Newsletter
AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 27 NO. 1
JANUARY/FEBRUARY 2002
AAPM President’s Column Staying Great Robert G. Gould San Francisco, CA As the new president of the AAPM, I look forward to the upcoming year with mixed feelings: confidence in our society, pride that I have been chosen to serve, and trepidation for the responsibilities. I take office with the AAPM well lead, well managed, fiscally sound, growing in membership, publishing the most prestigious medical physics journal in the world, and appearing willing to make changes necessary to remain the preeminent professional society of medical physicists. Over the past year, the Association’s accomplishments have been enormous. For example, the issue of medical physics examining boards has been resolved, in large part due to the efforts of my two predecessors, Ken Hogstrom and Charlie Coffey, and the AAPM Board of Directors has voted to become a sponsor of the American Board of Medical Physics. The structure for organizing the AAPM Annual Meeting has been revamped with the creation of the Meeting Coordination Committee,
International Electrotechnical Commission Geoffrey S. Ibbott Chair, US TAG to IEC 62C, Working Group 1
Who came up with the “IEC Scales”?
headed by Bruce Curran. This year’s meeting in Montreal will be the first organized under the new committee. Another accomplishment was the first ever AAPM Day-onthe-Hill, organized by Mike Gillin, chair of the Professional Council, and by Angie Furcon, the AAPM’s Government Affairs manager. Members of the AAPM visited offices of their senators and congressmen, promoting recognition of medical physicists and the AAPM. Activity of the AAPM in governmental affairs is critical to our Association, particularly with reimbursement challenges certain to occur, and will need to increase. I encourage AAPM members to become more politically active in areas that effect our profession. (See Gould - p. 2)
The AAPM considers the standards published by the IEC to be of great importance and significance to medical physicists. Consequently, the AAPM, jointly with the ACR and ASTRO, supports a group of medical physicists who participate on technical advisory groups (TAG) that review the work of several IEC subcommittees and working groups. These committees and working groups develop the standards that most directly affect imaging and radiation therapy equipment. This brief article is intended to inform members about the role and recent activities of the IEC.
What is the IEC? Founded in 1906, the International Electrotechnical Commission (IEC) is a global organization that prepares and pub(See IEC - p. 4)
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Gould (from p. 1) As I stated, leadership of AAPM has been superlative. Ken Hogstrom, the outgoing chairman of the board, completed three years on the Executive Committee (EXCOM) and contributed greatly to the society. His critical assessment of issues will be sorely missed. The efforts of Charlie Coffey, president this past year and now chairman of the board, are reflected in the Association’s numerous accomplishments. Melissa Martin, treasurer, and Jerry White, secretary, both contribute to EXCOM not only in their respective roles but also in their insight to the problems and issues before the Association. I look forward to working with incoming Presidentelect Marty Weinhous, and also to working with Sal Trofi,
TABLE OF CONTENTS President’s Column IEC Exec. Dir’s. Column ABR Equiv. Letter Ed. Council Report CAMPEP Econ. Comm. Report New IMRT Codes Gov’t. Affairs Column EMCC Update NIH Update Fellowship Award Residency Awards AIP Gov. Brd. Rep. New Member List Letter to the Editor Announcements
p. 1 p. 1 p. 6 p. 7 p. 8 p. 10 p. 11 p. 12 p. 14 p. 15 p. 16 p. 18 p. 18 p. 19 p. 20 p. 22 p. 23
Charlie Coffey (left) and Sal Trofi at the RSNA Meeting in Chicago last November.
our executive director and EXCOM member. Under Sal’s leadership, AAPM Headquarters has been transformed by assuming ever increasing administrative, organizational, and fiscal responsibilities. Our Association is now one of the best-run societies of its size. The voluntary work of the many members who serve on committees, subcommittees, and task groups is the principal reason for the preeminence of the AAPM, and I thank all of those who have served this past year. Changes in committee chairs for 2002 are as follows: Richard Stark replaces John Kent as head of the Investment Advisory Committee, Julie Dawson replaces Peter Biggs as chair of the Publications Committee, and Suresh Brahmavar replaces Fred Hetzel as chair of the General Medical Physics Committee. Bruce Curran becomes the chair of the Meeting Coordination Committee (MCC) and David Pickens, formally the chair of the Program Committee that has been eliminated, becomes head of the Scientific Program Subcommittee under 2
the MCC. I sincerely thank those rotating off as committee chairs and also those who served on committees and are rotating off. I also want to thank those who volunteered. For the first time, the appointment process was done all electronically and I thank Michael Woodward and Sean Benedict of Headquarters for their help in developing this complex process. I appreciate the cooperation of all chairs in working through the new process, which I know was, at times, frustrating. The AAPM is also preeminent because of the quality of its publications. Medical Physics, with Colin Ortin as editor, is a premier journal for all areas of medical physics from radiation oncology to diagnostic imaging. The reports of the task groups under the parent committees and the Publications Committee make significant contributions to our field. Five reports were produced in 2001. The non-scientific publications also reflect the health and wealth of our Association. The placement bulletin with Bob Rice as director of Placement
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Services has undergone much growth and the editors of the Newsletter, Allan and Susan deGuzman, who are just completing their first year, continue to produce an excellent copy. Looking at the AAPM in 2002, we are nearly 5000 strong, have an annual budget approaching five million dollars with reserves of more than three and a half million, an efficient Headquarters staff in newly renovated offices, and a flourishing journal. So what are the issues? I believe first and foremost is the challenge of maintaining a strong Annual Meeting. The AAPM relies on this meeting to provide members with a scientific forum and
accredited continuing education, and to provide the Association with revenue, specifically, the profits from the meeting are targeted to be >10% of the operating budget of the Association. The terrible and tragic events of this past year demonstrate that unpredictable events can affect any meeting. But other more controllable problems exist, namely the decrease in participation of imaging scientists in the meeting. This past year in Salt Lake City, ~12% of the proffered abstracts were other than therapy oriented, compared to ~28% five years ago. Since the absolute number of abstracts has risen only slightly, the absolute num-
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ber of imaging abstracts is nearly half that of five years ago. While the technical exhibits are growing, no sustained presence of diagnostic vendors has occurred. Yet, as judged by the number of scientific symposium and of continuing education courses oriented towards imaging, the participation of imaging scientists would seem far greater. Regardless of size, many societies are struggling to sustain their annual meetings. The reasons for this problem include the fragmentation of medicine into specialty societies, each with their own annual meeting, limited travel funds, and in(See Gould - p. 4)
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creased workloads leaving little time for research and professional activities. We must assess our own society and to this end, an Ad Hoc Committee on Imaging was appointed by Charlie Coffey. This committee, headed by Rick Morin, has the broad charge to investigate the response of the imaging physics community to the concept of a more autonomous medical imaging physics entity within the AAPM and, if positive, to recommend a structure for this entity. The committee is to suggest methods and programs for increased participation of imaging scientists as attendees and presenters at the Annual Meeting and other AAPM-sponsored science and education programs. I believe this committee, of which I am a member, will play a critical role in the future of our Association. The AAPM is also embarking on changing its planning pro-
cess such that the Board becomes more involved in identifying issues before the Association and is less mired in the implementation activities, which should occur at the committee/subcommittee level. A consultant, Jim Dalton, has met with the Board on two occasions, the most recent being for a full morning at the RSNA. While this change will take time to implement, the result will be that the expenditures of the Association better reflect the goals of the society and that the Association is better prepared to respond to changes in the profession of medical physics. In conclusion, it is an honor to serve the Association as its president. I am sure this coming year will bring many challenges and I hope that I can call on members to assist in meeting these. Likewise, I hope that you will call on me with issues ■ where I can be of help.
