AAPM Newsletter September/October 2003 Vol. 28 No. 5

Newsletter

American Association Of Physicists In Medicine VOLUME 28 NO. 5

SEPTEMBER/OCTOBER 2003

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

Follow-ups In my last column I raised two very important issues. The first was in regard to the ACMP and the second in regard to the forthcoming AAPM/NCRP shielding reports.

Follow-up, ACMP

Catching Up Like many of you, I’ve just returned from the very successful AAPM Meeting in San Diego.

This newsletter’s submission deadline, August 15th, overlapped with the end of the meeting. OK, I am submitting a bit late and thus this will be a very brief report. . .

Credits AAPM’s Headquarters staff, Meeting Coordination Committee members, and Local Arrangements Committee members are all to be congratulated for the quality of the meeting and for the smoothness with which it operated. They even arranged for wonderful weather.

The time has come for medical physicists to each, individually, make their own decision about joining the ACMP. Fencesitting only delays strategic planning for both the ACMP and AAPM. So, once again, learn what the ACMP might mean to you and join, or not, but at least make and act upon your decision.

Clinical Trials Update: Report from the Subcommittee on QA of Clinical Trials The RTOG H-0022 Protocol Geoffrey S. Ibbott Subcommittee Chair Most medical physicists are aware that the National Cancer Institute sponsors clinical trials that are conducted by cooperative clinical study groups. However, many medical physicists are unaware of how pervasive such trials are, and whether or not their institutions participate in such trials. The chances are they do, as (See Ibbott - p. 3)

Follow-up, NCRP Progress has been made with the NCRP and we may have a resolution to the quartering issue.

That is, the NCRP is in the process of approving language to appear in both of the joint shielding reports that would state that the annual effective dose limit for the general public exposed around medical facilities shall be 1 mSv. (That shielding shall be designed to achieve 1 mSv.) Further there will be no mention of quartering of that limit, i.e. of us(See Weinhous - p. 3)

TABLE OF CONTENTS Summer School Exec. Dir’s. Column Gov’t. Affairs Column CARE Bill CLA Subcomm. Rep. Chapter News Announcements Memorial Members List Mammography FAQs Letters to the Editor

p 5 p 6 p 7 p 8 p 10 p 12 p 14 p 15 p 16 p 18 p 20

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Weinhous

(from p. 1)

ing 0.25 mSv. While this compromise is not yet concluded (the NCRP must use their internal processes to approve the text), indications are that they will approve.

Said approval will open the door to further cooperation between the AAPM and the NCRP.

Next Year’s ExCom and Board AAPM’s election results were announced at our annual business meeting in San Diego. The following individuals will take office on January 1, 2004:

Howard Amols President-elect Maryellen Geiger Treasurer Robin Miller David Pickens Beth Schuler James Seibert Board Members

and our annual budget is about 5.5 million dollars. We intend to preserve our strengths by assuring that we are appropriately sized for our needs and goals.

State of the Profession While the state of the profession is also strong, there is widespread agreement that we must recruit new practitioners. Modest attempts to reach and mentor “youngsters” have been executed by our Regional Organizations Committee and by having an Educators’ Day at the Annual Meeting. Neither has yet been as fruitful as we had hoped. ExCom is presently considering additional outreach efforts to interest potential medical physicists. More on this topic will follow.

In Conclusion 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. Till ■ next time…

Congratulations to each and all.

State of the Association The AAPM continues to be strong scientifically, professionally, and financially. We seem to be meeting the needs and requests of our members, but have had to grow to do so. Our present HQ staff is twenty strong

Ibbott

(from p. 1)

according to the RPC records, approximately 1,300 radiation therapy facilities in the US participate in cooperative group clinical trials.

Study groups funded by the National Cancer Institute conduct such multi-institutional clinical trials. There are about a dozen study groups that conduct trials involving radiation; a list of the groups and links to their Web pages may be found on the RPC Web page at http:// rpc.mdanderson.org. Of these, the group best known to medical physicists is the Radiation Therapy Oncology Group (RTOG), because it conducts a large number of trials involving radiation, and membership in the RTOG requires a fair amount of work by the physicist.

The purpose of this column is to call to the attention of medical physicists recent developments involving study groups and their protocols. The focus is on issues of importance to medical physicists, with the hope that physicists will be able to use the advice presented here to facilitate their work in the clinic.

A number of current clinical trials involve high-technology radiation therapy. These trials generally require the involvement of medical physicists for credentialing or pre-approval activities prior to submitting patients, as well as in the preparation of patients for treatment on the protocol.

The RTOG H-0022 protocol is one such trial. This is a phase I/II (See Ibbott - p. 4)

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study of conformal and intensitymodulated irradiation for oropharyngeal cancer. Patients may be treated with conformal or intensity-modulated radiation therapy.

This moderate-sized study will require a sample of 64 patients who will be treated to the primary tumor, lymph node metastases, and lymph nodes at risk of metastases. Organs at risk, including the major salivary glands, are to be avoided. The protocol can be downloaded from the RTOG Web site, http://rtog.org. Before an institution can submit patients treated with IMRT, the institution must be credentialed by the Advanced Technology Consortium (ATC).* This is a three-step process that requires the institution to 1) complete and submit a facility questionnaire describing their equipment and procedures; 2) demonstrate the ability to submit treatment plan data digitally to the ATC; and 3) demonstrate their ability to plan and deliver an IMRT treatment to an anthropomorphic phantom obtained from the Radiological Physics Center (RPC). This phantom is shipped to the institution, which conducts imaging procedures and prepares a treatment plan. The phantom is then set up on the megavoltage treatment unit and the IMRT treatment is delivered according to the plan. The phantom is returned to the RPC where the dosimeters are removed and analyzed to evaluate the conformation of the dose delivery with the treatment plan.

The protocol requires that ICRU terminology be used in

defining patient target volumes.

Unlike many other treatment protocols, the dose is prescribed to a volume rather than a point. The prescription isodose is the isodose surface that encompasses at least 95% of the PTV. No more than 20% of the PTV may receive greater than 110% of the prescribed dose. No more than 1% of the PTV may receive less than 93% of the prescribed dose.

And no more than 1% or 1cm3 of the tissue outside the PTVs may receive greater than 110% of the dose prescribed to the primary PTV. The primary PTV, encompassing the gross tumor and lymph node metastases, is to receive 66 Gy, and is therefore known as PTV66. Lymph nodes at high risk are designated PTV60 (and receive 60 Gy) and subclinical disease is identified as PTV54 (which will receive 54 Gy). All doses are to be delivered in 30 fractions.

