% or about 300 members have no e-mail address in their record. If you are a member with an e-mail address and have not yet updated your record, you can do so by entering the AAPM Web site and clicking on
“member profile” on the lefthand side of the Web site. Besides e-mail addresses, we would also like to get as many home addresses for our members as possible. We currently have about 37% of our members with a home address in their profile. Home addresses allow us to determine what voting district you are in and the congresspersons that represent you. This address will not be used to contact you unless you indicate that it is your primary address. When a government issue arises that affects the medical physics profession and a congressperson in your voting district is involved, we will send an alert to your primary address and suggest actions you may want to take.
7
01_2140_AAPM_NovDec_cx.p65
7
11/5/01, 12:12 PM
(See Trofi - p. 8)
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Trofi (from p. 7) The 2002 dues renewal notices were communicated via the Web this year. We hope you found this as a convenient way to pay your dues. If you have not yet paid your dues, we ask that you seriously consider doing so via the AAPM Web site. Payments over the Web significantly reduce the amount of processing time for the Headquarters staff, and will save you the cost of postage and the inconvenience of going to a mailbox. If you prefer to mail your payment, we urge you to print a copy of the invoice from the Web to use as your remittance advice. The cost of printing and mailing dues renewal notices is expensive and Web communication can bring this cost close to zero. This is another good reason to update your member profile with an e-mail address.
Abt Associate Study AAPM and ACMP have entered into a joint contractual
arrangement with Abt Associates to conduct a survey of medical physics services. The survey is for services associated with radiation oncology and will develop a resource-based relative value scale for medical physicists working in radiation oncology. The last study was completed in 1995 and results from this new study will be completed early in 2002. As with the previous study, all AAPM members will have access to the study. It will be posted on the AAPM Web site and will be made available in paper copy upon request.
Staff News Falaq Moore-Pimienta, our accounting assistant, delivered a baby at 31 weeks of pregnancy on August 10, 2001. The baby boy’s name is Quentin. He weighed 3lbs-15oz at birth and spent an extended time in neonatal intensive care at a local hospital. At the time of writing this article, both Quentin and Falaq are doing just fine. Falaq
returned to work on October 10, 2001. Quentin is enrolled in the daycare center in the Headquarter’s office building. This will allow Falaq the opportunity to check on Quentin during the day and participate in his feeding at mealtimes.
Closing Remarks The AAPM office will be open all regularly scheduled workdays during the holiday season, but will be closed on Monday and Tuesday, December 24-25, 2001 and Tuesday, January 1, 2002. Some staff will take vacation days during the holiday season, but sufficient help will be available to service your needs. This is my last column for the 2001 year. I want to take this opportunity, speaking for all the staff, to wish you and your loved ones a happy and healthy holiday season. ■
2002 ABMP TESTING SCHEDULE Part I: General Medical Physics Written Exam - July 13, 2002 Montreal, Canada (AAPM Meeting) Part II: Written Exam - July 14, 2002 Montreal, Canada (AAPM Meeting) Radiation Oncology Physics, Diagnostic Imaging Physics, Hyperthermia Physics, Medical Health Physics, Magnetic Resonance Imaging Physics Applications must be received no later than 01/05/02 in order to take the written examinations in 2002. Part III: Oral Exams - April 18-21, 2002 Chicago, IL Applications must be received no later than 12/15/01 in order to take the oral examination in 2002.
8
01_2140_AAPM_NovDec.p65
8
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
IVB Calibration Instruments IVB 1000 for Intravascular Brachytherapy ■
Ideal for precision B and Y IVB source calibration
■
Flat 100 mm “Sweet Spot” to measure the longest source trains
■
Designed to meet NRC Requirements for independent source strength verification
■
FDA 510(k) clearance for IVB applications
■
ADCL 2 mm absorbed dose to water calibrations
NEW! IVB Film Phantom ■
Evaluate dose within mm of the source
■
Verify source uniformity
■
Verify seed presence and positioning
■
Quick, easy repositioning of source and film
NEW! X-Ray Contamination Test Tool ■
Evaluates Bremsstrahlung gamma component of 90
■
Provides a quick quality assurance check of the 90
■
Sr/90Y sources
Sr/90Y source
Used with IVB 1000 Well Chamber
www.standardimaging.com 7601 Murphy Drive ■ Middleton, WI 53562-2532 U.S.A. ■ Tel (608) 831-0025 ■ (800) 261-4446 ■ Fax (608) 831-2202
9
01_2140_AAPM_NovDec.p65
9
11/1/01, 3:41 PM
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Government Relations Column Angela L. Furcron College Park, MD Congress has put most bills that do not pertain to terrorism on the back burner after the events of September 11. As of this writing, Congress still has not passed any of the 13 appropriations bills and it is unclear when they will be completed. To check on the status of appropriations bills go to http:// thomas.loc.gov/ and click on Status of FY2002 Appropriations Bills. Senate Majority Leader Tom Daschle says the Senate will stay in session “in one form or another” until the end of the year. He further stated that the Senate may complete its legislative agenda by the beginning of November, but will continue to meet in pro forma sessions in case Congress is called upon to respond to emergencies. A pro forma session is a brief meeting held by the House or Senate in order to satisfy the constitutional requirement that each house must obtain the consent of the other if it adjourns for more than three days. I am continuing to watch for the Senate introduction of the CARE Act, but it is unlikely that it will happen in this session. Its Senate sponsor is probably waiting for a better climate in which to introduce the bill. If it is introduced now, it may not get any attention.