4
IEC (from
p. 1)
lishes international standards for all electrical, electronic and related technologies. The membership consists of more than 60 participating countries, including all of the world’s major trading nations and a growing number of industrializing countries. The IEC’s mission is to promote, through its members, international cooperation on all questions of electrotechnical standardization and related matters, such as the assessment of conformity to standards, in the fields of electricity, electronics and related technologies.
What is an international standard? A standard, as defined by the IEC, is a document that has been established by consensus and approved by a recognized body, that provides rules, guidelines or characteristics for activities or their results. The purpose of a standard is to achieve the highest degree of consistency in a given context. IEC international standards facilitate world trade by effectively removing technical barriers to trade, leading to new markets and economic growth. In many countries, IEC’s standards are adopted immediately and effectively become law in those countries. In other countries, such as the US, IEC standards are frequently adopted verbatim or in part by regulatory agencies. Consequently,
AAPM AAPM NEWSLETTER NEWSLETTER 2001
IEC standards can have a tremendous impact on the design of medical equipment.
So where did “IEC scales” come from? The IEC is presently celebrating the centennial anniversary (really!) of the birth of what is now known as the International System of Units, or SI. On October 13, 1901, during a meeting in Rome of the Associazione Elettrotecnica Italiana, the Italian Society of Electrical Engineers, a young engineer named Giovanni Giorgi presented a metrological proposal for a unified system of measuring units that included length, mass, time, and an electric unit. In 1950, the ampere was chosen as the fourth unit of the system. However, more than half a century elapsed before the inclusion of his proposal into the international metric system in 1960. The “IEC scales” represent the IEC’s efforts to achieve consensus on a set of coordinates and scales that comply with SI, are in accordance with accepted conventions, and, through their adoption, could reduce the risk of confusion when multiple pieces of equipment are in use in a single setting.
What is the IEC working on today? Many of the technical committees, subcommittees, and
working groups of the IEC met recently in Florence, Italy. At this meeting, the recent work of Subcommittee 62C (Equipment for Radiotherapy, Nuclear Medicine and Radiation Dosimetry) was reviewed. The subcommittee has recently published standards addressing radiotherapy equipment, including an amendment to the coordinates standard that defines the patient coordinates system. Standards addressing accelerators include an amendment changing the allowable leakage through collimators, to more realistically reflect the transmission of multi-leaf collimators; and standards addressing the functional performance characteristics of multi-leaf collimators. A safety standard for radiation therapy treatment planning systems has been published, and a guidance document explaining the implementation of DICOM is expected to be approved for publication in the near future. Several standards have been published recently addressing nuclear medicine equipment including radiation counting systems, scintillation cameras and single photon emission computed tomography. In addition, several new standards have been published addressing dosimetric instruments for use in radiation therapy and in X-ray imaging. Radiation therapy standards currently in development include a standard for the safety of automatically-controlled brachytherapy afterloading equipment. This standard is 5
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being revised to address betaemitting sources. The safety standard addressing cobalt units is being revised to include units with multiple cobalt sources, such as the gamma knife. And a standard is under development to address the safety of radiotherapy treatment verification systems. Questions regarding the IEC and the standards described here may be addressed to Geoffrey S. Ibbott at gibbott@mdanderson.org. ■
“If I knew what it was we were doing, it would not be called research, would it?” -Albert Einstein
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Executive Director’s Column Sal Trofi College Park, MD
Both publications will be available for purchase from Medical Physics Publishing in the first quarter of 2002. Members will be made aware of availability via e-mail and the monthly mailing.
AAPM Virtual Library The AAPM has partnered with DigiScript, Inc., to host AAPM educational courses on the Internet in the AAPM Virtual Library. The Virtual Library is now active and can be accessed by going to the AAPM home page at www.aapm.org and is free to AAPM members through the 2002 year. Among the presentations included in the Virtual Library are: 26 presentations from the Salt Lake Annual Meeting on Diagnostic Imaging, 40 presentations on Therapy, and eight presentations on IVB Medical Physics Lecture Series. Presentations posted in the Virtual Library include streaming audio and video of the speakers, transcription of the audio presentations, and slides of the presentations. Eventually, continuing education credits will be available for the majority of these presentations via the AAPM RDCE Program. Members will be contacted once credits are available. Members are encouraged to use the free AAPM Virtual Library for professional research, information and educational needs. It is easy to log in to the AAPM Web site by using your AAPM username and pass-
2002 AAPM Annual Meeting and Summer School word. Once logged into the AAPM site, then select the link on the home page to ‘AAPM Virtual Library.’ Then click ‘New User Registration’ under the ‘Getting Started’ menu on the left. Follow the instructions from that point on. If you have an interest in purchasing a CDROM containing the diagnostic, therapy or IVB presentations, you can do so while logged in to the Virtual Library by selecting the ‘Pricing’ link.