The dose to certain critical normal structures must be kept below specific levels. These include the parotid glands, the larynx, the brain stem, the spinal cord, and the mandible. More specifically, 2/3 of the glottic larynx must receive less than 50 Gy, while the maximum doses to the brainstem, spinal cord and mandible are 54 Gy, 45 Gy and 70 Gy respectively. In addition, the mean dose to either parotid must be below 26 Gy. Alternatively, 50% of the volume of either parotid must receive less than 30 Gy. And 20 cm3 of parotid tissue must be less than 20 Gy. The dose to the submandibular glands and the oral cavity must be kept as low as 4

possible. Similar dose constraints for the other organs at risk are provided by the protocol.

The protocol also defines planning priorities. Critical normal structure constraints are the most important planning priorities followed by the prescription goals, then the salivary gland limits.

Several other protocols involving advanced technology or otherwise of interest to physicists have opened recently or will open soon. These will be addressed in future newsletters. *The Advanced Technology Consortium was established and funded by the NCI to support the use of advanced technologies in clinical trials. It is composed of five entities, of which three are QA offices: the Radiological Physics Center (RPC), the Quality Assurance Resource Center (QARC), and the Radiation Therapy Oncology Group’s QA Office (RTOG). These groups communicate directly with the study groups. There are also two centers: the Image-Guided Therapy QA Center (ITC) and the Resource Center for Emerging Technologies (RCET) whose role is to develop and disseminate techniques for electronic submission and review of data related to clinical trials. Details may be found at the consortium Web site: http://atc.wustl.edu, or at the individual member Web sites: http://rpc.mdanderson.org, http://www.qarc.org, http:// www.rtog.org, http://rcet. health.ufl.edu, or http://itc. wustl.edu. â–

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Summer School Robin Miller Local Arrangements Task Force As you are all aware, the AAPM is primarily a volunteer organization run by both the Headquarters staff and by some extraordinarily dedicated members. At this year’s Summer School on IMRT, I was able to witness the collective effort and commitment of some of our members.

Rock Mackie and Jatinder Palta did a superb job as scientific program directors, drawing what very well may be the largest scientific attendance ever. All of the scientific sessions, as well as the evening sessions, were at near capacity despite the temptations of the beautiful Colorado mountains.

Nancy Vazquez, Shantelle Corado, and Angela Keyser

Some of the Summer School faculty gather on the beautiful campus of Colorado College.

kept things on track at AAPM Headquarters.

I am indebted to several of our members and their families for their non-stop energy and assistance. This Summer School could not have been possible without their generous efforts.

I’d like to give a special thanks to the Summer School Co-chairs Jerry White and Chris Dennett. The flawless execution

Summer School Local Arrangements Committee

of the talks and announcements was due to the efforts of Gregg and Josh Gibbs. Cathy White, Michele Dennett and Rene Gibbs kindly offered the hospitality for the companion’s suite.

The nuts and bolts of running around, gophering, chauffeuring and just doing whatever needed to be done can be attributed to: Mike Bailey, Lori Bergland, Gyongyver (Jennifer) Bulz, Rata Clark, Tim Davis, Gwen Henze, Kerri Hillers, Hal McDonough, Rich McKeown, Leslie RikerManros, Dan and Rita Marvel, Shawn Meyer, Marleen Moore, Jason Senn, Sherrie Wilson and Rebecca White. I also owe recognition to several folks from the Summer School Subcommittee: Sherry Connors, Will Parker and Peggy Blackwood. It is due to all your efforts that this school was a tremendous success.

Many thanks and then some— ■

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Executive Director’s Column Sal Trofi College Park, MD I am writing this column while in San Diego attending the AAPM Annual Meeting and prior to the AAPM Board Meeting.

The Annual Meeting is taking place about three weeks later than usual and the deadline for submitting this newsletter column has arrived. Scientific, exhibitor and guest attendance was greater than anticipated by over 500 registrants. Exhibit booth equivalents sold this year were about 11% greater than anticipated. The scientific, business, and social events are running smoothly. This is a testament to the hard work and commitment to excellence of the AAPM staff and the Local Arrangements Committee. This will be my last AAPM Annual Meeting as executive director; I must say that the outcome of this meeting could not be more gratifying.

At the Finance Committee Meeting the treasurer, Melissa Martin, reported that the 2002year financial audit was complete and no deficiencies were reported. The audit result indicated a net gain from operations of $272,477, but investment results from equity holdings were a loss of $379,320. The total financial result for 2002 was a deficit of $106,843. The AAPM reserves at the end of 2002 were $3,504,907. This is also very gratifying to me because at the end of 1993 (when the current

staff began), the reserve balance was $564,341.

Looking forward to the financial situation for 2003, it is apparent that we will have a net gain in operating funds. The extent of the gain cannot be predicted accurately at this time, but about $200,000 is likely. The finances of AAPM are definitely on an upswing: membership is up, the Placement Service has a record number of job offerings, Annual Meeting registrations and exhibit space sales are up, the Summer School had a greater than expected attendance, the Medical Physics Journal net of revenue and expense will be positive, and if the stock market continues its slow upward trend, it is possible that the value of the reserve funds will increase substantially.

As I reported in my last column, I will retire at the end of this year.

I also reported that I was following a transition plan approved by the AAPM Board, and that the reorganization phase of staff and office space was completed. We are now in the implementation 6

phase. I have been working closely with Cecilia Balazs, director of Finance and Administration, to pass on the routines of financial estimating and reporting to which the AAPM EXCOM and FINCOM are accustomed.

Cecilia is in attendance at the Annual Meeting to experience how the AAPM committees function.

At the office we have been reviewing a host of financial and administrative activities, such as, the budget process, insurance coverage, statistical reporting, etc. Angela Keyser is working closely with Karen MacFarland, meetings manager, to train her on how we organize our Annual Meeting. Karen is also in attendance at the San Diego meeting.

I am very glad to report that the whole staff is working together to make my transition into retirement and Angela’s ascent to the position of executive director a smooth and successful one. For this I am very grateful, but what else would I expect from such an outstanding and dedicated staff?

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Government Affairs Column Angela L. Lee College Park, MD Several people at the Annual Meeting asked me what I do for the AAPM. In this article, I will explain my role and the agencies, congressional committees and other associations that I work with in the Washington, D.C. area.

My core responsibilities are to: work with AAPM members to develop and advance a strategic agenda, track policy developments and keep members informed of current political events through newsletter articles and e-mails. Also, I provide educational information and serve as a liaison to congressional committees, federal agencies and nongovernment organizations, especially affiliated groups.

With the help of AAPM members and others, I have developed a strategic plan, which serves as a guideline for my job. I monitor the Federal Register daily to evaluate federal agencies, and I monitor the Congressional Record daily to evaluate the events of Congress. In order to make sure medical physics is represented, I attend many meetings and hearings on behalf of the AAPM. I work closely with related associations to coordinate our efforts as much as possible. I also research state issues, as assigned.