On September 30, President George W. Bush continued the President’s Council of Advisors on Science and Technology (PCAST) for another two years. Former President George H.W. Bush originally established PCAST in 1990 to enable the President to receive advice from the private sector and academic community on technology, scientific research priorities, and math and science education. Dr. Nils J. Diaz was sworn in for a second term as commissioner of the Nuclear Regulatory Commission on October 4 by the secretary of Housing and Urban Development, Mel Martinez, in a ceremony at NRC headquarters in Rockville, Maryland. On September 26, the Senate confirmed Dr. Diaz to serve a second term as NRC Commissioner through June 30, 2006. Dr. Diaz was a professor of nuclear engineering at the University of Florida before joining NRC.
The Nuclear Regulatory Commission held an Advisory Committee on the Medical Use of Isotopes (ACMUI) meeting on October 29. Some of the topics discussed were: the status the new 10 CFR Part 35, Medical Use of Byproduct Materials; Recognition of Certification Boards; Medical Physicist Qualification Criteria; and Intravascular Brachytherapy. NRC has selected Ralph Lieto, an AAPM member, to fill the nuclear medicine physicist vacancy on the ACMUI. Ralph Lieto is the chairman of the Radiation Protection Committee, as well as a member of the Ad Hoc Committee on Government Affairs Coordination. CONGRATULATIONS RALPH! The National Institute of Biomedical Imaging and Bioengineering (NIBIB) has moved to its permanent home. The address is: National Institute of Biomedical Imaging and Bioengineering, 31 Center Drive, Room 1B37, Bethesda, MD 20892-2077. The NIBIB Web site is also up and running and can be found at http:// www.nibib.nih.gov. The Web site provides information on all aspects of NIBIB structure, operation and activities. Specific topics addressed on the Web site include the history, mission, staff, budget, vacancy announcements, and legislative activities of NIBIB; a calendar of events for biomedical imag-
10
01_2140_AAPM_NovDec_cx.p65
10
11/5/01, 12:13 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
ing and bioengineering activities (symposia, application deadlines, conferences, workshops); articles describing news and events associated with imaging, bioengineering, and NIBIB; lists and links to NIBIB research and training opportunities and NIH extramural grant information.
Richard D. Klausner, M.D. officially stepped down as the director of the National Cancer Institute (NCI) on Friday, Sept. 28. Klausner was recently named president of the newly created Case Institute of Health, Science and Technology, which will be located in Washington, D.C. Health and
Human Services Secretary Tommy G. Thompson named NCI Deputy Director Alan S. Rabson, M.D. to acting director on Monday Oct. 1. He will serve as the acting director until a new director is named. See you at RSNA. Have a wonderful holiday season. ■
Summer Undergraduate Fellowship Program a Success Kenneth Hogstrom Education Council Chair The AAPM Summer Undergraduate Fellowship Program Subcommittee is pleased to report that its inaugural summer program was a huge success. Six undergraduate students were awarded ten-week AAPM fellowships that matched them with medical physicist mentors in research and clinical settings. The program is aimed at allowing the fellow to gain insight into medical physics research and clinical practice, which can help with future important career decisions. The AAPM wishes to give special thanks to those members who volunteered to serve as mentors for the fellows, and we encourage those not selected this year to volunteer again next year. Many of the applicants requested to study in specific scientific areas and in geographic areas nearby to their residences, so a large mentor base helped the AAPM best meet the individual fellow’s requests. The six re-
Shannon Treis, AAPM summer undergraduate fellow and junior physics major at University of Puget Sound, sits at ADAC Pinnacle3 treatment planning system with mentor Ray Luse of Sacred Heart Medical Center in Spokane.
cipients of the fellowships were selected from a large pool of outstanding applicants. A brief summary of each fellow’s summer work follows. Vanderbilt University Medical Center Joshua James, from Bowling Green, KY and currently a junior physics major at Western Kentucky University, spent his summer at Vanderbilt University Medical Center learning
about the medical physics of radiation oncology. Joshua was mentored by Darryl Kaurin, with whom he explored new techniques in radiation dose verification for high-precision cancer therapy. In addition to his research, Joshua also experienced how medical physics supports the high technology processes now so characteristic of modern radiation oncology.
