AAPM Newsletter January/February 2004 Vol. 29 No. 1

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 29 NO. 1

JANUARY/FEBRUARY 2004

AAPM President’s Column G. Donald Frey Charleston, SC

A New Year It is with a great deal of humility and a frisson of terror that I begin my term as your president.

The AAPM is a very effective organization because we command significant resources to help meet our goals. First among these is the countless volunteer hours put in by our members. The work of the members is amplified because we have an effective staff and the financial resources to assist the members with their tasks. As we begin 2004 I need to thank the many of you who volunteered to serve on AAPM committees this

year. I was able to place most of you into your first or second choice. Unfortunately, for many reasons, not every volunteer can be placed in any year. If you did not get an appointment I would

encourage you to persevere by talking with committee and task group chairs so that you will be more likely to get an appointment in 2005.

In 2004 we have a new chair for the Biological Effects Committee. We welcome Joseph Deasey. We also welcome Maryellen Giger as our new treasurer, and Howard Amols as president-elect. The committee structure of the AAPM undergoes constant revisions. At RSNA the Board of Directors voted to dissolve the Computer and Statistics Committees. I wish to thank Ray Rodebaugh, chair of the Computer Committee, and Timothy Schultheiss, chair of (See Frey - p. 2)

Clinical Trials Update Report from the Subcommittee on QA of Clinical Trials The RTOG P-0232 Protocol Geoffrey S. Ibbott Subcommittee Chair This the third in a series of articles that will describe clinical trials conducted by cooperative study groups that may be of particular interest to medical physicists. Previous newsletter articles have described the RTOG H0022 and P-0232 protocols. This

article discusses a recent amendment to an existing protocol that will allow the use of IMRT for prostate external beam therapy.

P-0126 is a phase III randomized study of high dose 3D-CRT versus standard dose 3D-CRT in patients treated for localized prostate cancer. The study (See Ibbott - p. 4)

TABLE OF CONTENTS

Executive Dir’s. Column p 5 Prof. Council Report p 7 Ed. Council Report p 9 Announcements pp 10, 16 Treasurer’s Report p 11 2004 Budget p 12 ABR Exam Statistics p 14 Chapter News p 18 New Members p 19 Mammography FAQs p 21 Let’s. to the Editor p 22

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Frey

(from p. 2)

the Statistics Committee, and the many members of each of those committees for their efforts on behalf of the AAPM. Angela Keyser, began her term as executive director on December 15th. She has been with the AAPM since we moved our Headquarters to the American Center for Physics in 1993.

She and her staff remain ready to meet the needs of the Association. We welcome her to her new position.

At the RSNA meeting the board voted to create a new committee of the Professional Council. The Member Services Committee (Bob Rice, chair) will coordinate our insurance program, job placement service & salary survey.

Colin Orton has decided to step down as the editor of Medical Physics at the end of 2004.

Bob Gould will chair the Ad Hoc Committee for the Selection of the New Editor.

The AAPM conducts an indepth review of Headquarters operations every three years. Jim Smathers will chair the Headquarters site survey team.

Promotion of Medical Physics to Physics Students One of the more serious problems facing the profession of medical physics is the shortage of practitioners. There are many aspects to this problem and in this column I am going to address the issue of recruiting. The number of undergraduate physics majors has

Comparison of the Number of Physics Bachelor Recipients to All Bachelor Recipients from 1955–2000 7000 1,200,000.00 6000 1,000,000.00 5000 800,000.00 4000 600,000.00

400,000.00

200,000.00

All Bachelors

3000

•For several years the summer undergraduate fellowship program has placed students with physicists for summer research.

This program, under the direction of the Summer Undergraduate Fellowship Subcommittee (George Sandison, chair), has been very successful but is limited by the number of fellowships the AAPM can afford to fund. I encourage chapters and physics groups to fund additional fellowships either through the AAPM or directly.

•The Association is increasing its liaison activities with the American Association of Physics 2

Physics

2000 1000

0.00 0 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

decreased steadily for many years (see graph). This reduces the pool of students available to enter medical physics programs.

Beyond that, medical physics is not well promoted to undergraduate students. This problem has developed over decades and it is only through the sustained efforts of the Association and individual members that this situation will change.

The Association has undertaken a number of initiatives in this area.

All

Physics Bachelors

Teachers (AAPT). Kevin Corrigan, our primary liaison to the AAPT, is working to increase our presence at their meetings and to promote medical physics as a career path for physics students.

•There is no substitute for direct contact, so the Association promotes the “Take a Student to Lunch” program. We encourage you to make contact with local physics programs and invite students to visit with you to learn about medical physics. Lists of interested students have been sent to each of the chapters but the information can also be obtained from Kathy Burroughs (Kathy@AAPM.org ) at AAPM Headquarters. I recently “Took a Student to Lunch” and it was quite rewarding. I challenge each of you to do the same.

•Participate in high school and college career days. The Public Education Committee is working on a PowerPoint presentation to assist you. Please contact Ken Hogstrom for further details.

•The Society of Physics Students newsletter is seeking ar-

AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER

ticles about medical physics and simple science articles that illustrate physics principles. If you are interested in writing such an article, please contact me.

Annual Meeting It is not too soon to be thinking about the Annual Meeting. One new aspect this year is the professional track. Check out Jerry White’s Professional Council Report for further details.

tors. However, to use this software properly we need your HOME ADDRESS AND ZIP CODE. I assure you that this information will be shared with no one. It is only used to match you with your appropriate legislator so we can send you information about pending legislation of interest. Please log on to the AAPM Web site to provide the Association with this information.

RSNA Government Relations Every day the Federal Government, through Congress and the many federal agencies, makes decisions that have a major effect on medical physics. This also happens in each of the 50 states.

These decisions will be made whether the AAPM is involved or not. At the RSNA meeting the AAPM Board voted to increase funding for government affairs.

There has also been a reorganization of the Governmental Affairs and Legislation Committee (Jeffrey Masten, chair). Medical physics is well positioned to influence legislation and regulation because medical physics has an excellent record of providing advice that is based on good science and promotes good patient care. We are not seen as having some of the financial and turf control biases that other organizations have.

As with student recruitment, we can increase our legislative success if each of you becomes involved in small ways. The AAPM has tracking software that will send you information for contacting your representatives and sena-

We have just completed another very successful RSNA meeting. The working relationship that the RSNA has with the AAPM is closer than that they have with any other organization.

One of the major benefits to AAPM members is the free registration at the RSNA meeting.