AAPM Publications AAPM is in the process of having two new books published through Medical Physics Publishing. One title is the Proceedings of the 6th Conference on Time/Dose Fractionation held September 23 – 25, 2001 in Madison, WI. The second is from an international workshop held on Oct 11-13, 2001 entitled Recent Developments in Accurate Radiation Dosimetry in Montreal at McGill University. 6
Mark your calendar to attend the 44th AAPM Annual Meeting and the 2002 Summer School, both to be held in July in Montreal, Quebec, Canada. The Annual Meeting will be held July 14-18 at the Palais des Congres de Montreal. Consider extending your stay in Montreal to attend the Summer School from July 18-21 at McGill University. The deadline for Annual Meeting abstract submission is March 6. The exhibit hall will once again open on Sunday and the poster sessions are scheduled on Sunday, as well. Arrive by Sunday to take advantage of the extra time to meet with the exhibiting companies and participate in the poster sessions. The 2002 Summer School will have a dual track focussing on Intravascular Brachytherapy and Fluoroscopically-Guided Interventions. The McGill campus, Canada’s oldest university, is conveniently located at the foot of Mount Royal in the heart of Montreal.
AAPM AAPM NEWSLETTER NEWSLETTER 2001
You can always find the latest information on registration and housing by logging on to the AAPM Web site.
Membership and Internet I am glad to report that the experiment of using the Internet for the paperless 2002 dues renewal notices appears to be successful. At the time of writing this column early in December, 2001, about 27% of the members had paid their dues over the Internet and 17% had paid by downloading a copy of the renewal notice and sending a payment by fax or US mail. We anticipate that the early December return of 44% will grow to 60% by the time paper copies will be printed and mailed to those who have not yet renewed early in January. The savings in printing, mailing, and staff effort is signifiâ– cant.
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Announcement ABR Letter of Equivalence In pursuance of the ABR and ABMP agreement of this summer, the ABR will provide a letter of equivalence in radiologic physics. Each physicist certified by the ABMP in a radiologic physics subspecialty will upon request, receive a letter from the ABR stating that ABMP certification is equivalent to ABR certification in the same field. The specific language in this letter will be as given below: The American Board of Radiology Letter of Equivalence in Radiologic Physics The American Board of Radiology, sponsored by the American College of Radiology, the American Roentgen Ray Society, the American Radium Society, the Radiological Society of North America, the Section on Radiology of the American Medical Association, the American Society for Therapeutic Radiology and Oncology, the Association of University Radiologists, and the American Association of Physicists in Medicine, hereby recognizes the equivalency of certification by the American Board of Medical Physics for: xxxxxxxx, xxxxx, degree In Subspecialty Expires December 31, 2007
The American Board of Radiology hereby affirms that the above individual has pursued an accepted course of graduate study and clinical experience, has met the required standards and qualifications, and has passed the examinations conducted under the authority of The American Board of Medical Physics.
Requests for the letter of equivalence are to be sent to: Paul Capp, M.D., Executive Director The American Board of Radiology 5441 E. Williams Cir., Suite 200 Tucson, AZ 85711 7
AAPM NEWSLETTER
JANUARY/FEBRUARY 2002
Education Council Report G. Donald Frey Ed. Council Chair, 2001
The AAPM Virtual Library has been accessible for several months now. Most of the educational activities from the Annual Meeting in Salt Lake City are available through a link from the AAPM Web site. As of December, more than 400 members have used the Virtual Library. I would strongly encourage all of you to visit the site. Presently you have to give a credit card number but there are no charges for viewing the AAPM material. I have been enjoying visiting the library. It allows me to view presentations I missed at the Annual Meeting and to review ones I especially enjoyed when I was in Salt Lake City. By the time you read this there should much more material, based on the Annual Meeting, on the AAPM Remote Directed Continuing Education site. AAPM plans to make the Virtual Li-
brary free to the membership through all of 2002. At the RSNA Meeting the Education Council voted to create a subcommittee on Medical Physics Residency Education under the Education and Training of Medical Physicists Committee. This committee will recommend AAPM policies on medical physics residencies, gather support for residencies, provide educational materials on residencies and identify sources of funding. The Public Education Committee has been working on a number of projects to increase public awareness of the role and importance of medical physics and physicists. If you have any suggestions for increasing public knowledge of medical physics, please contact Ken Hogstrom, the chair of the committee. It is not too early to begin thinking about the 2002 Summer School. This year we will have a dual track Summer School. The tracks are Intravascular Brachytherapy & Interventional Cardiology. The school will stress the practical aspects of these two areas. The school will be held in Montreal immediately following the Annual Meeting. The program directors are Stephen Balter, Rosanna Chan and Thomas Shope. The Continuing Education Committee has reviewed re8
quests for endorsement and cosponsorship of upcoming meetings that might be of interest to the AAPM membership. Opportunities within the next four months include the following: •“6 th Annual Digital X-Ray [CR/DR] and PACS: An Educational Forum,” San Francisco, California: February 1619, 2002. Information: http:// www.aafmed.com •“SPIE International Symposium on Medical Imaging,” San Diego, California: February 23-28, 2002. Information: http://www.spie.org/info/mi/ •“International Workshop in Medical Physics,” Havana, Cuba: April 8-10 2002. Information: e-mail to scf2002@ff.oc.edu.cu. The History Committee is seeking nominations on its Necrology Subcommittee. All are welcome to apply. Please e-mail J. Dare, dare.1@osu.edu. It is a pleasure to have served as chair of the Education Council in 2001. The many AAPM volunteers who contributed to the work of the council made the pleasure even greater. ■
AAPM AAPM NEWSLETTER NEWSLETTER 2001
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CAMPEP G. Donald Frey CAMPEP President, 2001 The Commission on Accreditation of Medical Physics Education Programs was founded to provide accreditation, documentation, and recognition of participation in educational activities for medical physicists and medical physics students. The American Association of Physicists in Medicine, the American College of Medical Physics, the American College of Radiology and the Canadian College of Physicists in Medicine sponsor CAMPEP. CAMPEP accredits graduate medical physics education programs, medical physics residencies and medical physics continuing education programs. Presently nine graduate medical education programs are accredited, as are four medical physics residencies. The University of Florida is the most recently accredited graduate program. CAMPEP establishes policies to insure that all these educational activities meet the highest educational standards. CAMPEP policies are modeled after those of the Accreditation Council for Graduate Medical Education and the Accreditation Council for Continuing Medical Education. The policies of these two organizations are accepted as the standard in their respective fields. People frequently ask why the proce-
dures for getting continuing medical education programs accredited are so complex. The policies are complex because CAMPEP feels that it is important to adhere to the highest standards for accrediting continuing education activities so that all groups will accept the credits without question.
