AAPM Newsletter September/October 2002 Vol. 27 No. 5

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 27 NO. 5

SEPTEMBER/OCTOBER 2002

AAPM President’s Column Robert G. Gould San Francisco, CA

AAPM in the News By now, I am sure everyone is aware of the success of the Annual Meeting. I would sum it up in a word: Wow! The meeting was proof of the vitality of our organization and of the contribution our members make to the advancement of therapeutic radiation and imaging technology, and we were not the only ones who noticed. This year the AAPM contracted with the American Institute of Physics (AIP), which maintains a significant staff in its Media and Public Relations Department, to enhance publicity of the meeting. Mary Fox, chair of

the Professional and Public Relations Committee, guided this effort. A press release identifying papers thought to be of interest to the press was prepared, a virtual press room was created, and a number of presenters prepared lay language versions of their papers for posting on the Web. Several publications ran articles on presentations at the meeting including The Economist, Health Scout News and even Wired.

The effort to increase publicity for our organization will continue.

For example, the Radiation Protection Committee, headed by Ralph Lieto, developed a position statement on whole body CT screening for the AAPM that is now posted on our Web site.

William D. Coolidge Award AAPM’s highest honor is presented to a member who has exhibited a distinguished career in medical physics, and who has exerted a significant impact on the practice of medical physics. The 2002 William D. Coolidge Award goes to Bhudatt R. Paliwal, Ph.D. Bhudatt Paliwal was born in 1938 in Khewra, a small village

near Delhi, India. He received a MS degree in physical sciences and a MA in philosophy from the Sri Aurobindo International Center of Education, Pondicherry. He won an International Atomic Energy Agency (IAEA) scholarship to receive training in the peaceful uses of atomic energy at the Bhabha Atomic Research Cen(See Coolidge Award - p. 3)

The AIP prepared a press release on our position with the result that several members have been contacted by the media on this topic.

Public relations are important to (See Gould - p. 2)

TABLE OF CONTENTS Election Results Dr. Paliwal’s Speech Chairman’s Report Exec. Dir’s. Column Gov’t. Affairs Column Accreditation & Cert.

ABR Letter Clarification Awards, Honors, Grants JACMP Best Papers Gold Medal Award Krohmer Prof. Course Est. Planning/Memorial Recognition New Part 35 Highlights NCI Update on IMRT Chapter News Announcements Letters to the Editor

p 2 p 3 p 6 p 8 p 10 p 11 p 12 p 14 p 16 p 16 p 17 p 17 p 18 p 19 p 22 p 25 p 26 p 27

AAPM NEWSLETTER

Gould

SEPTEMBER/OCTOBER 2002

(from p. 1)

our organization, serving to enhance us professionally, and we should welcome inquiries from the press and the public.

Physics Summit In July, Marty Weinhous, the president-elect, and I traveled to Santa Fe, New Mexico to represent the AAPM at the first annual Intersociety Physics Summit, which was held just prior to the ACR’s Intersociety Meeting that we also attended. The Physics

Summit, as I discussed in a previous column, was organized by Rick Morin, representing the ACR, Mike Herman, representing the ACMP, and myself.

Seven societies sent representatives to the meeting: AAPM, ACR, ACMP, ASTRO, RSNA, SCAR (Society of Computer Applications in Radiology) and ISMRM (International Society for Magnetic Resonance in Medicine). Presentations were made by each society that included the size of their organization, the number of physicist members, and a description of the

roles that physicists play within their organizations. A principal topic of discussion was the development of standards and how these might be developed and promulgated by a joint effort between multiple societies. A meeting will be held next year and an effort made to attract attendance from more societies.

I look forward to seeing you at the RSNA Meeting. Judging from the number of physics abstracts submitted, a measure which worked in judging attendance in Montreal, the physics attendance at the RSNA should be excellent. â–

2003 AAPM Officers and Board of Directors - Election Results

G. Donald Frey Charleston, SC President-Elect

David R. Pickens Nashville, TN Secretary

Board Members At Large

Julie Dawson St. Louis, MO

Benedick Fraass Ann Arbor, MI

Michael Herman Rochester, MN 2

Tim Solberg Los Angeles, CA

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

Coolidge Award

(from p. 1)

ter, Trombay, India. As a Fellow of the IAEA, he received additional training in medical physics from Professor Leonard Stanton at the Hahnemann Medical College in Philadelphia, after which he completed his Ph.D. from the University of Texas in Houston at the Graduate School of Biomedical Sciences, M. D. Anderson Hospital in 1973. He had the privilege to be mentored by Professors Peter Almond and Robert Shalek.

In 1973 Bhudatt moved to the University of Wisconsin in Madison as an assistant professor of radiology. This proved to be a stimulating environment for him that nurtured his scientific and professional career; learning from and collaborating with such giants as John Cameron and Herb Attix. He is currently a tenured professor of human oncology and medical physics and the director of radiation oncology physics in the Department of Human Oncology. He has mentored and taught many highly placed medical physicist all around the world.

Bhudatt has over 120 publications in refereed, scientific journals. He has been the editor, author or co-author of numerous books, chapters and AAPM monographs. His research and development interests have covered a wide range of topics that include: tomotherapy, time dose fractionation, hyperthermia, electron arc therapy and quality assurance.

Bhudatt has stimulated scientific research by organizing numerous national and international confer-

ences and workshops on topics of interest in radiation oncology.

The five international conferences on Time-Dose-fractionation in Radiation Oncology resulted in monographs edited by him that have stimulated many new research ideas in medical physics, statistics, biology and radiotherapy. Other monographs edited by him have covered hyperthermia, electron beam dosimetry and quality assurance in radiation therapy.

Bhudatt served as AAPM President in 1996. He consolidated a stable electronic age plat-

Therapeutic Radiation Oncology.

In 1999, Bhudatt also served as the president and chairman of the American College of Medical Physics. He has been the chief editor of Medical Physics World and an AAPM delegate to the International Organization of Medical Physics.

Currently, Bhudatt serves as a physics trustee of the American Board of Radiology and as its assistant executive director. ■

Dr. Paliwal’s Acceptance Speech

form for the AAPM Headquarters and his initiatives helped create the positive relationships and dialogue that in 2001 finally resulted in satisfactorily resolving the issue of two Boards for the certification of medical physicists.

He was the chairman of CAMPEP for six years and helped to include the Canadian College of Medical Physics as a sponsoring organization. He is continuing to serve on several AAPM committees and is the chair of the Education and Training of Medical Physicists Committee. He is also AAPM’s liaison to the European Society for 3

Mr President, Officers of the AAPM, members of the Honors and Awards Committee, Ladies and Gentlemen, Madams et Monsieurs: It is indeed a privilege to be with you all here tonight. When I look out at this gathering, I see much that has brought me joy these last four decades: my family, my friends, my colleagues, and our community. The opportunity to accept the Coolidge Award in this company is an honor beyond my ability to express and is an occasion that fills me with the greatest humility. For I know many who could easily stand in my place–they are here among us, just as those who have received this honor before me.

They are my one-time mentors, yet all-time masters. That the (See Paliwal - p. 4)

AAPM NEWSLETTER

Paliwal

SEPTEMBER/OCTOBER 2002

(from p. 3)

AAPM and its Awards and Honors Committee believe me worthy of joining those honored before, I humbly thank you; though, in my judgment, I could never replace them.

A man is touched by many lives in his time and is aided by them in innumerable ways. It is common these days, to hear the rebellious and independent ethic praised in an individual. One is encouraged to “blaze your own trail,” “find your own way,” or more curiously to become an “army of one.” I think these words are meant to grasp out a person’s courage. Had these slogans alone proved my example, I doubt I would be here today.

It was the inspiration and education derived from my mentors that drove me. It seemed to me, as if I was allowed into the company of giants. How lucky I was to be instructed by the likes of Prof. L. Stanton, Drs. R. Shalek, P. Almond, J. Cameron and the late Prof. Attix. Through their motivation and guidance, I found my way; but not on a road less traveled. Their footprints were there for me to follow. To these men do I owe my greatest gratitude, they gave me the tools. But to one woman do I owe my greatest love, my wife, she gave me all else. No one has supported and cared for me such as you have.

Thank you, Michele.

How I came to medical physics, I am not sure. From an obscure little town in northern India, my designs were never such.

In ways, it is more apt to say

medical physics came to me. A thing I never pursued until caught; whatever the process may have been, I am proud to be able to say now, “I am a Man of Science,” “My duty is to the less fortunate,” “I am a Medical Physicist,” and what a privilege that is.