This causes a problem because medical physicists choose not to join the RSNA. The AAPM has a number of liaisons that we appoint to RSNA committees but, in addition, the RSNA appoints medical physicists to most of their committees. To be eligible for direct RSNA appointment one must be a member of the RSNA. Currently there is a shortage of eligible physicists for RSNA committee appointments. If you would like to be considered for

RSNA committee appointment; please consider joining. There are other benefits of membership – two journals, a Web-based continuing education program and others.

Just for Fun I have been reading the book Prime Obsession by John Derbyshire. This is a book about the Riemann Hypothesis. It interleaves chapters about the mathematics with chapters about the mathematicians. The mathematician Hadamard makes an appearance. Until I read the book, Hadamard was a function, not a person. This book made me realize how often we identify people by their last names and don’t know their first names.

So, for your entertainment, what are the first names of the people listed below? (answers later in the newsletter) 1. Chebyshev 2. Coolidge 3. DeHevesy 4. Hadamard 5. Hounsfield 6. Mansfield 7. Potter 8. Quimby 9. Radon 10. Van de Graff

How to Quickly Update Your AAPM Member Profile You can quickly update your information by going to the following link: http://www.aapm.org/memb/profile/ If you have any questions, please feel free to contact the AAPM Headquarters office at aapm@aapm.org or 301-209-3350.

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Ibbott

(from p. 1)

opened in March 2002, and has a required sample size of 1,520 patients. To date, fewer than 200 patients have been registered to the study. To make this trial more consistent with current clinical practice, and to try to improve registration, the study PI has amended the protocol to permit the use of IMRT. The protocol has also been amended to incorporate ICRU 50/62 terminology, which has resulted in small changes to the prescribed doses of the two arms of the protocol.

The prescription dose is now defined as the minimum dose to the PTV. Arm 1 calls for 70.2 Gy in 39 fractions while Arm 2 calls for 79.2 Gy in 44 fractions.

In each arm, no more than 2% of the PTV and none of the CTV may receive less than the prescribed dose. To accommodate the heterogeneity frequently seen in IMRT dose distributions, a volume no greater than 2% of the PTV may receive up to 107% of the prescribed dose. The maximum dose must not be within an organ at risk such as the rectum, bladder or penile bulb. Specific guidelines are given in the protocol for dose limits to the organs at risk, as a function of percentage of volume.

These dose limits apply whether IMRT is used or the patient is treated with 3D-CRT. This protocol, like a number of other phase III trials (including P-0232 for prostate brachytherapy), is open through the Cancer Trials Support Unit (CTSU, see http://www.ctsu. org.) This means that the trial is

not limited to RTOG member institutions, but that any radiotherapy facility that meets CTSU requirements, is monitored by the RPC and has been credentialed (see below), may register patients.

This protocol is supported by the Advanced Technology Consortium (ATC, see http:// atc.wustl.edu). Electronic data submission to the Image-Guided Therapy Center (ITC) is required.

A dry run must be conducted successfully before institutions can participate in the study in order to confirm their ability to transmit data electronically. To facilitate electronic submission and review of patient treatment plans, institutions must comply with a scheme for the naming of structures on treatment plans defined by the ITC. A table of acceptable structure names appears in the protocol.

In addition, the P-0126 trial requires that institutions be credentialed by the RPC (http:// rpc.mdanderson.org) before registering patients. The credentialing process requires that institutions submit a facility questionnaire and complete the dry run with the ITC, and satisfactorily irradiate an anthropomorphic phantom.

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Institutions may request either the RPC head and neck phantom, or the RPC pelvis phantom.

Institutions that have previously completed the IMRT credentialing evaluations using the RPC’s head and neck phantom (e.g., for protocol H-0022) do not need to repeat this aspect of credentialing, unless significant changes in treatment planning or delivery systems have been made. Similarly, the dry run with ITC need not be repeated, unless the institution has changed treatment-planning systems. Institutions should be aware, however, that successful irradiation of the pelvis phantom will not qualify an institution to participate in a head and neck protocol or lung protocol requiring credentialing.

The phantom is shipped to the institution, which conducts imaging procedures and prepares a treatment plan in exactly the same fashion as they would a patient.

The phantom is then set up on a megavoltage treatment unit and the IMRT treatment is delivered according to the plan. Institutions are expected to conduct their customary QA procedures and notify the RPC of the results. The phantom is returned to the RPC where the dosimeters are removed and analyzed to evaluate the conformation of the dose delivered with the treatment plan.

Further details about this protocol and the credentialing requirements are available at the RPC Web page (http://rpc. mdanderson.org) or at the ATC Web page (http://atc.wustl.edu). â–

AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER

Executive Director’s Column Angela Keyser College Park, MD Writing this newsletter article is my first official task as the AAPM’s new executive director.

I appreciate the confidence placed in me by the AAPM Board of Directors. Sal Trofi has been my mentor for many years and I have immense respect for his innovative leadership style and his strategic and analytic talents.

My number one goal as the new executive director is to continue to promote the strong team spirit and commitment to customer service that has been the focus under Sal’s leadership. The transition plan that Sal initiated has been implemented and the HQ team is well prepared to forge ahead! I look forward to working with you for many years to come.

2004 Annual Meeting Pittsburgh, PA The 46th AAPM Annual Meeting will be held July 25–29, 2004 in downtown Pittsburgh, Pennsylvania. Scientific sessions will be held at the brand new David L. Lawrence Convention Center, while the committee meetings and Awards and Honors Ceremony and Reception will be held at the Headquarters hotel, the Westin.

Other hotels in the meeting block include the Westin William Penn, the Hilton and the Marriott. The online abstract program was activated in January. The deadline

2004 Summer School Carnegie-Mellon University

for abstract submission is February 25 at 5:00 PM Pacific Standard Time. The full meeting program will be posted online by mid-May. The exhibit hall will once again open on Sunday so make plans to arrive early to take advantage of the extra time to meet with the exhibiting companies. The online registration process is scheduled to open in midMarch, with the deadline for discount registration on June 9. Dan Pavord and the Local Arrangements Committee in Pittsburgh have planned an exciting family ‘Night Out’ at the Carnegie Science Center. Further details will be posted online as they are made available.

There will be two new registration categories this year for Junior Members and non-member residents from an ACGME accredited Medical Resident program. These new categories will have a lower registration fee than the weekly, member rate. Current AAPM members who are residents and Full Members will be allowed to register at the reduced rate.

The 2004 Summer School will be held at Carnegie-Mellon University in Pittsburgh from July 29–August 1. These dates are immediately following the Annual Meeting. The Summer School will start on Thursday afternoon at the David L. Lawrence Convention Center and then move to the CMU campus. The topic is “Specifications, Performance Evaluation and Quality Assurance of Radiographic and Fluoroscopic Systems in the Digital Era.” The program directors are Lee Goldman and Michael Yester. Michael Flynn, Ehsan Samei and Tony Seibert make up the Program Committee. Peggy Blackwood and Paul Feller are heading up the Local Arrangements Committee. Members will be notified via e-mail when additional information is posted online.