“CAMPEP is undertaking the construction of a new database to serve the needs of medical physicists.” CAMPEP is undertaking the construction of a new database to serve the needs of medical physicists. The new database will simplify all aspects of the accreditation process so that by the end of 2002, certificates from continuing education activities and annual summaries will be available online. In addition, educational activities will be described by a series of terms indicating the specific content of the program. The CAMPEP Board of Directors consists of two appointments from each of the sponsoring societies and the chairs of the committees. At the board meeting that was held at the annual meeting of RSNA, 2001, Edwin McCullough was elected president and 10
chairman of the board for 2002. Brenda G. Clark was elected as vice chairman and James B. Smathers was elected as secretary-treasurer. I will be rotating off the board, as will Charles A. Kelsey. It has been a pleasure serving on the CAMPEP board since its inception. The organization provides a valuable service for the medical physics community. AAPM has announced that Palmer Stuart will be their new appointment to the board ■ in 2002.
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Economics Committee Report Changes to the Hospital Outpatient Prospective Payment System for Calendar Year 2002 – Part 1 Michael Gillin Economics Committee Chair The Centers for Medicare and Medicaid Services (CMS) published their final rule for the year 2002 in the Federal Register on Friday, November 20, 2001. This rule is over 250 pages in length and addresses a number of significant issues in radiation oncology. A more
CPT
Status
APC
77336 77370
X X
304 305
Thus, hospitals will be receiving a substantial increase in 2002 from the 2001 amount they received for the services provided to a specific outpatient patient by the radiation oncology physicist. (ACR, ASTRO, and AAPM presented similar arguments on the need to increase the payment rate for 77336 and 77370 to the APC Advisory Committee in February, 2001. The data presented to CMS was from the 1995 Abt study, which was sponsored by
comprehensive analysis of this rule will be provided later. This article focuses on one minor change in the rule, which is very important for radiation oncology physicists, namely changes relating to CPT codes 77336 and 77370. In 2001, these two CPT codes were assigned to the same APC code, 0311. In 2002, CPT 77336 will
Relative Weight
1.63 3.71
be assigned to APC 0304, Level I Therapeutic Radiation Treatment Preparation, and CPT 77370 will be assigned to APC 0305, Level II Therapeutic Radiation Treatment Preparation. Addendum B, Payment Status by HCPCS Code and Related Information Calendar Year 2002, p. 60011, provides specific information on these codes, namely:
Payment Rate
National Unadjusted Copayment
Minimum Unadjusted Copayment
$82.97 $188.85
$41.42 $90.65
$16.59 $37.77
both the AAPM and the ACMP. The Abt survey data showed that the median time to perform 77336 was 1.5 hours, while the median time to perform 77370 was 4.0 hours. The Abt study will be redone in 2002.) The APC system is based upon the cost of providing a specific service. The services provided by CPT 77336, continuing medical physics consultation, including assessment of treatment parameters, quality 11
assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, should be fairly uniform for each patient. This service also includes the initial acceptance testing and commissioning and ongoing review of treatment planning and treatment delivery systems. Documentation of these services is essential. The records kept of the calibration and maintenance of the plan(See Economics - p. 12)
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Economics (from p. 11) ning and delivery systems are part of the required documentation. These records are not part of the patient’s chart. However, it is common for the patient’s chart to be annotated during a weekly review by the physicist. The services provided by CPT 77370, special medical radiation physics consultation, may be very different from each other. The physician may request these services due to the complexity of the treatment plan or when expertise of a qualified medical physicist is required. Examples of such services would include analysis of brachytherapy treatments, analysis of custom beam modification devices and special blocking procedures, and the
analysis of previous radiation therapy with the assessment of cumulative radiation dose to critical organs. The cost of providing 77370 is basically the time required by the qualified medical physicist to analyze the issue and to generate a written report. CMS is following the congressional directive to establish a cost-based system, as opposed to a charge-based system. Thus, it is important to establish the true costs of providing all services. Radiation oncology physicists should be working with their administration in defining the costs of providing services for 77336 and 77370. Part of this analysis should be an estimate of the time required to provide continuing medical physics services, which includes the com-
missioning time and the time spent in maintenance of quality averaged over the number of patients treated on a particular device in one year, and special medical physics consultations. The time required for the special consultation may vary considerably, depending upon the specific problem being addressed. It should be understood that CMS is obtaining cost data from hospitals and believes that data to be correct. Radiation oncology physicists should also insure that their departmental administrators are aware of the increase in reimbursement from Medicare for their services. This is good news, especially when the lower reimbursement rates of ■ 2001 are considered.
Announcement of New IMRT Codes James M. Hevezi ACR/ASTRO Joint Economics Committee On Jan 1, 2002, the Centers for Medicare and Medicaid Services (CMS) will publish two new codes in the AMA’s CPT manual in the Radiation Oncology 77XXX series of codes. These cover the work effort, professional and technical, required in the planning and delivery of Intensity Modulated RadioTherapy (IMRT). These codes are:
CPT 77301: Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications. (Dose plan is optimized using inverse or foward planning technique for modulated beam delivery (eg. binary, dynamic MLC) to create highly conformal dose distribution. Computer plan distribution must be verified for positional accuracy based on dosimetric verification of the intensity map with 12
verification of treatment setup and interpretation of verification methodology.) CPT 77418: Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams (eg. binary, dynamic MLC) per treatment session. These codes are now applicable for stand-alone centers performing the work of IMRT.
