AAPM Newsletter July/August 2003 Vol. 28 No. 4

Newsletter

American Association Of Physicists In Medicine VOLUME 28 NO. 4

JULY/AUGUST 2003

AAPM President’s Column Martin S. Weinhous Cleveland, Ohio

als, the commom goals are better care of patients, and the betterment of the profession of

Some Tough Questions Several tough questions will be posed in this column regarding the AAPM/ACMP relationship and regarding the NCRP-recommended annual effective dose limits and their quartering. Answers will be left to the reader.

Bhudatt Paliwal, William Hendee, and Stephen Thomas, Physics Trustees of the ABR The ABR Physics trustees are committed to providing upto-date information to the AAPM membership about board activities and decisions.

The following is a list of some of the topics relevant to medical physicists being discussed and implemented by the ABR.

AAPM/ACMP First, we must remember that “them are us.” A check of membership roles in early 2003 showed that every ACMP member was an AAPM member.

Second, we should all agree that for our Association, for the College, and for us as individu-

ABR Update

medical physics and its practitioners.

So, what are the tough questions and what is the context within which they need to be asked?

(See Weinhous - p. 2)

Strategic Planning After one year of study, the strategic planning committee has put forth the following objectives as adopted by the ABR Trustees: (See ABR - p. 5)

TABLE OF CONTENTS

Shamu at Seaworld in San Diego, the site of the AAPM 45th Annual Meeting, August 10-14. Photo by Seaworld San Diego

Exec. Dir’s. Column p 6 Summer UGrad. Annc. p 7 Gov’t. Affairs Column p 8 Education Council Rep. p 11 AAPM-ACMP Report p 12 Invitation to Members p 14 Chapter News p 16 Announcements p 17 Mammography FAQ’s p 18 Letters pp 20-4

AAPM NEWSLETTER NEWSLETTER

Weinhous

JULY/AUGUST 2003 JULY/AUGUST 2003

(from p. 1)

Question: Are patients, the profession and its practitioners better served by a one- or twosociety model?

Context: The ACMP was founded in 1983, with AAPM support, at a time when physicists were not allowed “equal” representation on the board of the American Board of Radiology.

The ACMP was then instrumental in creating the American Board of Medical Physics, the ABMP. These actions were likely contributory to the eventual equal representation of physicists on the ABR board. The vision of the time was modeled on complementary organizations, e.g. ASTRO/ACR and RSNA/ACR.

Question: Is the twosociety model sufficiently important, i.e. do the societies undertake different enough tasks, to outweigh the inefficiencies?

The ACMP has since been active in professional and now clinical issues producing position papers and standards of practice.

There is, and has been, perceived overlap in activities between the ACMP and the AAPM Professional (and now other) Council(s). There are some duplicated efforts Question: Is the two-society model sufficiently important, i.e. do the societies undertake different enough tasks, to outweigh the inefficiencies?

Context: In these tight financial times, the Association and the College compete for volunteer time, compete for attendance at seminars and meetings, and compete for “loyalty.”

Question: Is the ACMP large enough and fiscally sound enough to survive?

Context: At this time the College has about 275 dues-paying members and is in financial difficulty. The College must divest itself of the expense of the JACMP (and is negotiating with the AAPM for the continuation of the JACMP under AAPM auspices and AAPM financial support). The College’s programs and effect are limited by its small size and limited resources.

There may be as many answers to the above questions as there are readers. Each of us must decide what we think is best for patients, the profession and its practitioners and act accordingly.

Medical physicists should no longer be passive on these issues.

This is the time to act since the ACMP is beginning a very serious membership drive. All medical physicists should learn as much as they can about the ACMP and its mission, should consider the above issues, should make up their own minds, and then join the ACMP or not as their conscience decides. The necessary acts are to learn, think and decide.

The Emperor’s Attire The following issue is so important that it is the topic of the President’s Symposium at our 2

Annual Meeting (Monday August 11th from 10:00 to 12:00).

The full title is “Exposure Limits: Science, Policy, Regulation, and Consequences.”

The AAPM has long been involved with the NCRP (the National Council on Radiation Protection and Measurements) working on diagnostic and therapeutic rewrites of the old shielding reports (NCRP 49, 1976 and NCRP 51, 1977). This work is being accomplished respectively

by TG-13 of the Diagnostic XRay Imaging Committee and also

by TG-57 of the Radiation Therapy Committee, both of the Science Council.

There has been considerable debate within those groups, and between them and the NCRP representatives, as to the nature of the new reports. Should they be “shielding calculation technique” reports or should they be both technique and “policy” reports (i.e. include annual effective dose limits and fractions of those limits)? Generally the AAPM members have been very uncomfortable with including policy (the NCRP-recommended annual effective dose limits) and would very much rather produce shielding-methodology reports.

The NCRP’s recommendations for annual effective dose limits are already given in their 1993 Report No. 116, “Limitation of Exposure to Ionizing Radiation.” With regard to the limits for individual members of the public (nonoccupational), the NCRP makes three recommendations (pgs 46 & 47 of their re-

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

port 116). (1) “For continuous (or frequent) exposure, it is recommended that the annual effective dose not exceed 1 mSv.” (2) “Furthermore, a maximum annual effective dose limit of 5 mSv is recommended to provide for infrequent annual exposures.” and (3) “that whenever the potential exists for exposure of an individual member of the public to exceed 25 percent of the annual effective dose limit as a result of irradiation attributable to a single site, the site operator should ensure that the annual exposures of the maximally exposed individual, from all man-made exposures (excepting that individual’s medical exposure), does not exceed

1 mSv on a continuous basis.

Alternatively, if such an assessment is not conducted, no single source or set of sources under one control should result in an individual being exposed to more than 0.25 mSv annually.” The third recommendation represents a quartering of the limit and in the minds of most is not justified. There have been several problems caused by various interpretations of the above within the task groups. As of early June the NCRP (representatives) stance has been that 1 mSv is the limit, but that one must quarter it and shield for 0.25 mSv (because in reality no one makes an assessment of the maximally exposed individual’s exposure from all man-made sources). The NCRP

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

representatives have wanted this pseudo-limit of 0.25 mSv written into the task group reports.

But wait, what about those barriers that protect the members of the public who only get exposed infrequently? By No. (2) above, the limit should be 5 mSv. But that value was actively opposed for inclusion in the reports.

But wait, isn’t it just bad practice to put (pseudo) constants in many places? What if the recommending body changes its mind?

Wouldn’t it be better if the many reports that depend on the same numeric values just reference the one report that first introduced those values? (Programmers who make this mistake get fired!)

(See Weinhous - p. 4)

2003 RDCE

Need Continuing Education Credits?

