AAPM Newsletter March/April 2004 Vol. 29 No. 2

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 29 NO. 2

MARCH/APRIL 2004

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

Establishing Public Confidence in Medical Physics The Institute of Medicine study "To Err Is Human"1 has a significant influence on policy discussions about how medicine should be regulated and how competency should be established. This study suggested that in excess of 44,000 Americans die each year because of medical errors. This document poses important challenges to medical physics because it makes us confront how we define our professional status

and demonstrate our competence to the public. The document has suggested to some policy analysts that competency in medicine is too important to leave to private or for-profit health care organizations and medical specialty boards. Public advocacy groups, policy analysts and legislators are questioning the ability of medical specialty boards to "police" their own professions. This has added a sense of urgency to the maintenance of certification (MOC) activities of the American Board of Medical Specialties (ABMS) and to the efforts of individual medical specialty boards. The challenge for medical physics is to demonstrate to the public and to legislative authorities that

President-elect Report

medical physics is a true medical profession and not an ancillary service. This requires that we have the means to show both the initial competence and the continuing competence of individual medical physicists.

The general scheme that the ABMS has adopted is a program that has four components.

•Professional Standing •Lifelong Learning & Self Assessment

(See Frey - p. 2)

Announcement of AAPM Member Survey Howard Amols New York, NY First let me say hello, and thank you for making me your new president-elect. I look forward to the next three years and sincerely hope they will be productive ones for the AAPM. Let us also hope that your collective loss of sanity in electing me was only tempo-

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rary and will not result in any permanent damage either to yourselves or to the AAPM. Towards that end, I am happy to report that EXCOM has approved the distribution of AAPM's first-ever broad-ranging member survey. It is our attempt at taking the membership’s collective pulse.

Quite simply, we want to know

TABLE OF CONTENTS Executive Dir’s. Col. p 6 Professional Council p 7 Education Council p 7 Chapter News p 8 Med. Trav. Grant Rep. p 9 Mammography FAQs p 11 Letters pp 13-15

(See Amols - p. 5)

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(from p. 1)

•Cognitive Expertise •Evaluation of Performance in Practice Twenty hours of continuing education per year is no longer going to be considered as an adequate way to show our ongoing competence. While this program is only required for ABR diplomats in recent years, and for ABMP2 diplomats, it is important that all of us consider how we will demonstrate continuing competence.

The American Board of Radiology, under the direction of Steve Thomas, has developed a progressive scheme for the medical physics MOC program.

The Lifelong Learning & Self Assessment section combines traditional continuing education activities with a series of Self-Directed Learning Activities. These Self-Directed Learning Activities are innovative and establish medical physics as a leader in this area.

The Cognitive Expertise component is demonstrated by examination. Medical physics is a leader in this area also because the exam will allow physicists to use source materials and thus mimic the way we practice. The exam will be Web based and locally available. It is anticipated that three exams will be taken during each 10-year recertification period.

It is the areas of Professional Standing and Evaluation of Performance in Practice that there are issues for medical physicists.

For physicians, an unrestricted

medical license is the sine qua non of establishing professional standing. While one can argue about the quality of medical physics licensing programs in the few states where licensing exists, one cannot argue that a license is viewed by the public and policy analysts as the mark of a profession whose members practice independently. The Care Bill, which is working its way through congress, would require licensing for medical physicists who practice in a clinical setting. The AAPM has been an active part of an alliance that supports the bill. The AAPM has been working with other organizations to draft rules of implementation for the Care Bill. If the bill does pass, we must be ready to fight for a good implementation of licensure in each of the states where we are not currently licensed. It is difficult to know whether any piece of legislation will pass, but many people feel that because of the IOM study and Congress' desire to address the competency issue, the Care Bill may pass this year.

The other area of concern, not only for medical physics but also for all of medicine, is the establishment of a method for the Evaluation of Performance in Practice. Part of this effort is what is commonly called peer review. Most of us are uncomfortable with others reviewing our work, but practice performance review is another way that medical physicists can demonstrate to the public that we are competent professionals. Peer review can be difficult and costly. The AAPM needs to work with other profes-

sional organizations to develop cost-effective ways for practice performance evaluation so we can demonstrate to the ABR, the ABMS and the public that we are a profession where individuals practice safely and effectively.