Not only is the goal of our trade of noble spirit, the field in which we strive is SO dynamic, and if you like technology, IT’S FUN. Just think of the developments over the last half century. We witnessed advances that lead to the applications of cobalt, linear accelerators, CT, US, MRI and PET. This progress continues with IMRT, tomotherapy and CTPET. These developments, spearheaded and supported by the medical physicists, have contributed much to the formation and success of the NCI and, more importantly, have led to MAJOR improvements in the early detection and treatment of cancer.

Where we once had a hammer, we now have a blade. Where we once took aim from afar, we now look nearer on our foe.

The surge in laser technology, intravascular radiation, gene mapping, functional MRI and computer optimization for precision therapies are increasing the physicist’s role in the treatment of human disease. We ARE helping.

We ARE making a difference.

The future of medical physics and the AAPM is luminescent. It is no longer limited to radiation as a tool or to cancer as a disease. Physicists will continue to develop and implement new technologies, new therapies and new methods to collect informa4

tion once beyond our reach or comprehension that will improve the quality of our lives. Here lies our most immediate worry. We are going to need even greater indepth sub-specialization in our field. For this, the onus rests squarely on our universities.

More universities need to establish departments of medical physics, similar to the one at the University of Wisconsin, where a broad-based scientific training in physics and medicine can be provided and research is conducted outside of the industrial forum.

The recognition of the critical role played by medical physicists in the diagnosis and treatment of cancer has drawn physicists away from academic research and closer to becoming a part of the clinical team. In a very short time it would seem, the physicians have relearned their Latin, in that the physicists have some knowledge too, of the physica, the natural way of things. This is progress; but in this progress we cannot afford to be myopic, as there is now a shortage of manpower in the field. Our education and training programs produce about half the medical physicists needed per year. If this trend is not corrected most medical physicists will become application specialists and we will lose the academic edge of scientific innovation. So when we leave Montreal, I urge you to convince your schools to establish strong, broad-based medical physics departments.

Our profession is blessed in many ways, not least, in being associated with very effective

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

professional organizations. The cooperation between the AAPM, ACR, and ACMP, as well as between the two boards, is a matter of pride for us all. Medical physicists are one of the few nonMD’s who are board certified by a medical organization like the ABR and hence can work as a fully recognized member of a clinical health care team. In my work with the ABR as a physics trustee, I find great satisfaction in the respect we get from radiologists and radiation oncologists for our valued contribution to their professions. Like all friendships, this one, too must be kept in a state of constant repair. It is through the AAPM and ACMP that this can, and will, be best accomplished. The work of these two organizations can foster the development of new subspecialty certifications recognized by the ABR and ABMP. And as our discipline grows, these two groups could work to bring other medical boards into the fold that may require our talents.

I am a firm believer that medical physicists must support both the AAPM and ACMP. Their separate missions serve us well.

The AAPM represents us as scientific researchers, teachers, and innovators in the field of medicine.

The ACMP represents us as health care professionals. The AAPM is our sword, with which we may advance. The ACMP is our shield, with which we may protect. And together, they serve as guardians to our profession.

Finally, I would like to close by addressing the oldest and newest of our discipline. For you

rookies, with your freshly minted minds eager to embark on your careers, I ask you to pause for a moment and consider all you have seen and learned. I know it is more than I know. I took my boards over 30 years ago. But for just a moment, imagine that all that skill and brilliance you have is but a drop in the bucket. I do not mean to derogate, I hope only to illustrate the possibilities ahead.

Consider Sir Isaac Newton’s final estimate of his own epic achievement: “I do not know what I may appear to the world; but to myself I seem to have been only like a boy playing on the seashore, and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, while the great ocean of truth lay all undiscovered before me.”

This ocean that Newton brought us to, has not yet even got our feet wet. You are the pilgrims. You are the ones that will travel daily farther from the East.

Always a little further, until one day, one of you perhaps, will bring us in sight of the opposite shore, narrowing the chasm and expanding our horizon. This challenge falls on you. Embrace it.

As for us elder statesmen in our lingering days of honest toil, I ask you to try and remember your first AAPM meeting. I know it’s hard, but try. Think about what you saw, who impressed you, and who inspired you. Are you surprised we have come this far? I know I am. For that I am proud, 5

and I hope you are too; yet, be mindful of that pride when you consider: “If we have seen further, it has been by standing on the shoulders of giants.”

Again, many thanks to Sir Isaac.

Ladies and Gentlemen, thank you for your time. My sermon is over.

■

AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2002

Chairman of the Board Report Charles W. Coffey, II Nashville, TN The 2002 Summer Meeting of the AAPM Board of Directors was held on Thursday, July 18th from 1:00 to 6:30 PM in the Palais Convention Center in Montreal. 32 members were in attendance with two additional member representatives serving as proxies. A number of administrative policies and management issues were on the agenda for Board discussion. The Board approved that individual member type dues will be set at the following percentages of the Full Member dues: Associate, 100%; Charter, 100%; Corresponding #1, 40%; Corresponding #2, 65%; Corresponding #3 (paper journal), 50%; Corresponding #3 (electronic journal), 25%; Emeritus, 0%; Full Canadian, 70%; Full, 100%; Honorary, 0%; Junior, 70%; and Student, 20%.

EXCOM motioned for the addition of three new staff positions, one Information Services Applications Developer, a Programs Manager, and a Program Assistant. Justification of this personnel request was to increase administrative support for ongoing membership services and to implement recently requested new programs from various councils and committees. Additionally, the executive director reported that HQ had been asked to provide management services to a number of societies outside

the AAPM. The executive director further explained that one FTE of the three FTE positions requested would be funded with dollars charged to an outside society (American Association of Medical Dosimetrists (AAMD)), requesting management services from AAPM Headquarters. After discussion of HQ space availability, the adequate infrastructure of the HQ Information Services equipment and personnel, the advantages of offering management services to outside societies, and the increased membership services to be offered to the Association, the Board approved the personnel request. The Board voted to receive the final report of the Ad Hoc Committee for the Recruitment of Young Physicists chaired by Bruce Thomadsen.

Members of the Board approved the 2001 Auditor’s Report submitted by the auditing firm of McGladrey & Pullen, LLP, regarding the financial position and accounting practices of the AAPM for the year 2001.

The Board adopted two Science Council statements as AAPM 6

policy: one, a general statement opposing the use of computed tomography (CT) for total body screening of asymptomatic patients, and the other, a statement on dose management in diagnostic radiology. (Both policies in their entirety can be found in the AAPM policy section on the AAPM Web site.)

A motion from the Development Committee to authorize the expenditure of $56,000 from the proceeds of the Education Endowment Fund to support one existing Fellowship, one new Residency and one Research Seed Grant, was referred by Board vote back to the Development Committee. The Board did approve the expenditure of $16,000 from the proceeds of the Education Endowment Fund to support four Undergraduate Summer Fellowships for summer 2003. The Board approved a motion from the Journal Business Management Committee to authorize a dues discount of $25 for those individual members who opt for online-only access to the Medical Physics Journal in 2003. After much discussion, the Board approved a motion from the Meeting Coordination Committee (MCC) to adopt a policy that food and beverages will not be budgeted for the AAPM “Welcome Center” during future Annual Meetings. The Board also approved a policy regarding qualifications for student registration at the Annual Meeting. It also

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

approved Minneapolis as the site of the 2007 Annual Meeting.

The Board approved the recommendation from the MCC that the Annual Meeting Budget, beginning in 2009, no longer contain a return of $6,500 to the local chapter. Additionally, the Board of Directors approved a final motion from the MCC to adopt the policy that future AAPM Annual Meeting sites beginning in 2009 be selected by identifying an appropriate location in a region with the region selected by a specific rotation schema. (The entirety of the approved policy including region selection schema can be found in the AAPM policy section on the AAPM Web site.)

In executive session, the Board voted to approve Kawasumi Laboratories America, Inc. and North American Scientific as AAPM Corporate Affiliate Members. Also during executive session, EXCOM presented a proposed plan for transition to a new executive director prior to December 31, 2003. The proposed plan suggested that Angela Keyser, AAPM deputy executive director, become the executive director upon Sal Trofi’s retirement as the Association’s executive director and the hiring of a meetings manager and a director of finance and administration. Following adequate discussion of this proposed plan, a member of the

7

Board moved that the proposed transition plan to offer Angela Keyser the position of executive director effective on the date of Sal’s retirement (December 31, 2003), to allow Angela to become an ex-officio member of EXCOM beginning January 1, 2003, and to hire a meetings manager and a director of finance beginning July 1, 2003, be implemented by EXCOM. This motion was approved unanimously.