I monitor and interact with multiple government agencies. Here are some of the agencies that are

relevant to the AAPM: The Centers for Medicare and Medicaid Services (CMS) is the new name for the Health Care Financing Administration (HCFA). To help ensure appropriate reimbursement for medical physicists, I interact with CMS and track the Hospital Outpatient Prospective Payment System (OPPS) and other reimbursement mechanisms. I also track the suggested changes by the Advisory Panel on Ambulatory Payment Codes and how new technologies are reimbursed.

In order to discover which new devices have been approved and the status of safety regulations, I monitor the Food and Drug Administration (FDA), and the Centers for Devices and Radiological Health (CDRH). Some of the technologies I follow are: fluoroscopy, CT and IVBT. I monitor two agencies within the National Institutes of Health: the National Cancer Institute (NCI) and the National Institute of Biomedical Imaging and Bioengineering (NIBIB). It is very important to monitor the appro7

priations process in order to evaluate funding levels at the NIH. This funding may pay for the general operation of the NIH or for potential grants to AAPM members.

I review Nuclear Regulatory Commission proposed and final rules. To ensure that the NRC has sensible training and experience requirements, and to emphasize the importance of board certification of medical physicists, I attend NRC meetings. The Advisory Committee on the Medical Use of Isotopes (ACMUI), which has two medical physicist members, has similar goals.

To ensure that medical physics is represented, I interact with Congress. One way that I monitor Congress is by reading the Congressional Record daily and tracking relevant legislation. I organize a yearly Capitol Hill meeting, create legislative summaries and “leave behind” materials.

Here are some of the Congressional committees that I monitor: Appropriations subcommittees (4 of 13) in the House and Senate; Senate Committee on Health, Education, Labor and Pensions; Two subcommittees of the House Committee on Energy and Commerce; and the Committee on Ways and Means, Subcommittee on Health.

I also often coordinate with other non-government organizations such as the Academy of Radiology Research (which deals exclusively with the NIBIB), the (See Gov’t Affairs - p. 8)

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Time to Support the CARE Bill

American College of Radiology, the American Society for Therapeutic Radiology and Oncology, the Health Physics Society, and the Society of Nuclear Medicine.

If you have any questions about my job or need information on the topics that I have discussed, please contact me at angie@aapm.org.

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David J. Keys AAPM Liaison to the Alliance for Quality Medical Imaging and Radiation Therapy For the first time, we have both a House and a Senate version of the CARE Bill submitted to Congress. On June 5, 2003, Senator

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Enzi (R, WY) introduced the Senate version (S.1197) of the Consumer Assurance of Radiologic Excellence, RadCARE, Act. He was joined by Senators Kennedy (D, MA), Daschle (D, SD), Lautenberg (D, NJ), and Dorgan.(D, ND). Previously on March 11, 2003, Heather Wilson, (R, NM) with 16 cosponsors, had reintroduced the House version of the bill (H.R.1214).

The bills amend the ConsumerPatient Radiation Health and Safety Act, enacted as Part F of Title III of the Public Health Services Act (42 U.S.C. 262 et seq.).

Why is this Important?

In 1981, the Congress, realizing the importance of establishing a national standard for training of Radiologic Personnel, passed the Consumer-Patient Radiation Health and Safety Act. This act provided the states with standards for the certification and education of radiologic personnel, and also with a model statute for licensure. This act suffered from two major flaws.

The first flaw is that the act failed to see the dramatic developments which already were ongoing. Radiation therapy centers had already been moving out of the university and into community and private settings. Physicists and dosimetrists were becoming essential members of radiation therapy departments. Fewer and fewer radiologic technologists were being cross-trained in

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nuclear medicine and radiation therapy. Even within diagnostic radiology, there has been further specialization, requiring specific training in nuclear medicine, magnetic resonance imaging, mammographic imaging, and CT scanning. Other specialties, such as cardiovascular imaging and interventional radiology, also require individuals with specific training and experience.

An even greater flaw is that the act failed to have any means of enforcement. As currently written, the act is voluntary. Not surprising, only 35 states have implemented licensure laws for radiologic technologists and radiation therapists. Twenty-four states license nuclear medicine technologists. Eight regulate medical physicists (four by license, four require certification or other training). No states license medical dosimetrists or cardiovascular technologists. Self-imposed standards of care have resulted in most facilities employing qualified individuals. However, there are definite cracks in the process.

At a time where shortages in medical personnel are rampant, the temptation to use less than qualified individuals becomes that much greater.

What does the bill require?

Neither the Senate bill nor the House bill requires licensure. The House bill does require the states to establish a “radiation license,� however this license may be a license, certificate, or other document defined by the state. That option will be a state choice. The Senate version has no require-

ment for licensing at all. However, both bills require that individuals involved in the medical imaging (excluding ultrasound) and radiation therapy meet federal standards of education and training.

The wording of the bill is such that those physicists performing clinical duties in radiation oncology, in diagnostic imaging, including MR and including consultants performing patient dose measurements, and in nuclear medicine, will be required to meet the federal training and experience requirements. Standards will be promulgated within 18 months after passage of the bill. The standards being proposed include certification by the ABR or the ABMP as a method of meeting the standard. The education requirements are to be taken from the recent AAPM Report 79.

There will be a further interim time allotted each of the professions in order to ensure that the professions have the T&E programs in place. Grandfathering will also be included.

What are the benefits/drawbacks?

The obvious benefit to society is that individuals undergoing medical imaging and radiation therapy treatments will be reasonably assured that the individuals involved in their care have attained at least a minimum level of training and experience. The education and training in our own profession of medical physics is quite varied. Voluntary certification has improved the consistency in training and experience of individuals, but not all individuals 9

are certified, and some do not even belong to the AAPM. While there is never a guaranty of competence, it will be comforting to know that Uncle Bill in Whosville, USA is receiving care by trained individuals.

There is also a direct benefit to AAPM members. To be a true profession, we need to have required established standards of training and experience. Our work is not simple and straightforward. Even in the most routine of measurements and calculations, there are occasional nuances which must be addressed in order to provide a good quality of care. Mistakes made by unqualified personnel, even in other states, can affect your practice, your livelihood. Not only will we benefit by knowing that our fellow physicists have obtained sufficient training and experience, but that our coworkers (X-ray techs, radiation therapists, dosimetrists, etc.) will also be better, more consistently trained.

Drawbacks? Any additional paperwork is always a drawback. Additional fees, if any, could be a drawback. New York’s licensure, for example, has resulted in higher than anticipated fees. I believe, however, that in the long run the financial benefit will outweigh the relatively small fee. Shortages due to a lack of qualified personnel could be an issue, but we have shortages now.

