AAPM Newsletter May/June 2002 Vol. 27 No. 3

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 27 NO. 3

MAY/JUNE 2002

AAPM President’s Column

Spring Activities Robert G. Gould San Francisco, CA The 44th Annual AAPM Meeting in Montreal is approaching quickly and is promising to be a record-breaking meeting. Indeed, it has already broken the record for number of scientific abstract submissions with more than 750 submitted, up by more than 150 from last year. Encouragingly, the number of diagnostic submissions increased a whopping 76%, advancing to 16% of the total. This compares to 11% from last year. Certainly part of the increase is due to our Canadian colleagues, as the meeting will be held jointly with the Canadian Organization of Medical Physics, but a significant in-

crease in U.S. submissions has also occurred. History has shown that meetings with a large number of abstract submissions also have a large number of registrants. Plan to come and bring the family to this delightful Canadian city.

Following last year’s format, a Long Range Planning (LRP) Committee Meeting was held during the first week in April in Washington D.C. with the chairs of all AAPM committees invited.

This was followed on Monday by an AAPM Day-on-the-Hill.

With the cherry blossoms in full bloom, we met in a windowless room throughout Saturday and Sunday. The LRP Meeting was a follow-up on discussions that have been occurring for more than a year concerning the strategic planning process within the AAPM. The AAPM has hired a consultant, Jim Dalton, to aide in revamping the way in which the Association formulates objectives and identifies issues that affect both the Association and its members. Jim was involved with the LRP Committee last year, directed a planning session of the AAPM Board of Directors at this past RSNA, and led the sessions at the current LRP Meeting.

(See Gould - p. 2)

AAPM Financial Situation and Need for a Dues Increase Melissa Martin Treasurer The AAPM Board of Directors approved a dues increase at their November 2001 meeting that will take effect on January 1, 2003 if approved by the membership at the annual business meeting, which will take place on Wednesday, July 17, 2002 in Montreal.

The dues increase will affect all categories of membership according to a percentage of Full Member dues approved by the AAPM Board at the November 2001 meeting.

Full Member dues will increase in steps over a five-year period from $185 to $285. Dues have not increased for the past three years. The following chart tracks dues over a 17-year period compared to salaries reported by our own salary survey.

As the chart on page 3 indicates, salaries have outpaced the dues amount in all years from 1991 to 2002. The proposed dues increase will reverse this trend if salaries increase at a 5.2% rate yearly for the next six years.

(See Dues - p. 3)

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Gould

(from p. 1)

Twenty-three officers and council and committee chairs attended the LRP Committee Meeting.

The goal of the meeting was to continue to evolve the planning process within the AAPM, increasing the participation of the Board in identifying the goals of the Association and the issues that the Association should address.

Councils and committees would then be given the responsibility to develop objectives that further the goals and address the issues identified by the Board. The councils and committees would request funding to carry out tasks needed to meet the objectives. I note that the AAPM also has subcommittees which should follow a similar process under the guidance of the parent committee. Task groups are formed as a strategy

TABLE OF CONTENTS President’s Column Dues Increase Exec. Dir’s Column Gov’t Affairs Column Education Council Rep. Medicare Conflict IOMP Report New Member List Mammography FAQs Letter from the Editor Memorial Letter to the Editor Announcements

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p. 1 p. 1 p. 4 p. 6 p. 7 p. 8 p. 10 p. 11 p. 15 p. 16 p. 17 p. 18 p. 19

formed as a strategy to achieve a particular objective. In formulating budget requests for this year, committee chairs were asked to identify objectives that they intended to achieve, attempting to connect funds with objectives. However, little instruction was given to the chairs, no uniform format was provided and no centralized database was developed for the process. The LRP Committee identified these deficiencies which will be addressed this year.

The LRP Committee also attempted to establish a “radar screen” to identify and track critical issues that require the attention of the Board and committees. This screen will be presented to the Board at the Montreal meeting for editing, updating and priority setting. In the future, the Board will annually review the issues being monitored. Most of the activity of the Association applies to ongoing programs that advance the mission of the Association and meet the needs of the members. Jim Dalton’s estimate is that 80% of a typical society’s activities are in this category. The remaining 20% are devoted to addressing critical issues that appear on the radar screen.

The AAPM Day-on-the-Hill was organized by Mike Gillin, chair of the Professional Council, and Angie Furcron, government affairs manager of the AAPM. Eleven members of the AAPM visited their congressional and senatorial offices, meeting with staff members. Our message was to identify our organization, 2

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explain who we are and the important role we play in health care. Just as last year, two bills were identified that the AAPM supports: the Consumer Assurance of Radiologic Excellence (CARE) Act and the Assure Access to Mammography Act. Angie can provide more information on these. I feel it is important that we raise the awareness in our elected officials of our organization, our members, and the vital role we play in health care.

Hopefully then, when health care bills are being formulated, our needs and concerns will be considered. Mike and Angie both do a good job alerting us to legislative activities, and it is up to us to take the initiative and be vocal in expressing our opinions to our representatives.

I look forward to seeing you in ■ Montreal.

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Dues

(from p. 1)

Current Financial Status Although the AAPM currently has a comfortable amount in reserve, recent investment losses and two years of small operating deficits have caused some concern to find solutions to reverse this trend.

We all have experienced the enhanced member services over the last few years with the AAPM Web site, Annual Meeting arrangements, Medical Physics Journal online access, government affairs coverage, salary survey, etc. While we enjoy these services, it is obvious that funding them without generating more revenue will eventually lead to a situation where our financial

strength will dissipate to a point where drastic measures would be needed to cut expenses and increase prices to maintain financial stability. We must avoid this scenario because of the turmoil it could cause.

Future Financial Outlook We are dependent on a few major sources of revenue: dues, the Annual Meeting, the Placement Bulletin, the Medical Physics Journal and investments. There are other sources of revenue that are significant when combined, but individually are small.

The above revenues must support all programs whether or not these programs generate revenue or are no-fee services. For 3

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the 2002-year cash budget, expenses are predicted to exceed revenue by about $383,386, not including investment gains or losses. Expenses will increase each year in the future by about the inflation rate if the AAPM wants to continue the same programs. If new programs or spending requests are instituted, then the shortfall will be larger.