2004 Membership Directory The 2004 AAPM Membership Directory will be mailed at the end of February, which is a few weeks later than in most years.

We hope that the hardcopy product will have more accurate information regarding committee appointments because of the change. Please remember that some of the member contact data is stale even before the directory goes to print so you are encour(See Keyser - p. 7)

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER

Keyser

(from p. 5)

aged to use the online Membership Directory whenever possible.

Government Affairs Several years ago the AAPM decided to make a more serious effort toward improving government relations, thereby increasing the relevant committee budgets and hiring a staff person (Angie Lee) to do research, coordination and to distribute information to AAPM members. At that time there was discussion as to the nature of the position to be created. The AAPM had no direct experience with a staffbased government relations position and several options were reviewed. The Board decided to

begin with a research and coordination type position, with the understanding that the effort would need to be reviewed in the future based on experience obtained. Recent review and discussion within EXCOM and with Jeff Masten (Government and Regulatory Affairs Committee chair) and Jerry White (Professional Council chair) led to the desire to change the staff position from the current one to a position involving strategy development, issue analysis, etc. The position would require an individual with background in science and/or medicine. The AAPM Board approved funding for the position during an executive session at the December meeting. Angie Lee was made aware of the Board decision. Her

last day of employment with the AAPM was December 8, 2003.

A time line has not yet been established for recruitment for the new position, but the intention is to fill the vacancy promptly.

Staff News Jennifer Delp has taken on many new responsibilities in 2003. In acknowledgment of the growth in her job, her title has been changed to administrative assistant. Jennifer joined the AAPM team in April of 2001 as the receptionist.

Zailu Gao has been named senior applications developer. This change is in acknowledgment of Zailu’s increased level of involvement in the overall IS Department operations. Zailu joined the HQ ■ team in March of 2001.

Professional Council Report Jerry White Council Chair Many of you have been following the multi-year progress of the NRC’s revisions to Part 35 of the Code of Federal Regulations (the regulation set that deals with applications of byproduct material in medicine). The process is nearing a close with full validation of the old saying, “the devil is in the details.”

The NRC has recently published (http://a257.g.akamaitech. net/7/257/2422/14mar2001 0800/edocket.access.gpo.gov/ 2003/pdf/03-30358.pdf) the proposed Final Rule, with most of the recent changes involving Training and Experience require-

ments. These changes are in addition to those published in the spring and fall of this year.

Along with a lot of other changes in the New Part 35, the NRC decided to revise the Training and Experience (T&E) sections of the regulations. The results are in the various material specific sections of Part 35, as well as in separate sections for RSO’s and Authorized Medical Physicists (AMP’s). Recognizing that there might be some transition difficulties (just a few!), they also kept the old regulations regarding T&E until October of 2004. Currently an AU, AMP, RSO, etc. can qualify under either the old rules (which included ABR and ABMP certification) or 7

under the new rules. Beginning in October 2004, only the new rules will be applicable. There is also a grandfather clause in the new section of the regulations.

As in the past, the NRC will recognize various boards, but the process has changed significantly.

Each board must apply for listing, and the boards accepted by the NRC will not be published in the regulations, but rather will be listed on the NRC Web site.

The new regulations originally required boards wishing to achieve deemed status to apply and guarantee that their diplomates meet, at a minimum, the alternate pathway requirements of the new regulations. These re(See White - p. 8)

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White

(from p. 7)

quirements include a preceptor statement signed by an AU, AMP, etc. The Certification Board of Nuclear Cardiology was at an advantage in this regard as they are a new board with a limited mission, able to formulate the requirements for board eligibility to match the New Part 35 requirements. They are now the only board named on the NRC Web site. Organizations such as the ABR have a broader charge, lots of history and a mission that is greater than simply assisting practitioners to meet the New Part 35 requirements. Over the last year or two, there have been substantial discussions between the ABR and NRC staff in an attempt to find a regulatory language that would meet the needs of both organizations. A remaining point of disagreement has been the preceptor statement.

There has been a proposal to decouple the preceptor statement from the board application for deemed status, thus transferring the responsibility for the preceptor statement from the board to the individual. The current proposed Final Regulations will require a signed preceptor statement for all RSO’s and AMP unless they qualify under the grandfather clause. It’s also noteworthy that the commissioners (of the NRC) are unalterably committed to a signed preceptor statement. This position may be regrettable, but is unlikely to change.

What’s next? There was a December publication in the Federal

Register (referenced above) that describes the final text that the NRC proposes. In addition, the Advisory Committee on Medical Use of Isotopes (ACMUI, an advisory committee to the NRC that includes three physicists) is likely to make suggestions that may ease the burden on practitioners who need to supply a preceptor statement. After this FR publication there will be a brief comment period during which the AAPM (and ASTRO, ACR, etc.) will comment one last time.

The AAPM will submit formal comments; members are encouraged to comment directly to the NRC and may also send comments to me for possible addition to the AAPM comment sets.

Comments are due to the NRC on 23 February 2004. After the text of the new rules is finalized, we can (hopefully) expect the ACR to apply for deemed status.

There are a number of other issues that may impact the ultimate application of the regulations. It is unclear how the NRC intends to deal with certifications from boards such as the ABMP that are no longer providing certification in certain fields. We will offer comment on that issue as well as the status of the Letter of Equivalency holders from the ABR relating to the ABMP certifications. There may be some room for a more liberal definition of preceptor to ease the burden on those who are long out of training. In addition, the NRC has added language in the sections for both the RSO and the AMP regarding experience and or train8

ing in uses similar to those for which approval is requested. This may influence the ability of boardcertified medical physicists to serve as RSO’s for licensees whose range of byproduct uses transcends the diagnostic and therapeutic labels. It is our hope that with sufficiently persuasive comments, the NRC will agree that a medical physicist certified in Dx, Tx or nuclear medicine can serve as RSO with appropriate training in the radiation safety aspects of modalities that are not within their certification area.

As a practical matter, medical physicists and others who are not currently listed on a license and qualify under the old rules will find it advantageous to be named on a license prior to the October 24, 2004 date when the old T&E rules expire.

The above is a simplification of a fairly complex set of professional, political and regulatory issues and constraints, but hopefully is consistent with the current state of affairs. The AAPM will continue to actively monitor these NRC issues.