Do you really want the guy on the street to enter the profession unsupervised with limited T&E? The benefit to society and our pro(See CARE Bill - p. 10)

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fession as a whole, I believe, outweighs the limited drawbacks.

It is time to make medical physics a true profession recognized by all states.

How can I help?

This is the time to write/call your congressman and senators. Tell them that you support the bill. Ask them to cosponsor the bill, if they have not already done so. Sample letters can be downloaded from the AAPM Web site. â–

Calibration Laboratory Accreditation Subcommittee Report Changes in NIST Primary Standards for Air-kerma, on the Response of the Accredited Dosimetry Calibration Laboratories (ADCLs) and the Impact on Clinical Practice M. Saiful Huq (CLA Subcommittee Chair), Larry A. DeWerd (University of Wisconsin ADCL), Geoffrey S. Ibbott (Radiological Physics Center), Stephen M. Seltzer (NIST) The consensus at the international level is that Monte Carlo calculated values of kwall for graphite-walled cavity-ionization chambers are more accurate than the linear extrapolation technique that has been used for establish-

ing primary air-kerma standards in 60Co and 137Cs gamma-ray beams. As a consequence, the primary standards laboratories around the world are revising their standards for air-kerma by incorporating Monte Carlo calculated values of kwall for graphite-walled air-ionization chambers. NIST has done extensive Monte Carlo calculations of kwall for its inventory of graphitewalled cavity-ionization chambers. The results show that the US standards for the air-kerma

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rate from gamma-ray beams should be revised.

The last revision of NIST airkerma standards was in 1986 when the 60Co values were adjusted by –1.1% and the 137 Cs value was adjusted by –0.8%.

Effective July 1, 2003, NIST has revised its primary standards for 60 Co and 137 Cs gamma-ray beams to implement Monte Carlo calculated values of kwall. This revision consists of increasing the air-kerma standard for 60Co by about 1% and that for 137Cs gamma-ray beam by 0.9%. Effective January 1, 2003 NIST has also revised its air-kerma standards for 90Sr ophthalmic applicators, and conventional (W-anode) x-ray beam qualities. The standard for the 250 kVp beam has changed by +0.25%. This means that the standard for HDR – 192Ir will change by about 0.5%. Calibration coefficients and calibration factors reported prior to July 1, 2003 for instruments sent to NIST for calibration in these beams should be modified or redetermined to account for these changes.

The ADCLs maintain high-quality secondary standards that have NIST traceable calibration factors. They use these secondary standards to establish air-kerma standards in their own beams.

Since the NIST standards for airkerma rate have increased by about 1%, then the secondary standards of the ADCLs will also increase by the same amount.

However, because of existing small variations amongst the ADCLs, the change at an individual ADCL may be different from this nominal 1%. The

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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

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ADCLs are in the process of revising their standards for airkerma and will disseminate the revised standards to their customers effective October 1, 2003. The users should contact the ADCLs to get more information about changes of calibration coefficients of their ionization chambers.

The Radiation Interactions and Dosimetry Group of the NIST Ionizing Radiation Division has made a change in its terminology for calibration and special test reports pertaining to photon and electron dosimetry. This change in terminology is in effect as of May 1, 2002. The proposed changes are based on recommendations in ISO 31-0 (1992) that have been followed for some 11

years now by a number of other international organizations.

In this revised terminology, the calibration quantity is defined as the conventional true value of the quantity the instrument is intended to measure, divided by the instrument’s reading; this calibration ratio is termed a coefficient if it has dimensions, or a factor if it is dimensionless. The ADCLs have chosen to adopt the term “coefficient” for all calibrations.

This change should provide improved clarity in the calibration reports. It is emphasized that the “calibration factor” as defined in the AAPM TG-51 protocol is the same as “calibration coefficient” according to the new terminology.

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Chapter News North Central Randell Kruger Chapter President-elect The fall meeting of the NCCAAPM is scheduled for Friday, September 26, in the Froekle Conference Center of the Laird Building, Marshfield Clinic, Marshfield, WI. Please visit the NCCAAPM Web page ( w w w. d r a d . u m n . e d u / NCCAAPM/) for meeting details and agenda. The highlights of this meeting include: several invited speakers, PACS equipment tours, full field digital mammography equipment tours, Gamma Knife equipment tours, and several interesting presentations.

CAMPEP MPCEC hours have been applied for the attend■ ees of this meeting.

vious performances, I predict that Dr. Cameron will entertain us with a very interesting and thoughtprovoking talk. Several students and faculty will also make presentations on a variety of topics.

Non-chapter members are welcome to attend. For more information, please contact Ken Hoffmann, (kh9@acsu.buffalo. edu), chapter secretary.

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New England Eileen Cirino Chapter President Based on a recommendation from our AAPM Board representative, Bob Zimmerman, the New England Chapter is sponsoring two physicists from developing countries through the AAPM Partners in Physics Program:

Mr. Marin Bodale from Isasi, Romania and Ms. Diana Feld from Buenos Aires, Argentina.

In June of this year, the chapter received a letter of request from one of our members, Robert Zamenhof. As we announced our sponsorship through PIP, Ms. Feld was in Argentina trying to raise funds for a trip to the Boston area partially supported by the US DOE as a part of its Sister Laboratory Program in the Peaceful Uses of Nuclear Energy. According to Robert, the purpose of the trip was “to learn more about the clinical implementation of BNCT, which the Argentinean team is about to implement.” Ms. Feld was coming to Boston to work with Dr. Zamenhof in treating a patient at the MIT Nuclear Reactor.

The New England Chapter executive committee voted to provide Ms. Feld with a $500 travel grant to support her trip.

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Upstate New York Matthew Podgorsak Chapter President The Upstate New York Chapter of the AAPM will be holding its annual fall meeting in Rochester, NY on October 24. At the meeting, John Cameron will be presented with our chapter’s highest honor – the annual Lifetime Achievement in Medical Physics award. Based on pre-

On behalf of the New England Chapter, Robert Zamenhof presented a $500 travel grant to Diana Feld from Buenos Aires, Argentina.

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Chapter News New England Peter Biggs Chapter Member The New England Chapter held its summer meeting entitled “A Potpourri of Innovative Clinical Practice and Research” on Friday, June 6th at the Radisson Hotel in historic Plymouth, MA. A total of 74 chapter members, graduate students, vendors and others attended the meeting. Vendors from 12 companies demonstrated their products at the meeting.

The all-day program consisted of 10 talks, which, as the title implies, covered the whole range of medical physics. In addition to the range and depth of talks by local speakers, the program greatly benefited from the expertise of five outside faculty members.