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In 2001, hospital-based operations doing IMRT were reimbursed under the “G” codes available under the HOPPS APC’s, G0174 and G0178. These G codes were not applicable to stand-alone centers, but the approval of the new CPT codes allows specific reimbursement for IMRT no matter where it is performed. Eventually, the temporary APC “G” codes will be replaced with appropriate APC group(s) where CPT 77301 and 77418 will reside. Note that CPT 77301 contains a professional and technical component of reimbursement, reflecting the division of physician involvement in the planning process, as well as the contribution of medical physics work and the cost of equipment in the planning phase (this is the socalled practice expense segment of the cost for IMRT planning). In a stand-alone center where global billing is used, both professional and technical components are integrated into a single charge for IMRT planning. CPT77418, IMRT delivery, is a technical-only code that reimburses the facility for the cost of technical time and equipment cost to deliver the course of IMRT planned under CPT 77301. At this juncture, CMS is only reimbursing plans and treatment delivery based on the descriptors above. Any deviation from the work identified in the descriptors will necessarily place the reimbursement for the planning and delivery in the 3D conformal radiotherapy realm
with its attended CPT code coverage. For example, CMS does not allow physical compensators to be couched under either IMRT planning, nor IMRT delivery presently. Only binary arc, pencil beam, planning and delivery, along with dynamic, sliding window MLC or “Step & Shoot” MLC techniques are currently covered in the new CPT code designatory for IMRT.
“Medical physicists should meet with their administrators to impress upon them the large amount of work we do to implement an IMRT program, both in commissioning and training ancillary staff in performing this highly precise therapy.” There may be several Correct Coding Initiative (CCI) edits that will modify the individual CPT codes that may be reimbursable when planning or delivering IMRT under the two new CPT codes. It is not fully clear, at this point, how this will be allocated by CMS. Your best approach will be to meet with your institution’s billing department and review the latest CCI manual for these edits. As our committee receives more information about this, I 13
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will try to publish an addendum to this announcement. Last, it appears that the bulk of reimbursement for IMRT will appear in the delivery cycle under CPT 77418. Medical physicists should meet with their administrators to impress upon them the large amount of work we do to implement an IMRT program, both in commissioning and training ancillary staff in performing this highly precise therapy. Although the reimbursement under CPT 77418 will likely not appear in medical physics budgets, institutions should be cognizant of the intense contribution medical physicists make to a viable IMRT program. ■
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Government Affairs Column Angela L. Furcron College Park, MD Early in 2002, AAPM will add to its Web site a new feature in the Government Affairs section; a grass roots advocacy tool to enhance AAPM’s Washington presence. In this Newsletter column, I will discuss the software package, grass roots advocacy and why it is important, and give two grass roots success stories. The new Government Relations software will provide AAPM with the tools needed to educate both members and legislators about AAPM issues. This is where I will post issues and talking points for AAPM members to use when contacting their legislators. The Government Relations software package will include the follow features: •Legislation and voter information; •Tools to match AAPM members with their legislators; •Quick, easy communication tools for sending letters and email to legislators. This new software will be the primary tool used to organize and instruct AAPM’s grass roots network. A grass roots network is essentially a group of organized constituents who contact their legislators to educate the legislators on issues to which they feel strongly. It is
important to let your legislators know your opinion on legislation. One example of stating your opinion and using your expertise is HR 1011, the “Consumer Assurance of Radiologic Excellence” (CARE) Act. AAPM strongly believes that it is important for all people administering radiation to be licensed by their state to ensure patient safety. You, as a medical physicist, have unique expertise and your legislators need to know that your profession exists and that you are willing to answer their medical physics questions. There are instances when a staff person from a legislator’s office will call a constituent for their expert opinion on a subject that the legislator knows little about. As a medical physicist, you have a wealth of information that many people in government lack. It is impossible for your legislator and his or her staff to be knowledgeable on every issue. This creates an opportunity for the medical phys14
ics community to educate congress and present the AAPM point of view at the same time. I would encourage you to write your legislators letters and meet with them, when appropriate. Here are two examples of successful grass roots actions. The first example is of the Medical Physics Licensure Bill that was signed into law by Governor Pataki of New York in late November of last year. The medical physicists in New York have been working on passage of this bill for eleven years. This shows the results of perseverance. A bill may not be passed right away, but perseverance does pay off. The second example is the recent mass e-mail from the Professional Council to AAPM members in 15 chapters. This e-mail went to members who have a legislator on the Labor, Health and Human Service, Education Subcommittee of the Appropriations Committee. The e-mail went to nearly 2000 members asking them to contact their legislators regarding the funding of the National Institute on Biomedical Imaging and Bioengineering (NIBIB). AAPM does not currently have a mechanism to track how many letters were sent by members, but the new software will have that and it will also give members the opportunity to send a copy of the letter to Headquarters electronically. Last, I would like to let members know the best way to re-
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ceive notices from the Food and Drug Administration (FDA). FDA has a Web site that you can go to and register to receive updates. The Web address is: http:// www.accessdata.fda.gov/ scripts/cdrh/cfdocs/ cfCDRHNew/listman.cfm. ■
“Let me tell you the secret that has led me to my goal. My strength lies solely in my tenacity.” -Louis Pasteur
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Electronic Media Coordinating Committee Update Dan Bourland EMCC Chair The AAPM has recognized the importance of electronic munications and about four years ago formed an administrative committee called the Electronic Media Coordinating Committee (EMCC). EMCC provides oversight and discussions for AAPM’s e-mail communications, Web site (aapm.org), and other “electronic” topics (publishing, corporate affiliates). EMCC’s Web page shows our membership and can be found at: http:// www.aapm.org/org/structure/ level2.asp?council=AC&c1=EMCC. Two topics of interest to AAPM members have been addressed recently by EMCC. The first concerns the desire for AAPM members to have a medical physics list server - in other words, would AAPM host the medphys list server (or similar list)? EMCC has reviewed this request several times, most recently as of the 2001 RSNA meeting. We have consistently declined to host a medical physics mailing list for the following reasons: 1. Inappropriate postings directed towards persons, companies, or institutions reflect poorly on AAPM as the sponsor of the list; 2. Management or moderation of a mailing list requires value judgements to define “appropriateness” and “inappro15