The issues raised in the public's mind by the IOM study challenge us to show that medical physics is a profession that is serious about establishing and maintaining the competence of its practitioners.

E-mail from Vendors The AAPM gets frequent complaints about unsolicited e-mail sent to AAPM members. There are several possibilities. The first is that the person is sending the e-mail without using the AAPM directory. Unfortunately the AAPM has no control over this.

Many of the complaints that the Information Technology staff investigates turn out to be unrelated to the AAPM. In the second case it sometimes appears that the AAPM directory has been compromised. In that case we ask the AAPM attorneys to send a letter demanding that the individual stop using the list. The AAPM furnishes printed snail-mail lists to corporate affiliates and others but does not sell or distribute our members' e-mail addresses. Finally, the AAPM does send out some third party announcements.

You can opt out of this but I encourage you not to do so.

Presently the AAPM makes significant income from the advertisments in our print media and much smaller amounts from

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the electronic advertisments. It is likely that the amount of income from print advertisments will decrease as more and more members drop the paper journal. If large numbers of members opt out of the advertising e-mails, it will be hard to convince advertisers to buy this service. If you have not opted out, I thank you.

If you have, I ask you to consider changing your status so that you receive them.

Ribbon goes here (see file) Remove Box please

This specially designed ribbon (maroon with gold lettering) will be given out at the Annual Meeting to recognize those members who have contributed to the Education Endowment Fund. Those who wish to contribute, please send your donation to:

AAPM Education Endowment Fund One Physics Ellipse College Park, MD 20740-3846

Educational Endowment The AAPM started the Educational Endowment in 1988. While the existence of the endowment has done much good in the educational arena, I consider the activity as a whole a failure. Most of the money that has been spent has come either from other societies (RSNA & ASTRO), corporate affiliates or the general funds of the Association. After some original contributions, member support dried up almost completely. The AAPM treats the Educational Endowment like a restricted fund and by policy only spends the interest. This led to the situation where no money was spent from the endowment because there was not enough interest accrued to make spending worthwhile and no money was contributed because the society could not point out the value of contributing. At the 2003 RSNA meeting the Board decided to start spending from the fund. This means that either we need more contributions or the fund will be liquidated.

I think it is unlikely that we will get sufficient support from wealthy members, former presidents and the like to change this picture. The only way the fund will be successful is for everyone to contribute a small amount. If 1000 members give $50 dollars per year we will have enough money to make a real difference.

So, I ask each and every one of you to write a small check to the endowment. A donation of 0.1% of your salary would be great, but anything would be appreciated.

Contributions are tax deductible and the AAPM will recognize all contributors with a ribbon at the Annual Meeting.

founded in January of 1974, it has grown to be the most important journal for the publication of scientific and clinical papers in medical physics. Medical Physics has increased in status and has been economically successful under the current editor, Colin Orton. The Association owes him a large debt of gratitude.

There will be many challenges for the new editor. The long-term transition from paper to electronic publishing, reductions in library subscriptions and conversion from paper to electronic advertising will all face the new editor.

The Association hopes to name a new editor by July of this year.

I will keep you informed.

Medical Physics Editor Search

Survey

By the time you read this column you should have received a notice that the AAPM is seeking a new editor for Medical Physics. Since Medical Physics was

One of the most difficult tasks for the Board of Directors and the Executive Committee is representing the views of those who have elected us. In order for us (See Frey - p. 5)

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Frey

(from p. 3)

to better understand the views of the membership, Howard Amols, the president-elect, is directing a major survey of the membership. You will be receiving a copy soon. It is very important for you to give the Association a bit of your time by filling out the survey. The results of the survey will only be valid and useful if most of you take the time to fill it out.

Just for Fun In his book The Scientists, John Gribben presents an anecdote about Galileo Galilei.