11
01_2140_AAPM_NovDec_cx.p65
11
11/5/01, 12:13 PM
(See Undergraduate - p. 12)
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Undergraduate (from p. 11) University of FloridaGainesville Matthew Jessee, from Kingsport, TN and currently a junior majoring in nuclear engineering at the University of Tennessee-Knoxville, spent his summer investigating radiation oncology treatment problems associated with patient motion during intensity modulated radiation therapy. Matt worked under the supervision of Siyong Kim and Jatinder Palta in the Department of Radiation Oncology at the University of Florida-Gainesville. University of Kentucky Medical Center Jeananne Miller, from Lexington, KY and a University of Kentucky physics senior, chose to do her fellowship under the guidance of Ali Meigooni of the Radiation Medicine Department at the University of Kentucky Medical Center. Jeananne participated in research, studying dosimetry of new designs of brachytherapy sources, thermoluminescent dosimetry, and radio-chromic film dosimetry. As part of her clinical training she observed and assisted in radioactive seed implants for prostate cancer, head and neck cancer treatment planning, and intravascular brachytherapy to prevent the restenosis of heart vessels that have undergone angioplasty. Her lasting legacy to the hospital was the transformation of the “ugly” lead shield containers used to transport radioactive materials
throughout the hospital into “pink Miss Piggys” with a smiling face on them. Patient apprehension was surprisingly reduced by this clever decorative action on her part. University of Illinois at Chicago Nathaniel Nelms, a native of Urbandale, IA and currently a senior physics major at the University of Iowa, chose to take his fellowship at the University of Illinois at Chicago under the supervision of Russell Hamilton. Nathaniel spent time in the clinic observing the breadth and detail of clinical radiation therapy and in the laboratory participating in intensity modulated radiation therapy research and development. His contribution to the research, a computer code that adjusts multi-leaf collimators dynamically to deliver the desired radiation intensity profile, was tested and verified to be accurate. University of CaliforniaSan Francisco Anne Sadinawat, a native of Arlington, TX and a senior majoring in electrical engineering and computer science at the University of California – Berkeley, chose to take her fellowship at the University of California – San Francisco, working under the supervision of Bruce Hasegawa in the Department of Radiology. Anne was involved in research projects aimed at improving the definition of images obtained
using radioactive isotopes. She performed calculations to model different radiation focusing methods to optimize the image quality and the speed with which images can be acquired. Not only did Anne excel at her fellowship, but she has been an outstanding student at Berkeley as well, completing her electrical engineering and computer science degrees in only two years. She intends to pursue a second undergraduate degree in bioengineering and then move on to study medical physics or bioengineering in graduate school. Sacred Heart Medical Center Shannon Treis, a Walla Walla native and University of Puget Sound junior physics major, learned about the responsibilities involved in treating cancer patients at Sacred Heart Medical Center in Spokane under the direction of Ray Luse of the Department of Radiation Oncology at Sacred Heart. Shannon learned about the responsibilities of the medical physicist by helping physicians plan the radiation therapy treatment of cancer patients. She was actively involved in evaluating and commissioning newly installed software, and she also had opportunities to observe diagnostic procedures available in the radiology department, including nuclear medicine imaging, photon emission tomography, ultrasound, computed tomography, and magnetic reso■ nance imaging.
12
01_2140_AAPM_NovDec.p65
12
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
American College of Radiology - Councilor’s Report Gary T. Barnes AAPM ACR Councilor As the AAPM’s American College of Radiology (ACR) Councilor, I attended the 78th Annual Meeting of the ACR, September 9-12, 2001 in San Francisco, CA. In attendance were 383 state society officers, state society councilors and alternate councilors, society councilors (39), councilors-atlarge (10) and members of the board of chancellors (26). The ACR Council is modeled after the House of Representatives and the number of councilors that a given state has depends on the number of ACR members the state has. There is also additional councilor representation from the different radiology societies and from the councilors-at-large. Of the ten councilors-at-large in attendance, five represented radiation oncology and five represented medical physics (Nicholas Detorie, Richard Geise, Geoffrey Ibbot, Melissa Martin, and Steven Thomas). Additional medical physics representation consisted of myself (AAPM Councilor), Michael Gillin (ACMP Councilor) and Richard Morin (chair of the Physics Commission and member of the board of chancellors). Also in attendance were 26 residents whose travel costs were supported by the different state chapters.
The main council meeting consists of reports (of officers, Nominating Committee, AMA and ABR representatives, and reference committees), invited talks and voting on standards and resolutions. At the meeting, councilors are selected by council to serve on the board of chancellors, Council Steering Committee and Nominating Committee. On Monday there are open and closed Reference Committee sessions. New and old standards are considered by the Reference Committees and voted on by council. Previously adopted standards are reviewed at four year intervals and voted on by council to be readopted or not. There are four Reference Committees, each with a different set of standards and resolutions to review and on which to make recommendations to the ACR Council. The resolutions and drafts of standards assigned to each of the Reference Committees are sent to all councilors and alternate councilors, and given to all meeting attendees. During each Reference Committee open session, oral (and written) testimony, recommendations and suggestions on any and all items on the committee’s assignments are heard from all meeting attendees, councilors and alternative councilors who wish to comment. The open sessions started on Monday morning,
September 10th and carried into the afternoon, after which, in closed Reference Committee sessions, the presented testimony is reviewed and appropriate changes made to the resolutions and drafts of standards. The revised resolutions and drafts of standards, along with those that required no revision and associated recommendations, make up the committee’s reports. The reports are distributed to council on Tuesday morning prior to the oral reports of the Reference Committees. The revisions made by the Reference Committees are clearly indicated, as are all previous changes made during the evolution of the standard and/or resolution. Recommendations and changes made by each of the Reference Committees are voted on by council. The September 11th terrorist attack on the World Trade Center and the Pentagon had a major effect on the meeting. A number of informational sessions were cancelled and the discussion of resolutions was subdued and required less time than usual. Although the meeting was scheduled through Wednesday, all business was concluded on Tuesday. A dues increase had been recommended by the board of chancellors (there had been no dues increase since 1986). Due to a decrease in investment revenue (See ACR Report - p. 14)
13
01_2140_AAPM_NovDec.p65
13
11/1/01, 2:49 PM
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
ACR Report (from p. 13) during the past year and the expanded accreditation efforts of the College (although the College’s accreditation programs are intended to pay for themselves, there are start-up costs), the 2001 budget is in the red, and without a dues increase, the deficit will be even greater in 2002. After discussion, a greater than requested dues increase was passed by council. Medical Physics and Radiation Oncology Standards and Resolutions are traditionally assigned to Reference Committee II. Melissa Martin was one of six members of this committee. Standards of interest to medical physics assigned to this committee were Diagnostic Medical Physics Performance Monitoring of Radiographic and Fluoroscopic Equipment (Revised) and Medical Nuclear Physics Performance Monitoring of PET Imaging Equipment (New). Also assigned were clinical standards concerned with the performance of 3-D External Beam Radiation Planning and Conformal Therapy, Total Body Irradiation, and Stereotactic Radiation Therapy /Radiosurgery. There was no controversy and, with minor changes, all of the above standards were adopted by the ACR Council. Annually, an upto-date compilation of standards is mailed to all ACR members. ACR Standards can also be found on the ACR Web page (www.acr.org).