As an approved agenda item, a 90-minute discussion period was set aside as an opportunity for individual Board members to present their comments and suggestions on topics of concern to (See Coffey - p. 8)

AAPM NEWSLETTER

Coffey

SEPTEMBER/OCTOBER 2002

(from p. 7)

individual members and to the Association. Subjects discussed included program schedule specifics during the Annual Meeting, the need for including a session at the Annual Meeting oriented towards and organized by student members, and the need to enhance image-combined procedures and therapies scientific sessions at the Annual Meeting. A subsequent suggestion to the imaging modalities discussion was that the AAPM needed to increase its liaison activities with both radiology and non-radiology specialties and their respective organizations. Subsequent to this discussion, the Board approved a motion that the president develop a strategy within the existing AAPM structure committed

to promoting AAPM activity in nontraditional areas of the medical physics effort, coordinating the scientific, professional, regulatory, and educational aspects thereunto.

Other subjects discussed during this open discussion period included the professional need to mentor young medical physics students, the Presidential Ad Hoc Committee on Organization and Governance, electronic discussion and electronic voting on Board action items, and the progress of educational and professional collaboration discussions between the AAPM and the ACMP. President Gould announced to the Board that he will appoint an ad hoc committee of three or more AAPM members to meet with appointed members of the ACMP to discuss and in-

vestigate potential business plans for a clinical medical physics journal.

I want to conclude this column by thanking the individual Board members for their friendly and professional participation at the Board meeting. The individual administrative decisions made and approved by this recent Board action will impact the Association for years to come. The 90-minute “free topic” discussion period was a success and will be repeated on future agendas. I sense a renewed spirit of collegiality, cooperation, and openness within the Board, the Association, and between individual AAPM members. My congratulations and thanks to all of you as we continue to make the AAPM a success.

■

Executive Director’s Column Sal Trofi College Park, MD I am very pleased to report to you that the AAPM Board, at their July 2002 meeting, has designated Angela Keyser as my replacement as executive director when I retire at the end of 2003. This early decision helps ensure a smooth transition of responsibility. Angela is currently the deputy executive director and has been employed by AAPM since November of 1993. Angela is a very capable individual who will serve the AAPM in a profes-

sional and reliable manner when she takes on the responsibilities of executive director.

The number of job listings in our Placement Bulletin continues to 8

surpass previous counts. The number of listings through August of 2002 is almost equal to the total ads placed in 2001. Job offerings are listed on the AAPM Web site as received and published in paper version each month that is sent to you in your monthly mailing.

Bob Rice, placement director, is working with the Headquarters staff to automate the ad submission process. This new process would include Web-based submission of ads, online editing, and automatic invoicing, payment and posting to the Web site.

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

The AAPM recognizes the need to get more qualified people interested in a career in medical physics and has programs to address this issue. One program is the Summer Fellowship Program where 10 undergraduate students are offered a $4,000 stipend.

Each student works with a Full AAPM Member, who acts as a mentor for a 10-week period.

Another program is the AAPM’s close cooperation with the Society of Physics Students (SPS). This is an organization that the AIP instituted to get under-

graduate students interested in physics as a career. Members of SPS can elect to be an affiliate member of the AAPM and pay no dues. They receive all issues of the AAPM Newsletter, upcoming meeting information, and access to the most recent placement bulletin and salary survey posted to the AAPM Web site.

You can help to attract more young physicists to medical physics. One way to do this is to let them know what you, as medical physicist, do in your job every day. There are about 120 under9

graduate physics majors that have shown interest in medical physics. You may want to consider being a mentor to one of these students. To do this, simply contact Kathy Burroughs, membership manager, at Headquarters kathy@aapm.org or 301209-3386. â–

AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2002

Government Affairs Column

By Angela L. Lee Government Affairs Manager

This column will serve as a tutorial guide to the Government Affairs area of the AAPM Web site. The Government Affairs area has been totally redesigned. Special thanks goes to our “webmistress,” Farhana Khan, for all her hard work.

The first thing you will notice is that this section looks like a newspaper. It has a Government Affairs heading with the AAPM logo shadowed behind it. The current Government Affairs column from the Newsletter has been placed here. In this section of the AAPM Web site you can find everything from your congressman’s address and voting record to the latest Nuclear Regulatory Commission (NRC) guidance document.

The Legislative Action Center is where you will find the CapWiz legislative software. As you may remember from my last column, CapWiz is an online suite of tools that, combined with the data provided by their in-house

research team, will help AAPM members identify and contact elected officials at the federal level. This tool will help you determine who represents your state and district in congress and will give you the ability to send him/her an e-mail directly from the Web site. This software will also allow you to easily access voting records and cosponsor information.

The Comments area is where you will find all the comments that AAPM has submitted to regulatory agencies. Some examples are comments to the Center for Scientific Review (CSR) on their proposed changes to Integrated Review Groups (IRG) and joint comments with the American College of Radiology (ACR) and the American Society for Therapeutic Radiology and Oncology (ASTRO) to the Nuclear Regulatory Commission (NRC) regarding NUREG 1556, Volume 9.

The Regulatory Documents area is where you will find documents that a regulatory agency has published to give guidance and information to the public and stakeholders. Some examples of these documents are the Revised Guidance For Licensing Intravascular Brachytherapy Procedures, and the Advisory Committee on the Medical Use of Isotope’s (ACMUI) Subcommittee, Training and Experience Requirements.

The State Regulations tab is where you will find links to state 10

Web sites in order to keep track of all the latest regulatory changes.

AAPM Fact Sheet is a source of general information on AAPM. There are also links to agencies of interests, such as the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), the Nuclear Regulatory Commission (NRC), the White House, and Congress.

The Legislative Action Center provides AAPM with a powerful tool to keep abreast of government activities, as well as providing us with the means to make our voices heard.

■

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

Accreditation and Certification William R. Hendee, Edward L. Nickoloff, Jatinder R. Palta, Michael G. Herman, Bhudatt R. Paliwal, and Stephen R. Thomas of the Radiological Physics Examination Committee, American Board of Radiology Accreditation and Certification; these words are often used interchangeably, but in professional circles they refer to entirely different approaches to ensuring a satisfactory level of individual performance. This article explains this difference, and how accreditation and certification will ultimately be linked in the ongoing effort to improve the quality of medical physics services.

Accreditation is the expression used to recognize educational programs as meeting prescribed educational standards through review by an external accrediting agency. In the case of medical education programs, the reviews are conducted under the Liaison Council for Medical Education (LCME) for medical schools and under the Accreditation Council for Graduate Medical Education (ACGME) for residency programs. In medical physics, both graduate educational programs and residency programs are accredited by the same agency – the Commission on Accreditation of Medical Physics Educational Programs (CAMPEP). The CAMPEP Board of Directors consists of

eight members, two each from 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. Each member serves a three-year appointment.

Certification is the expression used to recognize individuals as meeting prescribed performance standards through review and examination by an external certification board. In the case of physicians, most are certified by one or more boards functioning under the umbrella of the American Board of Medical Specialties (ABMS). For medical physicists, several certification routes are available, including the American Board of Health Physics (ABHP) in medical health physics, the American Board of Nuclear Medical Specialists (ABNMS) in nuclear science, the American Board of Medical Physics (ABMP) in medical health physics and magnetic resonance imaging, and the American Board of Radiology (ABR) in therapeutic radiological physics, medical nuclear physics, and diagnostic radiological physics. Only the latter board functions under the ABMS. With the agreement between the ABMP and the ABR signed in 2001, physicists working in the traditional areas of medical physics pursue certification by the ABR. In medicine, accreditation and certification are linked because 11

admission of physicians to the certification process requires pending graduation from an ACGME-accredited residency program. There are occasional exceptions to this requirement; in radiology, for example, physicians completing a nonACGME-approved residency in certain English-speaking countries other than the United States can be admitted into the certification process.

In medical physics, accreditation and certification are not linked, and candidates for certification are not required to have completed a CAMPEP-accredited graduate program or residency. This lack of linkage means that the eligibility of each candidate for admission into the certification process must be evaluated by examining secondary criteria such as transcripts, letters of reference, work experience, and other factors. Candidates for certification display a wide range of credentials, reflecting the multiple pathways into medical physics currently available to scientists, not all of whom are physicists. The lack of credentialing standards for entering physicists potentially places the profession (and patients) at risk for substandard medical physics practice and reduced quality of care. Certification helps to ensure that medical physicists practice their discipline according to prescribed mini(See Accreditation - p. 12)

AAPM NEWSLETTER

Accreditation

SEPTEMBER/OCTOBER 2002

(from p. 11)

mum standards of competence – just as it does for physicians. The physician model, however, uses graduation from an accredited program to provide a standard path toward independent clinical practice, with certification as the final step in the path. Linking admission to certification with graduation from a CAMPEPapproved educational program

would achieve the same objective for medical physicists.