On the diagnostic side, Martin Yaffe from Toronto gave a comprehensive report on the current status of and the research activity in digital mammography. This was followed up by a talk by Kathryn Held (Massachussetts General Hospital) on the question of the effective dose in mammography and possible RBE. David Boas (MGH) spoke on developments in the field of optical tomography and its potential application to breast and brain imaging. Finally, Elizabeth Rafferty (MGH) presented extensive clinical results that dem-

Former NEAAPM President Martin Fraser and current NEAAPMPresident Eileen Cirino enjoying a break in the meeting.

onstrated the clear benefits of tomosynthesis in breast imaging.

On the nuclear medicine side, Roberto Accorsi (Children’s Hospital of Philadelphia) and Dawid Schellingerhout (MGH) discussed the principal and application of coded apertures to small animal imaging and its potential application in the clinic.

As a break from physics and clinical topics, Jim Hugh (AMAC consulting, GA) discussed the complex topic of reimbursement issues. Mr. Hugh showed himself to be well versed on the latest codes for radiation therapy, particularly in the area of IMRT where the reimbursement requirements are very detailed.

Therapy presentations included a talk by Nancy Lee (Memorial

Sloan Kettering Cancer Center) on IMRT for head and neck cancer. She covered all the physics and clinical aspects of IMRT and included an analysis of the results achieved to date, based on her experience while at the University of California, San Francisco.

Katja Langen (UCSF) compared two methods for daily prostate localization; implanted seeds, considered the “gold standard,” and a commercial ultrasound technique. Eike Rietzel (MGH) wrapped up the meeting with an update on the development of 4D computed tomography.

This meeting was approved by CAMPEP for five hours of credits; it was also approved for one hour of credit by the MDCB. ■

Three of the speakers at the recent New England chapter meeting: from l to r, David Boas (MGH), Martin Yaffe (Toronto) and Jim Hugh (AMAC consulting, GA)

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AAPM NEWSLETTER AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2003 SEPTEMBER/OCTOBER 2003

Announcements CIRMS 2003 Annual Meeting Oct. 27–29, 2003 The 12th Annual Meeting of the Council on Ionizing Radiation Measurements and Standards (CIRMS) will focus on radiation and radioactivity measurements and standards in industry. In the past twelve years, CIRMS has played an important role in serving as a public forum for discussion of radiation measurements and standards issues. Plenary pre-

sentations will address computational methods in dosimetry, standards required for homeland security, and special standards needs in medicine. The technical program will include oral and poster presentations and four parallel workshops that address the following topics: •Medical Applications (diagnostic and therapeutic radiology, nuclear medicine) •Homeland Security (environmental dosimetry, threat detection, first response)

•Radiation Protection (personnel dosimetry, electronic dosimeters, radiochemistry, waste analysis, bioassay, and environmental and internal dosimetry) •Industrial Applications and Materials Effects (dosimetry for radiation processing, radiobiology, safety at radiation facilities) Information is available at www.cirms.org or knardi@ cirms.org ■

Application Deadline for Certification in Medical Health Physics K. David Steidley MHP Panel Chair Those physicists practicing in the field of medical health physics may well wish to achieve certification by the American Board of Medical Physics (ABMP) in the subspecialty of Medical Health Physics (MHP). The certification consists of a three-part testing process after certain eligibility requirements have been met. Part I may be taken at any time with no prior working experience. Part I is a written, multiple choice question test. Recent graduates are strongly advised to take this examination as soon as possible. The ABMP will waive the Part I (General Medical Phys-

ics) exam requirement for physicists who have passed Part I of the ABHP, ABR or the Canadian College of Physics in Medicine (CCPM), or who are already certified by the ABMP, ABR, the CCPM or the ABHP. Prior to taking Parts II or III, candidates must have obtained a minimum of one to six years experience, depending on graduate degree and residency (see table).

The experience as a MHP must be obtained as a provider of services in a health care facility.

Part II is similar to Part I but tests the candidate in the specialty of medical health physics. It is possible to take Part I and II at the same sitting. The next scheduled examination is during the

14

Annual Meeting of the AAPM in Pittsburgh in July 2004. Part III is an oral examination of approximately two hours duration conducted by a multimember panel to determine the candidate’s knowledge and fitness to practice clinical medical physics in the arena of MHP. Additional information on the certification process may be obtained at www.acmp.org/ABMP. Since fees and reference letters are involved in the application process, the final medium of the work must be paper and, as such, must reach the ABMP before January 15, 2004. For an application form or to answer any procedural questions, please call our administrative staff at (309)

AAPM AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY2003 2001 AAPM NEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER 2003

343-1202. For professional questions, please communicate with the present panel chair, K. David Steidley, Ph.D. at dsteidley@sbhcs.com. Good luck to all!

Memorial S. V. Parthasarathy

Professional Experience Requirements Highest Degree

MS MS (medical physics) MS (medical physics, accredited) PhD PhD (medical physics) PhD (medical physics, accredited) MS (accredited, clinical residency) PhD (accredited, clinical residency)

Exp. Req. for Part II (Years)

Exp. Req. for Part III (Years)

4 2

6 4

1

3

2 1

4 3

1

2

0

1

0

1

Mary Louise Meurk, Bhaskaran Pillai and T.S.Subramanian

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S. V. Parthasarathy died suddenly on May 24, 2003 from complications following surgery. He received his bachelor’s degree in physics, chemistry and mathematics in Bangalore, India in 1957. In 1970 he obtained his master’s degree in radiological sciences from the University of Kansas.

Prior to immigrating to the US in 1968, Partha was instrumental in starting a national radiation monitoring program using film badges for workers in India.

After he received his master’s degree, Partha worked for several years at the Research Hospital and Medical Center in Kansas City. He then moved to work for the West Coast Cancer Foundation in San Francisco in 1975. He was certified by the American Board of Radiology in radiological physics in 1978. As a member of the WCCF he provided comprehensive radiological physics services to many client hospitals and freestanding centers in Northern California. He was also a consistent teacher of radiological physics to residents in radiation oncology and dosimetry trainees. He also served as the director of WCCF from 1990 to 2001 following the retirement of Mary Louise Meurk.

Partha was active in many professional societies, including the American Association of Physicists in Medicine, the Health Physics Society, the International Radiation Protection Association and the Association of Medical Physicists of India and the Indo-American Society of Medical Physicists, both of which he helped come into being.

Partha was one of the most caring and thoughtful of men, loyal and kind, and a true gentleman. He will be missed. ■ 15

AAPM NEWSLETTER AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2003 SEPTEMBER/OCTOBER 2003

Change of Status and NewMembers The following is a list of ‘Change of Status’ and ‘New Members’ from April through July, 2003. Prior newsletter lists combined both categories as ‘New Members.’ We hope this distinction is more informative.

