AAPM Newsletter September/October 2004 Vol. 29 No. 5

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 29 NO. 5

SEPTEMBER/OCTOBER 2004

AAPM President’s Column

AAPM Awards The following awards were presented at the AAPM Annual Meeting in Pittsburgh in July. Congratulations to the recipients!

G. Donald Frey Charleston, SC By every measure the recent AAPM Annual Meeting in Pittsburgh was very successful. We had a record attendance for a meeting that was not a joint activity. We had a record number of scientific abstracts, and a very successful technical show. We inaugurated a professional track; the educational program was of outstanding quality. Meetings like this do not occur by chance. It is only because we have a very dedicated group of volunteers and an extremely efficient professional staff that they happen. It is my pleasure to acknowledge the people without whom we would not have had this spectacular meeting in Pittsburgh, the people who have nurtured this meeting for several years, the people who have led the group that worked tirelessly to ensure its success.

Daniel Pavord, who chaired the Local Arrangements Committee, is at the top of the list. I also want to recognize the people who had major responsibility for the organization of the scientific, educational and professional components of the 46th AAPM Annual Meeting. This group included Scientific Program Co-Directors Ehsan Samei and Gary Ezzell,

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Farrington Daniels Award The AAPM presents the Farrington Daniels Award to the best dosimetry paper published in Medical Physics.

This year’s award is presented to: Education Program Co-Directors Eric Klein and Perry Sprawls, Professional Program Co-Directors Mike Herman and Jerry White, Subcommittee Chairs David Pickens and Jerry Allison, and Meeting Coordination Committee Chair Bruce Curran. Finally, I would like to thank the many professionals at AAPM Headquarters who labor above and beyond the call of duty for our association.

Because of all this hard work and dedication, the most recent (or this year’s) survey shows that the membership is pleased with the structure and content of the annual meeting. See you all in Seattle next year.

(See Frey - p. 2)

Brad Warkentin Stephen Steciw Satyapal Rathee B. Gino Fallone (See Awards - p. 3)

TABLE OF CONTENTS Chairman of Brd. Rep. President-elect Report Executive Dir’s. Column Leg. & Reg. Affairs Education Council Rep. News from CAMPEP CRCPD Report Clinical Trials Update Travel Grant Report In Memoriam Letters to the Editor

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p 4 p 7 p 9 p 11 p 13 p 14 p 15 p 21 p 23 p 27 p 28

AAPM NEWSLETTER NEWSLETTER AAPM

Frey

SEPTEMBER/OCTOBER 2004 SEPTEMBER/OCTOBER 2004

(from p. 1)

Payments Code 77336 As many of you know, Aetna has stopped paying code 77336 for medical physics services. Using the guidance of the Professional Council and the Economics Committee, I have written to Aetna pointing out how this will have a negative effect on patient care. The AAPM is working closely with the Medical Physics Commission of the ACR on this issue. I will keep you informed of any progress in this area.

Board of Directors For many years there has been discussion of how the size of our board of directors affects its efficiency. Our board is larger than the boards of most organizations our size. It consists of 37 voting members and three non-voting members. There has been a sense in the association that the board would be more efficient if it was smaller and that feeling was expressed by the membership in the recent survey. I believe that the board loses efficiency because the group is too large to work well; reducing its size could improve its efficiency. The challenge is to find a formula that reduces the size without disenfranchising any block within the association.

After many years of discussion, the Ad Hoc Committee on Governance has devised a proposal to do this. The plan deserves wide discussion within the organization and you will see many articles in this and future news-

letters about it. There is probably no such thing as the one best way to do this, but I think a fair and efficient plan is possible. I encourage everyone to take an interest in this and to provide comments to the board. You can email the whole board using the alias in the committee tree.

Conflict of Interest As I discussed in a previous column, it has become clear that organizations should provide greater transparency about possible conflicts of interest. At the Pittsburgh meeting the board voted to adopt a policy on conflicts of interest. This policy will require members who are active in the association to file a conflict of interest form. The Rules Committee is presently formulating changes that will allow full implementation of the policy.

Elections The results of the AAPM elections were announced at the AAPM Business Meeting. I would like to thank everyone who was willing to put himself or herself forward as a candidate. The commitment to the AAPM is substantial and the future of our organization and that of medical physics depends on people being willing to serve. As announced, E. Russell Ritenour will be the association’s president-elect in 2005. J. Ed Barnes, Dianna D. Cody, Willi Kalender and Matthew B. Podgorsak will be the new members-at-large of the board of di-

rectors. Chester R. Ramsey and Per H. Halvorsen will be the alternates.

AIP Director The AAPM is a member organization of the American Institute of Physics. Because membership in the AAPM has exceeded 5000, we now have three seats, rather than two, on the AIP Board of Directors. With the concurrence of the Executive Committee I have appointed Angela Keyser as our third director. She joins Christopher Marshall and James Smathers.

Just for Fun Charles Wilson recently sent me two documents from the early history of our association. The first, “The Future Role of Medical Physics: A Symposium” is the published results of a symposium held at the 10th Annual AAPM meeting in 1968. Bob Gorson chaired the program and the four panelists were: John Laughlin, PhD, Robert Mosley, MD, Edward Webster, PhD, and Frank Larson, MD. It is fascinating to

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see that many of the issues that we discuss today were issues for the AAPM as it struggled to determine its identity almost 40 years ago. Reading this document is definitely déjà vu all over again.

The panelists struggled with the relative roles of science and professionalism in the association.

They debated the appropriate educational background for medical physicists and whether or not we should limit ourselves to “radiation physics.” The second document is a short pamphlet, “The Medical Physicist – a Scientist in Modern Medicine.” This pamphlet, which we published in 1969, mentions that medical physicists salaries ranged from $7.5 to $20k. It is interesting to note that if you correct this number for changes in the consumer price index, the resultant salary of $38k to $103k would be low by modern standards. The pamphlet also mentions that demand for medical physicists exceeds supply; plus ca change, plus c’est la meme chose. While we clearly struggle with the past, from a professional point of view it is heartening to note that the equipment shown in the pamphlet looks hopelessly ancient. I want to thank Dr.Wilson for sharing these documents with me. I hope to post them on the Web site soon.

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Awards

(from p. 1)

for their paper entitled “Dosimetric IMRT verification with a flat-panel EPID,” Medical Physics 30 (12) / 3143-3155, 2003.

Third Place: Joel Wilkie for his paper entitled “Textural Analysis of Pelvis Bone Images for Early Detection of Osteolysis in Hip Replacement Patients.”

Second Place: Wesley Culberson

Sylvia Sorkin Greenfield Award The AAPM presents the Sylvia Sorkin Greenfield Award to the best non-dosimetry paper published in Medical Physics. This year’s award is presented to: Tao Wu Alexander Stewart Martin Stanton Thomas McCauley Walter Phillips Daniel Kopans Richard Moore Jeffrey Eberhard Beale Opsahl-Ong Loren Niklason Mark Williams for their paper entitled “Tomographic mammography using a limited number of low-dose cone-beam projection images.” Medical Physics 30 (3)/ 365-380, 2003.

Young Investigators Competition The winners of the 2004 Young Investigators Competition held in Pittsburgh are:

for his paper entitled “New 125I and 103Pd Brachytherapy Seed Air-KermaStrength Measurement Techniques.”

John R. Cameron Young Investigator Award: Amit Sawant for his paper entitled “Empirical Investigation of a New Generation of High QE Detectors for Active Matrix Flat-Panel Imager EPIDs.”