CT dosimetry has been discussed in the past year in the scientific literature and by the national news media. Two CT dosimetry resolutions were presented to the ACR Council. These were incorporated in the following resolution: “BE RESOLVED, that the ACR strongly encourages all radiologists to be aware of the radiation dose in CT examinations and to take the steps necessary to minimize the dose to patients, especially pediatric patients. BE FURTHER RESOLVED, that the ACR evaluate issues related to CT radiation dosage using its existing commission and committee structure to indicate areas of concern to the ACR membership and work with vendors to address these concerns.” That was passed unanimously by council. CT dosimetry is a complex topic and it has been my experience that radiologists can benefit from the help that medical physicists can provide in this area. It is important for the diagnostic medical physics community to have a good understanding of this topic and how to make and interpret CT dosimetry measurements. A formal and important part of the annual meeting is the ACR Convocation. At the convocation the 2001 ACR gold medalists, honorary fellows and fellows are presented. The gold medal was bestowed to Ronald G. Evens, M.D., John H. Harris, Jr., M.D. and Robert G. Parker, M.D. in recognition of their contributions. There were
seventy-five new ACR fellows inducted. Disappointing this year, unlike previous years, was that no medical physics fellows were inducted. Typically at the past meetings I have attended, there were five or more medical physicists inducted. At the close of the meeting, the 2001-2002 officers, chancellors and Council Steering Committee members were introduced to the council. James Hevezi, Ph.D. was appointed to the Council Steering Committee for a three year term (once renewable). This is an important leadership position within the council and College. Congratulations to Jim! I was glad to represent AAPM and felt that my time was well spent. ■
14
01_2140_AAPM_NovDec.p65
14
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
Travel Grant Report C-M Charlie Ma Stanford, CA As recipient of the 2000 AAPM/IPEM Medical Physics Travel Grant, I have been fortunate to be able to spend three weeks in the United Kingdom. On this trip I visited five medical physics and radiation therapy centers. I had the opportunity to meet many old friends and colleagues. I visited their facilities, observed their routine clinical practices, and discussed research that we were interested in and/or involved with. I prepared five different talks based on the research work with which I was involved at Stanford Medical Center. I presented either one or two of the talks at each institution, depending on the preferred topic(s) chosen by the staff. The following are the titles of these presentations: 1. “Beam Commissioning for Monte Carlo Treatment Planning” 2. “Monte Carlo for IMRT” 3. “Dosimetry for Kilovoltage X rays and Laser-accelerated Proton Beams” 4. “Recent Advances in Conformal Radiotherapy: the Cyberknife and Modulated Electron Beams” 5. “Dosimetry Verification for IMRT: Stanford Experience”
The first institution that I visited was the Joint Physics Department, Institute of Cancer Research (ICR) and Royal Marsden NHS Trust (RMT). About ten years ago I did my Ph.D. there in radiation therapy under the supervision of Drs. Alan Nahum and Bill Swindell and I continued on as a postdoctoral fellow until 1993. It was so nice to visit the Marsden again after all these years. Dr. Nahum is wellknown for his work on Monte Carlo dose calculations and radiobiological modeling and is still actively researching in these areas. I met Dr. Nahum and his research group at the Fulham Road site and we discussed many issues regarding the implementation of the Monte Carlo methods in radiotherapy treatment planning (RTP) dose calculations. We also participated in a MCENG two-day workshop on Monte Carlo RTP organized by his colleague, Dr. Frank Verhaegen. Later that week, I visited the main site of the physics department, the Sutton Branch. Professor Steve Webb, head of the department, organized my visit and discussions with representatives of major research efforts. The department has about 140 staff, roughly 50% of whom are funded by the National Health Service (NHS) and 50% through ICR. The department is organized around
nine ICR team leaders and five RMT senior staff. For operational convenience, several of these are grouped into two larger “superteams” for radiotherapy physics and radioisotope imaging. All research and development is aimed at improved treatment and diagnostic imaging which are central to the NHS R&D program. The department has, therefore, a major role in transferring basic physical science techniques to clinical applications in oncology. Professor Webb and I had detailed discussions on optimization methods for IMRT and new MLC designs for accurate beam delivery. Both of us were interested in robot-based radiotherapy systems. We exchanged our research experiences with the Cyberknife stereotactic radiosurgery/therapy system. The next stop on my trip was the National Physical Laboratory (NPL) at Teddington. Dr. Karen Rosser organized my visit and hosted a tour to the Radiation Dosimetry Branch. Karen and I worked closely on kilovoltage X-ray beam dosimetry when I was doing my Ph.D. at RMT/ICR. My postdoctoral research project was actually funded by the NPL on new ion chamber designs for electron beam dosimetry. I also collaborated with Dr. Simon Duane (section head), Alan Du Sautoy and Divid Shipley on Monte Carlo dosimeter re-
15
01_2140_AAPM_NovDec.p65
15
11/1/01, 2:49 PM
(See Travel Grant - p. 16)
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Travel Grant (from
p. 15)