Earn your medical physics continuing education credits online through the

AAPM Remotely Directed Continuing Education Program Answering 8 of the 10 questions will provide you with one Medical Physics Continuing Education Credit (MPCEC). The results of your passing scores will be forwarded to the Commission on Accreditation of Medical Physics Education Programs (CAMPEP). You will receive a summary of your MPCEC’s earned through the RDCE program at the end of the year from CAMPEP. Questions set categories: - CT - PACS, DICOM, and Monitors - Ultrasound - Diagnostic - Radiation Protection - Nuclear Medicine - Mammography - Radiation Oncology - MRI Question sets based on: - AAPM Virtual Library presentations - Medical Physics articles - Other easily accessible publications such as AAPM Task Group or NCRP Reports

Member Registration Fee: $25

www.aapm.org/educ/rdce.asp

3

AAPM NEWSLETTER NEWSLETTER

Weinhous

JULY/AUGUST 2003 JULY/AUGUST 2003

(from p. 3)

But wait, why include values in the shielding-methodology reports at all? The NCRP is not a regulatory body. It simply makes recommendations which may be adopted by those who do write regulations (generally the states).

If a state adopts something other than the number the NCRP rec ommends, then the number within the report might mislead the physicist doing the shielding calculation.

But wait, what is the basis of the numeric values cited in (1), (2) and (3)? The 1 and 5 mSv values are risk-based most likely using the very conservative Linear-No-Threshold, LNT, model for radiation effect. Does today’s radiobiology data support using that conservative model?

I’ve been told that should the AAPM (and other medical societies) oppose the use of these conservative (already small and shrinking) values for shielding for medical use, that we would be branded as ‘polluters not caring for humanity.’

But wait, it’s just the opposite!

In the health care arena the resources (funds) are limited. Dollars spent on (possibly excess) shielding are dollars not spent on patient diagnosis and care, likely resulting in harm to patients. Also, extra shielding exposes more lead miners, more concrete workers, and more construction workers, etc. to harm. Clearly there are unintended consequences that result from “protection at any cost.” So where is the balance

between protecting the public from radiation-induced illness on one hand, and doing a better job of detecting and curing illness and also protecting workers on the other hand? That balance will be difficult to find. But, it is imperative that valid scientific methods be applied to the problem. We intend to encourage and work with the NCRP to do just that – to broaden their approach and to

consider finding a proper balance.

I wish to congratulate the members of TG-13 for creating a more rigorous and realistic methodology for calculating diagnostic shielding. They have done a tremendous amount of very valuable work. The members of TG57 are doing similar work for therapy shielding and we look forward to another high-quality result.

Gammex RMI ® PRECISION DECISION, NO COMPETITION.

WHETHER YOU CHOOSE A RED OR GREEN LIGHT, THE DECISION TO GO WITH THE NEW GAMMEX CT SIM ROBOTIC TRACKING LASER SYSTEM IS RIGHT ON THE MARK. With the addition of the CTSim G, our CT Sim Systems offer more options and flexibility. The integrated PROBE G green laser enhances contrast on various skin tones and incorporates power stabilizing circuitry that extends diode life. The Dynamic Zero Function and optional independent control of each laser simplifies realignment and saves valuable time.

The system includes Gammex RMI’s user-friendly CTSim software package, a hand-held pendant that synchronizes with the software and installation flexibility, a Gammex RMI® trademark.

For more information, call your representative today.

SEE US AT AAPM, AUGUST 10-14 IN SAN DIEGO, BOOTH #900 GAMMEX RMI® P.O. BOX 620327 MIDDLETON, WI 53562-0327 USA 1-800-GAMMEX 1 (426-6391) 1-608-828-7000 FAX: 1-608-828-7500

4

GAMMEX–RMI LTD KARLSRUHE HOUSE 18 QUEENS BRIDGE ROAD NOTTINGHAM NG2 1NB ENGLAND (++44) (0) 115-985-0808 FAX: (++44) (0) 115-985-0344

GAMMEX-RMI GMBH ODESHEIMER WEG 17 53902 BAD MÜNSTEREIFEL GERMANY (++49) 2257-823 FAX: (++49) 2257-1692A

w w w. g a m m e x . c o m

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

Ongoing Activities The draft report of the AAPM-ACMP Ad Hoc Committee on Professional Medical Physics Issues has been reviewed

by AAPM’s Executive Committee. ExCom was not inclined to form another committee as recommended in the report. ExCom

thought the work intended for that committee should be accomplished within our Professional Council.

In Conclusion

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

As always, the Association’s officers and staff are available to the members to correspond on any issue as we all work together to improve the Association. ‘Til next time…

■

I hope to see many of you at our Annual Meeting to be held August 10–14 in San Diego, CA.

ABR Update (continued from page 1) • Continuously improve and refine the written examinations and oral examinations for the primary certificate in diagnostic radiology, radiation oncology and medical physics.

• Continue development of the Maintenance and Certification (MOC) process and specifics to incorporate components and competencies in medical physics, radiation oncology and diagnostic radiology.

• Develop a comprehensive electronic/digital environment with infrastructure, hardware, software and Web technologies to support the operations and examinations of the ABR. • Enhance the appropriate interactions with radiology and nonradiology organizations.

• Increase volunteer satisfaction.

• Ensure financial viability of the ABR short and long term.

• Serve the mission of the ABR. The Budget and Finance Committee, Executive Committee, and the Board of Trustees approved a new fee schedule for the

examination process (see the ABR Web site).

The trustees continue to discuss the validity, content, and relevance of the written examinations. The board is committed to continuous improvement of the written examination.

physics examination, avoiding the duplication in the past. The members of this group are: • From the ABR: Drs. William Hendee, Bhudatt Paliwal and Stephen Thomas • From the ABMP: Drs. Michael Herman, Jatinder Palta and Edward Nickoloff

New Officers Dr. William R. Hendee took office as the president of the ABR July 1, 2002.

M. Paul Capp, MD, executive director for the past nine years, asked that his successor be named. The board named Robert R. Hattery, MD, past president of the ABR, as the new executive director. Dr. Hattery took office July 2002.

The ABR Physics Committee will continue to meet at the Annual Meeting of the American Association of Physicists in Medicine. The primary focus of discussion will be the MOC process and its implementation. The next meeting of this committee is scheduled during the AAPM meeting in San Diego.

Maintenance of Certification

ABR/ABMP As a result of the agreement between these two organizations, a committee of six (three from each group) has been appointed to work out the details of a single

Ten-year, time-limited certificates began for first-time examinees at the June 2002 examination. The process of maintenance of certification will be a continuing process involving four parts: (See ABR - p. 6)

5

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

ABR (from p. 5) 1. CME credits 2. Self-Assessment 3. Attestation of competence from survey of peers 4. Examination – every three years, through the Web site, open-book, relative to ongoing physics material

Written and Oral Exams In a continuing effort to improve the written and oral exams as well as the development of the MOC process for radiological physicists, the ABR Physics Trustees reviewed a spectrum of issues. A summary of the status of some of

these issues and related developments is described below: • The eligibility criteria for Radiological Physics Parts I and II has been restated with greater clarity and emphasis on physical sciences, didactic background, and residency training. These changes are implemented on the ABR.org Web page.