Jack Fowler Junior Investigator Award A new award for junior investigators was established this year in honor of Dr. Jack Fowler, Emeritus Professor of Human Oncology and Medical Physics, University of Wisconsin. This award is given to the top scoring junior investigator abstract submission. This year the award is presented to: Alexei Trofimov, Ph.D. of Mass. General Hospital ■

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AAPM AAPM NEWSLETTER NEWSLETTER

SEPTEMBER/OCTOBER 2004 SEPTEMBER/OCTOBER 2004

Chairman of the Board Report Martin S. Weinhous Cleveland, Ohio

Report on the Board Meeting This column will read a bit like minutes, but is intended to illustrate the processes by which the board conducts business. The more we all understand about the operations of the association, the stronger the association will become.

Your board of directors met for five hours on July 29th. Many business items were dealt with and many lively discussions were held… The board meeting is structured to include a consent agenda and then reports and action items from the treasurer (initially a very brief statement of our financial posture followed later in the meeting by a detailed report), president, chairman of the board (including the “open-discussion” session), president-elect, education council chair, professional council chair and science council chair. After a short break, administrative committees reported and brought forward any action items.

This was followed by reports from the secretary, treasurer and executive director. Lastly, old, new and other business were accommodated prior to adjournment.

Consent Agenda In preparing for the board meeting, the Executive Commit-

tee will often put presumed noncontentious items on a consent agenda (intended to be passed by unanimous consent). Shortly after the board meeting is brought to order, the board members are asked if anyone objects to any of the items listed. If even just one board member objects to the presence of an item, it is removed from the consent agenda and individually discussed at the appropriate time in the meeting.

On the 29th, the following items passed by unanimous consent…

•Revision of PP 7, Process for Selection of AAPM Nominees for the following positions in external organizations: ABMP Board of Directors, ABR Physics Trustee, chair of ACR Commission on Medical Physics and CAMPEP Board of Directors (moved by ExCom) •Charging the Rules Committee to recommend changes as necessary to make council chairs exofficio, non-voting, members of the board (moved by ExCom) •Revision of AP 42, Procedure for Policy Book Revisions (moved by ExCom)

•Revision of AP 17, Summer School Tuition, to make the rolling-average three-year profit target $50,000 rather than $150,000 (moved by Education Council) •Full reaccreditation of the MD Anderson ADCL (moved by Science Council) •Charging the Rules Committee to recommend changes as necessary to reorganize the Science Council (moved by Science Council) •Selection of Anaheim, CA as the site of the 2009 annual meeting (moved by Meeting Coordination Committee) •Membership dues discount of $25 for those receiving Medical Physics online only (moved by Journal Business Management Committee) •Removal of member’s signature form outer ballot envelope (moved by Rules Committee) •Language cleanup for rule 3.9.1 (John R. Cameron Young Investigator Award) and cleanup of rule 3.25.3 concerning membership of the Electronic Media Coordinating Committee (moved by Rules Committee) •Repeal of rule 2.6.8 concerning treasurer’s review of all requests for membership mailing lists (moved by Rules Committee) •Approval of the minutes of the December 3, 2003 board of directors meeting.

One item was removed from the consent agenda having to do with the relocation of the International Affairs Committee from the ad-

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ministrative tree to the Educational Council tree (moved by ExCom, discussed later and then postponed ‘till the board meeting at RSNA).

President G. Donald Frey, PhD moved the ExCom motions (1) for the appointment of William R. Hendee, PhD as the editor of Medical Physics and (2) charging the Rules Committee to incorporate conflict-of-interest declarations for appointees. Both motions passed easily.

Chairman of the Board Martin S. Weinhous, PhD moved the ExCom motions (1) that the board direct chapters to promptly provide legal and tax information to headquarters, passed. (2) That the International Affairs Committee be relocated to within the Education Council, postponed till the board meeting at RSNA.

Chair’s Open Discussion Session During his term as chairman of the board, Charles W. Coffey II, PhD instituted an open discussion session wherein the members would brainstorm rather than simply react to motions. Charlie’s idea was very successful and has been continued by his successors.

The topics at this meeting’s open discussion included…

•Criteria for the Coolidge Award

•Concept of, and potential AAPM support for, Certificates of Added Qualification •Categories (types) of AAPM membership and the sufficient and necessary qualifications for each •AAPM Organization and Governance (including methods for electing board members, chapter boundaries, interaction with state legislators and regulators, etc.)

•An AAPM position on keeping “Intelligent Design” out of science classrooms •Concept of Structured Mentorship as alternatives to a Medical Physics Residency (for possible recommendation to CAMPEP).

There was lively discussion and many ideas were harvested. The open discussion sessions will continue as we endeavor to make better use of the brainpower of the board.

Council Chairs The three councils’ action items were approved in the consent agenda. The chairs provided brief reports and answered questions.

Secretary, Treasurer and Executive Director Reports were provided and questions answered (with any action items dealt with in the consent agenda).

Old, New and Other Business There was brief discussion of a few items, most raised from the floor, but no action items. The meeting was adjourned by the nominal ending time of 6:00 PM.

In Summary As has been the intent for the last several years, by changes in the style, process and operation, the board is being asked to be more proactive. This is evidenced by their thoughtful participation in the open discussions and in the ideas gathered during the meeting. It is very much to the advantage of the association that the board have that role. Howard Ira Amols, PhD plans further involvement of board members in the operation of the association.

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Administrative Committees While the Development Committee had several action items, the committee chair and the board deferred action till RSNA so as to have time to better understand the issues.

Reports were received from the other administrative committees (no action items beyond those of the consent agenda).

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AAPMNEWSLETTER NEWSLETTER AAPM

SEPTEMBER/OCTOBER 2004 SEPTEMBER/OCTOBER 2004

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AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM AAPM NEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER SEPTEMBER/OCTOBER 2004

President-elect Report Howard Amols New York, NY

Report on Member Survey Results of the member survey are in. This was the first-ever attempt to solicit member opinions on various issues such as satisfaction with AAPM services, publications, meetings, summer school, local chapters, AAPM organizational structure, Web site, training, professional issues, and dues. The online questionnaire was sent to all full and emeritus members and the response was most gratifying. In particular, 61% of the surveys were returned, representing nearly 2100 members. The survey gurus at AIP who conducted it for us noted that this is an exceptionally high response rate. By comparison, only 30% vote in the annual election, and fewer than 5% typically attend the annual business meeting. Several sections in the survey allowed freefield input for comments, and over 3000 individual comments were received—perhaps a 40-year backlog of comments just waiting to be tapped, with many members eager for the opportunity to make their opinions known. In this report I’ll first present a summary of survey results, and then tell you what we plan to do with the results.

Most AAPM services received high marks. Ninety-two percent

Howard with his grandson.

of members feel that AAPM dues are a good or excellent value for the money. Over 88% believe that task group reports, the Web site, and the journal are good or excellent. Sixty percent of members choose Medical Physics as their journal of choice when submitting manuscripts for publication. Another winner was the annual meeting. Typically 55% of members attend and most (55%) think it’s a good value for the money. Most members prefer holding the annual meeting in the summer in a major city with a nice climate and cheap hotel rates. If only there was such a place! There were numerous comments about holding meetings in hot and humid places (most of them not favorable) but attendance varies little from year to year.