priateness” of postings. While this job is not necessarily impossible, EMCC believes that AAPM staff and members have more valuable tasks than mailing list moderation; 3. Suitable mailing lists (medphys) or newsgroups (sci.med.physics) exist that are willingly hosted by institutions and provide suitable discussion forums with open formats; and 4. Hosting of a list server by AAPM will not provide a better service than now exists, nor will it “fix” the issues that are complained about (flames, possible libel, etc). Unfortunately, the history of list servers and newsgroups is that discussions often degrade to a variety of inappropriate directions. For these reasons EMCC has recommended that AAPM not host a list server. AAPM does provide list serving functions for its task groups and committees that desire that approach to their AAPM activities. The second topic where EMCC has acted relates to commercial, or sponsored, emails. AAPM’s corporate affiliates have long requested our email list. With 95% of our members having online access, EMCC has declined to sell our e-mail addresses. We have stated such in our privacy policy: (http://www.aapm.org/ aapmutilities/policies/ details.asp?id=104&type=AP (See EMCC - p. 16)
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EMCC (from p. 15) you will need your log in and password). We have also taken steps to prevent “data mining” from our member database, to prevent unsolicited e-mails from reaching our members outside of an approval from Headquarters. However, we recently began an experiment to send e-mails to our members on behalf of our corporate affiliates. A standardized format has been decided for clear identification, each message includes directions for an “opt-out” for the member, and we are deciding the frequency of these sponsored e-mails, to limit the number of commercial e-mails a member would receive. EMCC has extended the trial period through the summer July, 2002 AAPM meeting, where we will discuss how to proceed. Overall, EMCC is attempting to keep the commercial aspects of AAPM to a minimum while providing a balance for the electronic presence of our corporate affiliates. Other areas we have investigated include a corporate affiliate site on aapm.org, and the use of electronic banner ads. EMCC was formed to help the AAPM better serve its membership, students, the lay public, and the field of medical physics, consistent with AAPM’s mission. Some of our objectives are in progress, and we are planning for the future. We welcome your comments – please send any to feedback@aapm.org, and thank you for your response. ■
National Institutes of Health Update James Deye NCI Program Director Since coming to the National Cancer Institute a year ago, I have been asked repeatedly, “What do you do there?” Rather than taking this personally, I prefer to think this question really reflects that people need to know more about the National Institutes of Health (NIH), and hence the reason for this short update. The NIH is composed of 20 institutes and six centers. Detailed information on each of these can be found at the NIH Web site: www.nih.gov/icd. I wish to elaborate on just two of the institutes. The newest institute and the one attracting the most recent attention of the physics community is the National Institute of Biomedical Imaging and Bioengineering (NIBIB). NIBIB has an annual budget of about $100M while the NCI, the oldest and largest institute, has a budget of around $3.5B per year (see table). Though NIBIB was signed into existence in early 2001, it will really spring to life in 2002 as its permanent director and added staff are put into place. As with all institutes, the majority of its budget will be devoted to investigator-initiated research ( i.e. extramural), and it is not determined at this time if this new institute will have an intramural program as most of the other institutes do. 16
Some of its portfolio of grants will come from transfers of grants from other institutes when it is deemed that the grant’s research is more appropriate to the NIBIB mission (eg. technology development). Clearly, bioengineering efforts will comprise a substantial portion of the NIBIB expenditures in addition to bio-imaging. As for the NCI, it will continue to fund the NIH’s investments in cancer research, including devices, software and clinical trials. In its recent budget submissions, the NCI identified a number of areas that are seen as “extraordinary opportunities” for funding efforts: •Genes and the environment •Cancer imaging •Molecular targets •Tobacco and tobacco-related cancer research •Defining the signatures of cancer cells •Cancer communications. Therefore, cancer imaging (especially at the molecular level) will remain germane to the NCI mission. With regard to what is ‘done’ at the institutes, it can be summarized into four areas: research (intramural), grant review, grant management and administration. The review of grants is generally handled by the Center for Scientific Review (CSR) for all NIH institutes. This process utilizes
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about 100 standing study sections composed of scientists who peer review the majority of the 40,000 or so grants which are submitted to NIH each year. After the grants have been reviewed, it is the program management staff who interact with the principle investigators to aid in the execution of the grant or in its resubmission for re-review. As a program director in the extramural research part of the NCI, I am one of hundreds of scientists who provide scientific input into the management of research grants, whether investigator-initiated or not, once they have been awarded. We also help investigators in locating the most appropriate funding opportunities within the NIH and in understanding the critiques of their applications. In addition, we help to identify promising research opportunities for the institute by means of workshops. At these workshops there are usually 20 or so experts who are invited to address aspects of an evolving, and hopefully promising, research area in order to probe the need for solicited grant proposals. Summaries of these workshops are often published in order to promote further discussion and feedback from the radiation research community at large. Recent workshops have dealt with IMRT (IJROBP 51,4, 880-914, 2001); Late Effects of Radiation (in press in Radiation Research); Research in Medical Physics (IJROBP
49,3, 891-895,2001); Translational Research in Radiation Oncology (IJROBP 49,3,885890, 2001); Brachytherapy ( to be submitted); and Monte Carlo Methods in Radiation Therapy (held in Oct. 2001, report in process). These summaries often include recommendations which point the way for further developments in the area(s) covered. Medical physics, radiation oncology and radiology are rep-
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resented strongly within the Division of Cancer Treatment and Diagnosis (DCTD) of the NCI. This division includes the Biomedical Imaging Program (BIP, http://www.nci.nih.gov/ dip/) and the Radiation Research Program (RRP, http:// www.nci.nih.gov/rrp/). A visit to these Web sites will answer many additional questions about “what gets done” at the NIH. ■
2001 President’s Budget for NCI (dollars in thousands) Research Project Grants $1,721,812 Intramural Research 532,002 Research Support Contracts 367,286 Clinical Trials Infrastructure 223,995 Cancer Centers 182,216 Training and Education Grants 133,971 Research Management and Support 120,600 Cancer Control Management and Support 105,052 Specialized Programs of Research Excellence (SPORE) 60,916 Other Grants 57,222 TOTAL
$3,505,072
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AAPM NEWSLETTER
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AAPM/RSNA Fellowship Awarded to Kristin Stewart The Development Committee has awarded the sixth AAPM/RSNA Fellowship to Kristin Stewart of McGill University. The award was announced by Bhudatt Paliwal, chairman of the Awards Selection Subcommittee. Ms. Stewart will be supervised in her pre-doctoral studies by Jan Seuntjens. The award began July 1, 2001 and runs through June 30, 2003. Ms. Stewart received a B.Sc. degree in honors physics from the University of Regina and currently resides in Montreal. Previous AAPM/RSNA awards have been presented to Jason Polzin, Eric Niendorf, Mike Schuler and Susan Richardson of the University of Wisconsin, and to Martin Lachaine at McGill University. Belai Moftah was also a Varian Resident at McGill University from 1997-99.