Galeleo's father Vincenzo was a musician. He wished his son to be set up in a respectable career that would be both more secure and financially rewarding than that of a musician. Vincenzo sent his son to study medicine at the University of Pisa. Galileo became much more interested in mathematics than medicine and never finished his medical degree. After working from 1585 to 1589 as a private tutor in mathematics, he was hired as a professor of mathematics at the University of Pisa. His salary as professor of mathematics was 60 crowns per year. A professor of medicine earned 2000 crowns per year.

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“To Err is Human - Building a Safer Health Care System,” LT Kohn, JM Corrigan, & MS Donaldson, Eds, National Academy Press, Washington, DC 2003.

2 The ABMP has had time-limited certificates since the board was founded.

They are presently working to revise their existing MOC program.

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Amols

(from p. 1)

what members’ opinions are on various issues, and whether or not you think EXCOM and the Board of Directors are doing a good job.

This will be a Web-based survey, although you will also have the option of sending in your answers in the form of stylized blobs of dark colored liquid material systematically applied onto thin sheets of pliable chemically processed wood pulp if you prefer.

Further information on how to access this survey will be coming to you hopefully within the next few weeks. Your prompt responses will give us a reasonable shot at being able to report the results at this year’s Annual Meeting in Pittsburgh. AIP statisticians will be assisting us in preparing the survey, particularly the Web-based functions, and in analyzing the results.

The survey will be soliciting your opinions on various AAPM activities and services plus AAPM structure and organization. There will be questions on the Annual Meeting and Summer School, AAPM publications, structure and function of the Board of Directors, and professional issues such as training, certification, licensing, person-power shortage, etc. The survey is designed to take a minimum amount of your time. If you opt for the online version there will be pull-down menus and minimum typing required. Carpal tunnel syndrome on your mouse hand perhaps, but minimal typing! There will also be free format fields for written comments.

Thomas Jefferson once said that “in a democracy people usually get the government they deserve.”

Alright, so maybe things in Washington have changed since Jefferson said that, or maybe he just wasn't as smart as he's cracked up to be, but let's try to make that concept work for the AAPM. Speak now or forever hold your peace! Please respond to the upcoming survey. As the great philosopher Yogi Berra once said, "You got to be careful if you don't know where you're going, because you might not get there."

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Executive Director’s Column Angela Keyser College Park, MD

profit organizations, and commercial organizations. The AAPM does review the mailing prior to it being sent. You may request to be excluded from third party postal and e-mails in your "Online Member Profile."

2004 Annual Meeting July 25 – 29 David L. Lawrence Convention Center, Pittsburgh, PA AAPM's Privacy and Security Policy At HQ we receive complaints from members about spam emails that seem to come from AAPM sources or because the AAPM has sold your contact information. The AAPM has an official "Privacy and Security Policy." To view the entire text of this policy, log into aapm.org and go to the "Privacy and Security" link at the bottom of the main page.

While the AAPM does not sell e-mail addresses, we do send email messages on behalf of AAPM corporate affiliates for a fee. These messages are sent from aapmcorpaffil@aapm.org. You can also access the mass e-mails that have been sent to you by logging in to aapm.org and link to "Email Announcements" under "Membership and Services.” The AAPM does sell postal mailing lists to corporate affiliates, non-

mit an electronic file of a modified version of the presentation to be digitally posted in electronic poster viewing areas, located in the exhibit hall, during the meeting. The electronic file is to replace the previously required hardcopy 4' x 4' ‘poster’ display.

Strengthening Relations with COMP and AAMD

Registration for the AAPM 46th Annual Meeting opened in March. Make sure to register by June 9 to take advantage of discounted registration fees. The schedule of committee meetings is available online. The entire meeting program will be available online by mid-May.

New for 2004 •Jack Fowler Award (Junior Investigator Competition) – A new award for junior investigators has been established this year in honor of Jack Fowler. The top scoring Junior Investigator submission determined by abstract reviewers will be selected and announced at the awards ceremony.

•Professional Track – a dedicated professional track with proffered abstract and symposia.

•Electronic Posters – If selected for oral presentation, the presenting author will be required to sub-

The AAPM has entered into agreements with the Canadian Organization of Medical Physics (COMP) and the American Association of Medical Dosimetrists (AAMD) allowing these organizations to utilize AAPM online tools to service their members.