Membership needs have grown and members have less time to volunteer to the AAPM. Our members now look to AAPM Headquarter’s staff to perform more tasks. There is also a greater need for continuing education and monitoring of professional interests. There is a sense among the membership that we have a financial reserve and a competent staff to expand ser(See Dues - p. 4)

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Dues

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(from p. 3)

vices. This is good, but must be controlled to avoid a financial pinch in the future.

A balanced approach between revenue and expenses is needed.

Expenses must be justified and controlled. Programs should be periodically reviewed to weed out

those that are no longer relevant.

The Board of Directors has taken a major step in this direction by instituting a formal Strategic Planning Process which will help control expenses by periodically reviewing programs for their effectiveness and relevance.

On the other hand, revenue must keep pace with expenses to sus-

tain the AAPM. Revenue rates must be fair and defendable when compared to services received and other economic considerations. I ask you to support the proposed dues increase to help keep this balance in place.

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Executive Director’s Column Sal Trofi College Park, MD

Annual Meeting Update July 14 – 18 Indications are that the 2002 AAPM Annual Meeting in Montreal will be a success. The abstract submission process closed on March 6 with a record number of 753 abstracts received.

The number received in 2001 was 603. This is a 25% increase from the 2001 submissions. There were 404 distinct presenting authors for abstracts in 2001. There are 528 for 2002. This represents a 30% increase in authors. Exhibit sales have exceeded budget expectations. Register online before June 26.

AAPM Virtual Library Update The AAPM Virtual Library is now active and accessible via AAPM Online at www.aapm.org.

If you haven’t already registered to use the Virtual Library, I encourage you to view the dem-

onstration presentation and then take a moment to register.

The registration process is quick and simple and there is no registration fee required through 2002 for AAPM members. Once registered, you’ll have access to more than 60 presentations digitally captured at the 2001 AAPM Annual Meeting in Salt Lake City.

A goal of the AAPM Virtual Library is to provide an easy mechanism for AAPM members to obtain instant access to quality information to be used in assisting them with their professional and educational needs. The AAPM Remotely Directed Continuing Education (RDCE) Committee has been 4

working diligently on this goal by providing and posting continuing education quizzes for Virtual Library presentations.

To date, 12 quizzes have been posted to the RDCE site and the list will continue to grow. If you are interested in obtaining medical physics continuing education credits online, please review the information posted at the RDCE Program site at www.aapm.org/educ/ rdce.asp.

Another goal is to continually add content to the Virtual Library that will keep members up-todate and informed about cutting edge technologies as well as standard practices. Up to 40 hours of scientific content will be captured at the 2002 Annual Meeting. Even if you are unable to attend the meeting, you’ll now have the opportunity to view lectures presented by the leading medical physicists, researchers and experts in the field today.

It is hoped that you will discover the AAPM Virtual Library to be a viable tool for your professional and educational growth.

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Publications AAPM Online now includes two reports that track the status of task group reports to be published. You can find these report buttons on the main page of the AAPM Web site under “Publications and Products.”

The Status of AAPM Reports tracks the current status of AAPM task group reports. Once these reports are published, they will become available for purchase through Medical Physics Publishing. Note that not all AAPM task groups notify Headquarters that they are working on a report.

The Status of Non-AAPM Reports tracks the current status of

non-AAPM reports. AAPM does not own the copyright to these reports. Headquarters tracks these reports because they might be of interest to medical physicists and/or because AAPM members have made a significant contribution to the reports.

I would like to remind you that Medical Physics Publishing is always looking for new manuscripts to publish. They encourage anyone who has an idea for a book to contact them at mpp@medicalphysics.org or 4513 Vernon Blvd., Madison, WI 53705. They say they cannot guarantee they will publish it, but they will guarantee that every proposal will be carefully considered.

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Summer Fellowship Program This year 32 undergraduate students will compete for six summer fellowships. This is twice as many applicants compared to 2001. The selected junior- and senior-ranking undergraduates will each receive a $4,000 stipend from the AAPM. Student fellows are selected based on a combination of the quality of their personal statement, their GPA and their potential future in medical physics. Each student fellow chooses his or her mentor, a Full AAPM Member, based on location and the student’s interest in the mentor’s proposed project.

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Government Affairs Column Angela L. (Furcron) Lee Government Affairs Manager I would like to announce that I got married on April 20th and my new last name is Lee. My husband’s name is Marcel Lee. We had a beautiful wedding and reception here in Maryland.

The 2nd AAPM Capitol Hill meeting on Sunday and Monday, April 7 and 8, was a success. The conference was held in Washington D.C. and was attended by 11 AAPM members. The first day consisted of information sessions that prepared participants to go to Capitol Hill on the second day.

The preparation was an afternoon session focusing on political and legislative (bill) updates and information. There were presentations by a government relations representative from the American College of Radiology (ACR), and a lobbyist representing the Alliance for Quality Medical Imaging and Radiation Therapy, of which the AAPM is a member. The ACR representative presented the background information and an update on the Access to Mammography bills (S. 548 and H.R. 1354). The Alliance representative presented information on the CARE bills (H.R. 1011 and a potential senate bill).

The message that AAPM took to Capitol Hill was that: 1) medical physicists help to insure quality patient treatment and accuracy, 2) Congress should support the

“Consumer Assurance of Radiologic Excellence” (CARE) bill, HR 1011, which requires state licenses for practitioners of medical imaging and radiation therapy (except ultrasound), and 3) Congress should support the “Assure Access to Mammography Act of 2001,” S. 548/HR1354 which bridges the reimbursement gap to insure that facilities continue to provide mammography services.

The Radiology Advocacy Alliance (RAA), which is a division of the American College of Radiology (ACR), recently changed its bylaws to allow nonACR members to become members of RAA. Previously only ACR members could join RAA, but now “any radiologist, radiation oncologist, nuclear medicine physician or medical physicist” can join. RAA dues are $24.00 per year.