CHANGE OF STATUS Corresponding Tosiaki Miyati Kanazawa, JAPAN Full Ergun E Ahunbay Dallas, TX Francois DeBlois Montreal, QC, CANADA Jacqueline Esthappan St. Louis, MO Marvin J Glass Vacaville, CA Jennifer B Smilowitz Waukesha, WI Bronislawa E Wieckowska San Antonio, TX Claus C L Yang Sacramento, CA Qingyun Zhang Washington, DC Junior David K Chamberlain Reno, NV Jeremy F Cole Boynton Beach, FL Katie L Darner Bellflower, CA Chris R Hagness Rochester, MN Harjinder Singh Khaira Cincinnati, OH Stanley V Phillips Cuyahoga Falls, OH Michael T Sullivan Baton Rouge, LA

NEW MEMBERS

John Roy Gentry Freeport, IL Igor Gomola Schwarzenbruck, GERMANY Michael E Goodwill Bethesda, MD Shanjin He North Potomac, MD Della M Hutchinson Phoenixville, PA Robin G Kelly Ann Arbor, MI Daniel YJ Kim Syracuse, NY Michael C Kirk Chicago, IL Kamal Jyot Kota Exton, PA Joni T Lacey Port Charlotte, FL Chao-Jen Lai Houston, TX Richard Lee Vancouver, BC, CANADA Kali Kathleen Mather Bolling AFB, DC Fernando Mireles-Garcia Zacatecas, ZAC., MEXICO Asa Palm New York, NY Stig Palm New York, NY Anand D Prabhu Melbourne, FL Sven Prevrhal San Francisco, CA Michael J Rajecki Buffalo, NY Jonathan M Richardson Somerville, MA Maksudur R Sarder Fayetteville, AR Jeffrey C Seeber Fairport, NY Yao-Yang Shieh Orange, CA

Associate Daniel Fernandez Seville, SPAIN Katerina L Kuehler Flemington, NJ Donette E Lasher York, PA Mark C Petry West Allis, WI Chip I Starns Charlotte, NC Robert J Ziegler Flemington, NJ Corresponding Jussi A Moog Frankfurt Main, GERMANY Ali Paydar, London, UNITED KINGDOM Paul B Ravindran London, ON, CANADA Nando Romeo Giarre, ITALY Steven J Weston Leeds England, UNITED KINGDOM Full Rostem Bassalow Saskatoon, SK, CANADA Geert Bosmans Hasselt, BELGIUM Robert A Boyd Houston, TX Arion F Chatziioannou Los Angeles, CA Michael A Davis Cincinnati, OH Linda Ding Westborough, MA Jacqueline G Emrich Philadelphia, PA Yankhua Fan Madison, WI Graham P Freestone Adelaide, AUSTRALIA

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Stephen M Steuterman San Diego, CA Bryan G Tollenaar Lansing, MI Lester M Tripp Millville, NJ Tao Wu Boston, MA Christine Yu Surrey, BC, CANADA Junior Nasir U Bhuiyan Houston, TX Jonathan B Caldwell Elk Grove, CA Scott A Friesen Dorchester, MA Gary Gluckman Stony Brook, NY Ken Imhoff Ft. Lauderdale, FL Stephen P Iorio Freehold, NJ Wei Luo Augusta, GA Merrill L Mann Denver, CO Gregory S Mitchell Rockford, IL Robin H Overton Blythewood, SC Robin M Rodenbush Boston, MA Colm A Saidléar Dublin 1, IRELAND Michele L Verst Indiananpolis, IN He C Wang Houston, TX William P Wojciechowski Bayville, NJ Hua (Henry) Yang Mesquite, TX Andy A Zhu St Louis, MO

(See Members - p. 18)

AAPM AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY2003 2001 AAPM NEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER 2003

17

AAPM NEWSLETTER

Members

SEPTEMBER/OCTOBERAAPM 2003 NEWSLETTER AAPM NEWSLETTER 2001

(from p. 16)

Student Nicole M Alvarado Dearborn, IL Erin R Barnett Edmonton Alberta, CANADA Zheng Chang Vancouver, BC CANADA Yu Chen Ann Arbor, MI Paul Cheshire Devonshire, BERMUDA Swapna Chigurupati Miami, FL

Jinxian Dai Verdun, QC, CANADA Svetlana I Denissova Hubbards, NS, CANADA Suzan S El-Khatib Dayton, OH Carlos Esquivel San Antonio, TX Brenton E Gates Houston, TX Gregory S Hodges Toledo, OH Alana D Hudson Edmonton, AB, CANADA Ziping Jiang Baltimore, MD Bryan Kim London, ON, CANADA

JANUARY/FEBRUARY2003 SEPTEMBER/OCTOBER

Anna T Kress Edmonton, AB, CANADA Liang Liang Ann Arbor, MI Li Heng Liang Montreal, QC, CANADA Hilary Loupee Houston, TX Shuang Luan Notre Dame, IN Andrea L McNiven London, ON, CANADA Chisako Muramatsu Chicago, IL Jennifer A Segui Stony Brook, NY Bassam Z Shakhreet Amman, JORDAN

Erato Stylianou Yeroskipou, CYPRUS Alasdair M Syme Edmonton, AB, CANADA Deluan Tu Edmonton, AB, CANADA Peng Wang Rochester, NY Kai Yang Sacramento, CA Bo Zhao Stony Brook, NY

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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.

The topic for this issue is fullfield digital mammography. The FDA approved the ACR to accredit Fischer SenoScan full-field digital mammography units beginning August 15, 2003. ACR began accrediting GE 2000D full-field digital mammography units on February 15, 2003.

Q. We will be installing a new full-field digital mammography unit at our accredited

and certified facility. When can we start using the new unit to examine patients?

A. A facility with a current MQSA certificate may begin examining patients with the new unit ONLY AFTER the medical physicist indicates that the Equipment Evaluation has passed AND the facility has sent the complete new unit application (with the Equipment Evaluation results) to the ACR. Once approved, the ACR will notify the FDA (or the state certifying body) within two business days that an accreditation application has been accepted for the new unit. These facilities are not required to wait for a response from the ACR to begin clinical use of the new unit since they are operating with a current MQSA certificate. However, the ACR has become aware that the Center for Medicare and Medicaid Services (CMS) will not reimburse 18

for examinations performed on an FFDM unit until the FDA has received notification that your new unit has applied for accreditation. In order to ensure appropriate reimbursement, we recommend that MQSA-certified facilities do the following before using their new FFDM unit to examine patients: •Fax the application materials with the Equipment Evaluation results to the ACR at (703) 648-9176, and •After three business days, call the ACR at (800) 227-6440 to confirm that the new unit information was sent to the FDA. Q. When I expose the phantom to produce an image to send to the ACR for accreditation, should I use the exposure techniques specified in the manufacturer’s QC manual?