COMP is utilizing the online abstract submission process, the online profile and membership directory. AAMD is using our online membership directory and profile, dues payment processes and placement service.

Staff News Jean Rice returned to work in January after a long medical leave. While she was greatly missed and some things have had to slide in her absence, Falaq Moore-Pimienta and Dawn Taliford along with Cecilia Balazs really stepped in and did an excellent job in her absence.

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Professional Council Report Three Rivers and Three Tracks Jerry White Council Chair The 2004 AAPM meeting in Pittsburgh will break new ground.

We will be meeting in a beautiful city that has three impressive (at least for us Westerners) rivers.

Also, for the first time, we will have three meeting tracks. In addition to the traditional Scientific and Educational Tracks, AAPM 2004 will introduce a Professional Track. This track will in-

clude proffered and invited papers related to economics, government relations, legislation and regulation, ethical issues in clinical practice and science, legal activities, professional and personnel relations or topics that relate to the profession and practice of medical physics. Also included in the Professional Track will be symposia discussing economics, ethics, legal and regulatory topics of professional inter-

est to clinical, academic and research medical physicists. Some sessions will be cosponsored by the ACMP and the ACR, assuring a broad range of expertise and opinions. We anticipate that the addition of the 2004 Professional Track will make this year’s meeting an unusually robust and interesting meeting for all of us. See you in the 'burg in July.

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Education Council Report Herb Mower Council Chair I am happy to report that the AAPM is expanding its offerings at the RSNA meeting. At RSNA 2002 we experimented with the "Physics Case of the Day." This will return at RSNA 2004. This year we also anticipate a fourhour track on Monday dedicated to IMRT. This will give those AAPM members who are primarily radiation oncology physicists an opportunity to have a productive educational experience in a single day rather than spreading it out over the whole week. We hope that this format will dovetail well with our AAPM committee meetings.

In addition we will have over 40 hours of "Physics Track Courses" including topics as mammography physics, physics of ultra-

sound, molecular imaging, CT physics and technology, digital radiography, MR imaging physics, and radiation safety and risk management.

We will continue to offer minicourses including Physics for Residents: "Basics of MRI"; Equipment Selection: "Computed Tomography"; Radiologic Sciences Tutorial for Associated Sciences: "Digital Radiography, including Image Processing."

Our Summer Schools continue to be the best vehicle to keep the practicing clinical medical physicist up-to-date. Topics vary from broad coverage of radiation oncology physics, diagnostic radiology, and nuclear medicine to very specific topics within these disciplines. This year the topic is: "Specifications, Performance Evaluation and Quality Assurance of Radiographic and Fluoroscopic Systems in the Digital Era." It will be held July 29–August 1 at Carnegie-Mellon University. Presently we anticipate that the 2005 Summer School will be on brachytherapy. It will be 'linked' to the Annual Meeting.

Linked means that the school will be scheduled either the week preceding or the week following the Annual Meeting at a site reason-

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Mower

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(from p. 7)

Chapter News

ably close to the meeting. For 2006 the Summer School subcommittee is proposing a school on the clinical implementation of Monte-Carlo codes and organ motion issues in radiotherapy. If a topic near and dear to your heart has not been addressed recently, contact Paul Feller so that it can be considered for future schools. The Summer School subcommittee is also considering a PATG (Program Arrangements Task Group) to assist the faculty chairs of the Summer Schools.

Again, contact Paul if this might be of interest to you.

If you have any topics or ideas for any of the committees, subcommittees or task groups within the Education Council, please feel free to transmit them to me. As always, our groups welcome ideas, attendance at our meetings by any of our AAPM members, and new workers. Feel free to contact the chair indicated in the AAPM directory or communicate your ideas directly to me.

Great Lakes Chapter Jean Moran Chapter President GLC Ski Weekend The GLC-AAPM held their annual ski weekend on January 16-17 in northern Michigan. After a day of skiing with families, attendees enjoyed the scientific presentations. Dr. James Balter described different ways to deal with the effects of organ motion in radiation therapy. Dr. Drew Turrisi educated members on different therapeutic approaches to small cell lung cancer and the need for randomized clinical trials to identify appropriate treatment doses for radiation therapy.