RADPAC (a 501(c)(6) organization) is sponsored by the RAA because federal tax law precludes 501(c)(3) organizations such as the AAPM and the 6

ACR from forming political action committees (PACs). Forming a PAC is a way to become more politically active through political education, lobbying and contributing to campaigns. One must be a member of the RAA in order to contribute to RADPAC. “RADPAC’s goal is to support and elect pro-radiology candidates at the federal level through the voluntary contributions of RAA members.” RADPAC has already raised $350,000 in contributions from RAA members during the 2001-2002 election cycle. As a result of this strong support, the RAA ranks 12th in the top 20 health professional political action committees. The top three PACs are The American Society of Anesthesiologists, The American Dental Association, and The American Medical Association, respectively. RAA candidate contributions currently stand at $151,000 and will continue to increase between now and the November elections.

RAA members across the country host fund-raisers and arrange meetings with their legislators to discuss radiology-related issues and deliver RADPAC contributions. This is an effective way for the radiology community to solidify relationships with its friends in Congress as well as to establish new ones. RADPAC’s political activities have helped to increase congressional support for: access to quality mammography screening, reducing proposed

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cuts in the Medicare conversion factor, and adequate funding of the National Institute of Biomedical Imaging and Bioengineering (NIBIB).

If you would like more information on RAA, please contact Melanie T. Young, Director, Political Education, American College of Radiology at (888) 2958843.

See you in Montreal.

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Education Council Report

G. Donald Frey Education Council Chair

“People who practice service, who try to learn, believe that knowledge is good. They have a sense of guilt when they do not try to acquire it. This keeps them busy . . . It seems hard to live any other way than thinking that it was better to know something than not to know it; and that the more you know the better, provided you know it honestly.”

–Robert J. Oppenheimer People to People, Oxford Dictionary of Biographical Quotations, Ed: Susan Ratcliffe (2001)

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Professional organizations have responded to the need to insure the ongoing competence of medical personnel by adopting a wide variety of programs. In particular, board certification is now time limited, in all cases, for medical physicists. The ABMP has issued time-limited certificates from its inception and beginning this year the ABR certificates are time limited. The ABR process was discussed in the March/April Newsletter. The maintenance of certification will provide opportunities for the AAPM to serve its members and colleagues. The AAPM Education Council has begun addressing the issue. The Continuing Education Committee is working with the newly formed Meeting Coordination Committee and our sister societies ACMP, ACR & RSNA to insure that appropriate continuing education credit is available for physicists. The newly available AAPM Virtual Library has greatly increased the amount of CE credit

that is available through the AAPM RDCE program. In addition, the Continuing Education Committee is reviewing its charge to be sure it can meet the needs of the members in this area.

The AAPM takes its role in educating our colleagues very seriously. Several of the Education Council committees deal with the medical physics education of our colleagues. The Medical Physics Education of Physicians Committee has had to expand its role in recent years as radiation use by physicians has increased. With the emergence of maintenance of competency issues, they are working to find effective ways of providing ongoing physics education to radiologists and radiation oncologists.

The Education Council Symposium at the Annual Meeting will address maintenance of competency issues. In addition to a basic discussion of the matter, there will be speakers that will consider new ways of providing ongoing education and a look at how these issues are handled in Europe.

There is still time to register for both the AAPM Summer School and the Medical Physics Review Courses. This year’s Summer School is a dual track school that will follow directly after the Annual Meeting. The therapy track will focus on intravascular brachytherapy and the diagnostic track will look at fluoroscopically-guided interventions. The Medical Physics Review (See Education - p. 8)

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Education

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(from p. 7)

Courses provide an in-depth review of basic medical physics.

An interesting paper appeared in the journal Health Affairs last year. The paper, “Physicians’ Views of the Relative Importance of Thirty Medical Innovations,” VR Fuchs and HC Sox, Jr., Health Affairs, 20(30-42), 2001, had well-qualified internal medicine physicians rank the most important medical innovations in the last 30 years. Interestingly, three radiology innovations were in the top five (MRI & CT scanning were first, balloon angioplasty was third and

mammography was fifth). Ultrasonography and bone density measurements also made the list.

It is interesting to note the role that medical physicists played in both the development and clinical implementation of these innovations. The close working relationship between medical physicists and radiologists makes it possible to implement innovations rapidly and effectively.

The AAPM Long Range Planning Committee Meeting was held recently. The Education Council and its committees are working to review their present activities and select areas for

future development. The process can benefit from input from the membership. You can provide input either by becoming a member of one of the committees or by directly commenting to a committee or its chair.

If you are interested in serving, please contact the chair of the committee or subcommittee and President-elect Martin Weinhous. More details are on the AAPM Web site. If you wish to contact any of the committees to provide comments, you can do so through the addresses available on the AAPM ■ Web site.

The Medicare Conflict Between the Providers and the Payer Michael Gillin Professional Council Chair The front page of the Sunday, March 17, 2002 edition of The New York Times included a story entitled “Many doctors say they are refusing Medicare patients.”

Medicare cut payments to doctors in 2002 by 5.4%. The Centers for Medicare and Medicaid Services (CMS) estimates that fees will be reduced in each of the next three years for a total of 17%. The federal government is struggling to control Medicare costs. Total Medicare spending rose 24% in the last five years to $238B in 2001. Physician fees approached approximately $41B in 2001. The remaining

$198B went to hospitals, skilled nursing facilities, home health care, and hospices. The Congressional Budget Office estimates that the total Medicare spending in 2006 will be $310B. President Bush’s first priority is to increase benefits, including a prescription drug benefit and affordable plan options. The exact details as to how benefits would be increased and costs contained have yet to be presented. The Bush administration has stated that any increases in payments to some providers (physicians) would have to be offset by cuts in payments to others (hospitals).

One possible solution to the rising costs of Medicare was the development of Health Mainte8

nance Organizations for Medicare patients. In the last four years, 2.2 million patients have been dropped from Medicare HMOs, as HMOs concluded that federal payments were inadequate. This is greater than 5% of the total Medicare population.

The Medicare Payment Advisory Commission has recommended that Congress revise the current system from its sustainable growth rate system and increase payment to doctors by 2.5% in 2003. The administration is concerned that the price tag for this revision would be too high, costing approximately $126B over the next 10 years.

Organized medicine is reacting to this reduction of fees on mul-

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tiple fronts. The American Academy of Family Physicians states that 17% of family doctors are not taking new Medicare patients. The president of the National Committee to Preserve Social Security and Medicare, an advocacy group for the elderly, was quoted in the Times article as stating, “Many of our members across the country have told us that they are having difficulty finding a physician who accepts Medicare.” Medicine supports a bill (HR 3882), which was introduced by Rep. Nancy Johnson (R-Conn.) that would implement the recommendations of the Advisory Commission. The outlook for this bill is not clear.