Finally, it’s important to remember that the NRC regulates directly in only a dozen or so states; the non-NRC agreement states will shortly adopt their version of the New Part 35. Medical physicists who are involved in that effort in their states are encouraged to contact the AAPM (an e-mail to me is fine) so we can coordinate and assist as necessary in order to increase the possibility of an optimal nationwide rollout of the new regulatory scheme.

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER

Education Council Report Herb Mower Council Chair Most of the committees and subcommittees of the Education Council met at the 2003 AAPM/ RSNA Meeting. Many exciting things are happening and I want to thank the numerous members of the committees, subcommittees and task groups for their efforts.

In turn, we are indebted to you, our members, for your interest and input. One of our goals is to provide you with the tools and learning experiences that you need.

Let me remind you that the various chairs of our committees, etc., welcome input from our members. Also, if the activities of a particular group are of interest to you, communicate that to the

R Need E D Continuing C C Education Credits?

D R Earn your medical physics continuing E

chair or to me and we will try to get you involved with that group.

We are expanding our presence at the RSNA Meeting. This year we had five physics tracts. For 2004 we hope to add a ‘vertical’ tract on Monday, either the morning or all day, on a therapy topic. This will allow our therapy members who come for committee meetings on the weekend to also attain some continuing education credits by staying only one more day. At the RSNA Meeting we also offer a categorical topic (breast imaging for 2004), a tutorial on physics for residents (basics of MRI in 2004), equipment selection (computed tomography in 2004) and a basic physics lecture for radiologic technologists (2004: digital radi(See Mower - p. 10)

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 RDCE at the end of the year.

Questions set categories – CT, PACS, DICOM, and Monitors, Ultrasound, Diagnostic, Radiation Protection, Nuclear Medicine, Mammography, Radiation Oncology, and MRI – are based on AAPM Virtual Library presentations, Medical Physics articles, and other easily accessible publications such as AAPM Task Group or NCRP Reports.

Member Registration Fee: $30

www.aapm.org/educ/rdce.asp 9

AAPM Annual Business Meeting Minutes The minutes from the August 2003 Board Meeting in San Diego are available at http://www. aapm.org/org/.

For a hard copy of these minutes, please contact sharon@aapm.org or 301209-3350.

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Mower

(from p. 9)

ography including image processing).

Our Summer School in 2004 will be on the Carnegie-Mellon campus in Pittsburgh. Peggy Blackwood and Paul Feller are coordinating the local arrangement for this school. The topic is “Specifications, Performance, and Quality Assurance of Radiographic and Fluoroscopic Systems in the Digital Area.” Lee Goldman and Michael Yester are the faculty directors. The school will include interactive involvement with the equipment of about 15 different vendors.

If you were at the RSNA, you probably saw our new AAPM booth. It was great! Many thanks to all who contributed to this with special thanks to Lisa Rose Sullivan from Headquarters and Ken Hogstrom from the Public Education Committee. The booth can be easily updated to meet the needs of our Association.

The Public Education Committee recently completed The Medical Physicist in Diagnostic Medical Imaging brochure.

By now you should have received a copy of this. If you did not receive it or need more copies, please contact Headquarters.

Similar brochures for the nuclear

medicine physicist and the brachytherapy physicist are currently being developed.

Several of the committees and subcommittees in the council are working on updating and expanding slide sets and PowerPoint presentations. These will be available to our members through the AAPM Web site. For an introduction to what is or will be available, we invite you to attend the Education Council Symposium at the 2004 Annual Meeting. It will be at 8:30 AM on Sunday.

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Announcements ABMP Announces Changes in Medical Health Physics Certification Process The American Board of Medical Physics has now created a three-year window (January 2004 to December 2006) to allow the entrance of well-experienced medical health physicists (MHP) to their examination for certification in MHP. Candidates with a B.S. degree from an accredited university in physics, medical physics or another appropriately related field and with 15 years experience in medical health physics should now apply.

Also, now eligible for this threeyear period are those certified by the American Board of Health

Physics with five years experience in medical health physics.

Applications may be obtained from the ABMP, c/o Credentialing Service, Inc., P.O. Box 1502, Galesburg, IL, 61402-1502 or telephone (309) ■ 343-1202.

New CAMPEP Board Members At the last CAMPEP board meeting, Brenda Clark was elected to succeed Ed McCullough as the president of CAMPEP. Brenda is an adjunct professor at the University of British Columbia and a senior physicist at the BC Cancer Agency in Vancouver, Canada.

She is also currently president of 10

Brenda Clark the Canadian College of Physicists in Medicine.

Richard Geise has been elected to the position of vice president and James Smathers re-elected to serve as secretary/ treasurer.

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER

Treasurer’s Report: 2004 Program Budget Melissa Martin Bellflower, CA At the December 3, 2003 Board of Directors meeting, the proposed operating cash budget of $5,306,175 for the year 2004 was approved as detailed on the following pages. Although the approved budget shows a small negative balance of $71,184 (approximately 1.5% of the total budget), experience over the past six years shows that we have never spent all of the approved funds in any year. Predictions are that 2004 will show a positive return on the budget unless unforeseen activities occur such as all of the planned publications of task group reports, etc. actually get to the printers. The anticipated result of our activities for 2003 indicate a very favorable balance at the end of the year.

We approved an operating budget of $5,558,906 at last year’s Board of Directors meeting with an approved negative balance of $228,135. Because of our conservative budgeting methods and the tremendous success of all of our efforts in 2003, we anticipate a positive operating balance of approximately $680,000 and a return on our investment in the reserve fund of at least $500,000, resulting in an increase in our reserve fund of $1.2 million. This will be the first year in three years that the value of our reserve fund will actually increase after accounting for investment activity. Contributing to

the positive return for 2003 was a tremendously successful Annual Meeting in San Diego, an outstanding Summer School in Colorado Springs, a continuing shortage of medical physicists resulting in a very active Placement Service and a strong interest in our Medical Physics Journal. Our members and Headquarters staff continue to operate more frugally than anticipated resulting in less money being spent by our councils, committees, liaisons, and staff while performing their duties and activities. We anticipate a total membership of 5000 by mid-2004, which also returns more income to the organization from dues.

Details of the anticipated activities for 2004 are given in the following budget spreadsheet.

There is no anticipated increase in staff at Headquarters now that the transition plan for Sal Trofi’s retirement at the end of 2003 has been implemented with great success. We are all looking forward to the new era of Angela Keyser’s leadership and are confident in her demonstrated abili11

ties for the past 10 years. All of the approved projected activities are consistent with achieving the goals for the organization as outlined by the Strategic Plan developed at the 2002 Long Range Planning Meeting and updated by the Board of Directors on an annual basis.