Afterwards, the families joined the attendees, and everyone enjoyed a delicious Northwoods buffet. This meeting would not have been possible without the support of our sponsors. Special thanks to Philips and Elekta for

their generous support and for participating in the meeting.

Thanks also go to Tomotherapy and Landauer for their support.

CT Accreditation Meeting The GLC-AAPM also met on February 19 at William Beaumont Hospital (WBH) for a practical discussion of obtaining ACR accreditation for CT. Dr. Donovan Bakalyar and Dottie Cumper, RT of WBH, gave an excellent examination of the new ACR requirements and provided guidance in navigating the ACR accreditation process for CT scanners. The meeting was well attended by physicists and CT technologists. Cheryl Schultz and Shannon Robertson of WBH did a great job organizing and hosting this event. Special thanks to Siemens for providing a wonderful dessert table for the meeting.

2004 RDCE

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Need Continuing Education Credit s?

Credits?

Earn your medical physics continuing education credits online through the

AAPM Remotely Directed Continuing Education Program Answering 8 of the 10 questions will provide you with one Medical Physics Continuing Education Credit (MPCEC). The results of your passing scores will be forwarded to the Commission on Accreditation of Medical Physics Education Programs (CAMPEP).

You will receive a summary of your MPCECs earned through the RDCE program at the end of the year from CAMPEP. Member Registration Fee: $30

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2002 Medical Travel Grant Report Jean Moran, PhD Ann Arbor, MI With the generous support of the AAPM travel grant funded by Dr. Charles Lescrenier, I was privileged to visit four centers in the Netherlands. My hosts during my trip were Drs. Ben Mijnheer at the Netherlands Cancer Institute, Andre Minken at the Radiotherapeutic Institute of Limburg (RTIL), Maarten Dirkx at the Erasmus Cancer Center, and Henk Huizenga at the University of Nijmegen.

Discussions focused on issues related to IMRT, patient and organ localization, and use of EPIDs for dosimetry. I presented the work we have performed at the University of Michigan related to understanding dynamic (DMLC) and static (SMLC) delivery using dynamic log files and our work utilizing an active matrix flat panel dosimeter for static and IMRT phantom measurements.

The trip was an excellent opportunity to share my experiences with respect to IMRT as well as to learn from my colleagues about the challenges they face with IMRT optimization, delivery, and quality assurance. Due to the complexity of IMRT planning, several centers had research projects to evaluate different optimization systems; Hyperion (University of Tuebingen), Pinnacle, and CMS. Both the NKI and RTIL are evaluating the Hyperion system for optimization.

As one of its features, Hyperion

changes the inverse problem to place dose where critical organs at risk allow dose to be placed and then evaluates the resulting target doses for acceptability.

Among the various optimization systems, there are also differences between dose calculation algorithms, leaf sequencers (or leaf motion controllers), and whether or not the final patient calculation is based on the sequenced field as opposed to an idealized fluence distribution.

I was also impressed with the patient dosimetry projects at each center. I saw this as a major difference of emphasis in the routine practice of radiotherapy medical physics between the US and the Netherlands. At RTIL on the first day of a patient treatment, each field is verified by measurement. They are currently using MOSFETS but are actively extending their program to include measurements with portal dosimetry. At Erasmus, the group continues to develop CCD camera systems while at the same time using their systems for IMRT field verification (without the patient in the beam) for pre-treatment quality assurance.

At each center, I also had an opportunity to talk with physicists-in-training. These were typically individuals with doctoral degrees in other fields. The fouryear training program comprises practicum training at two centers and various related short courses.

Based upon my inquiries, I now understand that the program was

established in this way to standardize radiotherapy medical physics training in the Netherlands.

While at the NKI, I enjoyed observing the testing procedure of the first cone beam CT unit in the Netherlands. In a single gantry rotation, large amounts of data were acquired and the essential data were then quickly reconstructed. Part of their development work has been to improve reconstruction software to use in an adaptive treatment protocol.