As for why members attend, the major reasons are interacting with colleagues (81%), continuing education courses (77%), technical exhibits (70%), symposia and special sessions (69%). Of little surprise, at least to me (sorry

for editorializing), is that few people find oral paper presentations or poster viewing useful (46% and 36%, respectively). Of course, in any large group somebody has to be more than three sigma from the norm and there were 41 responders (2%) who would like to see more parallel sessions and 124 (6%) who want more posters.

On professional issues, 91% believe that board certification should be a requirement for calling oneself a qualified clinical medical physicist (QCMP), but only 41% believe that state licensure should be a requirement.

However, 65% believe that AAPM should be more active in support of state licensing. Similarly, 86% believe that AAPM should more actively support accredited training programs, but only 21% believe that a CAMPEP degree (and only 14% a CAMPEP residency) should be a requirement for becoming a QCMP. So, there is support for these issues, but not as an absolute requirement; sufficient, but not necessary. Members also feel strongly that AAPM should be more active in lobbying on regulatory issues (88%) and in support of independent billing by oncology physicists (64%).

Not everything at AAPM came out smelling like a rose. Only 54% believe that AAPM annual elections are very useful, although 63% claim to have voted in more than one election during the past

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(See Amols - p. 8)

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Amols

SEPTEMBER/OCTOBER 2004 SEPTEMBER/OCTOBER 2004

(from p. 7)

five years. Interestingly, from other sources we know that only one third of members vote in any given year. As a homework problem I leave it to the reader to prove that these two findings do not contradict each other.

Despite the fact that most AAPM services are considered to be good or excellent, only 28% of members feel that the board of directors (BOD) is effective.

However, since 81% of members have never attended a BOD meeting, one can only speculate on whether the board’s 28% approval rating would go up or down if more members did attend. Only superhuman self-restraint inhibits me from offering a personal opinion on this conundrum, but somebody, presumably council, committee, and task group members, editors, and AAPM Headquarters staff must be doing something right even if the BOD isn’t.

There was at least one loaded question in the survey. To whit, 78% of members agreed with the statement that the BOD might be more effective if it were reduced in size (currently 37 voting members), although there was little agreement on how to achieve this. Among the possibilities suggested; reduce the number of members at large, reduce the number of chapter reps, and elect all members regionally or nationally. Only the first option received more than a 50% agreement (55% to be precise).

Other disappointments were the finding that only 20% of mem-

bers are active in AAPM activities (i.e., serve on committees, task groups, etc.), 39% would like to be active, while 57% claim to be too busy. Physicists employed at medical schools and university hospitals are the most likely to be involved in AAPM activities (32%) and less likely to be ‘too busy to serve’ (48% say they are too busy) than physicists working in a private clinic or hospital (62% of whom say they are too busy). Hmm! Other issues: the preferred time of year for summer school is indeed summer, although it’s not clear whether this is a chicken and egg thing. How would members have replied, for example, if we had been calling it ‘winter school’ all along? Be that as it may, there is general agreement that the school should be scheduled either before or after the annual meeting, and that the program should continue to rotate between disciplines.

The survey also accumulated demographic information. Seventy-five percent of members describe their job function as mostly clinical, 72% as mostly therapy, and are about equally divided between university or medical school, private hospital or clinic, and private practice or other (i.e., about one third in each category).

For almost all questions in the survey there was very little divergence of opinion when responses were analyzed by age, by discipline, or by place of employment.

I suppose this means that we are in homogeneous disagreement.

This, then, is a statistical summary of the survey. Much more

difficult to analyze are the nearly 200 pages of member comments (10 point font). On many questions, comments spanned the spectrum from alpha to omega.

For example, someone suggested that ‘Amols better smarten up, and fast,’ while another said ‘Amols is right on.’ Since my mother has recently joined the AAPM, it is quite possible that the second comment came from her, but even so, opinions were all over the map on just about everything.

One thing that is certainly clear from the comments is, to paraphrase Abe Lincoln, ‘you can’t please all of the people all of the time, and at least somebody will complain no matter what you do.’

In this light, here are a few anecdotal excerpts from the free-field comments section—all guaranteed genuine and unedited.

•On the journal: ‘awesome.’ ‘essentially useless to most clinical physicists.’

•On the Web site: ‘Absolutely indispensable.’‘Not very user friendly.’

•On the annual meeting: ‘It should always be in the U.S.’ ‘Let’s go back to Montreal.’ ‘No more summer meetings in hot and humid locales.’ ‘San Antonio–the best meeting ever.’ ‘Eliminate the casual dress code’ (note to self: does this means dress more formally or go naked?)

•On the BOD: ‘A proper board should be no larger than 11 members.’ ‘Dominated by academic types.’ ‘It’s fine.’ ‘Too many atlarge members.’ ‘Reduce number of chapters.’ And my favorite on

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this topic–‘Is there a board?’

(Yes, Virginia, there is a board– it’s Santa Claus that isn’t real).

•On professional issues: ‘AAPM should be a professional organization.’ ‘All professional activities should proceed through the ACMP.’ ‘We need independent billing.’ ‘AAPM should not pursue independent billing.’

•General comments section: ‘Not enough unity in the medical physics community.’

Amen to that, and who said surveys can’t be fun as well as informative! Finally, how to make best use of these results? We have divided the results into various sections; services, publications, meetings, local chapters, AAPM organizational structure, professional issues, etc., and individual members of ExCom are reviewing both the statistical data and the comments. When this is completed, results and comments will be sent to members of the board and appropriate council and committee chairs for study, along with suggestions from ExCom for possible action items.

At the moment that’s all I have to report, but you can be sure that more will follow. Finally, to the 39% of you who said you would like to be more active in AAPM business, the appointment process for next year’s assignments is now in full swing, so please e-mail me with topics or assignments you are especially interested in.

I leave you with one final quote from the general comment section of the survey: ‘I’ve got to get to work. Bye.’

Executive Director’s Column Angela Keyser College Park, MD

Did you know…?

In continuation of my efforts to describe key features of the AAPM Web site, this article will highlight the types of information you can find under the “Membership and Member Services” heading on the left-hand side of the main aapm.org page.

•Membership in the AAPM – This area is geared to the nonmember. Direct potential members to this area for a list of membership benefits and membership application information. Information on corporate affiliation is also included. Likewise, you can find a general “fact sheet” about the AAPM and the medical physics profession.

•Placement Service – Here you can find information on placing a job advertisement in the AAPM online Placement Service and search the database for current listings. There are several criteria that you can search on, including type of position and location. You may also save search criteria and you will be instantly notified when a position that meets your specifications is posted.

•Directories – Both the Member and Corporate Affiliate directories are found in this area.

Once again, you can search the database based on several criteria. Using the Advance Search feature of the “Member Direc-

tory” you can search by most of the data points that are maintained on members: location, chapter, member type, just to name a few! With the “Vendor/Corporate Affiliate Directory” you can browse the entire list or search based on name, location, product focus, product line(s), etc.

E-mail Announcements – Remember getting an important email announcement from the AAPM but just can’t find the message in your inbox? You’re in luck. Here you will find a list of all the “mass e-mails” that have been sent to you by AAPM HQ since April of 2003.

•Get or Update Username and Password – Forgot your username and password? Enter your e-mail address and a link will be sent so you may reset them.

You can also change your username and password from this area.

•Update Membership Profile – It is important that you update your contact information online whenever you have a

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(See Keyser - p. 10)

AAPMNEWSLETTER NEWSLETTER AAPM

Keyser

SEPTEMBER/OCTOBER 2004 SEPTEMBER/OCTOBER 2004

(from p. 9)

change. In addition to contact information, you can also: -Indicate whether you want to receive a hard copy membership directory; -View how your actual directory listing will appear in the hard copy version; -Upload a photograph to be included in the online directory; -Opt-out of various types of email announcements; -Provide additional address information (home, courier, etc.); -List certifications; and, -Indicate chapter membership.