Kristin Stewart
2002-2004 AAPM Residencies Announced The Development Committee has announced the Residency Awards for 2002 to 2004. The Imaging Residency was awarded to the University of Texas M.D. Anderson Cancer Center. The resident will be Mr. Ishtiaq Hussain (pictured), supervised by Dr. John Hazle. Mr. Hussain has a bachelor’s degree in physics from the University of Peshawar and a M.S. degree in medical and radiation physics from the University of Birmingham (England). The AAPM Imaging Residency was previously awarded to Kalpana Kanai at the Mayo Clinic.
Two Varian Residencies were also announced. The University of Minnesota has received one residency under the supervision of Bruce Gerbi. The resident will be Lai (Lee) Leong (pictured), who received a Ph.D. in solid state physics from the University of Miami in 1993. She lives in Rochester, MN and is presently on the faculty of Rochester Community College. The Mayo Clinic had a previous Imaging Residency in 19961998. A Varian Residency was also awarded to McGill University under the supervision of Ervin Podgorsak. The resident is Siobhan Ozard (pictured), who received a Ph.D. in medical physics from the University of British Columbia and started the two-year residency in November, 2001. McGill University previously was awarded a Varian Residency in 199799. Two Varian Residencies have been awarded annually since 1993. Previous awardees include the Mallinckrodt Institute of Radiology, Memorial Sloan-Kettering, the University of Kentucky and the University of Minnesota. 18
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AIP Governing Board Representative Report Christopher H. Marshall AIP Board Representative I am very pleased to report that the AIP Governing Board voted at its meeting in October to elect Jim Smathers to its Executive Committee for the first of a potential maximum of two successive two-year terms starting in January, 2002. Since there is no formula to ensure that each society is represented by a voting member of the AIP Executive Committee, and the size of that committee is smaller than the number of member societies, it may, in principle, be dominated by the larger societies with more voting power on the governing board. It is gratifying, therefore, that a member of the AAPM has been elected as a voting member of the AIP Executive Committee, and it is particularly gratifying to me as I rotate off that committee after serving two terms in that capacity. Service on the AIP Governing Board (where Jim and I both continue to serve), and particularly on the AIP Executive Committee, has proven to be a significant, but very satisfying, commitment of my own time and effort. The Executive Committee meets four times a year, often in conjunction with events which last several days. There are periodic conference calls and other communications. The commitment is to oversee an approximately $80
million annual budget in the face of huge pressure on publishing, which is the primary source of income, and to sustain and shape the many physics and other programs that are supported by this income stream. All the member societies share the belief that the AIP is very well managed at this time by its professional officers. However, there are many complex issues that must be addressed if the institute is to continue to prosper. The current thrust is to offer technically sophisticated services at competitive rates. A measure of success is that an increasing number of nonmember societies are bringing their publishing and subscription fulfillment business to the AIP although they must pay relatively more than the member societies. This new business provides economy of scale and keeps our costs down. I am firmly convinced that engagement with the AIP provides significant and varied benefits to the AAPM. My view 19
on this is partially rooted in the experience we have had in managing our own journal, and where the AIP provides us with far greater depth than we could possibly acquire independently, and yet allows us to continue to be our own publisher. There are, however, many other recent examples of the value of investing effort in the relationship with the AIP. These include the successful renegotiation of the ACP lease, the launch of our government and legislative effort in close cooperation with the AIP Media and Government Relations team, support with the lobbying effort to create the new institute within the NIH, and the emerging relationship with the Society of Physics Students as a potential source of recruits into our field. On the horizon is a new system to manage manuscripts online through the editorial review process, and an entirely new e-commerce platform to underpin AIP activities, and which can be adapted to support society activities. Our ability to work closely with the AIP at various levels, including its governance structure, makes this a unique relationship: we are both owners and customers. I have extracted the following information from a report that the AIP provides and which shows how the AIP spends the surplus it generates (See AIP - p.20)
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AIP (from p. 19) primarily by publishing its own journals. The AIP will receive a budgeted $598K in dues from the member societies in 2001 but will spend a budgeted $14.5M on various physics-related programs. Although we do not actively participate in all these programs, we do benefit from many. Broken down on a per-capita basis, each of our members contributes $4.59 in dues to the AIP, but the AIP spends $110.95 per member. In financial terms this is known as leverage. If we wish to maximize the value of this leverage we must participate. My recommendation for this and future governing boards of the AAPM is that we should spend the time to maintain and develop the AIP relationship. To do so we must maintain and develop contacts at the staff and member levels. We must nominate members to serve on AIP committees, particularly on the AIP Governing Board, who have the necessary commitment, who are willing to spend time to get to know and understand a very different community of societies than the one we deal with when we express the “medical” half of our professional identity, and who can use this experience to serve the purposes of both parties. Many of the other member societies have done this more consistently than the AAPM has, but I believe we have made great progress and should maintain the momentum. ■
New Member List Welcome to the following new members who have joined the AAPM since August 15, 2001. Ali K Alkaissi Ypsilanti, MI Maxwell Leland Amurao San Antonio, TX William P Argo San Antonio, TX Sylviane Aubin Quebec, QC, CANADA John P. Balog Middleton, WI Raymond J. Beers Smithtown, NY Ravi Bhatnagar Madisonville, KY Paul A Bruce Baton Rouge, LA Shelley Marie Bulling Lausanne, SWITZERLAND Omar Chibani Baltimore, MD James Chun Lam Chow London, ON, CANADA Ian A. Crooks New Haven, CT Warren D. D’Souza Houston, TX Guang Yin Fang Middleton, WI Michael Ryan Folkert Cambridge, MA John C Garth Albuquerque, NM William Robert Geiser Houston, TX Emily C Heath Montreal, QC, CANADA Khandaker T Islam St. Louis, MO Jennifer Elizabeth Johnson Seattle, WA Mika Karel Kortesniemi Helsinki, FINLAND