The process involves scanning a patient with KVCT and then adapting the patient's treatment for that day based on the position of the target and normal tissues. During my visit we discussed how they were going to apply KVCT to improve daily prostate treatments. KVCT is just a part of the NKI's comprehensive imaging program for treatment verification. I look forward to hearing more about the NKI's KVCT applications in the future.

All centers are in a growth phase. The government of the Netherlands recently passed a

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(from p. 9)

law allowing the installation of additional linear accelerators, recognizing an increase in the population requiring radiation therapy treatments. This growth requires new personnel in all aspects of radiation therapy care.

I enjoyed my travel through the country. I found the train and bus system to be very reliable. In Amsterdam, I enjoyed walking along the streets, taking in all the flowers (container gardens, street corner florists, etc), visiting the museums, and joining friends and colleagues for a drink adjacent to one of the many canals. I also enjoyed visiting with Iain Bruinvis and Ben Mijnheer again.

In Rotterdam it was great to see Maarten Dirkx and Marion Essers after having met as graduate students. We also have our previous experience on the MM50 Racetrack Microtron in common.

In Nijmegen, Henk Huizenga and his family welcomed me to their home. We enjoyed sipping tea in the garden. Over the course of the evening, we discussed a variety of topics including the future role of electrons in radiotherapy, work-family balance, and how to educate patients so they can play a role in determining what risks they are willing to accept in radiotherapy treatment.

The University of Nijmegen was about to embark on a protocol that allowed patients to choose their dose level after discussions with a trained counselor. I look forward to their results.

In Heerlen I felt like I made some new friends. Andre Minken

shared the excitement of the RTIL's growth as it embarks on some new directions. A new department is being built in the city of Maastricht that will also result in the growth of the physics division. Maastricht was also where I enjoyed a delightful weekend trip. I fell in love with its cobblestoned streets, window shopping, and outdoor dining.

At each department I felt very welcome. I am grateful to all of

my hosts for a wonderful scientific and fun trip. It would not have been possible without the generous support of Dr. Charles Lescrenier who funds the AAPM travel grant. I would like to encourage other young investigators to consider applying for this wonderful opportunity to see how medical physics is practiced in another country and to meet new colleagues. â–

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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 question about the ACR Mammography QC Manual? Check out the ACR's Web site at www.acr.org; click "Mammography" and then "Frequently Asked Questions." You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I'll present questions of particular importance for medical physicists.

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

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

Q. Under the FDA's Interim Rules, the ACR Mammography Quality Control Manual was adopted by reference. A mammography facility had to meet the

performance criteria in the 1992 or 1994 ACR Mammography Quality Control Manuals in order to be accredited and meet MQSA standards. Does the ACR now require a facility to meet all of the performance criteria specified in the 1999 ACR Mammography Quality Control Manual in order to pass accreditation?

A. Under the MQSA Final Rules, the ACR cannot require facilities to meet accreditation standards that differ from MQSA regulations. In addition, the ACR Mammography Quality Control Manual is no longer adopted by reference in the FDA Final Rules.

That means the new quality control manual is no longer a regulatory document and that it can go back to what it was originally intended to be: a guidance document. The ACR can once again provide guidance on how things should be done for quality improvement as well as to meet MQSA regulations. The 1999 manual clearly differentiates between what is required by the FDA and performance criteria that are ACR recommendations (guidelines). Although facilities must only meet FDA requirements to be accredited, the ACR recommends that facilities consider implementing the ACR guidelines to further improve the quality of their mammography.

ACR Mammography Quality Control Manual on the ACR Web site?

A. The Technologist's QC Charts, the Medical Physicist's Summary Report and Data Recording and Analysis Forms and the MQSA Requirements for Equipment form are available in the accreditation section. The technologist's forms are in a Word format and the medical physicist's forms are in Excel. You must download the files as follows to your own computer (or disk) in order to use them: 1. Right click on the title of the form.

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

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

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Letters to the Editor Ishtiaq Hussain, MS Houston, TX ihussain@bcm.tmc.edu Inspired by a letter titled "Training Programs for Medical Physics" by Howard Amols, I would like to present a couple of my ideas on this topic.