sponse simulations. The group is responsible for the primary ionizing radiation standards in the UK. The topic of my presentation was the AAPM Task Group 61 Report on Kilovoltage X-ray Dosimetry for Radiotherapy and Radiobiology. I also had the opportunity to explain our new research directions on laser-accelerated proton beams for radiation therapy. In Clatterbridge, I was hosted by Dr. Philip Mayles and visited his department in the Clatterbridge Centre for Oncology (CCO). Dr. Mayles was the clinical chief at the Sutton Branch when I was with RMT and ICR. He left the Marsden in 1994 and established a very proficient and motivated physics group at CCO. His group is working on compensator-based IMRT for routine radiotherapy treatments. We discussed the details of the clinical implementation of IMRT and the Stanford experience with IMRT quality assurance. It was interesting to note the difference in health systems between the UK and the USA. Since the financial resources and the patient loads are more or less fixed for hospitals in the UK, there were difficulties in implementing technically advanced but labor-intensive or time-consuming treatment procedures. Only a few treatment centers are working on the IMRT technique, for example. I was also glad to see the proton accelerator at the CCO, which was the
only proton treatment facility in the UK. About 70 patients were treated annually in this facility. I learned that a new proton treatment facility had been approved and the CCO group would be actively involved in the planning and establishment of the new proton center. The journey to Princess Royal Hospital, Hull was a little adventurous. Because I lost the detailed driving directions, I decided to try my luck by following a simple map that I obtained from the Internet. After a few trials and errors, I eventually arrived at the conference room just ten minutes before the scheduled seminar time. It was nothing but joy and smiles when I met Dr. Andy Beavis, my host at Princess Royal Hospital, and his colleagues. Dr. Beavis came to Stanford Medical Center a few times to collaborate on IMRT techniques. Princess Royal Hospital is one of the few hospitals implementing the IMRT technique clinically. We also discussed possibilities of knowledge exchange and staff training at Stanford Medical Center. It was a very fruitful visit. The most memorable drive was from Cambridge to my final destination, Edinburgh University/West General Hospital. It began as a sunny spring day in Cambridge. While driving we passed many scenic areas in northern England and southern Scotland. The weather changed dramatically every 100 miles or so, and within a day we had already driven through drizzle, thunderstorms, hail and snow!
The last part of the journey was very pleasant. The highway snaked through small villages and green fields along the beautiful eastern coastline. By the time we arrived in Edinburgh it was near dusk. With the ancient castle and the old city as a backdrop, the fading colors of the sunset into the darkening sky were mesmerizing. Dr. David Thwaites hosted my visit to the radiation oncology department, which is the second largest among the five cancer treatment centers in Scotland. Dr. Thwaites is an expert on ionization chamber dosimetry and radiotherapy dosimetry QA. We have known each other for many years and kept in close contact. I was impressed by the QA procedures implemented in the clinic for treatment verification and the effort on IMRT implementation. I was very delighted to be able to make this trip. I was given a chance to meet so many established scientists and experienced physicists, and also to improve my scientific and clinical knowledge. The hospitality shown to me everywhere I visited is unforgettable. I appreciate the precious time and energy my hosts and their colleagues have taken to show their centers, discuss their practices and share their research and clinical experience with me. I would also like to thank the AAPM/IPEM, Dr. Charles Lescrenier and Varian Medical Systems for providing this wonderful opportunity, and Stanford University for supâ– porting my visit.
16
01_2140_AAPM_NovDec.p65
16
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
Reducing Doses from Pediatric CT Ed Nickoloff, New York, NY Walter Huda, Syracuse, NY A meeting entitled “The ALARA Concept in Pediatric CT� was held in Chicago on August 18-19, 2001 sponsored by the Society of Pediatric Radiology. The meeting was organized by Dr. Tom Slovis, a pediatric radiologist from Detroit, and attracted a diverse audience of radiologists, radiobiologists, physicists, radiological technologists, epidemiologists, administrators and representatives from the industry. The stimulus for the meeting was a series of papers on radiation exposure to pediatric patients undergoing CT examinations that appeared in the February 2001 issue of the AJR, and which received wide publicity in the popular press, including USA Today. One session focused on Radiation Biology and addressed the important topic of the magnitude of (any) radiation risks from pediatric CT examinations. Speakers included a radiobiologist (Eric Hall), medical physicists (David Brenner & Lou Wagner), as well as an epidemiologist from the National Cancer Institute (Elaine Ron). According to Dr. Hall, statistically significant risk estimates are now available at the radiation doses associated with CT examinations, and patient radiation risks can be determined without any need for extrapo-
lations from high doses, or other assumptions and theories. It was also emphasized that the risks to pediatric patients were an order of magnitude higher than those of middle-aged individuals. As a result, there was a consensus that risks from pediatric exposures were real and significant, and therefore need to be taken seriously by the radiological community. The second session dealt with the issue of how to measure radiation doses associated with diagnostic CT examinations. Tom Fearon described current CT dose parameters, and their limitations. Ed Nickoloff presented measurement data for current CT units obtained using phantoms that simulate patients ranging from infants to adults. Tom Toth (GE) talked about the design of commercial CT scanners and the opportunities available for dose reductions. Alan Brody, a pediatric radiologist from Cincinnati gave a talk on the topic of CT scanner design and patient radiation exposure. The final two presentations addressed the issue of computing patient effective doses (Walter Huda) and the design of pediatric phantoms (Vladimir Varchena). The session produced a lively debate on different ways of quantifying patient exposures in CT (i.e., effective dose vs organ dose). It was also noted that current multi-slice CT scanners force operators to trade im-