2004 Annual Meeting Attendance at the Pittsburgh annual meeting was greater than anticipated. Scientific registrations were up approximately 10%, from 1582 in 2003 to 1749 in 2004, and exhibitor reg-

istrations were up approximately 4%, from 1097 in 2003 to 1142 in 2004. Exhibit booth sales were about 14% greater than anticipated with 20 new companies exhibiting at the AAPM meeting this year. The number of abstracts for the meeting increased from 765 in 2003 to 936 in 2004. The acceptance rate was roughly 95%.

Financial Update The 2003 audit report has been submitted to the board of directors showing a net gain from operations of $1,646,282, including “unrealized” gains on investments of $632,234. The AAPM reserves at the end of 2003 were $5,581,609, which means that AAPM has reached its goal of having one-year’s operating funds in reserve.

In light of recent corporate scandals and the Sarbanes-Oxley

Act, the auditors have made several suggestions as part of the ongoing process of modifying and improving the association’s practices and procedures. One of the suggestions is for the AAPM to name an Audit Committee to serve as a conduit between the board of directors and the auditors. Don Frey will be naming an ad hoc committee to serve in this capacity.

At this point it is apparent that the AAPM will have a net gain in operating funds for the 2004 year.

A conservative estimate of the gain is roughly $350,000. This gain can be attributed in part to an increase in membership, a flourishing journal and placement service and a successful annual meeting and summer school. ■

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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RDCE

RDCE

*Need Continuing Education Credits?*

AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM SEPTEMBER/OCTOBER 2004 AAPMNEWSLETTER NEWSLETTER SEPTEMBER/OCTOBER

Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD

A. Part 35 Training and Experience Update What’s new on the regulatory front, particularly the Nuclear Regulatory Commission (NRC)?

As you know, the NRC completely revised 10 CFR Part 35, Medical Use of Byproduct Material, and the final rule was published on April 24, 2002 (67 FR 20249). At that time, the NRC determined that the new requirements for training and experience (T&E) for authorized users (AU), authorized nuclear pharmacists (ANP), authorized medical physicists (AMP), and radiation safety officers (RSO) needed additional consideration and rethinking so that certifying boards such as the American Board of Radiology (ABR) and the American Board of Medical Physicists (ABMP) could be granted recognized status. Having recognized status means that an individual certified by such a board would only have to submit a copy of his/her board certification in order to certify their qualifications to be listed on an NRC or Agreement State license.

Realizing that only one of the boards could be granted recognized status under the new rule, the commissioners instructed the staff to add a provision to the final rule that would allow the pre-

vious (now old) T&E requirements to remain in place for an additional two years, i.e., until October 24, 2004. In December 2003, the NRC published a draft rule that provided modification to the T&E requirements. Comments were due on February 23, 2004. The AAPM, in collaboration with the American College of Radiology (ACR) and others, submitted extensive comments.

The NRC staff is currently reviewing the comments. It was the intent of the commission that a final rule be published prior to October 24, 2004.

Based on comments received from several states, this will not happen. On August 17th the commission approved an extension to the inclusion of the subpart J requirements until October 24, 2005. This will allow for additional time to promulgate a final set of T&E requirements and to respond to a Petition for Rulemaking anticipated from the Organization of Agreement States.

B. August 17th Briefing by the Organization of Agreement States and the Conference of Radiation Control Program Directors On August 17th the OAS and the CRCPD conducted their annual briefing to the NRC Commission. Attending for the OAS

were: Stan Fitch (New Mexico), president; Jared Thompson (Arkansas), president-elect; Pearce O’Kelley (South Carolina), pastpresident and Gary Robertson (Washington), treasurer. Attending for CRCPD were: Ed Bailey (California), president and Debra McBaugh (Washington), president-elect.

Seven items were included for discussion.

1. Part 35 T&E Requirements – Jared Thompson. In response to the aforementioned proposed rule, the OAS formed a working group to develop comments regarding the proposed T&E requirements. The outcome of this effort is a Petition for Rulemaking to be submitted to the commission in early September. The basis for the petition is to request that the 700 hours specified in 10 CFR §§ 35.55, 35.290, 35.390 be delineated into didactic and experience, i.e., similar to how subpart J is worded. Until the petition is filed, we will not know the specific details.

The commissioners expressed frustration over continued delays in finalizing the T&E requirements, stated that they will look forward to reviewing the petition and the NRC staff’s analysis, and cautioned that resources were tight, especially those dedicated to rulemaking.

2. Progress of the National Materials Program Pilots – Preparing for Transition to a Perma-

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nent Program – Pearce O’Kelley. Due to the increasing number of Agreement States (currently 33), the NRC established the National Materials Program. The purpose is to look at how to better utilize the resources of the commission and the states.

There are currently four pilot projects underway. Results of these will determine whether or not the National Materials Program will continue. Pearce’s point to the commission focused on the need to increase the involvement of the stakeholder community in the working groups. There will be a meeting to discuss this program later this fall, so stay tuned.

3. The OAS’s Pending Action on the Resolution for a National Radiation Policy – Stan Fitch. In his opening remarks Stan indicated that the states believe that a single agency should be charged with the responsibility for establishing radiation standards in the US. This reflects the ongoing differing opinions between the NRC and the Environmental Protection Agency (EPA) in several areas.

The commissioners indicated that although they agree with the spirit of this, the realty of success is totally different. This would require congressional action. This will be a topic for discussion at the annual OAS meeting in September.

4. State Feedback on Clearance Rule – Debra McBaugh.

There is progress being made on the establishment of a draft clearance rule. The discussion was the

question of whether promulgation of uniform guidance would be of benefit to the states in order to establish state regulations. Response was that many states would have a difficult time adopting regulations based solely on guidance. However, guidance for case-by-case situations might be beneficial.

5. CRCPD Naturally Occurring Radioactive Materials (NORM) Rules – Ed Bailey. Ed indicated that after a number of years in development, the CRCPD has finally adopted a Suggested State Regulation (SSR) on NORM. Part N was adopted in 2003 and is available from the CRCPD. During the question and answer session on this topic, Senator Hilary Clinton’s bill (S. 2763, introduced July 22, 2004, link: http:// thomas.loc.gov/cgi-bin/query/ z?c108:S.2763: ), which would amend the Atomic Energy Act to include accelerator-produced material and discrete radioactive sources and give the NRC the authority to regulate them, was discussed. Although this legislation probably won’t be acted upon during this Congress, Senator Clinton will likely reintroduce it next session. The NRC is supportive of this legislation and has been in communication with Senator Clinton’s office. The current cosponsors of the bill are Senators Reid (D–Nevada) and Gregg (R–New Hampshire). In general the states seem supportive of this effort but acknowledge that there would be some states that would not support the bill.

6. The CRCPD’s Homeland Security Council – Debra McBaugh. Debra indicated that as a result of September 11, 2001, the CRCPD has formed a Homeland Security Council and has been actively working in this area. At the 2004 annual meeting there was a panel discussion which included representation from 10 federal agencies. The CRCPD feels there is a need to establish a handbook of “Rules of Thumb” for dealing with radiological terrorism, that training of first responders continues to be a high priority and that there is a need to establish a repository of scenarios that have been developed so that others might use them. It was acknowledged that this information would have to be restricted to those with a “need to know” based on security concerns.