AAPM AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY2003 2001 AAPM NEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER 2003

A. No. Although several manufacturers specify fixed, manual radiographic techniques to expose the phantom for routine QC, the ACR’s accreditation testing instructions specify that the phantom be exposed under routine clinical conditions. The clinical techniques may differ significantly from the QC techniques specified by the manufacturer. Screenfilm phantom images submitted for accreditation are produced with clinical techniques typically used for a 4.2 cm compressed breast of average density. The ACR’s Committee on Mammography Accreditation has specified that full-field digital mammography images submitted for accreditation should also be produced under clinical conditions.

Consequently, it is important that you carefully follow the ACR’s testing instructions when producing images for accreditation review.

Q. May I submit phantom and clinical images to the ACR on a CD? A. No. ACR reviewers only review hard copy images at this time. Furthermore, the FDA has only approved the ACR to review hard copy images. For purposes of transferring films, the FDA requires a facility to be able to “provide the medical institution, physician, health provider, patient or patient’s representative, with hard copy films of primary interpretation quality.” You should print hard copies of the test images using the laser film printer and film processor (if applicable) normally used for digital mammograms. (If your facil-

ity does not normally print hard copy images, you may have a third party do this.)

Q. How should I window and level the phantom image for accreditation? Does the dosimeter need to be seen on the image?

A. Process the image as typically done for digital mammography. You should window and 19

level the display to best show the test objects without creating excessive noise. Although it is not necessary to see the individual, square TLD chips inside the holes of the dosimeter, it is important to see the entire external outline of the dosimeter on the image to ensure that the dosimeter was completely exposed. Finally, do not zoom or rotate the image. ■

AAPM NEWSLETTER AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2003 SEPTEMBER/OCTOBER 2003

Letters to the Editor More on Licensing Howard Amols, PhD New York, NY amolsh@mskcc.org The pros and cons of licensing for medical physicists continue to be debated in this newsletter and other venues within the medical physics community. The discussion, unfortunately, has strayed somewhat from the main issue which is; ‘What’s the problem’?

What problem is licensing supposed to solve? Only after the problem has been identified and agreed upon, does it make sense to debate possible solutions. The problem, I think, is that some people purported to be medical physicists, functioning in hospitals and clinics under that guise, do not have the proper training or experience to properly serve patients in that capacity. Licensing, its proponents argue, will solve this problem. Secondary arguments include issues of independent billing, professional prestige, etc., but I personally consider these issues to be either unimportant or unachievable. Others may differ, but let us at least debate the problem before debating the solution.

I have always felt that the best way to keep unqualified individuals from practicing as medical physicists is through board certification (aka peer review), which has in fact been the primary mechanism for doing this since the ABR started giving exams to

physicists in 1947. The ABMP threw its hat into the ring in 1989, as many felt that certification for physicists could be best achieved by an all-physics organization rather than under the umbrella of an organization whose primary function is certifying physicians.

Whatever the pros and cons of those arguments might be, they are, thank goodness, behind us.

We again have a single board for certifying medical physicists.

Given that, why is there still a push for licensing?

Well, there are good reasons, even though I personally do not agree. The most important of these is that, despite board certification being around for over 50 years, there are still a lot of incompetent people functioning as medical physicists. If you think otherwise I submit as evidence the NRC Web site, which dutifully reports medical events (formerly called medical misadmin– istrations) that occur with great regularity, and are more often than not the result of some pretty boneheaded physics mistakes. I also strongly suspect that reported misadministrations represent only the tip of the iceberg, vis-a-vis the number of incompetent medical physicists running around loose out there. You might also want to talk to some of the individuals who have been actively involved in preparing and administering either the ABR or ABMP certification exams, most of whom have witnessed some remarkable displays of ignorance 20

by candidates already gainfully employed as medical physicists.

And at the risk of insulting some of you out there, I have another suspicion that some physicists, already certified, are also not quite up to snuff.

So why has 50 plus years of certification failed to achieve its primary goal? There are two reasons. First, both ABR and ABMP exams are too easy (the ABMP exam is, of course, being phased out as a result of the merger). The passing grade for some of the written exams (at least on the ABMP side, and I assume also on the ABR side) has often been less than 65%. Which I would suggest warrants a change in wording on board certificates from the current ‘... has satisfactorily met professional standards...’ to something a little more honest, such as ‘... less than 35% ignorant....’ An analogy would be certifying surgeons who only know where 65% of your nerves and blood vessels are located. I don’t know about you all, but it will be a cold day in hell before I knowingly get wheeled into a surgical suite staffed by a surgeon with that kind of knowledge base!

So why are the board exams too easy? Again, there are two reasons. First, prior to the recent merger, there was fear of competition. Both boards (I know for sure ABMP, and strongly suspect also for the ABR) were afraid that if they made their exams too difficult they would simply drive

AAPM AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY2003 2001 AAPM NEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER 2003

Letters to the Editor candidates away, as candidates would understandably prefer to take the easier exam. With competing boards now behind us I would passionately urge the people currently responsible for the ABR exam to set higher standards. A second reason for making exams too easy is fear of litigation. I don’t know if it’s ever happened, but a candidate who fails the certification exam could sue not only the board, but also individual examiners. If and when that were to happen, the burden of proof for demonstrating that the exam was fair, and that the individual in question truly deserved to fail, rests with the examiners. I don’t have an easy answer to that problem, although Shakespeare’s advice to ‘kill all the lawyers’ (II Henry VI, IV:2) does come to mind. But even in a utopia without lawyers it’s not the kind of situation anyone wants to put themselves into, especially given the magnitude of monetary honorariums examiners receive.

For those of you who don’t know, both ABR and ABMP examiners and question writers receive zero financial compensation for their efforts and are required to spend the better part of a week cooped up either in Louisville or at the O’Hare airport.

However, even if the exams were more difficult to pass, certification alone could not currently keep incompetent people out of our field because there are no laws, in any state, requiring that hospitals and clinics hire only

certified individuals. JCAHO and other accrediting agencies recommend this, but it is not a legal requirement.

“And at the risk of insulting some of you out there, I have another suspicion that some physicists, already certified, are also not quite up to snuff.”

For the above reasons therefore, many individuals have proposed licensing as the solution.