provements in imaging performance (i.e., better utilization of X-ray tube output) against higher doses. This differs markedly from past CT history where upgrades monotonically improved performance with no corresponding downside to the dose vs image quality equation. The final session addressed the role of the radiologists in radiation dose reduction. Two pediatric radiologists, Donald Frush (Duke University) and Lane Donnelly (Cincinnati) gave an excellent overview on this important topic. Ways in which patient doses could be reduced were covered, including the elimination of unnecessary examinations as well as modifications to the CT protocols (kVp, mAs, pitch, etc.). The relationship between CT technique factors and the resultant image quality was also addressed. Practical guidelines were proposed for CT scanning protocols designed to investigate a range of clinical problems. Major reduction in CT techniques can be made when scanning infants without sacrificing diagnostic imaging performance. Implementation of simple measures to reduce unnecessary radiation could reduce pediatric patient doses by up to an order of magnitude. To illustrate this point, Dr. Frush described CT protocols ranging from a high dose exam (140 kVp, 140 mAs, pitch of
17
01_2140_AAPM_NovDec.p65
17
11/1/01, 2:49 PM
(See Pediatric CT - p. 18)
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Pediatric CT (from p. 17) 1.0) that result in effective doses of ~4.5 mSv for a 10 kg infant to a low dose exam (120 kVp, 60 mAs, and a pitch of 2.0) that result in an effective dose of only ~0.7 mSv but which would result in diagnostic images in many clinical cases. There are several important conclusions to be drawn from this conference. The use of CT for pediatric patients has increased significantly over the years, and is a non-invasive modality that provides clinicians with valuable diagnostic
information. It is important that the relatively small carcinogenic risks from exposure to the X-ray radiation from CT scans are placed in proper perspective. At the same time, it is important for the medical community to recognize that the radiation doses to pediatric patients are higher (for the same scan techniques) and that the cancer risks in infants can be ten times greater than for adults. It is both a responsibility and an obligation of the medical staff to understand and utilize CT scanners in a manner which minimizes the radiation dose to all patients (especially children)
while maintaining clinically useful images. Methods available to reduce the radiation dose to pediatric patients include elimination of superfluous examinations, employing other imaging modalities like ultrasound and use of higher pitch ratios & lower mAs values. This meeting demonstrated that the radiology community is concerned about the issue of pediatric CT radiation doses; the consensus of the meeting was that appropriate utilization of pediatric CT should be based upon education and judicious triage. â–
Members Memorial Fund and Enhancing Your Bequests to AAPM Steven Goetsch La Jolla, CA The Development Committee has recently been asked to accept donations in the names of a number of members who have recently passed away. In response to these unsolicited gifts, the committee has created a Members Memorial Fund, inside the Education Endowment Fund. This fund will be used, at the discretion of the Development Committee, to promote educational opportunities in medical physics. AAPM Board of Directors voted in July, 1999 to give $3000.00 from the General Fund to the Education Endowment Fund in the name of
any AAPM member who notifies the Board in writing of a Planned Giving Commitment. No restrictions were placed on the type or amount of the bequests. The Board has received notification from two members of such a bequest and has therefore authorized an initial transfer of $6000.00 under Administrative Policy 18-A. Up to $300,000 was authorized to be transferred under this policy. This provides members a method of making a long term commitment to AAPM while at the same time providing an immediate boost to the fund. A total of seven AAPM Fellowships and 25 Residencies have been awarded by the Development Committee since 1990.
Jack Krohmer Fund Announced A memorial fund has been announced in honor of Jack Stewart Krohmer by the Development Committee. Ray Tanner announced establishment of this fund in his obituary for Dr. Krohmer in the October issue of Medical Physics. Doris Krohmer has requested that the fund be created to provide for the education of medical physicists. Further details will be announced shortly.
18
01_2140_AAPM_NovDec.p65
18
11/2/01, 12:34 AM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
Douglas Jones Memorial The medical physics community regrets the loss of another of its distinguished members. Douglas Jones was a pioneer in the field of medical physics. His relentless drive to improve the care of cancer patients was evident in the many techniques and devices he invented and implemented. Born on March 5th, 1940 in Liverpool, England, he began his career in medical physics supervising a research project involving thermoluminescent dosimetry as an assistant physicist in Rochester, England. This work led to a job offer in the United States as a research physicist at Controls for Radiation, Inc. in Cambridge, Massachusetts working with Bengt Bjarngard, Ph.D. In this capacity he traveled throughout the United States and settled briefly in California. While visiting the Pacific Northwest, he met Peter Wootton at the University of Washington and Dr. Willis Taylor of the Virginia Mason Medical Center (VMMC). They were so impressed by this
bright young gentleman with the charming British accent that they decided that Doug was the man they needed to utilize a grant to establish a regional medical physics program. Thus began the Northwest Center For Radiological Physics at the University of Washington. Douglas Jones became the director. In 1980 he decided to form his own company, Northwest Medical Physics Center (NMPC), which contracts radiological physics services to 21 hospitals throughout the Pacific Northwest. Doug was not only the director of NMPC but he served as Virginia Mason’s sole physicist.