As of October 2003, our invested reserves are valued at $4,015,225 and the Endowment Fund has a value of $1,031,200.

At this time, the rate of return for 2003 is approximately 12% for both accounts. We have not met our target of having one year’s operating budget in reserve but will be within 10% of that target at the end of 2003. The approved operating program budget for 2004 is actually less than that approved for 2003.

Our significant sources of revenue to our organization are the Annual Meeting, the Medical Physics Journal, dues, and the Placement Service. As noted above, the Annual Meeting in San Diego was a terrific success in every aspect: scientifically, socially, and financially. The support and attendance of our membership at our Annual Meeting is crucial to the continued success of our organization. Thanks to all of the members and families that enjoyed Southern California. The Summer School in 2003 on IMRT, directed by Rock Mackie and Jatinder Palta, drew a tremendous attendance of 450 members who were all treated to (See Budget - p. 14)

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Budget

(from p. 11)

the beautiful setting of Colorado Springs, lunch hour soccer games, and great information.

Many thanks to Robin Miller, Sherry Connors, Wil Parker, and Jerry White for making all of the local arrangements work so smoothly. The Placement Service has a new director, Tom Potts, who will finally give Bob Rice a break after 10 tremendously successful years as director. The transition to the all-electronic placement service operated out of Headquarters is going smoothly and with great success and support from the Headquarters staff. The operations of the Medical Physics Journal continue very successfully under the direction of Chris Marshall and the AIP staff. Our costs from AIP have actually decreased while the services we receive have increased. The relationship with the AIP staff has been very rewarding in all aspects and we appreciate their support.

I have enjoyed very much the opportunity for the past six years

to have served as your treasurer for this wonderful organization.

You have given me the chance to get to know a large cross section of you and count many of you as great friends. Your support and encouragement have been greatly appreciated. Under Sal Trofi’s direction, we have developed into a truly professional organization with a wide range of influence in all aspects of medical physics and I am certain that the new leadership will continue our great success. Please continue to give them the complete support and cooperation that you have given me during my tenure. Let’s all welcome Angela Keyser as our new executive director, Cecilia Balazs as director of finance and administration, and Maryellen Giger as treasurer as they step into new leadership roles. In conjunction with the terrific staff at Headquarters, they will continue our sound financial basis of operations and deliver another suc■ cessful year in 2004.

y Register Now! It’s quick — easy — a benefit of membership!

Through the AAPM Virtual Library you access a comprehensive database of knowledge to assist in your research efforts. You’ll save time and money by viewing presentations online – including audio, video, slides, and transcript! Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs.

NOW AVAILABLE: Selected presentations from • 2003 AAPM Annual Meeting in San Diego • 2003 Medical Imaging Research Symposium - Medical Imaging Analysis: Modalities Using Non-Ionizing Electromagnetic Radiation

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ABR Examination Statistics Bhudatt Paliwal, Stephen Thomas and William Hendee, ABR Physics Trustees In a previous issue of the AAPM Newsletter the medical physics community was provided an update of the ABR activities.

As we continue to make improvements in the development and implementation of the written and oral examination process, it is important to keep track of the impact of these changes on the overall outcome of the examination process. This, to some extent, can be assessed from the pass/fail rate of the candidates in the written and oral examinations.

A summary of this data for the period 1999 - 03 is given below.

Percent Pass Rate Range for Written Exam Part 1 82 – 86 Clinical 80 – 88 Therapy 70 – 81 Diagnostic 70 – 79 Nuc. Med. 37 – 75 Percent Pass Rate Range for Oral Exam Full Pass 45 - 64 Conditional Pass 62 - 86 The graphs provide additional details.

To some extent it is tempting to translate these numbers into degree of difficulty of the exams.

The ABR utilizes the services of

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a team of medical physicists and psychometrics experts to establish the degree of difficulty and the cut scores for each examination.

The physics trustees working with a large group of volunteer item writers and oral examiners are continuously working to improve the quality of examinations to assure a high level of competency in certified candidates. The entire examination and certification process is an outcome of the time and energy the candidates, the examiners and the trustees put into these activities. It can only be maintained at a high quality level as long as we all continue to contribute to this process. I therefore urge all AAPM members to participate and help maintain the high level of medical physics stan■ dards.

Answers to “Just for Fun” from Don Frey’s Column (page 3).

1. Pafnuty Chebyshev 2. William Coolidge 3. George DeHevesy 4. Jacques Hadamard 5. Godfrey Hounsfield 6. Peter Mansfield 7. Hollis Potter 8. Edith Qimby 9. Johann Radon 10. Robert Van de Graff

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Announcements Gold Medal of the Sociedad Española de Física Médica Awarded to Cari Borrás

On June 18, 2003, during the XIV Congress of the Spanish Medical Physics Society (SEFM), held in Vigo, Spain, Cari Borrás, D.SC. FACR received the gold medal of the SEFM for her invaluable scientific and professional contributions to the field of medical physics in the areas of services, teaching and research, especially in American countries but also in Spain, where she was one of its first medical physicists.

Cari Borrás has a doctor of science degree in physics from the University of Barcelona, Spain.

She did her doctoral thesis at Thomas Jefferson University (TJU), Philadelphia, PA, as a Fulbright Scholar. She is certified in Radiological Physics (ABR) and in Medical Health Physics (ABMP).

She worked as a radiological physicist at the Santa Creu i Sant

Pau Hospital, Barcelona; at TJU; at the West Coast Cancer Foundation, San Francisco, CA; at the Pan American Health Organization/World Health Organization, Washington, DC; and is now at The Institute for Radiological Image Sciences, Frederick, MD. She is an ABR examiner, chairman of the IOMP Science Committee and a fellow of the ACR. She joined the AAPM in 1968 and has served in 26 committees at the national and local chapter levels.

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Masters Program in Medical Physics at the Pakistan Institute of Engineering and Applied Sciences To meet the shortage of master’s level medical physicists in Pakistan and neighboring developing countries, this program was launched in 2001 at the perusal of the IAEA. Upon successful completion of this course, graduates will be professionally ready for a career as a medical physicist in radiotherapy and nuclear medicine departments, health physics, radiation protection in industrial and scientific facilities, medical physics instrumentation, regulatory applications, etc.

The basic eligibility criterion for participants in this program is a master of science degree in physics/chemistry or M.Sc. equivalent degree from abroad with a strong 16

mathematics and physics background.

PIEAS has a long tradition of imparting quality education in a broad spectrum of sophisticated technical disciplines at the highest academic levels for the past 32 years. For more details, please visit the PIEAS Web site: www.pieas.edu.pk or write to matiullah@pieas.edu.pk (local contact – M. Zaidi –zaidimk@ id.doe.gov).