7. The OAS Request for NRC Letter of Support for Agreement State Programs – Jared Thompson. There was discussion that there needs to be a mechanism for letters to be sent to state programs that have had good program reviews but might be facing difficulties in the future due to resource allocations and priority shifts in state agencies. It is felt that such a letter might help the radiation control programs obtain and maintain sufficient resources in order to have a “quality” program. The commission agreed to have dialogue on this and see if they could determine an appropriate level and type of communication.

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In order that the AAPM has time to consolidate comments from the membership, it is requested that comments be submitted to me by October 15, 2004. This will allow for a consolidated package to be prepared to be discussed at RSNA.

C. International Commission on Radiological Protection Draft Recommendations for Comment The International Commission on Radiological Protection (ICRP) has announced the publication of new guidelines for comment which will amend the existing framework. A draft of the guidelines can be downloaded from: http://www.icrp.org/ icrp_rec_june.asp

D. Watch Items

•The NRC Disposition of Solid Materials (i.e., the “Clearance Rule”) •Progress of the National Materials Program and room for AAPM participation •Draft International Commission on Radiological Protection (ICRP) recommendations – Comments due to the AAPM October 15, 2004 ■

•The OAS Petition for Rulemaking regarding Part 35 Training and Experience •Senate Bill 2763 •Efforts to Establish a National Radiation Policy

Education Council Report Herb Mower Council Chair We have just completed our annual meeting. As usual, we had our regular committee, subcommittee and task group meetings.

My thanks to all of our chairs for keeping on top of things for us. It sure makes my job a lot easier.

This year we see some of our chairs and coordinators nearing the end of their term of service.

We thank each of you for your dedicated service to the association.

Bhudatt Paliwal steps down as chair of our ‘Education and Training of Medical Physicists’ Committee. As its title implies, this committee is concerned with those coming into our profession and the programs needed to

make them proficient in our field.

The committee includes: •Medical Physicist Workforce •Secondary Education & Teaching •Summer Undergraduate Fellowship Program •TG 1: Revision of Report 44: Academic Program for an MS Degree in Medical Physics

Jerome Dare is stepping down as the chair of our ‘History’ Committee. Until this year, the History Committee had been an administrative committee. In 2004 it moved under the umbrella of the Education Council. Their responsibility is to make a record of our accomplishments, our organization, and our profession.

The committee includes: •Photographer •Apparatus Museum •Historian For the past several years Mark Rzeszotarski has overseen the Physics Review sessions that take place on the Saturday and Sunday at the start of the annual meeting. These are very

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Judging from the comments and enthusiasm shown at the session, you are very excited about our offerings in these areas. Next year the History Committee will make a presentation utilizing some of their resources. Jerry Dare will host this session.

As those of you who ship radioactive materials are aware, the Department of Transportation is spot-checking various medical institutions for proper training of shippers. Under the joint sponsorship of the Education Council and the Professional Council, Roy Parker led a symposium on Tuesday afternoon to address these issues. Standing room only was the rule of the session until more chairs could be appropri-

(from p. 13)

popular review courses and many of our members have taken advantage of their offerings.

Mark is stepping down this year after having served us well in this role.

Our Education Council Symposium this year introduced our members to: •“AAPM Resources and Projects for the Education of Physicians” presented by Richard Massoth •“Public Education Endeavors of the AAPM” presented by Kenneth Hogstrom •“Availability of Member Slide Sets” presented by Melissa Martin.

ated. Overall, it was a huge success.

As I write this, our summer school is in full swing under the direction of Lee Goldman and Mike Yester. The topic is “Specifications, Performance Evaluation and Quality Assurance of Radiographic and Fluoroscopic Systems in the Digital Era.” Peggy Blackwood has done a superb job in chairing the Local Arrangements Committee.

Next year’s school will be held the week prior to the annual meeting in Seattle, Washington. Bruce Thomadsen is directing a program on brachytherapy. Robin Miller and William Parker are coordinating the local arrangements.

■

News from CAMPEP Brenda Clark CAMPEP President

Medical Physics Residency Program in Radiation Oncology Vanderbilt University Medical Center, Nashville, Tennessee Director: Charles W. Coffey II

Three residency programs have recently been granted accreditation.

Congratulations to the following:

There are now 22 accredited programs in total and although there has recently been an increase in interest from facilities seeking program accreditation, there are currently no programs which have submitted self-study documents for consideration or are scheduled for a site visit. Therefore, if you are considering submitting an application for program accreditation, you are urged to do so as early as possible to receive prioritized attention.

Medical Physics Residency Program in Radiation Oncology University of Chicago Chicago, Illinois Director: Mary K. Martel Residency Program in Radiation Oncology Physics University of Wisconsin Madison, Wisconsin Director: Rupak Das

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36th Annual Conference on Radiation Control Program Directors (CRCPD) Keith Strauss & Melissa Martin Liaisons to the CRCPD from the AAPM The 36th annual meeting of the Conference of Radiation Control Program Directors (CRCPD) was held in Bloomington, Minnesota May 23 - 26, 2004. “Embracing Change in an Evolving Radiological Protection Environment” continued and built on last year’s theme, “Radiation Protection Challenges: Enhancement and Preparedness.” The program, as it has since 9/11, focused on the regulatory challenges of Homeland Security while maintaining standard programs that are protective of health, safety and the environment. Many issues continue to be discussed that underscore the need for medical physicists in each state to establish a strong working relationship with their CRCPD members to work through concerns and issues.

The working relationship and spirit of cooperation between state personnel, medical physicists, and other medical professionals continues to be strong.

Strong training programs at the annual meeting provided by members of the AAPM and ACR are well attended. State personnel clearly appreciate these training opportunities.

Training Sessions The AAPM sponsored a day of training prior to the meeting entitled “Digital Imaging in Medicine.” The training day, coordinated by Melissa Martin, included presentations on Principles of Computed Radiography; Dose, QC and Image Quality considerations in Computed and Direct Digital Radiography; Experience with CR/DR systems in the Clinical Setting, and Training and Education for Clinical Staff for Implementation and Use of CR/ DR. All reviews were excellent and this training was greatly appreciated by the conference participants. This one-day training program was the 11th annual session which is now very much an expected part of the education program at these annual meetings.

The ACR sponsored a half-day of training entitled Pediatric CT. Keith Strauss initiated the session by discussing the basic physics of CT scanning. Don Frey continued by discussing the continuum of dose parameters that physicists measure. Don concluded by presenting numerous clinical examples that illustrated the clinical versatility of state-of-the-art multislice CT scanners. Keith then finished the session by discussing the concept of ALARA CT and its application to pediatric imaging. He discussed radiation risk data for children, the unique anatomy of children rela-

tive to adults, the concept of dose vs. image quality, recent improvements to CT scanners to reduce dose, and the role of state radiation control programs.

A two-hour afternoon “Topical Training Session” during the main program featured three parallel tracks. One track was entitled “How to Deal with the Terror of Radiation and Nuclear Terrorism” coordinated by Ray Johnson, director of the Radiation Safety Academy in Gaithersburg, Maryland. A second track was coordinated by Roland G. Fletcher, manager of the Radiological Health Program in Maryland, and discussed “Radiation Directors Management Training.” The third track of topical training was coordinated by Lynne Fairobent, at that time of the ACR, on the topic of “Interventional Fluoroscopy and Dose.”