Only a minority of medical physics graduate programs and residencies are CAMPEP-approved, and only a fraction of candidates for certification graduate from such programs. With the current market demand for medical physicists, it would be folly to increase the rigor of the admission process and thereby reduce the influx of medical physicists

into the marketplace over the next several years. But it would be wise to announce that medical physicists involved in accreditation and in certification share the goal of linking these two processes sometime in the future. In anticipation of this event, it would be wise for educators involved in training medical physicists to seek CAMPEP-accreditation of their graduate and residency programs.

■

Clarification of ABR Letter of Certification Equivalence for ABMP Diplomates ABR Physics Trustees and ABMP Board of Directors

diagnostic imaging physics take advantage of this opportunity.

In a recent meeting of representatives of the American Board of Radiology (ABR) and the American Board of Medical Physics (ABMP), all agreed that it would be useful to further clarify the letter of certification equivalence to which ABMP boardcertified medical physicists are entitled. Hopefully, this article will clarify the terms of the July 9, 2001 Working Agreement between the ABR and the ABMP. The details of this agreement were published in a previous AAPM Newsletter (Nov/Dec 2001).

This clarification is important in that there are deadlines that will come into effect at the end of 2002. Additionally, we recommend that all medical physicists holding an ABMP certificate in radiation oncology physics and

Who is eligible for the letter of certification equivalence?

Medical physicists who are certified by the ABMP in the traditional fields of medical physics, i.e. radiation oncology physics and diagnostic imaging physics, are eligible to receive a letter of certification equivalence from the ABR. The letter of certification equivalence states that the ABMP certification is equivalent to ABR certification in therapeutic radiologic physics and diagnostic radiologic physics respectively.

What benefit is it to acquire the letter of certification equivalence?

By obtaining the letter of certification equivalence ABMP diplomates are recognized as 12

equivalent to ABR diplomates in all guidelines, standards, regulations, and privileges of scientific, professional, and regulatory bodies. This includes being eligible for membership in the American College of Radiology (ACR). In addition, the letter of certification equivalence makes the medical physicist eligible for the ABR’s Maintenance of Certification (MOC) program (see also below). Upon satisfying the MOC conditions, the medical physicist will be awarded an ABR certificate and placed in the listings of the American Board of Medical Specialties.

If one receives a letter of certification equivalence on or before December 31, 2002, how long is it valid?

For any letter of certification equivalence issued by December 31, 2002 (this includes all is-

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

sued to date), the expiration date will be exactly the same as the expiration date issued by the ABMP on the current certificate.

In addition, if one continues with the ABMP recertification program and is issued a recertification certificate, an ABR letter of certification equivalence will be issued with the new expiration date. Thus the equivalence is in force so long as one’s ABMP certification is current.

If one receives a letter of certification equivalence after December 31, 2002, how long is it valid?

For any letter of certification equivalence issued after December 31, 2002, the date of expiration will be the same as for those issued on or before December 31, 2002, with the exception that the expiration date cannot be later than 10 years after the original date of issuance. During that 10year period, the individual will need to participate in the ABR Maintenance of Certification (MOC) program. After successfully fulfilling the requirements for the ABR MOC, there is no further need for the letter of certification equivalence, as at that time the ABR will award an ABR certificate in the appropriate traditional field.

the ABR MOC, then the ABR will award an ABR certificate in the appropriate traditional field.

Upon receipt of an ABR certificate, there is no further need for a letter of certification equivalence.

Is there a deadline for availability of the letter of certification equivalence?

Yes, the letter of certification equivalence must be issued by July 8, 2006, after which it is no longer available.

How does one apply for the letter of certification equivalence?

To apply for the letter of certification equivalence the medical physicist must submit a written request accompanied by a copy of his or her ABMP certificate to the ABR office: The American Board of Radiology 5441 E. Williams Blvd, Suite 200 Tucson, AZ 85711 Fax: 520.790.3200 e-mail: info@theabr.org â–

Can one participate in the ABR maintenance of certification program if issued a letter of certification equivalence on or before December 31, 2002?

Yes! This is optional; however, if one fulfills the requirements for 13

CAMPEP Announces New Accreditation Fees Ed McCullough President/Chair, CAMPEP The Commission on Accreditation of Medical Physics Education Programs (CAMPEP) wants AAPM Membership to be aware of an increase in fees. The fees affected relate to application for first time or renewal accreditation of either medical physics graduate education (pre-doctoral) or residency programs. Effective immediately the fee is now $4000. All questions should be directed to the appropriate Review Committee chair as listed on the CAMPEP Web site (www.campep.org).

AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2002

AAPM Awards, Honors & Grants Award for Achievement in Medical Physics

2002 AAPM Fellows

This award recognizes AAPM members whose careers have been notable based on their outstanding achievements. The 2002 AAPM Award for Achievement in Medical Physics is given to: Amos Norman, Ph.D.

AAPM Fellowship recognizes distinguished contributions by AAPM members:

Dr. Norman (l) at Award Ceremony with President Bob Gould.

Farrington Daniels Award American Association of Physicists in Medicine presents the Farrington Daniels Award to: Mark Oldham Jeffrey Siewerdsen Anil Shetty David Jaffray for the best scientific paper on Radiation Dosimetry entitled “High resolution geldosimetry by optical-CT and MR scanning,” Med. Phys. 28 (7) 2001, pp. 1436-1445.

Peter H. Bloch J. Daniel Bourland Julie E. Dawson Peter B. Dunscombe Paul A. Feller Doracy P. Fontenla Richard A. Geise Glenn P. Glasgow Allen F. Hrejsa Willi A. Kalender Robert W. Kline Mary Ellen MastersonMcGary Yakov M. Pipman Thomas M. Potts Robert E. Rice Almon S. Shiu Douglas J. Simpkin Palmer G. Steward Lawrence E. Sweeney Marcia M. Urie Lynn J. Verhey Cedric X. Yu Eric C. Zickgraf

Sylvia Sorkin Greenfield Award American Association of Physicists in Medicine presents the Sylvia Sorkin Greenfield Award to Yingtian Pan, John Lavelle, Sheldon Bastacky, Susan Meyers, George Pirtskhalaishvili, Mark Zeidel, Daniel Farkas for the best scientific paper entitled “Detection of tumorigenesis in rat bladders with optical coherence tomography,” Med. Phys. 28 (12) 2001, pp. 2432 - 2440.

14

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

AAPM Awards, Honors & Grants AAPM-IPEM Medical Physics Travel Grant

AAPM Medical Physics Travel Grant

Eric E. Klein

Jean M. Moran

Young Investigators Competition This is a competition for new investigators with a special symposium in honor of Dr. John Cameron.

A panel of judges scores each oral presentation according to criteria that include scientific merit, originality, and organization of the material.

1st Place

Deidre Batchelar for the best scientific paper presentation entitled “Imaging Bone Mineralization Using Coherently Scattered X Rays.”

2nd Place

Parminder Basran for an outstanding scientific paper presentation entitled “Functional CT with a Conventional Scanner to Measure Regional Lung Perfusion.”

3rd Place

Seemantini Nadkarni for an outstanding scientific paper presentation entitled “Retrospective Cardiac Gating for Three-Dimensional Intravascular Ultrasound Imaging Using an Image-Based Technique.”

Call for Competitive Applications for 2003 Travel Grants • AAPM - IPEM Medical Physics Travel Grant

• AAPM Medical Physics Travel Grant

Call for Nominations • William D. Coolidge Award • AAPM Award for Achievement in Medical Physics • AAPM Fellows Details can be found in the July/August AAPM Newsletter. Updated information from last issue’s article on the nomination of AAPM Fellows is as follows: The category of Fellow is established to honor members who have distinguished themselves by their contributions on: • The advancement of medical physics knowledge based upon original research and/or development; and/ or, • medical physics educational activities, especially in regard to the education and training of medical physicists, medical students, medical residents and allied health personnel or, • leadership in the medical physics community.

***Application & Nomination Deadline - October 15, 2002*** Send applications and nominations to: AAPM Awards and Honors Committee, One Physics Ellipse, College Park, MD 20740-3846 15

AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2002

JACMP Best Paper Awards Peter R. Almond Editor-in- Chief, JACMP palmond@mail.mdanderson.org At the annual meeting of the American College of Medical Physics in June, the awards for the best papers published in the Journal of Applied Medical Physics during 2001 were announced.