Congress has mandated that Medicare reimbursement be based upon costs, as opposed to charges. Hospitals have routinely provided CMS with cost data.

The data, which indicates the cost of providing specific services in radiation oncology, has wide variations in it. To date, CMS has only analyzed cost data from bills, which contain a single claim, i.e. they have not analyzed cost data from claims that contain more than one item for a specific day.

ASTRO has requested on multiple occasions that multi-claim data be analyzed, as most radiation oncology procedures involve multiple claims on the same day.

(The AAPM has supported ASTRO in its letters to CMS.) ASTRO believes that the multiclaim data will provide a more accurate indication of the costs for providing radiation oncology services.

The main instrument which defines the cost of providing radiation oncology medical physics services, was a study performed by Abt Associates, Inc. entitled “The Abt Study of Physicist Work Values for Radiation Oncology Physics Services.” The study was prepared for the American College of Medical Physics (ACMP) and the American Association of Physicists in Medicine (AAPM) on October 3, 1995.

There is an updated 2002 version of this study, which was mailed in March, 2002 to a limited number of physicists. The 2002 study should reflect changes in medical physics practice since the early 1990s. It includes questions on three dimensional therapeutic radiology simulation aided field setting, 77295, and on IMRT treatment planning, 77301. The results from this survey should be available within a year. It is hoped that the 100 plus institutions that receive this survey will complete it in a timely manner, as it is very important.

The labor costs of providing medical physics services can be determined from the time, in hours, required to perform a specific service multiplied by the hourly wage rate for the medical physicist. On a national basis, the hourly wage rate can be determined from the AAPM salary survey. On an institutional basis, the hourly wage rate should reflect the specific wages being paid to the physicist(s), who is (are) providing the services.

The importance of each institution establishing and accurately reporting to CMS the costs of 9

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providing medical physics services cannot be overstated.

Medical physicists should be key players in this team effort.

Costs should be reviewed for established services, e.g. three dimensional treatment delivery, and new services, e.g.

IMRT treatment planning. Substantial effort may be required to develop a reasonable cost structure. Inaccurate reporting of costs is a disservice to everyone in radiation oncology, as CMS prefers to believe the numbers they receive from their service providers, as opposed to any other data, such as the Abt survey results.

In summary, the payer, the federal government, wishes to increase services and limit the rate of increase of costs. The providers state that the current reimbursement rate is not adequate to meet their current costs. The number of Medicare beneficiaries is increasing. The solution to this complex societal issue has yet to be defined and may not be based upon a reasonable consensus. The solution will impact upon every element of the healthcare delivery system. ■

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Report on the AAPM/IOMP International Scientific Exchange Program: Radiation Therapy Physics Course & Workshop – Riyadh, Saudi Arabia Azam Niroomand-Rad ISEP Chair & IOMP Vice President and Muthana Al-Ghazi Orange, CA

The 12th AAPM/IOMP oneweek course/workshop on Radiation Therapy Physics was held successfully at the King Faisal Specialist Hospital and Research Centre (KFSHRC) in Riyadh, Saudi Arabia March 9-13, 2002.

The course/workshop was sponsored by the AAPM International Scientific Exchange Programs (ISEP) and endorsed by the International Organization for Medical Physics (IOMP) Education and Training Committee.

Local sponsorship was provided by the Department of Biomedical Physics, KFSHRC. This program was also accredited by CAMPEP. The objectives of this workshop were to discuss the fundamentals of the physics of radiation therapy, to present the current status of treatment of cancer patients using state of the art treatment technology to medical physicists, radiation oncologists, medical dosimetrists, radiation therapists and allied professionals, to intercompare calibration of photon and electron beams using the IAEA and the AAPM TG-51 protocols, and to exchange information relating to the medical physics profession in

Saudi Arabia and neighboring countries. Another major objective of this program was to promote the professioanl profile of the field of medical physics in Saudi Arabia and assist our Saudi colleagues in establishing a Saudi Association of Medical Physics (SAMP) .

Dr. Abdulkarim Al-Beteri, chairman of the Department of Biomedical Physics at KFSHRC, was the local host director and chairman of the Local Arrangement Committee and co-director of this course. AAPM faculty were Drs. Faiz M. Khan, Bhudatt R. Paliwal, LeRoy J. Humphries, Theodore Thorson, as well as the authors of this report. There were 70 participants: 63 from Saudi Arabia, two from Egypt, two from Sudan, two from Bahrain and one from Syria. The participants included medical physicists, health physicists, radiation oncologists, dosimetrists and radiation therapists.

The lectures were held at Prince Salman Auditorium at KFSHRC. In addition, there were two workshops; one on intercomparison of the IAEA and TG-51 dosimetry protocols, and one on chamber intercomparisons. Attendees from five countries brought chambers and electrometers for this purpose. One of the treatment machines (Varian 2100 C/D) at KFSHRC was used for these two workshops.

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It should be noted that KFSHRC is a large and modern tertiary care hospital. It acts as the referral centre for the entire Kingdom of Saudi Arabia. It is extremely well equipped. The range of technological devices and clinical programs available at KFSHRC is impressive and parallels that in any US university healthcare institution. The faculty also visited the Radiation Oncology Department of the Riyadh Military Hospital and was impressed by the extent of the medical physics activities in this hospital as presented by the chief physicist, Dr. Miola.

Local expenses of the faculty were supported by the host institution. Faculty travel expenses were financed by funds provided by the AAPM, vendors and the King Fahad University of Petroleum and Minerals. Corporate Sponsors (+$1,000) were Elekta Oncology Systems and Best Industries. Supporters ($500 – 999) were Siemens, Europe. Contributors ($100499) were Standard Imaging and CDRS. The Department of Biomedical Physics, KFSHRC supported the entire program locally.

Vendors (Varian, BrainLab, PTW) supported attendees from outside Riyadh.