Special Interest Meetings and Posters Scheduled special interest meetings and poster topics provide an indicator of topics of concern to state regulators. This year’s special interest meetings were: 1. General License Program for Devices—Regulatory Issues 2. National Air Monitoring System (EPA): Update on Activities, Real time Monitors

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(from p. 15)

3. Energizing and Expanding the National Radon Program: The Role We All Play 4. Low Activity Radioactive Waste Management 5. National Institute for Occupational Safety and Health (NIOSH) Study of Transportation Security Administration (TSA) Screeners—Radiation environment around checkedbaggage screening areas 6. NRC/State Communications During Emergencies Twenty-eight posters were presented; 12 addressed topics directly or indirectly related to the medical industry: 1. Applications of Optically Stimulated Luminescence (OSL) Dosimetry 2. Digital is Here! Images Now, Never Latent!

3. E-24 Committee on Decontamination and Decommission ing: Ongoing Projects 2004 4. Effects of New Jersey’s QA Program on Patient Radiation Dose and Image Quality 5. General Licenses Tracking System (GLTS) 6. Lasers—Growing Diverse Uses and Minimal Regulations 7. Radioactive Materials in Biosolids: National Survey, Dose Modeling, and POTW Guidance 8. Records, Records, Who’s Watching the Records 9. SR-X: Accelerating into the 21st Century 10. SSR Process—Bigger, Stronger, Faster 11. The Agreement State Regulation Review Process

12. The IAEA’s Code of Conduct on the Safety and Security of Radioactive Sources: Moving Toward Implementation within the United States

Opening Session Richard Ratliff, chairperson of the CRCPD, summarized the CRCPD’s activities during the past year. He highlighted some of the CRCPD’s discussions with various agencies and groups and commented on the strong working relationship with the AAPM and the ACR. The CRCPD continues to be concerned about emerging issues and new modalities in medicine. An advisory committee of past chairpersons of the CRCPD has been created to provide suggestions to the CRCPD Board of Directors. He encouraged state personnel to become more involved as resources for local police and fire departments as Homeland Security Programs continue to ramp up.

Charles B. Meinhold, president of the Brookhaven National Laboratory, delivered the annual John C. Villforth Lecture entitled, “History of Radiation Protection of the Public: How Did It Become So Difficult and Contentious?” Mr. Meinhold began with a description of allowed radiation dose levels to members of the public prior to World War II and traced their evolution through the six succeeding decades. He concluded his remarks with the NCRP’s current recommended level of 1 mSv/yr from all sources suggesting that the limit from any

single source should not exceed 0.25 mSv/yr.

Ron Fraass, the executive director of the CRCPD, presented “What Works for Us.” Program directors need to have the courage to provide straight answers based on facts, to try new methods, to initiate pilot projects, and to ask more of their people, management and themselves. He encouraged persistence noting that one must keep asking, trying, and always be prepared when opportunities arise. He concluded by noting the immense value of federal, professional, and business partners to successful state programs.

Barnes Johnson, deputy director of the Office of Radiation and Indoor Air of the EPA, presented “Status of Revisions to Federal Guidance for the General Public and International.” The EPA wants feedback from the state programs for future federal guidance. The guidance document under current development has two proposed options for limits to the general public: 1) No numeric limit + ALARA, or 2) 100 mrem/yr + ALARA. At the end of this presentation Charles Meinhold from the floor noted that current occupational guidelines are better established on science than public guidelines.

Lynne Fairobent requested that the EPA conduct roundtable discussions with stakeholders in the medical community before finalizing any future guidance. A final comment from the floor stated that guidance without a numerical limit is not a standard and serves no purpose. This approach

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suggests to the general public that no level can be determined to be safe. This last comment received applause from the audience.

Robert Dixon, medical physicist from Wake Forest University School of Medicine, discussed appropriate dose limit recommendations for the design of shielding of medical installations.

He agreed with the 1 mSv/yr design limit for the general public, but disagreed with the NCRP’s suggestion that the effective design limit for any one installation be 0.25 mSv/yr because a member of the general public could be exposed to up to four different sources of radiation. Bob noted that since an individual can only be in one place at one time, he/ she will most likely be exposed to only one source. He pointed out that 0.25 mSv/yr is smaller than the “noise band” of background radiation (excluding Radon) across the US. A reduced design limit of 0.25 mSv/yr instead of 1 mSv/yr would significantly impact the cost of health care by requiring additional shielding. Bob estimated an additional one half billion pounds of lead would be needed annually for medical shielding. He concluded by asking the regulatory community to not force health care to suffer the same injustice to which Nuclear Power was subjected.

Debbie Gilley, environmental manager for Florida, discussed “Radiation Safety Without Boarders, the Jamaica Experience.” Debbie led a task force that visited Jamaica and provided them with refurbished survey instruments. Jamaica currently has

AAPM President Don Frey receives a plaque from Jill Lipoti of the CRCPD at the annual meeting in Pittsburgh in recognition of AAPM’s long-term support to the CRCPD in both financial and technical areas.

no laws governing radioactive materials, needs better survey equipment, and training. Two private centers provide radiation therapy while 19 facilities have diagnostic X-ray capabilities. Industrial facilities do not have survey equipment or proper operational controls. The task force left five recommendations: 1. Develop operational policies, 2. Inventory all radiation sources, 3.

Develop operational policies for industrial applications, 4. Obtain permanent storage for Radium sources no longer used, and 5.

Analyze tailings of active mines.

John Cardella, radiologist at University of Colorado Health Sciences Center, presented “The Future of Radiation Protection in Medicine: Challenges and Opportunities.” Dr. Cardella opened by discussing issues: world population is aging, use of ionizing radiation especially by nonradiologists is increasing, selfreferral is growing, screening procedures are increasing and imaging is growing three times faster than overall healthcare. Dr. Cardella predicted that: use of ionizing radiation with digital re-

ceptors by nonradiologists will dramatically expand; new polices will mandate better dose recording, more limited screening, and forced formal training; and the lay public will demand more information with less dose. He further speculated that molecular imaging will become more accurate than current biopsy techniques, robotics will reduce occupational exposure, limits will be standardized at the federal level, and states will manage compliance.

Dr. Cardella concluded that a frightened public will demand more in the future and regulators must respond based on fact to insure that safety, quality, and cost are all achieved equitably.

The CRCPD gives two major awards annually in recognition of distinguished service to the conference. Roland Fletcher, manager of the Radiological Health Program in Maryland, was presented with the Gerald S. Parker Award in recognition of his many years of service to the CRCPD. Debra McBaugh, manager of the State of Washington’s Radiation

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Protection Program, received the James W. Miller Award for her efforts in the clean up of the Hanford Nuclear Reservation and preparation for future early response to environmental contamination. Debra coauthored the Radiation Protection Manual “Plan and Procedures for Responding to a Radiological Attack” which is available on the CRCPD’s Web site.

Medical Session Michael Divine, MQSA Compliance Expert CDRH, discussed “MQSA Update.” Among other topics, Mike noted that up to 70% of all mammography facilities have no violations noted during their inspections. Facilities with violations respond more appropriately to follow-up inspections as opposed to warning letters that identify violations and potential regulatory actions. Approximately 300 warning letters are sent annually. The CDRH conducted a study in which 160 facilities with no violations were inspected biannually instead of annually. The number of violations increased compared to a control group when the inspection frequency was reduced.