Currently there are three awards, (i) The LAP Award for Excellence for the best radiation oncology physics paper, (ii) The RIT Award for Excellence for the best diagnostic physics paper, and (iii) The Elekta Award for Excellence for the best professional paper.

These awards are sponsored

by LAP of America, Radiological Imaging Technology and Elekta, respectively. Each award consists of a $500 check and framed certificates.

The LAP Award for Excellence for the best paper in radiation oncology physics went to Maria F. Chan, Albert YC Fung, Yu-Chi Hu, Chen-Shou Chui, Howard Amols, Marco Zaider, from the Department of Medical Physics at Memorial Sloan-Kettering Cancer Center, NY and David Abramson from the Department of Opthalmology, New York Presbyterian Hospital, NY for their paper, “The measurement of three dimensional dose distribution of a r u t h e n i u m - 1 0 6 opthalmological applicator using magnetic resonance imaging of BANG polymer gels.”

Richard Morin Awarded Gold Medal in Florida Richard L. Morin, Ph.D. was awarded the Gold Medal at the annual meeting of the Florida Radiological Society.

This is the highest award of the Florida Radiological Society and is presented for service to the profession of diagnostic radiology and the people of the state of Florida through contributions to academic radiology and leadership in radiology organizations. Dr. Morin is the first medical physicist to receive this award from the Florida Radiological Society.

(JACMP, Vol.2, No.2, Spring 2001 p85) The RIT Award for Excellence for the best paper in diagnostic physics went to Eugene Mah from the Department of Radiology, Medical University of SC, Charleston, Ehsan Samei from the Department of Radiology, Duke University Medical Center, Durham, NC and Donald J. Peck from the Department of Radiology, Henry Ford Hospital, Detroit, MI for their paper, “Evaluation of a quality control phantom for digital chest radiography.”

(JACMP, Vol.2, No.2, Spring 2001, p90) The Elekta Award for Excellence for the best professional paper went to William Que from the Department of Medical Physics, Toronto Sunnybrook Regional Cancer Center, Toronto, 16

Rick Morin poses with parents, Chuck and Joyce, during the award ceremony.

Ontario Canada for his paper, “Radiation safety issues regarding the cremation of the body of an I-125 prostate implant patient.” (JACMP, Vol.2 No.3, Summer 2001, p174) All of these authors are to be congratulated for their outstanding work and fine papers. The ACMP and the JACMP also wish to acknowledge and express their appreciation to each of the sponsors for making these awards possible.

These papers, along with the rest of the manuscripts published in Volumes 1 and 2, can be viewed from the JACMP CDROM recently distributed to all AAPM members.

The awards are annual and next year it is planned to add one other for the best paper in radiation dosimetry.

■

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

Jack Krohmer Memorial Professional Course Steve Goetsch Chair, Development Comm. stevegoetsch@sdgkc.com The Jack Krohmer Memorial Professional Course was given on Tuesday, July 16 at the combined AAPM/COMP Meeting in Montreal and was moderated by Michael Gillin. Ray Tanner pointed out in his opening remarks that it was appropriate that such a course be named in honor of Jack Krohmer, since he had given lectures on both topics of

the course at the Winter Institute of Medical Physics Meetings about 20 years ago. Over 100 AAPM and COMP members in attendance heard a talk by Jeffrey Masten, an attorney from Sioux Falls, SD on “The Deposition Process” in litigation.

AAPM Member Jim Hevezi gave the second part of the seminar entitled “Using the (ASTRO) Guide for Technical Charges in Radiation Oncology.

Bill Hendee, chairman of the Jack Krohmer Memorial Educa-

tional Fund, Jack Krohmer’s widow, Doris, and Jack and Doris’ son, Jack L. Krohmer, and daughter, Candace K. Cooke, also attended the professional course. Contributions to the Jack Krohmer Fund are climbing, and income from the Fund will be used for graduate scholarships in medical physics. Tax deductible contributions in the name of Jack Krohmer may be made payable to AAPM and sent to AAPM Headquarters, care of Sal Trofi.

■

Estate Planning & Memorial Fund Steve Goetsch Chair, Development Comm. & Jean St. Germain Chair, Planned Giving Subcomm., Dev. Comm.

Estate Planning Seminar Offered in Montreal The Development Committee sponsored a seminar on Estate Planning on Sunday evening, July 14, 2002 at the Annual Meeting in Montreal. The event was organized by Jonathan Harrier of CFG Wealth Management, the firm that has managed AAPM’s investment portfolios for three years. Phillip Thrasher, an attorney who specializes in tax law and estate planning, gave the presentation. About 30 people attended and many later com-

mented that the information presented was very useful and often surprising.

This event marks the beginning of the Planned Giving Campaign of the Development Committee.

The Education Endowment Fund reached the $1 million mark about three years ago, dropped back, and has now regained that level. The original goal of the Development Committee was $2 million, an amount that is most likely to be reached with longterm planning and estate gifts. Mr. Thrasher gave a great deal of useful information about the United States tax code, and especially the “estate” or “death tax,” which can be very high. In addition, many states have their own inheritance taxes as well. Copies of Mr. Thrasher’s remarks are available from CFG by e-mailing 17

Jonathan Harrier at: jharrier@cfgwms.com.

The Development Committee has sponsored a total of seven Graduate Fellowships (at three institutions) and 31 Residencies at 15 different institutions since 1990. Contributing to the tax deductible Education Endowment Fund is one way that AAPM members can help to train young medical physicists to help relieve the most acute shortage the field has ever experienced.

Members’ Memorial Fund Announced The Development Committee has created a special fund called the Members’ Memorial Fund. It will serve as a fund for memorial (See Est. Planning - p. 18)

AAPM NEWSLETTER

Est. Planning

SEPTEMBER/OCTOBER 2002

(from p. 17)

donations given in honor of deceased members. A number of unsolicited donations have been given in recent years in honor of Dr. Arata Suzuki (by Capintec), Hy Glasser (anonymous) and Doug Jones (Northwest Medical Physics). At a breakfast meeting on July 15, 2002, Dr. Anil Sharma, treasurer of the Southern California Chapter of the AAPM, presented Sal Trofi with a check for $2,000 in honor of deceased SCC AAPM members. A plaque is being created which will contain the name of

each person so memorialized.

The plaque will be on display at AAPM Headquarters in College Park and will be brought to the Annual Meeting and RSNA Meeting each year. The plaque will honor donations in the amount of $2,000 or more.

Such tax-deductible donations may be unrestricted, in which case they will be added to the Education Endowment Fund, or they may be designated for a special use, such as travel awards for students. The Awards and Honors Committee is open to the idea of special awards (e.g., best radiation therapy poster) in honor of a

deceased member, if it is discussed with them in advance. All members have the opportunity to contribute to the Education Endowment Fund by checking the appropriate box on their annual dues statement. Members may also take advantage of Administrative Policy 18A. The Board of Directors will donate $3,000 to the Education Endowment Fund in the name of any member who notifies the Board in writing of a Planned Giving bequest. Members may find that this fund is a fitting and appropriate way to memorialize their friends and colleagues. â–

Recognition of the Medical Physicist

by National and International Organizations Azam Niroomand-Rad Chair, Int’l. Affairs Comm.

Vice-President, IOMP nirooma@gunet.georgetown.edu The history of medical physics is quite short relative to that of most recognized academic and professional specialties. The rapid growth of this specialty in the US after formation of the AAPM (1958) and internationally after formation of the IOMP (1963), has been tremendous.

Despite this rapid growth, however, medical physics is still not recognized by most of the governments in their national classification of professional occupations.

In the past 12 years, medical physicists throughout the world, especially those in developed

countries, have tried to establish recognition of the medical physics profession by various government agencies. Some AAPM members such as Colin Orton and I have been in communication with the International Labor Office (ILO) in Geneva, Switzerland to achieve this. Formal recognition of the medical physics profession would require a revision of the International Standard Classification of Occupations (ISCO-88) that was approved by the ILO Governing Body at the 14th International Conference of Labor Statistics (ICLS) in 1988. The updating and revision of ISCO-88 involves providing many statistical data to ILO, including such information as the number of medical physicists in various countries, the number of 18

years required for education and training of medical physicists, the number of professional and scientific organizations for accreditation, and registration or licensure requirements in various countries. In addition, information needs to be provided regarding the definition of the medical physics profession, treatment of this profession by the national classification of occupations, as well as a depiction of various job descriptions by medical physicists, which varies in different countries.