Following the conclusion of the course, a one-day workshop was held at the King Fahad University of Petroleum and Minerals (KFUPM) in Dhahran. The

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title of the workshop was, “Medical Physics: Its Importance and Its Future in the Kingdom of Saudi Arabia.” The workshop was organized by the Physics Department (Dr. Muhammed Naqqadi, chairman) of KFUPM. The objective of the workshop was to discuss the current status and future of medical physics in Saudi Arabia. A panel discussion concluded this workshop. The importance of establishing a Saudi

Association of Medical Physicists was made very clear in this workshop. A tour of the Saudi Aramco and Aramco Hospital Radiation Oncology Department in Dhahran were arranged for visiting faculty.

Last but not least, we would like to express our appreciation to the AAPM faculty and Dr. Abdelkarim Al-Beteri and his staff for their extraordinary efforts in organizing this program. The

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success of this program is due to the hard work and commitment of local organizers as well as faculty. The warm welcome, affability and generous hospitality accorded to us was indeed unsurpassed. We had a memorable experience and made new friendships. Wonderful memories of this experience will certainly be lasting.

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New Members Welcome to the following new members who have joined the AAPM or upgraded their status since December 15, 2001.

Gregory A. Abell Redlands, CA Nihal Aboud Woodstock, GA Abdulrahman Saleh Al-Suwayan Riyadh, SAUDI ARABIA Richard A. Amos Loma Linda, CA Kenneth L. Andrews St. Louis, MO Jose Manuel Artigues-Pedrola Reus, SPAIN Sylviane Aubin Quebec, QC, CANADA Steven M. Avery Newport News, VA Aldo Badano Rockville, MD Rajeev K. Badkul St. Louis, MO Christopher T. Baird San Francisco, CA Colin R. Baker Liverpool, UNITED KINGDOM Dennis Bradley Barhorst Baton Rouge, LA

John T. Bauer Buffalo, NY Frederic Beaulieu QC, CANADA Eric A. Berns Chicago, IL Zubin H. Bharucha Kalamazoo, MI Ravi Bhatnagar Madisonville, KY Miroslaw M. Bialkowski Mequon, WI Rose-Ann M. Blenman Rochester, MN Melissa M. Blough San Antonio, TX Jeremy T. Booth Camperdown, AUSTRALIA Elizabeth L. Bossart Gainesville, FL Lionel G. Bouchet Gainesville, FL Carla D. Bradford Providence, RI Peter J.M. Brands Eindhoven, NETHERLANDS Charles M. Budris Morris Plains, NJ

Stuart S.C. Burnett Houston, TX Christopher H. Cagnon Los Angeles, CA Marco C. Carlone Ottawa, ON, CANADA Ricardo E. Carrillo Stony Brook, NY Michael Joseph Casey Dublin 4, IRELAND Koruth Chacko Terre Haute, IN Kish Chakrabarti Rockville, MD David K. Chamberlain Reno, NV Matthew Thomas Chapman Reno, NY Paule Charland Ann Arbor, MI Lili Chen Philadelphia, PA James Chin-An Chen Potomac, MD Chin-Cheng Chen Taoyuan, TAIWAN Weimin Chen Newark, NJ

Cody Chen Lake Worth, FL Lip Teck Chew Singapore, SINGAPORE Pai-Chun Melinda Chi Houston, TX Nathan Lewis Childress Houston, TX Hung Ching Woodside, NY Byung-Chul Cho Anyang, KOREA, REPUBLIC OF Mark E. Colgan Indianapolis, IN Virgil N. Cooper Los Angeles, CA Bruce T. Crawford Memphis, TN Wesley Stuart Culberson Madison, WI Arthur J. Curtin-Savard Manchester, NH Kimberly A. Cutler Greenville, NC Nathan Crane Davis Madison, WI

(See New Members - p. 12)

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New Members (from p. 11) Cleber N. De Souza Sao Paulo, BRAZIL Cesar Della Biancia New York, NY Jun Deng New Haven, CT Meisong Ding Philadelphia, PA Li Ding Gainesville, FL Angela Mary Donohoe Dublin 8, IRELAND Douglas G. Drake Novi, MI Karen Drukker Chicago, IL Donald F. Dubois Biloxi, MS Benoit Michel Francis Dufeu Montreal, QC, CANADA Richard Dunia Anaheim, CA Stephen B. Easterling Melbourne, FL Yuri A. Ellis Deerfield, IL Sean Bedilion Fain Madison, WI Gregory Ross Fairchild San Diego, CA Tony Falco Montreal, QC, CANADA Anthony S. Fernando Terre Haute, IN Pamela Turner Fetherston Suffolk, VA Gary David Fisher Houston, TX Eugene S. Fourkal Philadelphia, PA Walter R. Fowler Ann Arbor, MI Stephanie C. Franz Colorado Springs, CO Eduardo Galiano Asuncion, PARAGUAY Jose L. Garcia Ramirez St. Louis, MO Dominic Gelinas Trois-Rivieres, QC, CANADA Dietmar Georg Vienna, AUSTRIA

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Anthony Leon Gerig Madison, WI Stefano Gianolini Sutton, UNITED KINGDOM Nikolaos A. Gkanatsios Danbury, CT Carri Kaye Glide Harrison Twp, MI Edward Joseph Goldschmidt Marlton, NJ Anant Gopal Buffalo, NY Alexander S. Gray Norfolk, VA Peter B. Greer Adelaide, AUSTRALIA Kerry L. Grow Hollister, CA Huaiqun Guan Detroit, MI Mariana Guerrero Baltimore, MD Hong Guo Honolulu, HI Adam David Hall Cincinnati, OH Rashid Ali Hameedi North Babylon, NY Eun Young Han Gainesville, FL Ishiuan K. Hargrove Macon, GA Gayle A. Harnisch Cleveland, OH Emily C. Heath Montreal, QC, CANADA Todd M. Hill Rossford, OH Kenith Lane Hogue Flemington, NJ Jeremy D.P. Hoisak Toronto, ON, CANADA Zenan Hu Westmont, IL Chia-Ho Hua New York, NY Yunxiang Shawn Huang Dallas, TX John Laurence Humm New York, NY Zhimin Huo Rochester, NY Anna Lynn Iwinski Atlanta, GA Wassim T. Jalbout New York, NY