Medical physics is a new and emerging profession that is undergoing constant refinement and expansion at the same time. Refinement in terms of highly structured training programs such as clinical residency training in medical physics and expansion in the context of application of medical physics beyond the traditional roles such as radiation compliance testing of various imaging equipment to areas such as modern digital imaging associated image processing and data communication issues. This certainly means that we need medical physics syllabi that cover a broad range of subjects rather then having a narrow focus. Not only that, I think the medical physics courses need to be revised frequently to keep up with the everchanging world of medical physics. Most of the current medical physics graduate programs, to my knowledge, tend to cover a diverse range of subjects from radiation physics to digital signal/image processing, etc. I can safely imagine that modern day medical physics programs are substantially broad in terms of their scope. I therefore do not understand what my colleague wants to convey when he

says that medical physics programs are narrowly focused and rigid. Further, all medical physics graduates who had an undergraduate major in physics have gone through subjects such as electromagnetic theory and quantum mechanics. I thus fail to understand what my respected colleague wants to achieve by "diversity" that he seems to be advocating. At the end of the day, if any one from any of the physical sciences were to enter medical physics, then why initiate medical physics as separate graduate programs in the first place, not to mention the recent trends of clinical residency programs in medical physics.

I do agree that finances could be an issue in terms of CAMPEP accreditation-related matters.

Having said that, I think that if the medical institutions and health care facilities and their administrators are convinced of advantages associated with medical physics support, then probably many hurdles, including economic issues, can be surmounted at all levels in both government and the

private sector. To do this we need appropriately trained scientific professionals with proper credentials that can testify for the skills of a candidate. Medical physics graduate programs and clinical medical physics residency programs and their CAMPEP accreditation vouches for the fact that at least a basic set of standards has been met by the program in the field of medical physics which is of direct consequence to the graduate.

To conclude, if the word out there is to set a deadline for recognizing "CAMPEP only" medical physicists as the only qualified medical physicists, and to allow them to appear on the boards, then I think that's a very healthy step towards strengthening the base of the profession of medical physics, as well as ensuring the fact that right individuals are doing the right job. I finish with a couple of points to ponder: a. What you know about what you do and from where you learn it DOES count and is of significance as well as relevance. b. Every old fashioned (physicist) should know that every religion needs to be translated to fulfill the demands of times in which we live, and if not so, then religions and their practitioners become obsolete and outdated and an impediment to the progress of societies and systems. Modern day world is replete with such examples. â–

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AAPM AAPM NEWSLETTER NEWSLETTER

NOVEMBER/DECEMBER 2003 MARCH/APRIL 2004 MARCH/APRIL 2004

Letters to the Editor In response to Dr. Amols' letter regarding Training Programs for Medical Physics George W. Sherouse, PhD Chapel Hill, NC gws@gwsherouse.com Dr. Amols makes some fine points, and makes them well, in regard to the very brief history of our profession. The pioneers he names and many he does not are only one or two mentorial generations removed from some of the more mature practicing medical physicists. We remember them, or at least the secondhand stories, and we revere them.

What Dr. Amols' comments fail to account, though, is that those pioneers had no other option but to bring their generalist training with them into this new field.

There just weren't any mentors to be had for those who were inventing the field. The pioneers that we remember and revere worked in close partnership with physician colleagues to develop the whole notion of medical use of radiation from the ground up.

They often got it wrong. Some of them injured themselves and others with their own naivetĂŠ.

They learned, they invented, they taught.

Our situation is very different today. While we still do a whole lot of inventing and learning the field is well established and, as

Dr. Amols helpfully points out, our membership is rich with seasoned professionals who have had the opportunity to grow with the field.

Even in my short time in this field (roughly the fourth quarter of the medical physics timeline so far) the complexity of what we do has mushroomed and its differentiation from other physics applications has grown exponentially.

There is, as there has always been, a need for creative people to make new stuff up, to push the envelope. But the bedrock is now very thick. Much of what is medical physics is institutionalized in a way that the pioneers would have had trouble imagining. Those who enter the field today thinking they will reinvent the enormous canon of standard practice are fooling themselves and are a danger to us all.