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Report on the Council on Ionizing Radiation Measurements and Standards (CIRMS) Meeting Larry A. DeWerd and Geoffrey Ibbott The Council on Ionizing Radiation Measurements and Standards (CIRMS) is organized for educational and scientific purposes to analyze the current and future needs of ionizing radiation measurements and standards.

The main objectives of CIRMS are the advancement and dissemination of the physical measurements and standards needed for applications of ionizing radiations. For more information, see: www.cirms.org.

The CIRMS annual meeting this year on October 27-29, held at NIST in Gaithersburg, MD, had as its theme “Radiation/Radioactivity Measurements and Stan-

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dards in Industry.” Plenary talks were organized into sessions entitled: Computational Methods, Homeland Security Issues and Measurements Implications and Applications. Breakout sessions were on Monday and Tuesday for each of the subcommittees.

The meeting ended with student presentations, three of which were related to medical concerns.

Randall Caswell, who organized the first meeting of CIRMS in 1991, gave an opening address. Dr. Caswell recalled the events leading to his recognition that the views of outside experts and recipients of NIST’s services could provide meaningful direction to the Ionizing Radiation Division.

The first plenary session on Computational Methods dealt with industrial applications of Monte Carlo calculations.

Michael Saylor spoke about calculations of dose from high activity sterilizers, David Rodgers discussed Monte Carlo calculations in medical applications in radiation therapy, and Nolan Hertel described the use of Monte Carlo for radiation protection applications.

The second plenary session covered topics of Homeland Security, and included risks envisioned by the IAEA, the role to be played by medical staff and hospitals, and other important issues that might be faced by first responders. Speakers included Rolf Arlt, Morgan Cox, Lynne Fairobent, Pamela Greenlaw, and John Cardarelli.

On the third morning, Ian Hamilton spoke during a plenary session that dealt with the provi-

sions of NCRP Report 138 on radiological terrorism and the implications for measurement needs. This was followed by a session at which representatives of several manufacturers discussed their companies’ concerns regarding the marketing and transportation of radioactive sources and devices. Speakers were Craig Yoder, Mark Smith, Ray McIntyre, Lisa Dimmick, and Ian Hamilton.

The Radiation Protection breakout section dealt with lowdose rate calibrations and measurements for environmental and human protections concerns.

Also of concern was geochemical and geophysics application and radiation detectors used in these areas.

The Homeland Security breakout session discussed the role of NIST in providing standards and measurement methods for radiation detection. A discussion on instrumentation for detection of radiological and nuclear agents was a major part of this subcommittee. The standards necessary for hand-held radioactivity instruments, electronic personnel dosimeters and portal detectors were discussed. An unexpected complication was the limitations that national security placed on the discussion. Because many participants did not have security clearance, some of the details of calibration and measurement requirements could not be discussed.

The Industrial Applications and Materials Effects breakout session discussed computer simulations and dosimetry, including geometry modeling and ray trac17

ing with CAD and voxel interfaces for particle transport problems. Benchmarking was discussed with regard to specific problems in industrial applications. Irradiation of passenger luggage to prevent the risk from smuggling of bioterrorism agents was also discussed.

The Medical Subcommittee breakout section was divided into two portions. The first day explored treatments using the new liquid- or slurry-based materials containing beta or low energy gamma-ray emitters. This area of “microbrachytherapy” has a number of potential problems associated with it and consequently, treatment uncertainties can be large. Recommendations from this area included that a brachytherapy model, rather than a nuclear medicine model, be employed. A system of calibrations through the ADCLs should be encouraged. A consensus meeting including AAPM therapy representatives, the ADCL Subcommittee, manufacturers and NIST on liquid–based brachytherapy and microbrachytherapy is needed. The second day was devoted to an update on beta brachytherapy calibrations.

In addition to work at NIST the international community has been working in this area. A number of interesting talks on the advancement of primary measurements were given by NIST, PTB in Germany and NMi in the Netherlands.

Copies of the presentations can be found on the CIRMS Web site, www.cirms.org, in the near future.

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Chapter News Florida Zoubir Ouhib Delray Beach, FL The Florida AAPM Chapter held its fall meeting jointly with the Florida Health Physics Society (HPS) Chapter on September 18 and 19 at the South Seas Resort in Captiva Island Florida.

A total of 67 AAPM chapter members, 30 HPS members, eight medical physics students and 39 vendors (29 companies) were present.

The meeting started with the ‘night out.’ All attendees had a chance to interact at a cocktail hour and dinner. Friday morning was a combined program for medical and health physicists.

Therapy presentations included a talk by Allen F. Hrejan on Ethics for the Medical and the Health Physicist. Allen presented a good overview on what is expected from the physicist dealing with difficult issues. This topic was followed with an update from the Florida Radiation Control on rules and regulations. Business updates from both boards (AAPM and HPS) were given prior to the break.

The HPS presented the second part of the morning program. The first talk was from Sandy Pearl from ICN Worldwide Dosimetry Service. His topic was on ANSI/ HPS N13.32 Revision-Performance Testing of Extremity Dosimeters. The second talk was by Farah Moulvi from the Univer-

sity of South Florida. Her presentation covered a Research Biosafety Overview.

The afternoon consisted of two parallel sessions. The medical physics presentation included talks by Debbie Gillie and Don Steiner, both from the Bureau of Radiation Control, on medical errors. Debbie covered HDR Quality Assurance to prevent medical errors. Don covered the external beam part on medical errors. Cases were presented for awareness and discussion. Following the afternoon break there were two presentations on Q.A. for IMRT. Steven deBoer from Roswell Park Cancer Institute in Buffalo, NY shared his experience with the RIT system while Daniel Letourneau from William Beaumont Hospital talked about the use of the Mapcheck. Frank Bova from the University of Florida finished the afternoon session by covering his specialty, stereotactic radiosurgery.

The HPS had presentations on Material Clearance by Eric Abelquist from Oak Ridge Institute for Science and Education.

Teri Rutherford from Kennedy Space Center followed with a Respiratory Protection Update.

The afternoon sessions ended with a presentation from Rich Greene from Laser Institute of America on Laser Safety Officer Certification.

The meeting was approved by the chapter for seven CE hours.

The fall meeting will continue to be an opportunity for health and 18

medical physicists to meet once a year and share their knowledge.