State governments have the huge trump card over the ABR or ABMP in that governments can pass laws making it illegal for hospitals to employ unlicensed individuals. All well and good. So why am I still not a big fan of licensing? Well, so far in the three states that have passed licensing regulations (Texas, Florida, and New York) I’ve seen zero evidence that the states are doing a better job of weeding out the bozos than the boards have been (not) doing over the last 50 years.

In New York, for example, the only criteria for obtaining a license are not having a criminal record, having some kind of college degree in some kind of physics, finding someone (not necessarily more qualified than yourself) willing to vouch for your

ability to walk and chew gum at the same time, and the willingness to plunk down 450 hard earned dollars. Admittedly New York licensing is still in its ‘grandfather’ phase and the requirements may get tougher in future, but as far as I know, the requirements in Texas and Florida (where licensing has been around for a number of years) aren’t much different, as any ABR or ABMP certified physicist is almost guaranteed approval of a license application in these states.

Despite the fact that I usually vote Democratic, I do have a firmly held belief that governments rarely do things better than private industry. So I have little expectation that Texas, Florida, New York, or any other state is really going to do a good job keeping incompetent people out of medical physics. Heck — they can’t even keep incompetent people out of government! Further, once we hand over the authority to regulate the practice of medical physics to the government we will have lost all control! For those of you who think it was tough (and expensive) to get licensing laws passed, wait till you see how tough it will be to get them unpassed!

What I would like to see happen is the following: 1. The requirements for obtaining ABR certification should be toughened – a lot.

2. Physicists, in collaboration with our physician colleagues, (See Amols - p. 22)

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AAPM NEWSLETTER AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2003 SEPTEMBER/OCTOBER 2003

Letters to the Editor Amols

(from p. 21)

should be more proactive in JCAHO and other certifying bodies to insure that hospitals only hire qualified medical physicists (whatever we ultimately decide that means). JCAHO, in particular, has a potentially huge stick at its disposal in that hospitals that fail JCAHO inspections risk losing their HCFA reimbursements.

3. Physicists, in collaboration with our physician colleagues, need to be more proactive in public education. Patients, hospital administrators, and health insurance providers all need to know that people don’t have to get their radiation therapy, or mammo– grams, or PET scans, or whatever at a hospital or clinic that does not meet certain standards.

If others out there think that licensing can achieve all of the above, or if I’ve misstated the crux of the problem, let’s start discussing it. But don’t put the cart in front of the horse. First, define the problem, then debate the possible solutions. I, for one, favor putting some real teeth into board certification rather than passing the problem off to government bureaucrats.

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Medical Physics Licensure – do we need to license medical health physics, too?

P. Andrew Karam, PhD, CHP Rochester, NY Andrew_Karam@URMC.Rochester.edu As noted in recent letters to this publication, several states have passed licensure requirements for medical physics. I applaud this effort because, unlike most people working with radiation and radioactivity, medical physicists actually have the opportunity to hurt people. I was frankly surprised to find there are so many states in which medical physicists are NOT licensed, especially given the number of times that incompetent people have ended up injuring their patients.

Treatment planning, dosimetry, and the other aspects of radiation oncology are complex and it is vitally important that they be done correctly, by qualified personnel.

On the other hand, I find myself somewhat perplexed at the inclusion of health physics in the medical physics licensing regulations. I have been working in health physics for over 20 years and, in that time, I have done radiation measurements, shielding calculations, and other routine health physics tasks in nuclear submarines, commercial nuclear power plants, DOE facilities, hospitals, and universities. Most of 22

the work I have done in all of these settings is almost identical – I use the same instruments, follow the same procedures, crunch numbers in the same software packages, and follow similar regulations. The biggest difference is that, in the hospital, I have to have HIPAA training, and I’ve learned where to stand in the OR to stay out of the way. To a large extent, routine health physics procedures translate well from one setting to another. Why should I (or my colleagues) need to be licensed to do this work only at a hospital?

I understand that many hospitals are not sufficiently large to support a full-time health physics staff and that, at these institutions, a medical physicist may double as RSO or, indeed, as the entire radiation safety department.

However, this does not change the fact that the routine radiation safety that the Medical Health Physics certification seeks to license is still routine, even in a hospital setting.

I doubt that a medical physicist is better trained for having achieved one more certification, and I am certain that the public health is no better served. Such certification seems aimed primarily at taking health physicists out of the hospital, and I am not sure that achieving this goal will help the public at all. It also seems aimed at raising more money for the credentialing states, and I am certain that there is no improvement in radiation safety as a re-

AAPM AAPM NEWSLETTER SEPTEMBER/OCTOBER JANUARY/FEBRUARY2003 2001 AAPM NEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER 2003

Letters to the Editor sult of the fees paid to the states.

In fact, the only group that stands to benefit from segregating medical health physics from non-medical health physics is those consultants who routinely work in medical settings. Such a legislative distinction can give them more work by keeping competent health physicists out of hospitals.

Medical physicists are in high demand. They don’t need added credentials in medical health physics to assure themselves of jobs or high salaries. Similarly, health physicists are in high demand at this time, and most do not need this credential for job security. What this certification does is to further limit the number of people who can practice radiation safety in our hospitals and, by so doing, dump even more work on the medical physicists. It’s too late to do anything in NY or the other states in which medical physics licensure has already been passed, but I can hope that other states will understand that there are already very good registration and certification programs for health physics (the National Registry of Radiation Protection Technologists and the American Board of Health Physics), and that these are perfectly adequate to address health physics in academic, industrial, and medical settings.

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AAPM President Marty Weinhous (r) and President-elect Don Frey enjoy the AAPM Annual Meeting ‘Night Out’ in San Diego.

AIP STATE DEPARTMENT SCIENCE FELLOWSHIP PROGRAM This fellowship program represents an opportunity for scientists to make a unique contribution to the nation’s foreign policy.

The American Institute of Physics will sponsor one fellow annually to spend a year working in a bureau or office of the State Department, providing scientific and technical expertise to the department while becoming actively and directly involved in the foreign policy process. Fellows are required to be US citizens and members of at least one of the 10 AIP member societies at the time of application. Qualifications needed include a Ph.D. in physics or closely related field, or equivalent research experience. Applicants should possess interest or experience in scientific or technical aspects of foreign policy. Applications should consist of a letter of intent, a two-page resume, and three letters of reference. Please visit http://www.aip.org/mgr/sdf.html for more details. All application materials must be postmarked by November 1, 2003 and sent to: AIP State Dept. Science Fellowship, AIP, ATTN: Audrey Leath, One Physics Ellipse, College Park, MD 20740-3843. For additional information or questions, please contact Audrey Leath at aleath@aip.org or (301) 209-3094.

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AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2003 SEPTEMBER/OCTOBER 2003

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 2003 Postmark Date: November 15 Deadline: October 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

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