We believe medical physicists, especially in developing countries, are desperately in need of proper acknowledgement of their profession in order to justify their employment to government and other health authorities. Many

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

governmental officials and agencies have used the lack of formal professional recognition by ILO as an excuse not to establish educational programs or new job opportunities for medical physicists. With the rapid advancement of technology in cancer diagnosis and treatment, this trend would result in a great shortage of qualified medical physicists worldwide, which would significantly compromise the quality of health care provided to patients in need.

Therefore, in pursuit of data compilation for ILO, we learned of two major developments since 1991: In the USA, the “Medical Physics” profession has been listed on the United State Department of Labor, Office of Administrative Law Judges Law Library, and Dictionary of Occupational Titles (4th Ed., Rev. 1991), and

in Europe, the European Commission has adopted the Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure (Official Journal of the European Communities, L180, 9.7.97, p. 22-27).

This document (a) defines the medical physics expert, and (b) requires involvement of the medical physics expert in all radiotherapeutic facilities. For other radiological practices, a medical physics expert shall be involved, as appropriate, for consultation.

In some European countries the medical physicists are regulated by the state and need licensure in order to practice.

With these recent developments, we hope that the proposal for revision of the ISCO-88 at

the 17th ICLS in 2003-04 will be considered. If approved, the ISCO-88 will be updated and taken to the 18th ICLS in 200809 for final approval. According to Dr. Eivind Hoffmann, Bureau of Statistics at ILO, the proposal for inclusion of medical physics as a subdivision of physics (2111), will consist of the addition of a two-digit extension to the unit group code; “21” for physics. Such extensions will be proposed if it has been made clear that international exchange of occupational information, including statistics, on these groups will warrant their separate identification within the ISCO-88 structure.

■

Highlights of the New Part 35 David J. Keys Chair, Legislation and Regulation Committee davek@med-phys.com On April 24, 2002, the NRC released its long-awaited revisions to 10 CFR part 35. All NRC licenses in non-agreement states must implement the revised rules by October 24, 2002. The changes are major and reflect a paradigm shift from a prescriptive-based system to a risk-informed, performance-based system. There will also be corresponding changes in the process of licensing and in inspections.

Everyone involved in radioactive

material licensed activities needs to read the new part 35 rules, including those individuals in agreement states. Agreement states have three years to implement a compatible version of the rules.

A copy of the rules can be obtained at http://www.nrc.gov/ reading-rm/doc-collections/cfr.

A copy of the April 24, 2002 Federal Register notice, which contains the NRC’s responses to comments, can be found at http:/ /www.nrc.gov/reading-rm/doccollections/cfr/fr/20022404.html.

The following is a listing of some of the highlights:

•The terms Misadministration and Medical Event have been replaced by the term Medical Event. The term Medical Event excludes cases involving patient intervention. I refer you to § 35.3045 for a complete definition. Gone are the 10% teletherapy total dose, 30% weekly dose errors; replaced by 20% total dose, 50% single fraction error. Under the new definition, if the dose to the right lung is prescribed for 40 Gy in 20 fractions using Co-60 teletherapy and the left lung is inadvertently treated for 16 Gy, a Medical Event (See New Part 35 - p. 20)

19

AAPM NEWSLETTER

New Part 35

SEPTEMBER/OCTOBER 2002

(from p. 19)

would not occur because the dose to the unintended organ, while greater than 50 rem, is less than 50% of the prescribed dose to specified organ.

•The Quality Management Program is now gone. Instead it is the responsibility of the licensee to ensure that the written directive is fulfilled with a “high degree of confidence.”

•New definitions for training and experience (T & E) for authorized users (AU), authorized nuclear pharmacists, authorized medical physicists, and radiation safety officers have been developed.

However, these definitions proved to be controversial. In the end, the NRC provided two sets of T & E guidelines – the new guidelines plus the previous guidelines. Both sets will co-exist for two years giving the NRC sufficient time to develop agreeable T & E. •There have been three new categories of radioactive material use added. The categories are Subpart G—Sealed Sources for Diagnosis, Subpart H—Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery Units, and Subpart K— Other Medical Uses of Byproduct Material or Radiation From Byproduct Material (a catch-all which currently houses IVBT).

•Many of the ministerial change requirements, such as specifying area of use, are eliminated.

•No longer is there any 60-day visiting AU allowance, but we now have a 60-day visiting RSO

allowance. A licensee must provide the commission a copy of the board certification, the commission or agreement state license, the permit issued by a commission master material licensee, the permit issued by a commission or agreement state licensee of broad scope, or the permit issued by a commission master material license broad scope permittee for each individual no later than 30 days after the date that the licensee permits the individual to work as an authorized user, an authorized nuclear pharmacist, or an authorized medical physicist.

•Individual calibration of unit doses, vial doses, prostate seed strengths, etc. are no longer required provided the facility uses the manufacturer’s calibration and decays the isotope activity appropriately.

•Survey requirements have changed significantly: i.) end of day survey only required if unsealed radioactive material requiring a written directive was prepared or used, ii.) no weekly/ monthly surveys of stored radiopharmaceuticals, iii.) no weekly wipe tests, and iv.) no immediate notification if one exceeds the trip level.

•Testing of treatment planning systems is now part of the regulation.

•The final version of the rules apparently disallows the use of many survey meters for use with both low energies isotopes, such as I-125, and higher energy isotopes, such as Cs-137, as the meters will not be able to be calibrated so that the display readings are accurate to within 20% of the actual exposure rate with20

out the use of a factor (which is now disallowed). The NRC is reviewing this limitation.

The licensing process will also greatly change. The new licensing process will not require the submittal of procedures, except for the submission of Emergency Procedures, plus spot check procedures for HDR, Gamma Knife, and Co-60 teletherapy. A guidance document, NUREG-1556, Volume 9, “Consolidated Guidance About Materials Licenses; Program-Specific Guidance About Medical Use Licenses”, was initially issued. This document, however, contained many of the old guidance documents.

A revised document is being created by the NRC. The inspection process will also change. Inspections are not intended to determine if every line item of the licensee’s procedures is being fulfilled. Instead, the program, as a whole, will be inspected for its safety performance.

As you can see, the changes are sweeping. Many of the procedures we now follow will change from regulatory requirements to good practice standards. Many of the states are struggling with the concept of performancebased versus prescriptive-based regulations. There will be a period of uncertain interpretation. It will take time for everything to settle in, but with a cooperative effort between the NRC, states, and licensees, we will achieve the goal of safe, effective use of radioactive materials, while maintaining a lessened regulatory ■ framework.

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

21

AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2002

NCI Update on the Use of IMRT in Clinical Trials James Deye Head, Medical Physics Section, RRP, DCTD, NCI deyej@mail.nih.gov One of the most clinically important issues dealt with over the past few months within the radiation research programs at the NCI is the concern for the proper use of IMRT as the method of radiation delivery within clinical trials. Specifically, radiation therapy treatment planning and delivery are in the process of changing dramatically. This change is being driven in large part by continuing advances in computer technology that has led to the development of sophisticated three-dimensional radiation treatment planning (3DRTP) systems and computer-controlled radiation therapy treatment delivery systems. Yet, currently, most published reports on the clinical use of IMRT are either treatment planning studies showing the improvement in dose distributions generated by IMRT and involve only a limited number of cases, or dosimetric studies confirming IMRT treatment. There are no published reports of prospective randomized clinical studies involving IMRT, and this lack of information clearly limits our knowledge of how clinical outcomes will be affected by the use of IMRT. It is clear that IMRT offers the opportunity of more conformal dose distributions and for increasing daily treatment dose to tumor with a decreased

dose to normal tissues. Although most agree with the potential advantages in physical dose distributions produced with IMRT, and therefore the potential for improvement in patient outcomes, there exists G concern for actual IMRT treatment execution. This includes proper plan optimization, as optimization algorithms and quality assurance (QA) procedures for this new modality are still evolving. Specific concerns include the potential to miss the tumor (or at least underdose a portion of the tumor) and/or to have significant high dose volumes in the normal tissues. There is also the additional concern that the widespread use of IMRT could lead to an increased incidence of radiation-induced carcinomas due to the larger volume of normal tissue exposed to lower doses and the increase in whole body doses as a result of the increased monitor units required for the delivery of IMRT. This may be especially important in the pediatric patient population and in the young adult patient population.