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Penn-Ohio Allan Wilkinson Chapter President The annual Penn-Ohio Fall Symposium was held September 26-27 at the Sheraton Hotel in Cleveland, OH. Approximately 75 people attended, including representatives from 22 commercial vendors. Friday afternoon, September 26, was devoted to presentations by local physicists on a wide range of topics including brachytherapy, IMRT, image registration, and software development. On Friday evening, a dinner cruise on Lake Erie was enjoyed by symposium attendees. Saturday’s topics included 4-D CT (G. Chen), IMRT QA issues (G. Ezzell), volume targeting (P. Hoban), biological models in treatment planning (M. Wiesmeyer), extracranial radioablation (R. Crownover), cross-sectional anatomy and pathophysiology of the brain (T. Barnauskas), and the cellular response to ionizing radiation (A. Almasan). CAMPEP (7 hrs) and MDCB credits were awarded.

Our next business meeting will be held in the spring of 2004. We also wish to remind people that the AAPM’s 2004 Annual Meeting will take place within our chapter boundaries in Pittsburgh, PA, July 25-29.

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Upstate New York Matthew Podgorsak Chapter President The Upstate New York Chapter of the AAPM held its semiannual meeting at Strong Memorial Hospital in Rochester, NY on October 24. In addition to a business meeting, the program was comprised of presentations given by students and faculty aligned with various departments within the State University of New York (SUNY) system. From the Toshiba Stroke Research Center in Buffalo, NY, three students described their research, including Anant Gopal, who presented work which earlier this year won third prize at the Young Investigators’ Symposium at the annual AAPM meeting in San Diego.

Two interesting presentations from the Departments of Radiology and Radiation Oncology at SUNY Upstate Medical Center in Syracuse were delivered. Also, three students affiliated with the Department of Radiation Medicine at Roswell Park Cancer Institute in Buffalo gave talks on their research projects. Rounding out the program was John Balog, PhD, from Tomotherapy, Inc., who was invited to describe the state-of-the-art in tomotherapy.

The highlight of the meeting, however, was the annual presentation of the chapter’s highest accolade, the Award for Lifetime Achievement in Medical Physics.

This year’s recipient was John Cameron, Ph.D., who entertained us with a very thought-provoking and controversial keynote

John Cameron receives the Upstate NY Chapter’s Lifetime Achievement Award from Matthew Podgorsak (l) and Mike Schell (r).

address entitled “Longevity is the most appropriate measure of the health effects of radiation exposure.”

The next chapter meeting is scheduled for May 2004 and, as always, non-members are welcome to attend. Details can be obtained from the chapter secretary, Ken Hoffmann (kh9@ ■ acsu.buffalo.edu).

New Members The following is a list of ‘Change of Status’ and ‘New Members’ from August through November, 2003.

Change of Status Full Angela Mary Donohoe Altamonte Springs, FL Keith M Furutani Rochester, MN Robert J Meiler Kent, OH Dan O Odero Topeka, KS Karl Otto Vancouver, BC, CANADA

New Members Associate Linda J Allison West Vancouver, BC, CANADA

Michael C Erdman Hershey, PA Leonard H Kim Royal Oak, MI

Mohammad M Hamadeh Winfield, IL Amy S Harrison Ann Arbor, MI Julia M Marlette Marquette, MI Nitin K Mathur Fresh Meadows, NY Stephen L McCourt II Green Bay, WI Joseph A Milone Lincoln, NE Chin K Ng Louisville, KY Stephane Pilotte Montreal, QC, CANADA Baorui Ren Bedford, MA Eike R Rietzel Boston, MA

Corresponding Sen Bai Chengdu Sichuan, CHINA Roberto Cirio Torino, ITALY Slavik Tabakov London, UK

Full Jennifer Barker Montreal, QC, CANADA Frederic Dube Manchester, NH Issam M Elnaqa St. Louis, MO

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James Scott Winnipeg, MB, CANADA Polad M. Shikhaliev Irvine, CA Dustin M Simonson Frederick, MD Arkadiusz Sitek Boston, MA Jose Eduardo Villarreal-Barajas San Mateo, CA Karen D Wheeler Bristol, PA David H Whittum Palo Alto, CA Yuanguang Xu New York, NY Chuanfang Zhang Bronx, NY

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ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler Sen. Dir., ACR Breast Imaging Accreditation Programs Does your facility need help applying for mammography accreditation? Do you have a quesion 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. This issue deals with frequent questions we receive on scoring the phantom image.

Q. Occasionally, I see a linear artifactual structure in the ACR mammography phantom image that looks like a partial fiber. How should I deduct from the fiber score?

A. Subtraction is a penalty against the phantom score to reflect the presence of disturbing artifacts that could interfere with detection or diagnosis on clinical films. This is why we deduct from the fiber score for artifactual structures larger than or equal to the last scored fiber, even though

Specks Seen 5 in 4th group 4 in 4th group 3 in 4th group 2 in 4th group 1 in 4th group

they would not be confused with the last scored fiber.

If the artifact is at least as apparent with a diameter at least as large as that of the last fiber scored and the artifact has a fiber-like, rather than a mass or speck-like shape, deduct the artifact from the raw score as follows: •If the last fiber being scored is seen as a whole fiber and the artifact is seen as essentially a full fiber (at least 75%), then deduct 1.0.

•If the last fiber being scored is seen as one-half of a fiber and the artifact is seen as at least a half fiber, then deduct 0.5 for a fiber-like artifact.

•Do this even if the artifact has a larger diameter than the last fiber scored. The normal rule that the deduction is only from the last fiber scored still applies. For example: Fiber Scores Raw Corrected 5 4 4.5 4 4 3

Q. I see artifactual specks

of those in the last scored speck group. How should I deduct these from the speck group score?

A. Again, subtract these one for one from the specks in the last scored group to reduce the score. Subtract if the speck is at least as apparent (i.e. at least as bright as and of equal or greater diameter to the specks in the last scored group). Only subtract from the speck(s) seen in the last scored group (even if only one speck was visible and it received a score of “zero”). Do not subtract for artifacts that are obviously due to dust or emulsion pickoff and are much brighter than a speck would be. The example in the table is given for one and for two artifactual specks.

Q. I get a different answer depending on how I view the masses. What is the standard approach?

A. For scoring purposes, the masses should be viewed without a magnifier. Aviewing distance of greater than 18 inches is suggested.

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that are larger than the size Speck Group Scores Raw Corrected (deduct one speck) 4 4 in 4th group = 4 4 3 in 4th group = 3.5 3.5 2 in 4th group = 3.5 3.5 1 in 4th group = 3 3 0 in 4th group = 3 21

Corrected (deduct two specks) 3 in 4th group = 3.5 2 in 4th group = 3.5 1 in 4th group = 3 0 in 4th group = 3 0 in 4th group = 3

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Letters to the Editor Members in Print It has been suggested that AAPM members send notices to the newsletter regarding articles they have published in journals other than Medical Physics and which might be of interest to others(see following).