• The ABR Physics Trustees restructured the oral and written examination item preparation process. Key individuals were identified to provide overall review of the material to be prepared by committees. Some of the committees utilized the WEB meeting software to review the material. This approach has the potential of allowing participation by

many more committee members without incurring any additional cost.

• Committees for oral and written examinations were updated to reflect the current membership.

• The ABR Trustees approved participation of ABMP-certified physicists with a letter of equivalency from the ABR to participate as item writers and examiners in the ABR examination process.

• In order to assure a higher and uniform standard for candidates seeking certification in Radiologic Physics, the ABR, beginning in 2012, is considering successful completion of CAMPEP accredited residency as an eligibility cri■ terion.

Executive Director’s Column Sal Trofi College Park, MD I announced to the AAPM Board of Directors in July of 2002 that I plan to retire at the end of 2003. I will turn 68 at that time and look forward to pursuing other (non-work related) activities before it becomes too late.

In this column, I would like to explain to the AAPM membership the transition plan agreed to by the Board.

In July of 2002, I recommended to the Board a transition plan, which had as its main element the appointment of Angela Keyser as my replacement. I also suggested a staff reorganization that would strengthen both the

financial and meeting logistics responsibilities. The two plans combined resulted in an increase of one staff person, but annual costs remained essentially the same.

We are now in the reorganization phase and employees are now on board to implement the plan.

6

Angela Keyser Angela will take over the duties of executive director on the first day of 2004. Angela served as the deputy executive director for the last few years and is highly qualified to take on the responsibility of director. Angela and I worked together for over ten years. During that time, I frequently asked for her advice on difficult issues. I have always found her advice to be based on sound logic, and have used her input in most cases. Her ability to work with committees is well known by most of the current and past committee members. Angela has the qualifications and experience to lead the Headquarters operations successfully, and I

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

have no doubt that the membership will be pleased with her leadership.

Cecilia Balazs Cecilia was hired as the director of finance and administration effective June 30. She has over 30 years experience in nonprofit association management. Cecilia earned an MBA from the University of Maryland. She will be responsible for financial matters (accounting, budgeting, investments, inventory, etc.) administrative matters (employee benefits, building matters, insurance coverage, etc.) and other major functions (membership and journal affairs). She will also liaison with outside service providers for auditing, banking and publication services.

Karen MacFarland Karen was hired, effective June 16, as a meetings manager. Karen earned a BA degree from Hamilton College, Clinton, NY. She has worked as a meeting planner for the American Physical Society for the last four years.

Prior to that, she worked for the American Society for Parenteral and Enteral Nutrition assisting with the organization’s conventions, meetings and exhibits. For the AAPM she will oversee the operational aspects of our meetings to include the annual meeting, committee meetings, and other conferences. She will assist Angela with the negotiation of meeting-related contracts and site selections.

Dawn Taliford Dawn was hired as a staff accountant on June 16. This position came about by eliminating an administration assistant position in order to reinforce our accounting department. Dawn has a BS degree in accounting from Liberty University located in Virginia.

She has more than 15 years experience in accounting. Her experience in accounting is diverse with both profit and nonprofit organizations because she worked several years as a consultant to various organizations.

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

two more if we convert a small conference room to workspaces.

This would give us 25 workspaces. With the reorganization staffing now complete, we have 20 employees. This will leave five work areas available for future expansion.

The time between now and year-end will be a period of intense training of the new employees. I am confident that the day after my retirement the Headquarters office will operate without skipping a beat. â–

Office Space We currently have 23 available work areas. To this we could add

ATTENTION DIRECTORS OF MEDICAL PHYSICS GRADUATE PROGRAMS George Sandison Summer Undergraduate Program Subcommittee Chair A list of the applicants for the 2003 AAPM Summer Undergraduate Fellowship Program and their contact addresses is available upon e-mail request to Sharon Cohen at Sharon@aapm.org. Many students on this list are excellent candidates for graduate programs in medical physics and have great interest in pursuing a career in this field. All program directors are encouraged to reach out to these students and welcome them to study at the graduate level. Remember that financial support for study is a strong attractor! (Please note that availability of this list is restricted to program directors of CAMPEP-accredited and unaccredited medical physics graduate education programs in the United States and Canada).

7

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

Government Affairs Column Angela L. Lee College Park, MD

NEW BILL INFORMATION HAS BEEN POSTED ON THE AAPM WEB SITE Legislative information can be accessed on the AAPM Web site, in the Government Affairs section (http://www.aapm.org/ govtaffairs/default.asp). The software that AAPM is using will allow you to easily access bills, voting records and cosponsor information. In this newsletter article, I will give you background information on the bills that you will find on the AAPM Web site, and I will also provide the AAPM’s position on them, when available. Some bills are being evaluated and AAPM does not have a position on them at this time.

The Consumer Assurance of Radiologic Excellence Act (H.R. 1214 & S. 1197) Rep. Heather Wilson (R-NM1) introduced H.R. 1214 on March 11, 2003. The bill has 25 cosponsors and was referred to the Health Subcommittee of the House Energy and Commerce Committee. Sen. Michael B. Enzi (R-WY) introduced S. 1197 on

June 5, 2003. The bill has four cosponsors and was referred to the Health, Education, Labor, and Pensions (HELP) Committee. The bill introduced by Sen. Enzi was cosponsored by Sens. Kennedy, Daschle, Dorgan and Lautenberg. This is the bill for which we have been waiting.

The bill is referred to as “RadCARE,” because there is already a CARE bill in the Senate.

AAPM is part of an alliance that supports these bills.

These bills seek to establish standards that states must follow

AAPM Virtual Library Corporate Affiliate Presentations We are pleased to announce the inclusion of AAPM Corporate Affiliates - Vendor Presentations in the AAPM Virtual Library AAPM recognizes the significant contributions to the field of medical physics our Corporate Affiliates provide.

We welcome their inclusion in the AAPM Virtual Library and hope members will find these presentations a resource for learning about products, techniques, and company activities.

AAPM Corporate Affiliates Presentations currently posted include

Impac Medical Systems, Inc. Varian Medical Systems We encourage you to view the presentations and learn more about our Corporate Affiliates

AAPM Virtual Library • www.aapm.org

8

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

in order to determine who is qualified to administer or plan medical imaging or radiation therapy procedures. “Such standards shall include licensure or certification….”

The two bills are similar, but there are several differences.

H.R. 1214 uses the terms “administer or plan,” while S. 1197 uses the terms “perform or plan.”