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Thomas J. Krupa River Forest, IL John Campbell Le Heron Christchurch, NEW ZEALAND Etienne Lessard San Francisco, CA Jun Li Toledo, OH Jerry Markman St. Louis, MO Dorothy Bea McGarrah Woodland Hills, CA Kyle Kevin Millage Atlanta, GA Rebecca Jane Milman Houston, TX Satoshi Miyajima Suita Osaka, JAPAN Iris Pauline Nogueira Alpharetta, GA Sung Ho Park Seoul, KOREA, REPUBLIC OF Norris J Parks El Paso, TX Tamas Porubszky Budapest, HUNGARY Arnoldus Hubertus Renders ‘s-Hertogenbosch, NETHERLANDS William Charles Salsbury Naperville, IL Archana Rajesh Somnay Detroit, MI Derek M. Wells Victoria, BC, CANADA Junqing Wu Baton Rouge, LA Shigeru Kennedy Yokoyama Ann Arbor, MI
AAPM AAPM NEWSLETTER NEWSLETTER 2001
JANUARY/FEBRUARY2002 JANUARY/FEBRUARY
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AAPM NEWSLETTER
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Letter to the Editor Medical Physicists: We Are One Michael G. Herman Rochester, MN These are challenging times both nationally and internationally with terrorism, war and the unstable economy being all too real. We all, however, can take pride in and feel confident about our profession of medical physics. Our profession remains very strong with an unwavering commitment to advance and enhance the practice of physics in medicine. Furthermore, the demand for quality medical physics services continues to increase and the demand for qualified medical physicists remains even higher. We all have an obligation to provide services to meet these demands. We all have an opportunity to satisfy these demands by working together for the betterment of medical physics, which in turn improves the quality of service we provide to the medical community. The services we provide in our daily practices are essential to good patient care and relations among our coworkers. However, improvements in the profession do not occur by each of us performing our daily medical physics tasks. Beyond this, volunteers within the medical physics community serve as officers and committee members in numerous organizations.
It is within these groups that the issues of science, education and the profession relative to medical physicists are discussed and promulgated for the betterment of our profession and the quality of care we provide. These volunteers, on our behalf, develop statements of policy, standards, guidance, science, education and more. Recently, the ABMP and the ABR entered into an historic agreement eliminating the competition between medical physics certification boards. This is an excellent example of how we all can work together with the best interest of medical physicists and for those we service in mind. The leadership of the ABR and the ABMP should be commended for developing a mechanism that ensures the highest quality certification process, eliminates contention and opens the door for new certification issues to be productively addressed. The AAPM board voted unanimously on November 28th to sponsor the ABMP to help promote the development of additional competency strategies for medical physicists. A second example of working toward the betterment of our profession occurred as the boards of AAPM and ACMP both voted to approve the formation of an ad hoc committee
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charged with investigating the potential for improving the synergy, efficiency and efficacy of the AAPM and ACMP on professional medical physics activities. The Ad Hoc committee met for the first time on November 28th with representatives of both the AAPM and ACMP, plus consultants representing the leadership of the Professional Council of the AAPM and the ACR Commission on Medical Physics (CMP). One additional example is the effort that the trilateral committee (composed of the AAPM, ACMP and ACR CMP) is making to organize a medical physics summit that will be held immediately preceding the ACR intersociety meeting. The meeting will be focussed on one or two issues of significance to the medical physics community. Invitations will be sent to organizations that have a medical physics component. Whether the issues are scientific, educational, professional, or political, our commitment to provide the most responsible actions on behalf of the medical physics community does not depend on which organizations we belong to, rather that we each take an active role in working toward the common goal of improving our profession and the services we pro-
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vide to our colleagues and our patients. Recent events provide all of us with the opportunity to recognize that we are but one small group of professionals within the medical community. Becoming active and working together, we can overcome large barriers and make great strides toward improving our profession and the services that ■ we provide.
Letter from the Editor I would like to thank all of those members who sent me contributions to the Newsletter last year. The abundance of material, both from the “regular contributors” and the general membership, along with the hard work of the managing editor, have made the first year of publication a successful one. I would encourage all of the members of the AAPM to send me material that you think might be of interest to the other members or suggestions on ways you think the Newsletter might be improved. I hope you all enjoyed the holidays and are off to a happy, healthy New Year. -Allan F. deGuzman “The Editor”
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Announcements Workshop on Survival Skills for Successful Women Physicists (Registration is open to both men and women)
Seeking to improve your leadership skills? The Committee on the Status of Women in Physics will offer a one half day workshop on “Survival Skills for Successful Women Physicists” on Sunday, March 17, 2002 from 1:30-6:00 p.m. at the APS Annual Meeting in Indianapolis, IN. A panel of highly successful women physicists will share their perspectives on scientific careers, raising research funds, and balancing career and family. Dr. Sandra Shullman of the Executive Development Group of Columbus, OH will lead an interactive session to develop leadership skills. The workshop will cover such issues as effective communica-
tion and networking, negotiation, leadership, advancement in organizations, and more. To ensure interaction, seats will be limited. Registration is open to both men and women. The fee is $60. You need not be registered for the APS Annual Meeting in order to attend this workshop, however, pre-registration is strongly recommended. Information on the program and invited speakers as well as registration information can be found at: http:// www.aps.org/educ/cswp/ index.html. -Azam Niroomand-Rad, Washington, DC
Health Physics Society Summer School The Health Physics Society is pleased to sponsor the 2002 Summer School at the University of Florida in Gainesville. The topic, “Internal Dosimetry,” will be discussed by national experts. The academic dean for the Summer School, Dr. Wesley Bolch, has organized a panel of experienced practitioners who will provide both the theoretical and practical sides of this important topic.
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The course begins on June 9 and runs through June 14, 2002. Registration information is available from the Health Physics Society office in McLean, Virginia (703) 7901745 or via the Internet (www.hps.org). Make plans to attend the weeklong event. -Bill Thomas HPS Summer School Committee 419-423-4701
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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: March/April 2002 Deadline: February 15, 2002 Postmark Date: March 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
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