He is well-known in the world of radiation therapy as the man who took complex problems and produced simple, clinically usable solutions. Throughout his long and distinguished career, Doug developed devices and systems that considered both patient comfort and ease of use. He is credited with devices ranging from simple patient repositioning tools to completely frameless stereotactic radiosurgery systems based on implanted fiducials. His most recent project is a hypofractionated, stereotactic technique for treatment of the prostate. Douglas Jones had published and presented over 75 papers in his career based on his research in radiation therapy. He was a fellow of the American College of Radiology and the American Association of Physicists in Medicine. He served on the AAPM Board of Directors from 1979-1982, and served as well on several task groups. â–
19
01_2140_AAPM_NovDec_cx.p65
19
11/5/01, 12:53 PM
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Letter to the Editor Response to H. Amols and J. Ting: IMRT is yet to be proven! R. J. Schulz Johnson, VT I was most pleased that Howard Amols and Joseph Ting responded to my letter in the August Newsletter in which I raised questions about the efficacy of intensity-modulated radiation therapy. Because IMRT is being promoted by manufacturers, physicians and physicists alike as a major advance in radiation oncology, this complex and costly technology deserves the widest possible discussion before every clinic in the country is convinced to make the requisite investment in equipment and personnel. To enhance this discussion, permit me to point out some of the shortcomings in their rebuttals. Dr. Amols begins by posing the question of how I would want to be treated if I had prostate cancer, and then offers me the limited choice of conventional irradiation or IMRT. Well, a personal question deserves a personal answer. The simple fact is that 70% of men in my age group already have prostate cancer and will die with it but not from it. This is but one reason why I have declined to have my PSA measured. But what if I did have a PSA and DRE done, followed by a biopsy, and my Gleason score was 6. As reported by
Albertsen et al (1), my risk of dying from this disease within 15 years is about 10%, hardly a risk that will send me looking for a definitive treatment. But, to further appease Dr. Amols, what if I did? There are other possibilities in addition to external beam that he chose to ignore such as prostatectomy, brachytherapy and simple observation. For someone living over an hour’s driving time from a major medical center, the prospect of devoting three hours per day for a course of 35-40 sessions of IMRT does not hold much appeal. Albeit more traumatic, prostatectomy is still regarded by many physicians as the “gold standard,” and it and brachytherapy require relatively brief hospital stays. Observation, which is practiced much more widely in Europe than in the U.S., has great appeal to procrastinators, and would likely be my first choice. Now, I do not wish to beg Dr. Amols question by framing the issues faced by prostate patients within my personal terms. The point I wish to make is that if physicists want to be part of the treatment team, they should broaden their perspective and take into consideration all aspects of the disease and which treatment best suits a specific patient. Again the prostate (one wonders where IMRT would be
without it). It is common for the proponents of IMRT to state their results in terms of “fiveyear actuarial PSA relapse-free survival” or as “biochemical no-evidence-of-disease (bNED).” What these data provide are the percentage of patients alive after treatment whose PSA’s declined and remained low for some period of time. These types of data are generally supportive of IMRT but, as pointed out by Maartense et al (2), Peschel (3) and others, post-treatment PSA’s are not surrogates for cause-specific survival. As PSA levels do not in any way affect how men feel and function, what is far more important are data that compare the life spans following IMRT, brachytherapy, prostatectomy and various other treatments. If clear-cut improvements cannot be demonstrated for IMRT, then the issue of complication rates is secondary. As a clinical colleague suggested to me, “you just cannot treat the prostate without treating the anterior wall of the rectum.” Could it be that IMRT patients have a lower rate of rectal bleeding because of variations in daily positioning and involuntary motion of internal organs, such that the rectum wanders into and away from the small, precisely-defined dose distributions to such an extent that the
20
01_2140_AAPM_NovDec.p65
20
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
rectal dose is lower than that from a four-field box? I found it fascinating that Drs. Amols and Ting disagreed on the value of IMRT for postlumpectomy adjuvant irradiation of the breast. The concerns of Dr. Amols, pneumonitis, cardiac complications, and even secondary malignancies, are by all accounts unfounded, i.e., the incidence of these complications is far below most oncologists’ radar screens. As pointed out by Landau et al (4), by using simple shielding techniques and conventional tangential fields, the dose to the heart can be reduced to the same levels as obtained by IMRT. As for dose inhomogeneities, let’s bear in mind that the purpose of this irradiation is to sterilize microscopic disease and that the smaller the cluster of cells, the smaller the dose required to reduce the probability of survival. After all, it is an “adjuvant” and not a “curative” procedure. Dr. Ting makes the case when he suggests “If it is not broken, don’t fix it.” Dr. Amols tells us that other technologies were adopted before their value was demonstrated but then goes on to undermine his argument by referring to megavoltage therapy, CT, MRI and PET. The interaction of X rays with matter was fairly well understood when the first million-volt machines were put to use in the 1930’s. Based upon physics, it was predicted that skin sparing would be obtained, the f-factor
for bone would be close to that for muscle, and dose distributions would be far better than those from orthovoltage before these machines were widely introduced. As for CT, MRI and PET, the very first images were all it took to convince physicians of the role these devices would play in almost every aspect of medical care. Unfortunately, the same cannot be said for IMRT for if it had, the present discussion would not be taking place. As for the cost of IMRT, to put it into the perspective of national defense, or the GNP, is clearly a diversion without merit. Our market-driven health-care system will require every radiation center in the U.S. to install IMRT if it is to maintain its image of providing the most up-to-date technology, and this will cost about two billion dollars. That’s a lot of money for unproven radiation treatments. This amount given to the World Health Organization would help millions to better health and longer lives. In addition to the capital investment, the reimbursement rate for IMRT is four times the rate for conventional radiation therapy (5), and this too adds to our annual costs for health care. As far as testing the efficacy of IMRT, I’m all for it under NIH-funded, carefully controlled conditions, however, it appears that the time for this is long past. Drs. Amols and Ting, among other converts, are convinced that it works, and have mistakenly relegated its
future into the hands of commercial interests. With all of the hoopla about IMRT, I can’t help but wonder about the enthusiasm displayed by physicians and physicists alike for this unproven technology. It seems to have followed a pattern similar to that of the dot coms over the past decade when irrational exuberance for a “new economy” was the order of the day. The dot coms subsequently failed because they lost sight of a business basic: profits must be turned. Likewise, new treatment modalities will ultimately fail if they don’t achieve their stated goals. To argue that IMRT is inherently good because it produces more precisely defined dose distributions is to miss the point. Sooner or later its customers will want to see the bottom line: what can it do to increase their life expectancy. I, for one, wait with growing impatience to see a site-by-site run-down of improved diseasespecific survival, which can be clearly attributed to the use of IMRT. Only when such data are subject to peer review and widely disseminated will the overall medical community and its prospective patients be able to judge the extent to which IMRT can justify its existence. 1. Albertsen, P. C., Fryback, D. G., Storer, B. E., Kolon, T. F. and Fine, J. Long-term Survival Among Men with Conservatively Treated Localized Prostate Cancer. JAMA 274: Aug 23/30 (1995). (See Schulz - p.22)
21
01_2140_AAPM_NovDec.p65
21
11/1/01, 2:49 PM
AAPM NEWSLETTER NOVEMBER/DECEMBER 2001
Schulz (from p. 21) 2. Maartense, S., Hermans, J. and Leer, J. W. H. Radiation Therapy in Localized Prostate Cancer: Long-term Results and Late Toxicity. Clinical Oncology 12: 222-228 (2000).