The meanings are the same, but the words are different. S. 1197 mentions the fact that medical physicists are only licensed or required to be board certified in eight states. This is not mentioned in H.R. 1214. Both bills state that the Secretary of Health and Human Services will consult with organizations that are nationally recognized for their expertise.

S. 1197 has gone a step further by setting up a criterion to approve and withdraw approval from nonprofit organizations or state agencies that “accredit [programs] or administer examinations to individuals who perform or plan medical imaging or radiation therapy.”

Harkin (D-IA) introduced S. 869 on April 10, 2003. The bill has 18 cosponsors and was referred to the Committee on Finance.

These two bills are identical in the House and Senate. The AAPM supports these bills.

These bills have two distinct subsections. The first makes provision for screening and diagnostic mammography services to be reimbursed at an enhanced rate (200% of the amount applied under the physician fee schedule).

The bill specifies that the enhanced reimbursement rate must go to a hospital-based facility for services furnished to a Medicare beneficiary.

The second specifies that certain radiology residents will not count against the graduate medical education limitation. “The Secretary of Health and Human Services shall not take into account one additional [full-time equivalent] resident in the field of radiology per post-graduate year….” This provision applies each year a full-time equivalent resident is in an approved medical residency-training program.

Assure Access to Mammography Act of 2003 (H.R. 817 & S. 869)

Dirty Bomb Prevention Act of 2003 (H.R. 891 & S. 350)

Rep. Peter T. King (R-NY-3) introduced H.R. 817 on February 13, 2003. The bill has 97 cosponsors and was referred to the Health Subcommittee of the House Energy and Commerce Committee, and the Health Subcommittee of the Ways and Means Committee. Sen. Tom

Sen. Hillary Clinton (D-NY) introduced S. 350 on February 11, 2003. The bill has two cosponsors and was referred to the Committee on the Environment and Public Works. Rep Edward J. Markey (D-MA-7) introduced H.R. 891 on February 25, 2003.The bill has eight cospon9

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

sors and was referred to the Energy and Air Quality subcommittee of the Energy and Commerce Committee. The AAPM is reviewing these bills at this time.

These two bills are similar, but use different terms. Sen. Clinton’s bill refers to sensitive radioactive material, which is defined as “a source material, byproduct material or special nuclear material… that warrants improved security and protection against loss, theft, or sabotage.” Rep. Markey’s bill refers to sealed sources.

These bills propose a task force made up of 10 federal agencies to evaluate the security of radioactive materials and recommend legislative and administrative action. The task force determines how radioactive materials should be classified and develops a classification system based on the potential use by terrorists and the threat to public health and safety.

This classification system takes into account: radioactivity levels, dispersibility, the chemical and material form, and the availability of pharmaceuticals containing radioactive materials. Rep. Markey also recommends looking at other technologies that “can perform some or all of the functions currently performed by devices that employ sealed sources… in order to reduce the number of sealed sources in the United States.” Sen. Clinton does not make this recommendation in her bill.

These bills are identical in their recommendation to create or modify “procedures for improv(See Gov’t Affairs - p. 11)

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

Full Page Mentor Ad to Go Here

10

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

Gov’t Affairs (from

p. 9)

ing the security of [sealed sources or sensitive radioactive materials] in use, transportation, and stor-

age.” Procedures to improve security include: imposition of increased fines for violations, background checks for people with access to radioactive mate-

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

rials and taking steps to ensure the physical security of facilities where radioactive materials are ■ stored.

Education Council Report Herbert Mower Education Council Chair We thank Don Frey for his leadership of the council over the past six years and wish him well as he serves our society as president-elect and then president. At the recent RSNA meeting several of the committee chairs who had served on the council under Don honored him at dinner.

With a new chair for the Education Council and some changes in committee leadership, we started the year with a retreat with the theme of “How to better serve our membership.” Some of the items that the various committees are currently working on include: Continuing Professional Development: This was formerly the “Continuing Education Committee.” Last year the committee changed its name to more properly reflect its goals. One of the goals of this committee is to better integrate the various educational opportunities within the association and to better coordinate activities with other groups such as the RSNA and ASTRO. In this vein, they will try to coordinate educational programs so that the AAPM will not have the same topic for the summer school as

the ACMP has at its annual meeting. Also, to better utilize resources, educational topics at the summer school may reappear at future RSNA meetings, at a suitable time, as categorical courses.

An effort will also be made to better coordinate the ‘tract’ sessions at the annual meeting so as not to conflict with the current summer school.

Remotely Directed Continuing Education: This subcommittee lets you accrue continuing education credits over the Web. There are questions related to Medical Physics articles as well as questions related to some of the sessions recorded by DigiScript at our Annual Meeting. Again, this year, DigiScript will record about 30 hours at the Annual Meeting.

RSNA Education Coordination: Last year Perry Sprawls intro11

duced a Physics Case of the Day session. This went over very well and will be repeated this year.

AAPM also provides a tutorial on equipment purchasing at the RSNA. This year the topic will be ultrasound equipment. We also provide categorical courses and a residents’ tutorial.

Maintenance of Certification: For those certified by the ABMP or who are now being certified by the ABR, this is an important topic. Certifications by the ABR are no longer a ‘one-time’ process but must be updated on a regular basis. We will keep our members informed as things develop with the ABR relative to this. As a part of the Education Council Symposium at our Annual Meeting, Bhudatt Paliwal will update us on this important topic.

Presently the symposium is scheduled for 9:30-11:00 AM on Sunday morning, but check your meeting agenda for any updates.

Educators’ Day at the Annual Meeting: As we become more aware of the growing shortage of medical physicists, we are looking for more and better ways to advertise our profession. One of these is the Educators’ Day at our Annual Meeting. We send out (See Mower - p. 12)

AAPM NEWSLETTER NEWSLETTER

Mower

JULY/AUGUST 2003 JULY/AUGUST 2003

(from p. 11)

invitations to high school and college faculty in the area that are involved with teaching physics and invite them to join us for the day. During this period we introduce them to the various aspects of medical physics and hope that they will carry this information back to their students. This year we hope to involve members of the local AAPM chapter in this program, as they will have the best opportunity to follow-up with our guests.

This article has only touched on some of our programs. In future editions of the newsletter we will talk about some of our other programs. If you are interested in the workings of any of the committees or subcommittees of the Education Council, please feel free to stop by their meeting(s) at our Annual Meeting. Committees welcome input from the membership. If you wish to be considered for appointment to one of these groups, mention it to the chair, our president-elect ■ (Don Frey), or to me.

AAPM-ACMP Ad Hoc Committee on Professional Issues Report Kenneth Hogstrom Former Committee Co-Chair In 2001, the AAPM Executive Committee and the American College of Medical Physics (ACMP) appointed a joint ad hoc committee on professional issues. I served as co-chair along with Jerry Allison, Charlie Coffey, Bob Gould, and Marty Weinhous representing the AAPM, and Mike Herman (co-chair), Ben Archer, John Horton, Bhudatt Paliwal, and Ken Vanek representing the ACMP. Mike Gillin, chair of AAPM Professional Council, and Rick Morin, chair of American College of Radiology (ACR) Commission on Physics, served as consultants.