12

Quan Jiang Nina E. Lee Troy, MI Fort Sam Houston, TX Zhenxue Jing Qing Lei Danbury, CT Dallas, TX Lois Charlotte Jones Michael R. Lemacks Liverpool, BC, AUSTRALIA Fargo, ND Bapu A. Kamble Daphne Levin-Plotnik Staten Island, NY Chicago, IL Jeffrey M. Kapatoes Hui Li Middleton, WI Nashville, TN Ajay Kapur Jun Li Niskayuna, NY Toledo, OH William M. Kassing Texin Li Cincinnati, OH Gainesville, FL Kimberly D. Kearney An Liu Allentown, PA Arcadia, CA Justin Mark Keister Xinming Liu Appleton, WI Houston, TX Shahed Khan Julie W. Lo Twickenham Middlesex, Greenwich, CT UNITED KINGDOM Yulia Lyatskaya Kwang Pyo Kim Boston, MA Gainesville, FL Jingfei Ma Sun Ung Kim Houston, TX Choongnam, KOREA, Chi-Hsiang Ma REPUBLIC OF Dover, NH William Lester Kiser Marc Alexander MacKenzie Clayton, IN Edmonton, AB, CANADA Mika Karel Kortesniemi Harish K. Malhotra Helsinki, FINLAND Bronx, NY Daiva Kristupaitis Paul M. Mandelin Minneapolis, MN Waukegan, IL Andrzej Krol Steven E. Martin Syracuse, NY Wellington, FL Kerry T. Krugh Osama R. Mawlawi Toledo, OH Houston, TX Eugenia Kulama Boyd M. C. McCurdy London, Winnipeg, MB, CANADA UNITED KINGDOM Luke B. McLemore Gopalakrishna P.G. Kurup Rochester, MN Madras, BAHRAIN Pedro Mendez-Correa Martin Lachaine Temple, TX Tucson, AZ Wido Menhardt Bernard Lachance Los Gatos, CA Quebec, QC, CANADA Gabor Menyhart Denise Lambert Lexington, KY Vancouver, BC, CANADA Klaudia H. Meyer Claude Lapointe Minneapolis, MN Saskatoon, SK, CANADA Rachid Mghari Marc H. Lauterbach Graham, NC Heidelberg, GERMANY Rod Milbrandt Robert J. Leclair Garden City, KS Sudbury, ON, CANADA Stanley Lee Mills Choonik Lee Oklahoma City, OK Gainesville, FL Charles L. Lee Baltimore, MD (See New Members - p.14)

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2002

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AAPM NEWSLETTER

New Members (from p. 12) Juan G. Miranda Las Vegas, NV Chad A. Mitchell Hilliard, OH Michael L. Mitchum Duluth, GA Allen Movahed North Vancouver, BC, CANADA Daniel L. Munini Redwood City, CA Daryl P. Nazareth Buffalo, NY Daniel W. Neck Lafayette, LA Christopher L. Nelson Greenville, NC Nina (Hoan) T. Nguyen Minneapolis, MN Agapitus U. Nkwocha Westland, MI Uwe Nocken Duisburg, GERMANY Heath J. Odau Verona, WI Iris Ouyang Troy, MI Cihat Ozhasoglu Pittsburgh, PA Naim Ozturk Greenville, NC Samuel D. Painter Augusta, GA Joon H. Park Roanoke, VA Norris J. Parks El Paso, TX Homayon Parsai Seattle, WA Larry Dean Partain Mountain View, CA Massimo Pasquino IVREA, ITALY Rajen Mahendra Patel Winterville, NC Pradeep Kumar Patra Bartlett, TN Nakorn Phaisangittisakul Greenbelt, MD Sushakumari Pillai OMAHA, NE Christopher David Pitcher Gainesville, FL Brian William W. Pogue Hanover, NH

MAY/JUNE 2002

Carmen C. Popescu Victoria, BC, CANADA Bjoern Poppe Oldenburg, GERMANY Dattatraya Manjanath Powar Manama, BAHRAIN Miguel A. Rios Guaynabo, PR Timothy Ritter Biloxi, MS Dante E. Roa New Haven, CT James L. Robar Vancouver, BC, CANADA Robert A. Rodgers Houston, TX Lara Michele Rodriguez New York, NY Norma W. Roques Alexandria, LA Rachel A. Ross Bakersfield, CA Kenneth J. Ruchala Middleton, WI Kelly James Ryan Sierra Vista, AZ Kym L. Rykers West Heidelberg, AUSTRALIA Eric S. Rzad Augusta, GA Victoria L. Sandy Peachtree City, GA Carlo T. Santa Ana Marquette, MI Amit Sawant Ann Arbor, MI Renu Saxena Chicago, IL Bryan J. Schaly London, ON, CANADA Jennifer H. Scharff Mountain View, CA Albert J. Schlocker St. Louis, MO Charles E. Schroeder Edmonton, AB, CANADA Shakil Bin Shafique San Juan, PR Sam Zhongmin Shen Toronto, CANADA Rompin Shih Taipei, TAIWAN Rebecca C. Sine Bethesda, MD Zhong Su Ann Arbor, MI

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Michelle M. Svatos Concord, CA Yuri Tabrizi Evanston, IL Yuan-Chuan Tai St. Louis, MO Mat M. Tamimi Knoxville, TN Michael S. Taylor St. Louis, MO Michael Dean Thomas Kernersville, NC Heather K. Thompson Edmonton, AB, CANADA Vaidehi Venkatakrishnan Boston, MA Karl K. Vigen Stanford, CA Lindsey M. Voeltz San Antonio, TX Xiaochun Wang Houston, TX Jian Zhong Wang Laurel, MD Lei Wang Sacramento, CA Rose Wang Gaithersburg, MD Brad J. Warkentin Edmonton, AB, CANADA Lauren Weinstein Brooklyn, NY Carel F. Westermann Leidschendam, NETHERLANDS D. Jay J. Wieczorek Miami, FL Kathryn Ellen Wilson Dallas, TX Thaddeus A. Wilson Memphis, TN Jerry Wise Lexington, KY Dennis J. Wood Pascagoula, MS Edward E. Wroblewski Indianapolis, IN Tao Wu Rochester, MN Nathaniel Wyckoff Los Angeles, CA Jinyu Xue Cleveland, OH Ravindra Yaparpalvi Bronx, NY Kamil M. Yenice New York, NY

Inhwan J. Yeo Toronto, ON, CANADA Chris Song K. Yun Los Angeles, CA Jiandong Zhang Carlstadt, NJ Hualin Zhang Lexington, KY Jay J. Zheng Las Vegas, NV Yifang Zhou Newport Beach, CA Feng Zhou Philadelphia, PA Xiaohong Joe Zhou Houston, TX John R. Zimmer Portland, OR â–

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2002

ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler Senior Director, ACR Breast Imaging Accreditation Programs Does your facility need help applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? Check out the ACR’s Web site at www.acr.org; click on the blue bar, “Mammography” and then “Frequently Asked Questions.” In each issue of this Newsletter, I’ll present a question or two of particular importance for medical physicists.