Dr. Amols' argument that requiring rigorous training as a medical physicist would be hurtful to the intellectual diversity of its practice is just preposterous. Education does not begin and end with medical physics graduate school, never has. People come to this profession, indeed to any profession, from all sorts of backgrounds. I, for one, came from a pure physics undergraduate and graduate degree program, augmented heavily with computing.

None of that qualified me to practice medical physics. It surely did enable me to make the developmental contributions to the field that I have since made. But

it was my graduate training and mentoring in medical physics by Mr. Tom Mitchell and Drs. Larry Fitzgerald and Walter Mauderli and Frank Bova, and clinical training in Dr. Rodney Million's department at the University of Florida, where the training of medical physicists was integrated into the fabric of the academic medical practice, that taught me how to take care of patients and showed me where the interfaces were between my interests and the practical patient care needs.

Dr. Amols seems to conclude that it is impractical to properly train people. I cannot argue with his numbers, but I certainly argue with his conclusion. The story he tells with his numbers is based on a faulty premise. I truly do not understand whose interest it serves to set the bar as low as it takes to produce adequate numbers of new bodies, other than opportunists who have discovered that they can leverage their credentials in another discipline, without bothering with troublesome formal retraining, to easily cash in on the unregulated highpaying career of faux medical physics. The fact that our profession allows this to happen is, not least among the sins, an insult to the legacy of the very pioneers that Dr. Amols has invoked. It is a tacit endorsement of the objectionable notion that even after so many generations of refinements and innovations it still doesn't take any specialized knowledge or

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AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MARCH/APRIL 2004

Letters to the Editor training to practice medical physics. That's just a damnable lie, my friends.

The bar needs to be set high for two very important reasons. It needs to be set high because ultimately it is the health care of a sizeable fraction of our communities that is at stake, and because it is the very existence of our profession which hangs in the balance. It is not 1904 or even 1974, it is 2004 and this is capitalist America. We can no longer rely on goodwill to see us through.

The money and the personnel and programs which Dr. Amols has listed as missing will appear when the requirements for proper credentialing are established. It is indeed naive to think that the converse would be an effective strategy.

It is my hard-won opinion that the time has come for medical physicists to pull our heads out of the warm sand of laissez faire that Dr. Amols has so soothingly described and realize that we are cogs in a very big business. We still have a glimmer of a fleeting chance to influence whether we are independent practitioner cogs or technician cogs. The latter is the default path, reinforced every time someone with a generalist background gets away with a self-declared overnight transformation into a medical physicist. The former will only come from those greybeards among us finally beginning to define the profession with some rigor and

“It is my hard-won opinion that the time has come for medical physicists to pull our heads out of the warm sand of laissez faire that Dr. Amols has so soothingly described and realize that we are cogs in a very big business.”

establishing clear training and credentialing rules that are in every possible way exactly analogous to those held by other professionals. To give one particularly pertinent example, young would-be physicians can major in anything they choose as undergraduates, can even go to graduate school before, after or during medical school if they choose, maybe practice for awhile in some other field. But what matters on the path to becoming a legitimate medical specialist is that one complete medical school, complete a formal clinical residency training, pass a rigorous certification exam that tests for clinical competency and be licensed by the requisite state licensure board. To be credible as a profession medical physics needs to adopt that very same structure as a requirement, not a suggestion, and that needs to occur as quickly as possible. The cost of not being credible as a

profession is that we lose the professional autonomy that 100 years of ad hoc practice has built.

I have had the skill and good fortune to invent some things that have made a difference. When I was doing that I was working completely without a net and really digging it. I made up some concepts and named some things and now we all live with some of those things every day without ever thinking about where they came from. That's what success looks like. Part of the price of success is that once the new ideas are established they get codified and regulated and task-grouped and aren't much fun anymore. I hate that as much as the next guy.

But I also clearly see it as part of the cost of progress. If you don't structure and define what you have invented then it's not possible for those who come after to understand and use it. I think medical physics, the invented profession, is overdue for just that kind of coming of age, painful as the process will surely be.

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AAPM NEWSLETTER

2004 MARCH/APRILMARCH/APRIL 2004

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: May/June 2004 Postmark Date: May 15 Submission Deadline: April 15, 2004

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