Please send them to me at the address listed on the last page.

–The Editor

John Cameron Madison, WI jrcamero@wisc.edu Dear Editors . . ., My opinion article “Longevity is the most appropriate measure of health effects of radiation” which appeared on pages 14-16

Training Programs for Medical Physics Howard Amols New York, NY amolsh@mskcc.org There has been a good deal of discussion recently on training programs for medical physics.

The traditional road to a career in medical physics, the way people like Gail Adams, Harold Johns, Jack Krohmer, Larry Lanzl, John Laughlin, Robert

of the October 2003 issue of Radiology . . . I think . . . will be of interest to many AAPM members. My article is followed by comments by Professor Louis Wagner, an AAPM member and Professor Eric Hall, a wellknown radiobiologist. An ecopy of my article is available at: h t t p : / / w w w. m e d p h y s i c s . wisc.edu/~jrc/art_longevity.htm My related article on “Radiation increased the longevity of British radiologists” appeared in Br J Radiol 2002;75:637-8. An e-copy can be obtained by e-mail request to jrcamero@wisc.edu.

Some AAPM members may be interested in a review article on the Nuclear Shipyard Worker Study (1980-1988): A Large Cohort Exposed To Low DoseRate Gamma Radiation by Ruth Sponsler and John R. Cameron located at: http://www.med

physics.wisc.edu/~jrcart_ nsws1.htm. The details of this large DOE supported study have yet to be published in a peer reviewed journal. The final report of the study is available on the Web: Matanoski G: Health effects of low-level radiation in shipyard workers final report. 471 pages Baltimore, MD, DOE DEAC02-79 EV10095, (1991) Finally, I call attention to the Virtual Radiation Museum, which is the first “wing” of the Science Museum on the Web at http:// www.sciencemuseum.us. I hope that other science museums on the Web will be willing to be linked to the Science Museum. I hope to add a Museum of the Human Body to the Science Museum within the next year. I encourage the AAPM Public Education Museum to organize a Museum of Medical Imaging.

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Loevinger, Edith Quimby, Marvin Williams, Rosalyn Yalow, et. al. did it, was to obtain a degree in ‘traditional physics’ and drift or stumble into medical physics inventing and apprenticing along the way, not unlike the guild system—apprentice, journeyman, master. As the field matured and the need for medical physicists increased, postdoctoral programs began to spring up. Next came graduate programs in medical physics, and now we have both CAMPEP approved graduate programs and CAMPEP ap-

proved residencies. But still, the vast majority of people in this field and entering this field came from, or are coming from traditional areas of physics and/or ‘non-approved’ graduate programs. By whatever mechanism one receives their training there are, at least in theory, certification exams, state licenses, and state defined ‘qualified expert’ criteria to identify people with the required experience and knowledge to call themselves medical physicists.

Some medical physicists are now supporting the idea that in

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the near future only graduates of CAMPEP approved graduate or residency programs should be recognized as qualified medical physicists. There is even a proposal that only CAMPEP approved graduates be allowed to sit for certain certification boards.

I would propose that such ideas are at best premature, and at worst self destructive. Putting aside for the moment the intellectual merits of such a policy, consider first the finances and the numbers.

There are currently 4000 full members of AAPM with a median age of 50 years. Without including growth, and assuming a mean working lifetime of 30 years, the attrition rate (retirement and death, hopefully in that order) is approximately 130 replacements needed per year.

However, as training periods become longer and people start to retire earlier, working lifetimes decrease. That, coupled with continued growth of medical physics positions, translates into a replacement rate closer to perhaps 200 new medical physicists per year. There are currently eight CAMPEP approved graduate programs in the US (plus two more in Canada), plus six CAMPEP approved residency programs (plus one more in Canada). Counting the overlap between graduate programs and residency programs, the total number of CAMPEP institutions is only 13 (11 in US plus two in Canada).

Well, now we have some pretty simple math — either each of the 15 CAMPEP approved pro-

grams have to churn out 13-14 graduates annually (more if most of the Canadian graduates actually stay in Canada), or we need a lot more CAMPEP approved programs. Estimates vary, and exact numbers don’t exist, but there are on the order of 20-40 non-approved MS and/or PhD medical physics graduate programs plus a few dozen postdoctoral programs in the US and Canada. Even if all of these programs obtained CAMPEP accreditation tomorrow, they would each have to pump out at least four to five graduates annually. And for this all to happen by 2012 (the target date some have set for making CAMPEP approval THE requirement for becoming a medical physicist), CAMPEP would have to be approving four to five new programs per year. The current rate of approval is between zero and one new programs per year, and the application process is tedious and time consuming.

Not to mention the cost. Who exactly is going to pay for all this?

The US government, state governments, and ‘the Blues’ are already knee deep into their cutbacks of funding for medical residencies, and hospitals are struggling financially to support medical interns and residents. It will be difficult, if not impossible, to find significant funding for physics residents. And how about physics teachers? Who’s going to pay them (i.e., us) to train all these students in all these CAMPEP approved programs? I don’t know about you all, but personally I’m too busy with my clinical 23

chores and writing ditties to this newsletter to have much time to teach CAMPEP students. In short, there has been a good deal of sabre rattling without enough thought to finances and practicality; an almost Reganesque naivety that if we wish it to be true, it will be true.

And what about the intellectual ramifications of limiting entry into medical physics only to those persons who have gone through a rigid, highly focused program specifically tailored to medical physics? No more quantum mechanics, no more advanced electromagnetic theory, no more linear algebra, no more complex number theory. No more engineers or computer scientists, no more nuclear chemists, just TG-25, and 40, and 51, etc., etc.

So call me old fashioned, but I prefer that ‘old time religion.’ I think a physicist should have as broad a knowledge base and training as possible, and I think the apprentice system has worked fine for almost 1000 years for most trades known to man, including medical physics.

Should CAMPEP approved programs be encouraged — absolutely YES. But should it be the only entryway into medical physics? I hope not! Let’s keep diversity in our profession, and let’s (for the umpteenth time) fix up the certification boards and/or state licensing (whichever you prefer) as vehicles for identifying qualified people from unqualified people whatever training route they might have chosen. It’s what you know that counts, not where ■ you learned it!

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Many thanks to Rick Morin for his efforts as he completes two three-year terms on the Newsletter Editorial Board.

–The Editor

Retiring AAPM Executive Director Sal Trofi is presented a retirement gift from 2003 President Marty Weinhous.

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

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

Next Issue: March/April 2004 Postmark Date: March 15 Submission Deadline: February 15, 2004

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE

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

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