3. Peschel, R. E. Three-dimensional Conformal Radiation Therapy for Early Prostate Cancer. The Cancer Journal From Scientific American 5: 145-146 (1999). 4. Landau, D., Adams, E. J., Webb, S. and Ross, G. Cardiac
Avoidance in Breast Radiotherapy: A Comparison of Simple Shielding Techniques with Intensity-Modulated Radiotherapy. Radiotherapy and Oncology 60:247-255 (2001). 5. Editorial, Medical Imaging: ■ page 7, August (2001).
Missouri River Valley Chapter News Jason W. Sohn MRV President-Elect On October 6, 2001 the Missouri River Valley Chapter of AAPM held their fall meeting at St. Anthony’s Cancer Center in St. Louis. Dr. Fred Abrath was the host at his wonderful conference facility. The scientific session focused on brachytherapy, which included intravascular brachytherapy, prostate implant, and high dose-rate brachytherapy. The conference turned out to be very successful with vendors’ support. During the business meeting, two of our chapter members were nominated for AAPM fellowship. Following are the meeting presentations: “Intracoronary Brachytherapy-clinical and Interventional Considerations” Ivan Casserly, M.D., Washington University “Fusion of Biplane Angiography and Intravascular Ultrasound Imaging” Andreas Wahle, Ph.D., University of Iowa “Dosimetry Issues on Intravascular Brachytherapy” Allen Li, Ph.D.,University of Maryland “Dosimetry of Low Energy Brachytherapy Sources: Recent Development” Jeff Williamson, Ph.D., Washington University “Comparison of Seeds Used for Prostate Seed Implant” Robert Wallace, Ph.D., University of California - LA “Current NRC Regulations on Brachytherapy and Upcoming Changes in the Regulations” Jeff Williamson, Ph.D., Washington University “Intraluminal Brachytherapy using HDR and LDR” Zuofeng Li, D.Sc., Washington University The spring 2002 meeting will be held in Lake of the Ozarks, Missouri on May 4th.
22
01_2140_AAPM_NovDec.p65
22
11/1/01, 2:49 PM
AAPM NEWSLETTERNOVEMBER/DECEMBER JANUARY/FEBRUARY2001 2001 AAPM NEWSLETTER
Letter to the Editor Stu Korchin, Cheshire, CT At least a few weeks will have passed between the deadline for submission for this Newsletter, and when it finally is in print. We are living in an age of email and faxes. The need for a listserver for the medical physics community is clear. Unfortunately, the need is currently being inadequately filled by a listserver which does not allow vendors to participate and limits the ability to post more than two items per day. Moreover, the management of the list is run as a personal fiefdom by unelected “owners” who are unaccountable to anyone. We are on the frontiers of
Announcement
the Internet age, and I have been dealt some frontier justice. I propose that AAPM set up a listserver aimed at providing a communication vehicle for the medical physics community. AAPM could provide the leadership to bring about democratic change to the way that the community would be served. Membership in AAPM would guarantee access to the listserver, unencumbered by the personal politics of the list “owners.” I am positive that AAPM has among its members many who would be willing to devote time and effort to oper■ ate such a list.
There is a position of Advertising Liaison available for the Medical Physics World Bulletin, the official bulletin of the International Organization for Medical Physics (IOMP). This bulletin is published twice a year and has a circulation of approximately 16,500 and is mailed to over 70 countries around the globe . . . If you are interested in knowing more about this, please contact Ishmael Parsai, Editor, Medical Physics World, Medical College of Ohio, Department of Radiation Oncology, 3000 Arlington Ave., Toledo, Ohio 43614-2598, (419) 383-4541, e-mail: eparsai@mco.edu
23
01_2140_AAPM_NovDec_cx.p65
23
11/5/01, 9:43 AM
AAPM NEWSLETTER NOVEMBER/DECEMBER 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: January/February 2002 Deadline: December 10th Postmark Date: January 15
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
24
01_2140_AAPM_NovDec_cx.p65
24
11/5/01, 12:14 PM