John O’Connell, Bureau of Environmental Radiation Protection, New York, presented a discussion on “Mammography Outcome Analysis.” John presented data that suggested serious deficits in the interpretative skills of some radiologists. He suggested that the certification process must assess the ability of the radiolo-

gist to interpret mammograms and reassess this ability periodically. He believes that MQSA has improved all aspects of the mammography screening process except interpretation by the radiologist.

Michael Divine presented the “FDA’s Viewpoint on Mammography Outcome Analysis.” He discussed some of the issues that make it difficult to evaluate and assess accuracy of he radiologist’s interpretation. Mike did support the idea that states need full jurisdiction to regulate the performance of the radiologist. At the conclusion of this presentation, Penny Butler from the ACR commented that this is a difficult issue. The ACR has an interpretive skill assessment program, but this must remain an educational tool that is not discoverable.

Penny expressed concern about the future of mammography since low reimbursement rates and the threat of lawsuits have prevented some young radiologists from practicing the interpretation of mammography.

John O’Connell presented a discussion of “Measuring Peak Skin Dose: A Critical Step in Improving the Quality and Safety of Interventional Fluoroscopy.”

John reported that initial attempts using TLD chips to measure peak skin dose provided sporadic results at best. Patients have been monitored using a commercial film product that does not require development, Gafchromatic XR Film. Peak skin doses in the range of 150 – 750 rad have been measured. John reported that Dose Area Product (DAP) meters on some of these cases have under-

estimated peak skin doses to the patient.

Tom Shope, CDRH, discussed “Amendments to the Federal XRay Systems Performance for Fluoroscopy.” Tom reported that the development of a new rule began in response to concern in the late 1980s and early 1990s before the performance standard was modified to eliminate unlimited fluoroscopic rates in the high dose mode. The final rule has been completed based on final comments received in April 2003 and is working its way through bureaucratic sign off. While Tom was not at liberty to state specifics concerning the unpublished rule, it is pretty certain that the manufacturers of fluoroscopic equipment will be required to provide some type of display of patient radiation dose. The estimated cost of the rule over 10 years is 0.31 billion dollars with a benefit estimated at 0.3 – 1.1 billion dollars. Tom hopes the rule will be published sometime in the summer of 2004. He concluded that the CDRH needs to harmonize its equipment standards to existing international standards and turn its attention to Quality Control, Quality Assurance, and other operational issues.

David Spelic, CDRH, and Mary Ann Spohrer, chairperson of the NEXT Committee, discussed “Update on the Activities of the Committee on Nationwide Evaluation of X-Ray Trends (NEXT).” Data from the 2000 study on CT has not been published due to difficulties in interpreting the collected data. The CRCPD is still collecting data on upper GI exams as part of the

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2003 study. The committee is currently planning to repeat the CT survey in 2005 followed by a study involving c-arm fluoroscopes in 2006. David and Mary Ann thanked the states for their continued participation in this program.

Thomas Ohlhaber, CDRH, spoke on “Radiation Protection in Computed Tomography.” Tom described some of the newer clinical applications of CT scanners and discussed some of the newer design features that affect patient dose and image quality.

With respect to the control of patient doses, he called for the development of standards to address potential machine problems. He stressed the need for QA and QC programs that, among other things, would check to insure that the users were operating the machine correctly to exploit the machine’s design features. He proposed that the states should require QC programs, encourage dose reduction techniques, and require specific protocols for adults, children, and pregnant patients. He did indicate that if a facility has a good QC program in place, including dose measurements by a physicist, the state programs do not need to repeat these measurements. Tom believes current CT doses can be reduced by factors of two to four times without affecting patient care!

Mary Ann Spohrer, chairperson for the Taskforce for New Modalities, concluded the medical session by discussing “Fusion Imaging: What to do Now.” Mary Ann complimented the ACR and the AAPM for the in-

formation presented at the training session for state personnel in Kansas City, MO, this past year on New Modalities. Mary Ann stated that the most critical tasks ahead of the CRCPD, with respect to new modalities, included: 1. Gap analysis: training on these modalities 2. Development of Suggested State Regulations (SSRs) for new modalities 3. Develop inspection guidance 4. Develop relationships with professional organizations that can assist with training.

and ACR chapters including the five AAPM liaisons (Keith Strauss, Melissa Martin, Mike Tkacik, Don Frey and Jerry White). The AAPM cannot be overrepresented at this meeting.

Thank you for the opportunity to represent you at this year’s meeting. The published proceedings should become available prior to the fall. Copies of these can be purchased by contacting the CRCPD’s executive office: 205 Capital Avenue, Frankfort, Kentucky 40801, (502) 227-4543.

36th Annual CRCPD Meeting Schedule of Additional Presentations

Other Sessions The appendix lists the title and presenting author of each presentation at the meeting that was not specifically reported on above to give you a concept of the topics important to the CRCPD and state radiation control programs.

The session titles of the remaining portions of the meeting were Homeland Security/Emergency Response, Decommissioning, and General. The first session provided an opportunity for the various governmental stakeholders to discuss their views with respect to Homeland Security.

The Decommissioning Session discussed management of radioactive materials and waste.

Next year’s CRCPD meeting will be at the downtown Marriott in Kansas City, Missouri on April 25-28, 2005. This is the location where the Fusion Modality Conference jointly sponsored by the ACR, AAPM, and CRCPD was held in February 2004. Typically, about a dozen medical physicists attend, representing local AAPM

•Amendments to 10 CFR Part 35 – Recognition of Specialty Board Certifications (Training & Experience, Implementation of Part 35; Emerging Technologies’ Licensing of Medical Uses of Byproduct Material): Patricia Holahan (NRC) Homeland Security Session/Emergency Response •Relationship between NNSA and DHS: Joseph J. Krol (DOE) •TOPOFF2 and Much, Much More Preparation, Participation, Lessons Learned, and Ongoing Efforts: Debra McBaugh (Washington) •Delta Fire-General Motors Radiological Dispersion Device Exercise (May 13, 2003) – Lessons Learned: Lou Brandon (Michigan) •Elements of a “Toolkit” to Help Public Health Officials Prepare for Nuclear/Radiological Emergency: Charles W. Miller (CDC) •Enhancing Security for Radioactive Materials: Michael Layton (NRC) •Update on National Response Plan/ National Incident Management System – A Radiological Perspective: Susan Frant (NRC) •EPA’s Protective Action Guides – An Update: Carl S. Pavetto (EPA)

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•Radiation Protection Activities Related to Security Screening Systems: Daniel F. Kassiday (CDRH) •US Customs Security Scanning Systems Exposure Limits: Richard T. Whitman (DHS) •Homeland Security Forum – Centers for Disease Control and Prevention (CDC): Charles Miller •Homeland Security Forum – Customs and Border Protection: Richard Whitman •Homeland Security Forum – Department of Energy/National Nuclear Security Agency (DOE/NNSA): Joseph Krol •Homeland Security Forum – Department of Homeland Security (DHS): Jeffrey Hall •Homeland Security Forum – Environmental Protection Agency (EPA): Frank Marcinowski •Homeland Security Forum – Federal Bureau of Investigations (FBI): Chris Borcher •Homeland Security Forum – Federal Emergency Management Agency (FEMA): Craig Conklin •Homeland Security Forum – Food and Drug Administration (FDA): Michael Noska •Homeland Security Forum – Health and Human Services (HHS): John Carney •Homeland Security Forum – Nuclear Regulatory Commission (NRC): Michael Layton