The problem of specifying and planning the dose distribution to a high dose target volume and a lower dose to a clinical target volume with little or no regard to an accounting for geometric uncertainties is present with IMRT. In such situations, the physician is evaluating a dose distribution to a patient image that can be substantially different from what is actually delivered. The reality 22

is that over the course of treatment, the patient’s target volume is going to vary from the geometry captured at the initial imaging study for treatment planning due to organ movements and daily patient setup variations, as well as changes in the tumor volume over the course of the radiation therapy. In addition, one must fully appreciate that IMRT, depending on how it is implemented, can be “less forgiving� than conventional radiation therapy in regard to the effects resulting from geometric uncertainties. For example, IMRT dose distributions are shaped to conform more closely to the tumor volume and avoid normal tissues, introducing large gradients near the perimeter of both the target volume and normal structures. Also, because IMRT techniques (unlike 3DCRT) treat only a portion of the target volume at a particular time, there is the potential for significant dosimetric consequences if the patient and/ or the target volume move during treatment (intrafraction geometric uncertainties). For example, respiratory-related excursions of a target volume could potentially cause the tumor to be grossly underdosed despite a beautiful dose distribution in a static plan. Furthermore, since IMRT treatments typically take longer than conventional radiation therapy treatments, the patient must remain in a fixed position for a longer period of time, increasing the vulnerability to

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

intrafraction geometric uncertainties. Hence, it is clear that IMRT imposes a more stringent requirement than conventional radiation therapy on an accounting for both intrafraction and interfraction patient position and organ motion.

Thus, it is apparent that comprehensive QA is vital for IMRT due to the high dose gradients and non-intuitive nature of the treatment planning, but it is not guaranteed that all institutions that may wish to use IMRT in a routine clinical trial perform adequate quality assurance. This is a special concern for facilities that lie outside the orbit of cooperative groups but that may enter patients through the CTSU. In 1999, the NCI funded the Advanced Technology Radiation Therapy Quality Assurance Review Consortium (ATC), which is composed of the Image Guided Therapy Center (ITC) at Washington Univ., the Quality Assurance Review Center (QARC), the Radiological Physics Center (RPC), and the Resource Center for Emerging Technologies (RCET) at the Univ. of Florida.

This QA consortium represents the QA review process for radiation therapy for most, if not all, of the cooperative clinical groups.

And the consortium provides a unique opportunity to further develop guidelines for the utilization of IMRT treatment techniques in protocols that will be transparent to all of the cooperative groups.

The NCI held a meeting of the radiation oncology committee chairs from the NCI-funded clinical trials groups on June 20,

2002. The following guidelines were discussed and agreed upon.

These guidelines are meant only for clinical trials in which the utility of IMRT is not the purpose of the study, but where radiation therapy is part of the study. This does not mandate that any specific protocol allow IMRT, but if it is to be allowed, the following requirements must be submitted as part of the initial protocol or as an amendment if IMRT is to be subsequently allowed.

Protocol Requirements 1. Protocols permitting IMRT treatment delivery must be written using the nomenclature defined in the NCI IMRT Working Group Report5 (IMRT Collaborative Working Group: Intensity modulated radiation therapy: current status and issues of interest.

Int. J. Radiat. Oncol. Biol. Phys.

51:880-914, 2001) and the International Commission on Radiation Units and Measurements (ICRU) Reports 50 and 62 for specifying the volumes of known tumor, i.e., Gross Tumor Volume (GTV), the volumes of suspected microscopic spread, i.e., Clinical Target Volume (CTV), and the marginal volumes necessary to account for setup variations and organ and patient motion, i.e., Planning Target Volume (PTV).

Report 62 introduced the concept of the Planning Organ at Risk Volume (PRV), in which a margin is added around the critical structure to compensate for that organ’s geometric uncertainties. The PRV margin around the critical structure is analogous to 23

the PTV margin around the CTV. The use of the PRV concept is even more important for those cases involving IMRT because of the increased sensitivity of this type treatment to geometric uncertainties. The PTV and the PRV may overlap, and often do so, which implies searching for a compromise in weighing the importance of each in the planning process.

2. The protocol must provide a clear definition of the Gross Tumor Volume (GTV), Clinical Target Volume (CTV), and Planning Target Volume (PTV).

3. The protocol must provide a clear definition of the prescription dose and dose heterogeneity allowed throughout the PTV. Heterogeneity must be compatible with the requirements for nonIMRT treated patients.

4. The protocol must require that a volumetric treatment planning CT study be used to define the GTV. 5. The protocol must clearly define the organs-at-risk that are required for each study and provide clear guidelines for contouring each organ-at-risk defined in the study. Dose constraints for each organ-at-risk in the irradiated volume must be defined. This should include a reasonable definition of major and minor deviation for each item of interest. Participants are required to be within the protocol-specified limits.

6. The GTV, CTV, PTV, PRV(s), and skin contours must be depicted on all planning CT slices in which each structure exists.

(See NCI Update - p. 24)

AAPM NEWSLETTER

NCI Update

SEPTEMBER/OCTOBER 2002

(from p. 23)

7. The protocol must require that specific procedures be in place to insure correct, reproducible positioning of the patient. As a minimum, orthogonal (AP and lateral) DRRs and corresponding orthogonal portal images (film or electronic) are to be required.

8. Copies of all images required by the protocol in defining the GTV must be submitted to the cooperative group QA office for review. The intended dose distribution from the planning system in the coronal, axial, and sagittal planes must be submitted for QA review. Isodose lines superimposed on CT images must be clear and comprehensive. Areas receiving more than 100% of the prescription dose must be clearly indicated, as well as “cold spots” within the PTV. DVHs for the GTV, CTV, PTV, and all PRVs defined for the study must be submitted for QA review. Review must be completed within the first week of treatment or before the treatment is 15% completed.

9. A DVH will be submitted for a category of tissue called “unspecified tissue” that is defined as tissue contained within the skin, but which is not otherwise identified by containment within any other structure. This will help insure that the IMRT plan does not result in increased doses in normal tissues that were not selected for DVH analysis. This must also be reviewed within the first week of treatment or before the treatment is 15% completed.

10. The treatment machine monitor units generated using the

IMRT planning system must be independently checked prior to the patient’s first treatment. Measurements in a QA phantom can suffice for a check as long as the plan’s fluence distributions can be recomputed for a phantom geometry.

11. IMRT for lung cancer, esophageal tumors, or other areas with significant heterogeneities, or where tumor mobility cannot be easily accounted for, is not allowed.

Credentialing As a minimum, the IMRT questionnaire and benchmark developed by the ATC must be completed by each institution, and reviewed and approved by the cooperative group’s QA review process. (This questionnaire and benchmark is available through the QA review groups.) The institution can then be approved for treatment with IMRT on study. If an institution has already successfully completed the questionnaire and benchmark for one study, it will suffice for other group studies unless the protocol specifically requires additional data. Based on feedback from cooperative groups, the ATC will continue to refine the IMRT benchmark and promote it as a credentialing document that will be recognized by all groups, at least for one tier of credentialing.

In addition, some cooperative groups may wish to require that a phantom be planned and irradiated using IMRT as a part of the IMRT credentialing requirement for specific protocols. In 24

such cases, the RPC has developed an anthropomorphic (or geometric phantom) to meet the specific requirements of the protocol. If future protocols in which IMRT plays a significant role require this additional credentialing, the ATC will develop site-specific phantoms similar to that used for RTOG H-0022. The phantoms will contain imageable objects definable as the target, appropriate critical structures, heterogeneities, and dosimeters. The phantoms are relatively inexpensive and can be commissioned quickly by the RPC. These phantoms are intended to allow quantitative assessment of the institution’s ability to localize the target, plan a treatment, and deliver a dose distribution specified by the protocol. The phantoms will be designed to assess the accuracy of a delivered dose (+5%) near the center of the target, the dose homogeneity (if appropriate) across the target, and the positioning of the field relative to the target (±2mm). The phantoms will be constructed and mailed to the participating institutions. Experience suggests that the turnaround time for a phantom sent to an institution is one to two months, depending on the complexity of the treatment.

(These guidelines were developed at the request of the NCI by Drs. James Purdy, T.J. Fitzgerald and Mack Roach with subsequent review by the ATC members and the Radiation Chairs of the Cooperative Groups. Questions may be addressed to the submitter at: deyej@mail.nih.gov.)

■

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

Chapter News Regional Organization Committee René J. Smith Chairman, Regional Organization Committee SmithRe@readinghospital.org One of the goals of this committee is to improve communication among chapters. During our committee meeting in Montreal, it was suggested that, when a chapter meeting is scheduled, the president, or the secretary of that chapter e-mail his/her counterpart in adjacent chapters, who can, in turn, inform the members about the meeting. Headquarters can be very helpful in assisting local chapters in this endeavour.