The goal of the committee was to investigate the potential for improving synergism, efficiency, and efficacy of efforts of the AAPM and ACMP that address professional medical physics issues. The committee met three times between November 28, 2001 and December 2, 2002.

The final report, submitted to AAPM Executive Committee on April 14, 2003, is summarized below by presenting its preface and summary recommendations.

Although it was not possible to recommend a permanent, longterm solution to the issues, I feel that the committee’s recommendations provide a pathway to a long-term solution to the committee’s charge. I urge all interested to read the excerpt from 12

the report carefully and to communicate your thoughts to AAPM leadership and Professional Council.

Preface The professional aspects of the clinical practice of medical physics are an integral component of the clinical activities of each practicing medical physicist. These aspects include but are not limited to reimbursement, compensation, liability, standards, public and professional education, and ethics. In order to increase the effort and focus on the professional aspects of the clinical practice of medical physics, the ACMP and the AAPM should develop mechanisms to improve synergy, increase efficacy, and reduce duplication of effort on professional activities. A cooperative, coordinated two-bodied (AAPM and ACMP) approach can provide a flexible and powerful advocacy that demonstrates the importance

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

of the professional activities related to our practice and benefits medical physicists.

The summary recommendations are presented on the following page. The committee feels that implementation of these recommendations accomplishes a significant first step toward improving communication, coordination, and cooperation of the ACMP and the AAPM and increasing the professional practice activities on behalf of medical physicists in clinical practice....

In considering the summary recommendations, it is important to recognize that all members of ACMP are AAPM members.

Summary Recommendations of the Committee to the AAPM and ACMP The ad hoc committee reached consensus and recommends that the following be endorsed or enacted by the respective boards of the AAPM and ACMP.

AAPM and ACMP working closely with sister societies (ACR, ASTRO, etc.) in addressing medical physics clinical practice specific efforts. It is recommended that the boards of both organizations recognize this principle.

Recommended Actions AAPM and ACMP should: • Establish a Joint AAPMACMP Committee on Professional Practice.

1. Its membership would consist of (a) Professional Council Chair and Vice Chair plus two at-large members from AAPM and (b) four members from ACMP. 2. This is a standing committee, making recommendations to Executive Committees of the AAPM and ACMP. 3. The charge of the Joint AAPM-ACMP Committee on Professional Practice is to make recommendations to the respective organizations that (a) coordinate short-term and

•

•

•

• •

• •

long-term professional practice activities of both societies and (b) encourage effective and efficient professional practice-specific activities of both societies.

4. The committee is expected to meet no less than twice annually (e.g. ACMP and AAPM).

Develop a joint business model for a clinical medical physics journal (JACMP).

Organize joint symposia to be held at meetings of AAPM, ACMP, ASTRO, etc.

Arrange adjacent booths at annual meetings of the AAPM and ACMP. Coordinate summer schools and educational programs.

Establish reciprocal liaisons to appropriate committees and subcommittees within ACMP and AAPM. Develop joint documents, where appropriate.

Develop linked or supplemental documents for common areas, when appropriate (e.g. task group reports with practice guidelines). ■

Benefit of Coordinated Joint Effort - it is recognized that there is benefit in the AAPM and ACMP working jointly to ensure coordination of professional aspects of clinical practice. It is recommended that the boards of both organizations adopt this underlying principle.

Increased Coordination with Sister Societies - It is recognized that there is benefit in the

San Diego Skyline Photo by James Blank

13

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

Invitation to AAPM Members John Horton ACMP Chairman Dear AAPM Members, I am writing to extend to all clinical medical physicists an invitation to join the professional society that represents medical physicists in the United States.

Clearly, I feel that the American College of Medical Physics (ACMP) is an important organization, and I hope I can convince you to lend your support not only by joining the society, but also by becoming active in one or more of its many commissions and committees.

First, I would like to dispel some misconceptions that have circulated in our community over the years. Some have the impression that there is an adversarial relationship between the AAPM and ACMP. In fact, nothing could be farther from the truth. All full members of the ACMP are also members of the AAPM. The majority of past presidents of AAPM are currently members of ACMP. As Marty Weinhous, the current AAPM president (and an ACMP Fellow) has often said when referring to the ACMP, “Them are us!” The AAPM and the ACMP are complementary organizations, patterned after the many medical specialties with both professional and scientific societies, e.g. ACR/ RSNA and ACR/ASTRO. If the ACMP is to survive, however, we need to increase our membership – we need you!

Some people have the impression that the ACMP is an “Old Boys Club” that meets at expensive resorts in remote locations to play golf, eat at exclusive restaurants, and reminisce about old times. In fact, this is definitely not the case in today’s ACMP. Several years ago, the ACMP Board of Chancellors explicitly endorsed a policy that every future meeting should be held at an affordable venue, in a city with a major airport that is easily accessible from all parts of the country. As an example, next year’s annual meeting will be held in Phoenix, at a hotel that charges $119 per night. In 2005, our annual meeting will be held in Orlando, at an equally affordable hotel. Every effort is being made to keep meeting costs to a minimum.

In some ways, however, the reputation that ACMP is an “Old Boys Club” may be deserved.

Many of its members are highly accomplished medical physicists (boys and girls) in the “overforty” crowd. Because of the consistent participation and support of these senior medical 14

physicists, ACMP meetings provide a unique opportunity for younger members to network not only with their peers, but also with the “gray eminences” of our profession in a very friendly and relaxed atmosphere.

Why should you join the ACMP? What value will it have to your career and our profession? I believe there are five primary reasons: • You will have the ability to get involved in important professional issues and to make a difference in our future.

• You will have the ability to network with senior medical physicists in the collegial atmosphere that characterizes ACMP meetings.

• You will have the ability to attend meetings and workshops that focus on the practical clinical information you need to do your job.

• You will have the ability to talk with and develop professional relationships with our vendors in a relaxed, less formal atmosphere.

• You will have the prestige and recognition associated with membership in a professional, medical college.

The professional issues that ACMP has addressed in the past and is working on now are far too numerous to list in this article.

However, I encourage you to visit the ACMP’s Web site (See Mower - p. 16)

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

15

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

AAPM NEWSLETTER NEWSLETTER

Mower

JULY/AUGUST 2003 JULY/AUGUST 2003

(from p. 14)

www.acmp.org to have a look at some of the presentations from our 2003 annual meeting, as well as to get a feeling for some of the other ongoing activities of the College.