Q. What accreditation testing is required when a facility purchases a new (or previously owned) unit?

A. If the facility has over 13 months left on its current accreditation when the new unit is installed, the ACR will ask the facility to complete a New Unit Addendum and submit a phantom image (with dosimeter), images of a fatty and a dense breast, 30 days of processor QC data and a medical physicist’s

Equipment Evaluation report along with a reduced fee. Once accreditation is approved for that unit, its expiration date will be the same as the expiration dates for the other units at the facility (or will be the same as the expiration date of the unit it replaced.)

If the facility has less than 13 months left on its accreditation

when the new unit is installed, the ACR will instruct the facility to begin Early Renewal on all units at the usual renewal fee. Facilities should contact the ACR for the appropriate instructions and applications prior to installation of any new units.

Q. We will be moving our mammography unit to another existing, certified site affiliated with our facility.

Do we have to inform the ACR?

A. Yes. Since this moved unit would be “new” to an existing, separately accredited and certified facility, it is considered a “new” unit and must undergo appropriate testing. Please call the ACR at (800) 227-6440 and in-

form our staff that your facility will be moving your mammography unit to another site and when you will be moving, so that we may provide you with appropriate instructions to accredit this unit (see previous question). You may

use the unit after your medical physicist has performed an Equipment Evaluation that indicates compliance with all MQSA requirements.

Q. May we use our new unit as soon as it is installed?

A. Yes, if certain conditions are met. Please call the ACR as soon as possible with an effective date of installation so that we may provide you with the appro-

priate application materials. Provided that your facility is already fully accredited, you may use the unit after your medical physicist has performed an Equipment 15

Evaluation that indicates compliance with all MQSA requirements. As soon as possible, but within 10 business days after your (See FAQs - p. 16)

AAPM NEWSLETTER

FAQs (from p. 15) Equipment Evaluation, you must submit the initial application materials (either the New Unit Addendum or the Early Renewal

MAY/JUNE 2002

Entry Application) to the ACR along with the appropriate fees to start the appropriate testing procedures.

Finally, you should contact your state radiation control

agency to determine if they have their own special requirements for operating new equipment that you must meet.

Q. Our facility recently added a new mammography unit. When we received the paperwork from the ACR to start the accreditation process on our unit, the package contained a New Unit Addendum and an MQSA Requirements for Mammography Equipment form. Since our physicist already performed his survey when the unit was installed, can we just disregard the MQSA Requirements for Mammography Equipment form?

A. No. It is important that you give this MQSA Requirements for Mammography Equipment form to your medical physicist to complete. In order to accredit a mammography unit that is new to the facility, the ACR must ensure that your medical physicist has conducted an Equipment

Evaluation. This Equipment Evaluation must determine whether the new or changed equipment meets applicable MQSA requirements for mammography equipment [section 900.12(b)] in addition to the applicable QA requirements for equipment listed in

[900.12(e)] that the medical physicist checks during the routine annual survey. All problems must be corrected before the new or changed equipment is put into service for examinations or film processing. ■

Letter from the Editor Allan F. deGuzman Winston-Salem, NC Someone sent me an article about HIPAA the other day for publication in the Newsletter as a “general information” article for the benefit of our members. It ended up being an “almost-cleverly-disguised” advertisement for the author’s company, which helps people understand and comply with the rules and regulations of HIPAA. Although the motive for the article was questionable, the message seemed valid.

I did a little research to find out how HIPAA might affect our lives as medical physicists and, I suppose, as patients. The information is overwhelming and often confusing.

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. In December of 2000, the Secretary of Health and Human Services (HHS) issued a number of final privacy regulation changes.

These changes were scheduled to take effect as of April 14, 2001, but the HHS Department said it will not enforce the privacy rule 16

until April 14, 2003. Two of the primary areas addressed by HIPAA concern the privacy and protection of a patient’s individually identifiable health information. HIPAA restricts the use or disclosure of patient identifiable information (whether it occurs orally, electronically and/or on paper or film) unless the patient specifically consents to such use or disclosure. This restriction seems to apply even to discussion of the patient’s care with the referring physician. Apparently, this can be resolved with a carefully worded consent form.

AAPM NEWSLETTER AAPM NEWSLETTER

Criminal penalties can be as severe as a $250,000 fine and/or a 10-year imprisonment.

As part of a team of individuals providing health care, we must be careful not to leave films or treatment plans in places where they shouldn’t be left, or to discuss a patient’s care within earshot of others. I personally almost asked a friend (whom we were treating for breast cancer at the time) how she was feeling while we were both at our daughters’ soccer game. Luckily, I realized that the information I had concerning her condition was information that should not be disclosed. Even the kindest of gestures can be inappropriate and apparently even illegal.

I hope that some of our government liasons and/or those who are better informed than I about these rulings, can provide us with more information regarding this ■ important topic.

JANUARY/FEBRUARY 2001 MAY/JUNE 2002

Memorial Andrezj Jan Demidecki

Lawrence E. Williams and Cecil L. Staud Duarte, CA We regret to announce the recent death of Andrezj Jan Demidecki after a long battle with melanoma. Andre, as he was known to his friends, passed away in his sleep on the morning of January 10, 2002. He left behind Jolanta , his wife of 40 years, and their son, Adam.