Spring Meeting of the AAPM Upstate NY Chapter Matthew Podgorsak President, Upstate NY Chapter of the AAPM Matthew.Podgorsak@RoswellPark.org The Upstate New York Chapter of the AAPM held its semiannual meeting at Roswell Park Cancer Institute (RPCI) in Buffalo, NY on May 16, 2002. This marked the first time the meeting has been held in Buffalo since RPCI moved to its new state-ofthe-art building. The program included presentations from students aligned with various departments within the Buffalo campus of the State University of New

The use of a Web site is also highly recommended.

Chapters are encouraged to invite the AAPM president-elect to one of their meetings. This will help to make him/her aware of local chapters’ needs. Some chapters may sponsor the meeting with other chapters to reduce expenses and decrease the number of trips for the president-elect (these individuals DO hold a job).

Another alternative is to schedule meetings on successive days.

Some chapters are doing this successfully. Some of the bigger chapters are willing to share their experiences with smaller chapters

by organizing symposiums, if so desired.

There are two more items that should be brought to your attention. First, send a copy of your By-Laws to HQ. Some chapters are struggling with this, but your cooperation is very important.

The other item has to do with the recruitment of young physicists interested in medical physics. The Regional Organization Committee is going to form a sub-committee that will be in charge of helping all the chapters along this line. We need everybody’s cooperation.

■

York system. In particular, the Toshiba Stroke Research Center was well represented by five students describing their research under amicable scrutiny from their mentors Drs. Steve Rudin, Dan Bednarek, and Ken Hoffmann.

Several invited presentations were also given. Russell Ruo, M.S., from the University of Rochester, described the effect of target position uncertainty on dose delivery in extra-cranial radiosurgery for two stereotactic localization methods. Doug Boccuzzi, M.S. from the RPCI followed this talk by describing RPCI’s experience with an ultrasound-based positioning system.

In the afternoon session, two members of the committee which recently successfully lobbied the

NY State legislature to pass a licensure bill for medical physicists practicing in NY, gave an invited symposium. Steve Nagy, Ph.D. and Bob Pizzutiello, M.S. described the efforts made by the committee to have the licensure bill passed and detailed some of the requirements that we will have to meet in May 2003 when the license bill is finally enacted. With this bill, NY becomes the fourth state to require licensing of medical physicists, joining Texas, Hawaii, and Florida. The last talk of the meeting was given by John Schreiner, Ph.D. from Queen’s University and the Kingston Regional Cancer Center in Kingston, Ontario, Canada. Dr. Schreiner’s invited talk was titled “Gel do-

25

(See Upstate NY - p. 26)

AAPM NEWSLETTER

Upstate NY

SEPTEMBER/OCTOBER 2002

(from p. 25)

simetry - history and state-ofthe-art” and gave us all a new

appreciation for the potential of using gels as dosimeters. At the business meeting immediately following the scientific session, it

was decided to once again hold the meeting at RPCI in the fall.

■

Announcements New Online Processing of Medical Physics Manuscripts Colin G. Orton Editor, Medical Physics We are pleased to announce that, beginning October 1 st, 2002, we will initiate online processing of manuscripts submitted to Medical Physics. After this date, all authors will be expected to submit their articles online (the URL will be posted on the AAPM and Medical Physics Web sites, and in e-mail messages sent to AAPM members and past authors). However, there is provision for those authors without adequate online access. They may still submit manuscripts in hardcopy but these must be accompanied by electronic versions

on disk. Nevertheless, since this will inevitably slow down the review process, authors will be discouraged from taking advantage of this option.

Once submitted online, the review process will commence immediately. Potential associate editors and referees will be invited via e-mail. They will be given online access to the manuscripts and may accept or decline the invitations online. Subsequent reviews and recommendations will be submitted online. Finally, after acceptance, manuscripts will be transmitted to the AIP for publication online.

By moving to online processing, we anticipate that we will be able to reduce the time it takes to move manuscripts from receipt to publication by several months.

■

Biomedical Imaging Research Opportunities Workshop January 31 - February 1, 2003 Bethesda, Maryland Sponsors: AAPM, RSNA, ARR Poster Abstract Deadline: October 10, 2002 Registration (Discounted) Deadline - November 5 Registration (Final) Deadline - November 20 For more information go to: http://www.birow.org 26

Computed Tomography: Patient Dose Symposium William M. Beckner Executive Director, NCRP The National Council on Radiation Protection and Measurements will hold a two-day symposium November 6-7, 2002 at the Crystal City Marriott in Arlington, Virginia on the topic of excessive x-ray exposures to patients and physicians from computed tomographic (CT) diagnostic procedures.

Some 25 radiologists, physicists, radiographers, industry scientists, public health officials, and others will outline the problem and possible solutions. The meeting is open and there will be opportunitites for audience contributions. The symposium will be conducted by the NCRP under a grant from the Diagnostic Imaging Branch of the National Cancer Institute.

There is no charge to attendees. For more information, contact the NCRP at ncrp@ncrp.com, or by calling 301-657-2652.

■

AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2002

Workshop and Symposium on IORT “The First Intercontinental Workshop and Symposium on Intra-Operative Radiation Therapy using Mobile Systems” will convene on December 1st and 2nd, 2002, at the University of Sydney in Australia. The symposium will be organized with a clinical day on Sunday, December 1st with more technical presentations on Monday, December 2nd.

IORT has a long history, but until recently it has had limited application because of the expense of installing a dedicated linear accelerator in an operating theatre, or the difficulty of moving patients to a radiation oncology department. Recently several mobile systems have been developed which allow IORT to be given in normal operating theatres. The aim of this event is to convene the world’s finest, most experienced IORT clinicians to: 1) present the mobile systems available today, 2) identify successful applications and 3) explore the potential future of this unique treatment modality. We will bring together a diversity of professions from developed and developing countries from all over the world with a strong participation from the South East Asia region, Australia and New Zealand. Greater detail is available on the following Web site: www.acpsem.org.au/ IORT/index.html or by contacting the convening committee: “abeddar@mdanderson.org”, “natalka@email.cs.nsw.gov.au”, “tomas.kron@lrcc.on.ca.”

■

Letters to the Editor Don’t Change a Thing!

Joe Wong San Luis Obispo, Ca joewongt@aol.com While perusing through the latest issue of the AAPM Newsletter, I noticed that recently the newsletters have become more and more DULL. This last issue contains the normal 16 pages of which seven pages were devoted to the affairs of AAPM, i.e. messages from the president, executive director and other news at HQ, two pages of announcements of sorts and one page or so of advertisements. The rest were about 1.5 pages of interest (Mammography) and the travels of two physicists whom AAPM helped in their expenses. Interesting to note that nobody (AAPM past or present members) died during the two months (nice to know that we are all well health-wise), and nothing controversial, like someone drew an offensive cartoon. Have we become so politically correct that we must be BORING? ■

Stewart C. Bushong Houston, TX sbushong@bcm.tmc.edu Hey John … I disagree with your assessment of the AAPM Newsletter content. I’m sure I receive the same four newsletters you receive, but for me the AAPM Newsletter is the best.

Editor Al deGuzman continues the good job that Bob Dixon did… publishing items of interest to me, not to members of some other organizations.

Time is precious to all of us so to load our Newsletter with items from other organizations, COMP, SCOPE, etc., will only increase the burden of wading through trivia.

I took your challenge and looked again at the June 2002 issue of the HPS Newsletter— 52 pages compared to 20 pages in the AAPM Newsletter— which I often shelve without a look. The first 11 pages were in tribute to Laurie Taylor. Nice, but 11 pages! Two pages of NRC News to be skipped. Five pages of Chapter News and Committee Activities—good stuff, and I agree we should include chapter news in our Newsletter. 52 pages of boring CHP News. Five appropriate pages as repositories of HPS position statements. The rest was ads and trivia. Bottom line…I found 12 of 52 HPS Newsletter pages of modest interest.

(See Bushong - p. 28)

27

AAPM NEWSLETTER

Bushong

SEPTEMBER/OCTOBER 2002

(from p. 27)

In comparison, I read nearly every line of every page of our AAPM Newsletter, though I don’t understand why we spend

pages on “New Members.” I think our advertising burden, 2.5 pages, is appropriate. Bottom line… I found 14 of 20 pages of interest; twice the rate for the Health Physics Newsletter.

So Allan, keep up the good work; Don’t Change a Thing!

Except, I do agree with Cameron’s call for e-mail ad■ dresses.

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

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

Next Issue: November/December 2002 Postmark Date: November 15 Deadline: October 15, 2002

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

28 1