I hope that you agree that joining the ACMP will be a positive career move for you. Membership applications can be downloaded from the ACMP Web site (www.acmp.org) or obtained from ACMP Headquarters office (address below). Board-certified physicists are eligible for full membership, while non-certified medical physicists are welcomed as provisional members. (Dues are $225 per year, but are not payable until next January.) In addition to joining the professional organization representing medical physicists, I hope you will also give some thought to volunteering to serve on one of our commissions or committees. Our profession sorely needs people who are willing and able to devote some of their valuable time to work that benefits us all individually and collectively. If you have some time, now or in the future, I would appreciate your participation on one of the College’s commissions or committees. Just let me know your preference.

I hope that you decide that it is in your interest to join the College, and I look forward to welcoming you personally at one of our future meetings.

Chapter News Southern California Chapter Gives Norm Baily Awards Steven Goetsch Education Chair

L to R: Chapter President John DeMarco, Stephen Tenn, Martin Janecek, Dan Rubins, and Steve Goetsch

The Ninth Annual Norm Baily Student Awards were given at a Southern California Chapter meeting held in Oceanside, CA on May 8. This year’s winners included Martin Janecek (advisor Ed Hoffman) who gave a talk titled “Developing a Miniature Imaging Probe for Detection of Vulnerable Plaque in the Coronary Arteries.” Stephen Tenn gave a talk titled “Prostate Motion and CTV Expansion” (advisor Nzhde Agazaryan).

The third award winner was Dan Rubins (advisors Simon Cherry and William Melega)

ACMP Headquarters 12100 Sunset Hills Rd, Suite 130 Reston, VA 20190-5202 ■ ph: 703-481-5001

16

whose talk was titled “Development and Evaluation of an Automated Atlas-Based Image Analysis Method of PET Studies of Rat Brain Neurochemistry.” All three students are enrolled in the UCLA Biomedical Physics Graduate Program.

Each student received a certificate from Chapter Presidentelect Ralph Mackintosh and an award of $500. These awards are given in memory of the late Professor Norm Baily of the University of California San Diego. Con■ gratulations to the winners.

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

Announcements Benjamin Archer Inducted as ACR Fellow The following is a press release from the ACR. Reston, VA—May 21, 2003— Benjamin R. Archer, Ph.D., of Houston, Texas has been inducted as a Fellow in the American College of Radiology. The induction took place at a formal convocation ceremony during theACR’s recent annual meeting in Washington, D.C. Archer is affiliated with Baylor University College of Medicine and with Ben Taub General Hospital, both in Houston.

Fellowship is one of the highest honors conferred by the ACR. While all ACR members are expected to maintain high standards,

only about 10 percent of the members are selected for ACR Fellowship. Nominees are considered based on their service to organized medicine, their significant accomplishments in scientific or clinical research in the fields of radiology, radiation oncology or medical physics, their exemplary performance as a teacher and their outstanding reputation among colleagues and the local community. ... #

Dennis Leavitt Receives ACS Sword of Hope Award Kenneth Hogstrom Houston,TX On June 7th I had the pleasure of attending the “History of Hope Gala” in Salt Lake City, Utah. At the event, the Utah American Cancer Society (ACS) honored AAPM Fellow Dennis Leavitt, Ph.D. with its Sword of Hope Award. The Gala, held in the Salt Lake City Library, commemorated the 60th anniversary of the Utah ACS and the 90th anniversary of the national ACS. The award was presented to Dennis in recognition of his contributions to the technology of radiation therapy, which have had a significant im-

recognized by a group such as the ACS. Congratulations to Dennis and his colleagues at the Univer■ sity of Utah!

pact on the treatment of cancer and care of patients. Dennis was specifically recognized for his research accomplishments and clinical contributions to electron arc therapy and the Varian dynamic wedge. It is an honor for both Dennis and our profession to be 17

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler, M.S. Sen. Dir., 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 “Mammography” and then “Frequently Asked Questions.” You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. We are opening a new site and will be accrediting with the ACR. How and when will I receive a Mammography Quality Control Manual?

A. The ACR will send a new facility applying for accreditation one copy of the 1999 ACR Mammography Quality Control Manual with the testing materials after a complete Entry Application and fee is received and processed. You may, however, want to start setting up your QC program before you receive the manual. All of the QC forms in the manual are available from the ACR Web site at http:// www.acr.org/dyna/ ?doc=mammography for printing or downloading.

Q. Under the FDA’s Interim Rules, the ACR Mammography Quality Control Manual was adopted by reference. A mammography facility had to meet the performance criteria in the 1992 or 1994 ACR Mammography

Quality Control Manuals in order to be accredited and meet MQSA standards. Does the ACR now require a facility to meet all of the performance criteria specified in the 1999 ACR Mammography Quality Control Manual in order to pass accreditation?

A. Under the MQSA Final Rules, the ACR cannot require facilities to meet accreditation standards that differ from MQSA regulations. In addition, the ACR Mammography Quality Control Manual is no longer adopted by reference in the FDA Final Rules. That means the new quality control manual is no longer a regulatory document and that it can go back to what it was originally intended to be: a guidance document. The ACR can once again provide guidance on how things should be done for quality improvement as well as to meet MQSA regulations. The 1999 manual clearly differentiates between what is required by the FDA and performance criteria that are ACR recommendations (guidelines). Although facilities must only meet FDA requirements to be accredited, the ACR recommends that facilities consider implementing the ACR guidelines to further improve the quality of their mammography.

Q. How can I access the quality control forms from the 1999 ACR Mammography Quality 18

Control Manual on the ACR Web site?

A. The Technologist’s QC Charts, the Medical Physicist’s Summary Report and Data Recording and Analysis Forms and the MQSA Requirements for Equipment form are available in the accreditation section. The technologist’s forms are in a Word format and the medical physicist’s forms are in Excel.

You must download the files as follows to your own computer (or disk) in order to use them: 1. Right click on the title of the form.

2. Click “save” on the pop-up menu and designate where the file should be downloaded.

Q. Can all technologists contribute to performing QC? A. In a facility where more than one technologist does mammography, one technologist must be assigned the responsibilities of quality control. Other qualified individuals may perform specific QC tests but they must be reviewed and evaluated by the designated QC tech. The designated QC tech is responsible for ensuring that tasks are done properly by standardizing test methodology, reviewing all data, overseeing repeat testing before calling the medical physicist or service personnel, etc. (see page 121 of the manual).

■

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

“The Clinical Advantage”

Dose Calibrators & Thyroid Uptake Systems, designed to fit your needs and budget... from Biodex

BIODEX www.biodex.com

1-800-224-6339 In New York and Int’l, call 631-924-9000

20 Ramsay Road, Shirley, New York, 11967-0702, Tel: 800-224-6339 (In NY and Int’l, call 631-924-9000), Fax: 631-924-9241, Email: sales@biodex.com, www.biodex.com FN: 03-012

19

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

Letters to the Editor Response to “Prostate Cancer for Physicists” Tim Schultheiss Duarte, CA Schultheiss@coh.org The short article entitled “Prostate Cancer for Physicists” by Professor Robert Schulz (1) contains some errors that bear correcting if it is to serve as an educational tool. Furthermore, as I understood the article, Professor Schulz believes that radical prostatectomy (RP) yields superior outcomes to radiation treatment (XRT) for prostate cancer. This opinion seems to be written as if this were an accepted fact. There is some disagreement on this issue, and although it is unlikely that many minds will be changed, I will briefly make the case that the two modalities yield equivalent results.