Andre Demidecki was born in Poland in 1933 and trained in experimental physics at the Warsaw University, eventually receiving a M.Sc. in the area of radiation and solid state devices. He then underwent two years of clinical work involving nuclear medicine, X-ray and radium therapy at the Royal Marsden Hospital in London and the Christie Hospital in Manchester, England. In 1965 he joined the Department of Radiotherapy and Radioisotopes at the Al-Sabah Hospital in Kuwait. In 1969 he moved to St. Louis and joined the Radiation Oncology Department at Washington University. His most

famous achievement occurred while at Washington University where, with William Powers, Arnold Feldman and others, he developed the material Cerrobend. Used extensively for the casting of reusable shielding for external beam applications, the material is in worldwide use.

For this work, Andre received a Certificate of Merit from the Radiological Society of North America in 1971.

He moved to the University of California at San Francisco from 1972-1976 and then went on to be staff physicist for 10 years at the Centers for Radiological Physics in Chevy Chase, Maryland. During this time, he worked extensively on the assessment of breast doses during mammography. Andre spent two academic years at the University of Vermont before coming to the City of Hope in 1987. During the final years of this career and before retiring in 1995, he helped develop novel methods for malignancy treatment using radioactive proteins.

These efforts with antibodies were correlated with measurement of absorbed doses using modified implanted thermoluminescent (TLD) dosimeters. It was during this project that Andre Demidecki discovered that exposure of the TLDs to extensive times in fluids or in vivo could significantly reduce their light output. The cause of the decay was (See Demidecki - p. 18)

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AAPM NEWSLETTER

Demidecki

MAY/JUNE 2002

(from p. 17)

eventually found to be due to leaching of LiF material from within the teflon matrix of the TLD. Future dosimetry using implanted TLDs will greatly benefit from his thoroughness in this research effort.

Andre Demidecki was on the Organizing Committee of the Polish Society of Medical Physics in 1964. He reviewed the medical physics program in Iran in 1969 and presented a report on the program to the International Atomic Energy Agency in Vienna, Austria. Andre was a member of AAPM since 1969 and was president of the Missouri River Chapter in 1972 and president of the Mid-Atlantic Chapter from 1983-1984. He was on the AAPM Board of Directors from 1979-1982.

Andre’s outside interests ranged from primitive art to classical music. We will miss his gentlemanly demeanor, his concern for others and his commitment to the integrity of the data.

All of his many friends and colleagues valued his warmth and sincerity.

■

Letter to the Editor Comments on the AAPM Newsletter John R. Cameron Gainesville, FL jrcamero@facstaff.wisc.edu In the March/April Newsletter you asked for submissions.

I assume you also welcome comments to improve the Newsletter.

Of the four newsletters I receive regularly, the AAPM Newsletter is the least interesting. I agree that it comes out on time and is well formatted.

Many years ago when I was chair of the AAPM Publications Committee, I remember my frustration of even getting the Newsletter out at all!

A general comment is that the Newsletter seems more apt to have news items about professional matters than on educational and scientific matters. I suggest that you look at the Health Physics Society Newsletter for ways to make our Newsletter more interesting. You might consider opinion pieces of 500 words not dealing with professional topics.

I think the Newsletter should have associate editors to look after specific areas of interest to medical physics. For example, there was only news of one AAPM chapter in the last issue.

The Florida chapter had an excellent meeting in Orlando on February 15-16 where the president of AAPM and the three past presidents participated. An asso18

ciate editor should work on getting more chapter news. With e-mail it should be easy to solicit news from a chapter officer.

Do you have an exchange arrangement with the editors of other medical physics newsletters, such as the COMP Newsletter in Canada (Interactions), which carries much more information than our Newsletter?

SCOPE, the quarterly news magazine of IPEM in the UK, is generally more broad in scope than our Newsletter. If you need contact information for any of these publications, let me know.

I think every article in our Newsletter should give the e-mail address of the author; it wouldn’t need an extra line. I sent e-mail messages to several authors of the recent Newsletter and I had to look up their e-mail addresses in the directory.

I think the Newsletter could include reviews of material not usually covered in Medical Physics.

For example, the Newsletter could call attention to articles relevant to medical physics that appear in other journals. This would be especially useful if the articles are available on the Web. I appreciated the obituaries in the recent issue, even though I don’t like to lose old friends.

Don’t hesitate to contact me if you feel I can be of help.

Best wishes.

■

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2002

This year attend two AAPM Meetings in one week!

Visit AAPM Online at http://www.aapm.org for program and registration information 44th AAPM Annual Meeting Ý July 14 - 18, 2002 Ý Montreal, Quebec Canada P Remember...scientific sessions and exhibit hours now begin on Sunday.

P The AAPM Committee Meeting Schedule is available online only.

If you would like a faxed copy, please call AAPM at 301-209-3371.

P Pre-register for the meeting by June 26.

P Housing reservation deadline is June 3.

2002 Summer School Intravascular Brachytherapy - Fluoroscopically-Guided Interventions July 18 - 21, 2002 Ý Montreal, Quebec Canada Ý McGill University P Pre-register for the meeting by June 26.

P Housing reservation deadline is June 15.

Medical Health Physics Section Announces Special Sessions at the 2002 HPS Meeting in Tampa Kathleen Hintenlang Local Arrangements Committee Co-Chair

Population Risks.” In addition to the standing technical session, the special sessions also include “Doses from Medical Procedures - Special Considerations for Women and Children,” “21st Century - The Century of Medical Science,” “Shielding of Medical Facilities” and “Regulation in Medicine.” A list of speakers for the program and registration information are available at www.hps.org. Hope to see you there.

The Medical Health Physics Section, spearheaded by Jean St. Germaine, is pleased to sponsor the plenary session and several additional special sessions at the upcoming Health Physics Society (HPS) Meeting in Tampa from June 16-20. The plenary session is entitled “Trends in Medical Doses, Technology and 19

AAPM NEWSLETTER

MAY/JUNE 2002

AAMP NEWSLETTER EDITOR Allan F. deGuzman MANAGING EDITOR Susan deGuzman

Please send submissions (with pictures when possible) to the editors at: e-mail: deguzman@wfubmc.edu (336)773-0537 Phone (336)716-7837 Fax 2340 Westover Drive, Winston-Salem, NC 27103 The AAPM Newsletter is printed bi-monthly.

Next Issue: July/August 2002 Postmark Date: July 15 Deadline: June 15, 2002

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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