Disease-specific survival (DSS) and relative survival are not the same thing, but are sometimes confused. Relative survival is in fact determined by dividing the overall survival by the expected survival of an age-matched population. However, because the target population and the agematched population are different, there are inherent biases built into the relative survival that make it an awkward statistic. In prostate cancer, it is not uncommon for the overall survival to be higher than the expected survival of an agematched cohort, yielding a relative of more than 100% (2,3), an

obviously biased result. Generally, to compare a target survival with that of an age-matched cohort, one simply puts both survival plots on the same graph.

DSS is determined by common actuarial methods (usually the product limit method) with only disease-specific deaths being regarded as failures. Other endpoints are censoring events. In other words, the probability of surviving to any time is the product of having survived all time intervals up to that time. The probability of surviving a given interval is the number surviving that interval divided by the number at risk during the interval. Determining the number at risk during the interval is usually what distinguishes specific survival calculation methods.

The Gleason score is the sum of grades of the two most common histologic patterns (primary and secondary) and is not determined by the sum of scores from two pathologists each grading from 1 to 5.

Because of the many possible ways to define being biochemically (by PSA) free of disease (bNED), ASTRO sponsored a consensus conference (4) to settle the issue. According to this conference, a patient fails biochemically upon two rises in PSA following a nadir. It is possible for a patient’s PSA to be rising at the time of death and still have a PSA below the pretreatment level. Any definition of 20

bNED would be arbitrary, and the real problem with biochemical failures (and PSA in general) is that in a given individual, PSA failure is not necessarily a harbinger of a poor clinical outcome.

In referring to the work of Kupelian et al, it was accurately stated that “biochemical failure has not been associated with increased mortality for up to 10 years after initial therapy.” However, an association with overall survival is the most difficult relationship between prognostic variables and outcome measures to prove. Certainly PSA is correlated with disease control, and there is a clear correlation between local failure and development of metastases (5,6). In a multivariate analysis, Kupelian et al reported that the level of significance between PSA failure and overall survival was 0.052— not achieving the most widely accepted level of significance, but sufficiently low to reasonably expect that the association may become significant with more patients or further follow-up. It is likely that PSA is the most effective tumor marker discovered thus far.

There also appears to be some confusion about surgical versus clinical staging. Schulz points out that surgical patients are pathologically staged and states that the “advantage of surgery over irradiation is to some extent an artifact of the staging process,” quoting 10-year DSS for stages

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

T1 and T2 for prostatectomy and irradiation. However, these quoted results both refer to the clinical staging system, as there is no T1 stage in the surgical staging system. The example he gives of a clinical T2b being a pT3 is not a true example of understaging. Understaging occurs when clinical or diagnostic exams are incomplete and the true extent of disease is therefore unappreciated. Therapeutic procedures are not used in clinical staging, but “all available information before the first definitive treatment may be used for clinical staging.” (7) The pathological staging system and the clinical staging system are simply different systems. A clinical T2b tumor which is a pathologically T3 tumor is not “in reality” a T3, it is a T3 by a different measure. Furthermore surgeons generally report their findings by clinical stage precisely so that comparisons can be made. The clinical TNM staging system does not use either the PSA or the Gleason score as is suggested.

Finally, the survival advantage that surgery has over irradiation is generally attributed to the fact that prostatectomy patients are, by definition, fit surgical candidates and therefore less likely to die from certain intercurrent diseases.

A stated disadvantage of radiation treatment is the absence of a pathologically based prognosis.

(Note it is the basis of the prognosis that is being addressed, not the prognosis itself.) Radiation treatment does in fact utilize pathology to determine the progno-

sis. First, it would not be standard of care to treat without a pathologically confirmed diagnosis. Second, proper staging would suggest sextant biopsies to determine tumor extent. Third, there has not been a study that shows that the prognosis is any more accurate after surgery than after radiation. Finally, there is a large body of literature devoted to post RT prognosis based on initial PSA, PSA doubling time, clinical stage, Gleason grade, perineural invasion, lymphovascular space invasion, age, race, ploidy, etc. All of these parameters are part of the disease pathology except age and race.

It is not the accuracy of the prognosis that is the issue, it is the prognosis itself as determined by the treatment.

Professor Schulz implies that the prognosis from surgery is superior to radiation when he states that “moderate dose escalation could reduce but not close the present gap between radiation and surgery.” [The emphasis is his.] Many believe that there is no gap. There cannot be a direct comparison between surgery and radiation in a well-executed clinical trial because of unavoidable selection bias. However, there are reports from single institutions where it was possible to perform a multivariate analysis on cases that included both XRT and RP treatments. In a study of 382 patients treated at William Beaumont Hospital from 1987 through 1994, Martinez et al (8) found only pretreatment PSA and Gleason score to be significantly related to PSA failure on multi21

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

variate analysis; treatment with XRT vs. RP was not significant (p=0.9). Subgroup analysis also failed to reveal a difference between treatment techniques.

Kupelian et al report on nearly 1700 cases from the Cleveland Clinic (9). In this series also, treatment technique was not a statistically significant predictor of outcome (p=0.1). In both the surgery and the radiation literature, one finds that results are improving over time. Furthermore, by selection of reports, either treatment can be shown to be superior. However, the best results from surgery and radiation are comparable. Certainly one must use modern data when comparing the two modalities (10), not 10-year old papers reporting data as much as 30 years old.

It is my belief that improved clinical outcomes as a result of the application of conformal therapy have been convincingly demonstrated for prostate cancer. I also believe that this is a widely held opinion.

It is because the best results from surgery and radiation are comparable that one should seek to be treated by the best possible clinicians using the best techniques. Schulz demonstrates a healthy skepticism of “new technology when there is a dearth of clinical trials that show improved outcomes or, for the prostate, the very limited benefits predicted by the most optimistic scenarios.”

Frankly, I believe that this understates the case for conformal therapy and IMRT. It is remarkable that solely by applying new (See Schultheiss - p. 22)

AAPM NEWSLETTER NEWSLETTER

JULY/AUGUST 2003 JULY/AUGUST 2003

Letters to the Editor Schultheiss

(from p. 21)

technology we have positively impacted outcomes. This is not a new drug or a new form of radiation where some different mode of action changes the mechanism of cell kill. It is simply an improvement in radiation delivery. Because of clear physical considerations, clinical trials were not required to demonstrate the superiority of cobalt over orthovoltage or linacs over cobalt. Although these physical considerations may not directly apply in the case for IMRT, demonstrably superior dose distributions using objective measures are achievable. Why would we question doing a demonstrably better job at what we do?

1. Schulz RJ. 2003. Prostate cancer for physicists. AAPM Newsletter. 28:10-14.

2. Hanks GE, Hanlon AL, Epstein

Response to John Smith’s Letter to the Editor (from the May/June AAPM Newsletter, page 15) Ivan A. Brezovich Birmingham, AL ibrezovich@uabmc.edu On one hand, John points out that he is “lucky to be in a very well-paid profession that [he] enjoys.” He seems happy, and

B, Horwitz EM. Dose response in prostate cancer with 8-12 years’ follow-up. Int J Radiat Oncol Biol Phys 2002; 54:427-35.

3. Zagars GK, Pollack A, von Eschenbach AC. 1996. Prognostic factors for clinically localized prostate cancer. Cancer 79:137080.

4. ASTRO Consensus Panel.

Consensus statement: guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 1997; 37:1035-41.

5. Zagars GK. 1993. The prognostic significance of a single serum prostate-specific antigen value beyond six months after radiation therapy for adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 27:39-45.

6. Zagars GK, von Eschenbach AD, Ayala AG, Schultheiss TE, Sherman NE. 1991. The influence of local control on metastatic dissemination of prostate cancer treated by external beam megavoltage radiation therapy.

Cancer 68:2370-76.

7. American Joint Committee on Cancer. 2002. AJCC Cancer Staging Handbook. Sixth Edition.

Springer, New York. p. 339.

8. Martinez AA, Gonzalez JA, Chung AK, Kestin LL, Balasubramaniam M, Diokno AC, et al. A comparison of external beam radiation therapy versus radical prostatectomy for patients with low risk prostate carcinoma diagnosed, staged, and treated at a single institution. Cancer 2000; 88:425-32.

9. Kupelian PA, Elshaikh M, Reddy CA, Zippe C, Klein EA. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol 2002; 20:3376-85.

10. Zelefsky MJ. 2002. Comparing contemporary surgery to external-beam radiotherapy for clinically localized prostate cancer.

■ J Clin Oncol. 20:3363-4.

that implies that the efforts by AAPM and ACMP on improving the status of medical physicists have, at least in this one case, paid off. On the other hand, John points out that “[his] hospital is reimbursed for [his] services many times what they pay [him].”

He wants a pay raise, and is considering the unpleasant task of changing employers if it is denied.

So he seems less than fully satisfied.

Based on my personal statistics, I believe the majority of medical

physicists share the latter of John’s thoughts. Indeed, in no other industry – not even in other areas of healthcare – do employers reap profits exceeding more than a few percentage points off their employees. If General Motors strived for a several hundred percent return off their $70k+ auto workers, cars would be unaffordable for most Americans.

The current Medicare reimbursement for medical physics services is based on the value of these services in relation to other

22

AAPM NEWSLETTER AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 JULY/AUGUST 2003 JULY/AUGUST 2003

Letters to the Editor medical specialties, e.g. radiology. It is to assure that cancer patients get the very best of care.

An article in the New England Journal of Medicine (Vol. 327:1497-1501, 1992) shows a correlation between survival of cancer patients and the extent of medical physics services received. At a hospital in Ohio, nearly one thousand cancer patients were injured or died due to inadequate medical physics services, despite sufficient reimbursement.

We, as medical professionals, have to accept some of the blame

whenever patients suffer. Changing employers may solve the problems for one individual, but it often happens at the expense of patients, like in the Ohio incident, or of the physicists who are left behind. Establishing medical physics as a profession in its own right seems a better solution.

Medical physicists would then receive a more industry-typical fraction of the money they generate. It would also give them the professional independence and authority to fully apply their skills.

An excellent presentation on how to achieve professional sta-

tus has been given at the recent 2003 ACMP meeting by John B. Barsotti, MD, MBA, a radiologist turned businessman. It can be downloaded from the ACMP Web site (you don’t have to be a member) by clicking http:// www.acmp.org. Meetings (left hand side of screen), Practice Paradigms in Medical Physics.

My presentation, “Medical Physics Profession,” given at the same meeting, can be downloaded in Word or in PowerPoint format.

■

Licensing of Medical Physicists

continuing education, which insure that medical physicists are competent to practice. The AAPM Policy 2B is due for renewal this year. So now is a good time to review the reasons that licensure might be appropriate.

People usually list protection of the public, improved compensation, and independent billing as reasons for the licensing of medical physicists. Protection of the public is the only argument that I find compelling, but I find it very compelling. Medical physics demands a high level of skill and, because of its technical nature, medical physics competency is difficult for non-medical physicist peers to evaluate. Our physician colleagues frequently lack the technical knowledge to properly judge the quality of our work.

Thus, to assure the protection of the public, the states must provide that only qualified individuals practice medical physics.

I would urge everyone to read AAPM Policy 2B which is the position paper on licensure for medical physicists. This policy quotes the American Medical Association: “A health profession or occupation should be licensed if the practice of that profession or occupation by persons who have not shown themselves to be competent and qualified to deliver healthcare services and would pose a risk to the life, health, or safety of the public.”

And further the policy quotes the American College of Radiology: “The medical well-being of patients, as well as the health, safety

G. Donald Frey Charleston, SC freyd@musc.edu There has been considerable discussion of the licensing of medical physicists both in this newsletter and on the Medical Physics List Server. Most of the discussion was generated by the passage of a licensure law in New York. The AAPM has supported the concept of licensure for some time both through AAPM Policy 2B and by allocating funds for the support of this effort. The AAPM Board saw the support of licensure as one of the tools, along with Board certification, peer review, and

(See Frey - p. 24)

23

AAPM NEWSLETTER

JULY/AUGUST 2003

Announcements

Letters to the Editor Frey

(from p. 23)

and welfare of the public are potentially impacted by measurements, calculations, and adjustments concerning nuclear medicine, diagnostic and therapeutic radiology equipment by medical radiological physicists.�

I would also like to mention that while board certification provides a measure of competency in medical physics and the time-limited board certificates provide a measure of continuing competence, neither of these mechanisms provide an easy way to eliminate medical physicists when

matters of fraud, substance abuse, or unethical behavior are involved.

I personally support the renewal of AAPM 2B. I would again encourage each of you to read the policy and hope you also would support the extension. â–

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: September/October 2003 Postmark Date: September 15 Deadline: August 15, 2003 AMERICAN ASSOCIATES OF PHYSICISTS IN MEDICINE

One Physics Ellipse College Park, Maryland 20740-3846 (301)209-3350 Phone (301)209-0862 Fax e-mail: aapm@aapm.org http://www.aapm.org

24