Costello (NRC) •NRC Activities for Controlling the Disposition of Solid Materials: Patricia Holahan (NRC) General Session •The Off-Site Source Recovery (OSR) Project at Los Alamos National Laboratory: Where Are We and Where Are We Going? Shelby J. Leonard (Los Alamos National Laboratory) •EPA Radiation Laboratories: Laboratory Resources for State Agencies: Edwin L. Sensintaffar (EPA) •Tightrope Radiation Control – Balancing Competing Requirements in Today’s Regulatory Environment:

David Wesley (Radiation Safety Academy) •Observations on Our 15-Year Journey (States’ Radon Program Experiences): N. Michael Gilley (Florida) •MARLAP: John A. Volpe (Coordinator for Multi-Agency Radiological Laboratory Analytical Protocols Manual) •A Summary of Recent NRC Activities Related to 10 CFR Part 40, “Domestic Licensing of Source Material”: Gary C. Comfort, Jr. (NRC) •Legislative Update on Possible Changes to Regulatory Authority Over Radioactive Materials (NARM): Stuart A. Treby (NRC) ■

Decommissioning Session •Organization of Agreement States Update: Jared Thompson (OAS) •Exploring Additional Disposal Options for Low Activity Waste: An Overview and Update of EPA’s Advanced Notice of Proposed Rulemaking (ANPR): Adam Klinger (EPA) •Trials and Tribulations of Decommissioning a Large Thorium Lantern Mantle Production Facility: Thomas A. Conley (Kansas) •It Came From Where: K. David Walter (Alabama) •Decommissioning of a Bankrupt Underwater Irradiator Facility: Frank

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Clinical Trials Update Geoffrey S. Ibbott Subcommittee Chair

Report from the Subcommittee on QA of Clinical Trials The RTOG 0236 Lung Protocol This article continues a series that describes clinical trials conducted by cooperative study groups that involve advanced technologies or are otherwise of particular interest to medical physicists. Previous newsletter articles have described RTOG protocols addressing tumors of the head and neck and the prostate, and a Children’s Oncology Group (COG) protocol addressing medulloblastoma tumors. This article discusses a new clinical trial that was opened in May 2004 by the RTOG entitled “A Phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Patients with Medically Inoperable Stage I/II Non-Small Cell Lung Cancer.”

The principal investigator of this trial is Robert D. Timmerman, M.D. who, at the time of this writing, is in the process of moving from Indiana University to UT Southwestern in Dallas. The physics co-chair of the protocol is James M. Galvin, D.Sc. of Thomas Jefferson University Hospital.

The primary objective of the study is to determine if high-dose radiation therapy delivered to

small target volumes using SBRT techniques can achieve acceptable local control (≥80%) in patients with medically inoperable early stage non-small cell lung cancer who have failed standard therapy. The study will also evaluate the toxicity of SBRT techniques in the lung, and observe patterns of failure, disease-free survival, and overall survival.

Eligible patients must have no involved lymph nodes and no metastases, and must have tumors ≤5 cm in diameter. Additional specifications on the location of the tumor are defined in the protocol. In addition, the primary tumor must be deemed technically resectable, but the patient must have underlying medical conditions that would prevent a potentially curative resection.

To participate in the study, institutions must be credentialed by the Advanced Technology Consortium (ATC). The ATC subcontractors involved in the study include the Image-Guided Therapy QA Center (ITC) at Washington University, the Radiological Physics Center (RPC),

and the RTOG Quality Assurance Office in Philadelphia. Institutions must complete a 3D QA facility questionnaire for SBRT available on the ATC Web site at http://atc.wustl.edu. Each institution must contact the ITC (itc@castor.wustl.edu) and request an FTP account for digital data submission. In addition, each institution must irradiate a standardized phantom provided by the RPC. Instructions for requesting and irradiating the phantom are available at the RPC Web site http://rpc.mdanderson.org by selecting “Credentialing” and “RTOG.” The phantom simulates a lung tumor within lung-tissue equivalent material. Institutions must conduct imaging procedures, develop a treatment plan, and deliver a treatment that is consistent with the plan and with the requirements of the protocol.

The treatment plan for irradiation of the phantom must be submitted electronically to the ITC. Institutions must also submit a protocol-specific dry run test to the ITC. Consistent with guidelines published by the National Cancer Institute (NCI), IMRT is not permitted on the study. However, a unique feature of this protocol is that special considerations must be made to account for the effects of respiratory motion on target positioning and reproducibility. Institutions must describe their techniques for assuring treat-

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(from p. 21)

ment reproducibility, and these procedures will be validated and accredited by the principal investigator and co-chairs before institutions may enroll or treat patients on this trial. The procedure required for this test can be downloaded from the ATC Web site at http://atc.wustl.edu/protocols. Institutions must perform a single patient study of reproducibility of targeting using one of the following methods: serial CT sessions with the patient repositioned between each procedure, repeat orthogonal planar images, or an equivalent study devised by the institution and accepted by the ATC. The number of repeated imaging sessions must be at least four. The testing method selected must be the technique that will be used to control respiratory motion during treatment. For example, if a compression paddle is used for the abdomen to suppress breathing motion, the CT or other imaging studies must be gathered with this equipment in place. After the results of the first patient are reviewed and accepted, the second through fifth patients are to be studied in the same manner. However, these patients may be enrolled in the protocol. The second and third patients must be reviewed before the fourth and fifth patients may be submitted. After acceptance of the fifth patient, the institution will no longer have to follow these strict imaging requirements, and the protocol statement (Section 6.3.3) on imaging to localize the isocenter of the treatment fields can be used instead.

Specific instructions for performing the imaging procedures and measuring the extent of respiratory motions are described in the instructions mentioned earlier.

Institutions must recognize that the imaging procedures may result in increased radiation dose to the patient over the dose that would be expected to be received from conventional imaging studies. IRB approval for these patient studies will very likely be required. The instructions provide procedures for determining the random variation in isocenter location.

The protocol stipulates that three-dimensional coplanar or non-coplanar beam arrangements will be used with customdesigned field shaping to deliver highly conformal dose distributions. It is expected that seven to 10 non-opposing, non-coplanar beams will be used with approximately equal weighting. Rotation techniques are acceptable. ICRU 50/62 terminology for target volumes must be used. The GTV and CTV are considered to be identical, but a margin of 0.5 cm in the axial plane and 1.0 cm in the longitudinal plane must be added to the GTV to constitute the PTV. Fields will be defined so that the field edge corresponds to the projection of the PTV in the beam’s eye view, meaning that no additional margin for dose buildup at the edges of the field will be included.

However, a minimum field dimension of 3.5 cm is mandated.

The protocol stipulates that the treatment plan should be normalized to the center of the PTV,

which will most likely be the isocenter. The prescription isodose surface will be that isodose that encompasses 95% of the target volume. This isodose surface will receive 20 Gy per fraction for a total of 60 Gy. 99% of the target volume must receive at least 90% of the prescription dose. The prescription isodose surface must be ≼60% but more than 90% of the dose at the center of the PTV. Doses exceeding 105% of the prescription dose (>21 Gy per fraction) should occur within the PTV itself. The cumulative volume of all tissue outside the PTV receiving a dose >105% of the prescribed dose should be no more than 15% of the PTV volume.

The protocol also specifies, for different sized tumors, the allowable ratio of the prescription isodose volume to the PTV, the ratio of 50% prescription isodose volume to the PTV, the maximum dose at 2 cm from the PTV in any direction, and the percent of lung receiving 20 Gy or more.

Dose limits to organs at risk (OAR) are also specified for the spinal cord, esophagus, ipsilateral brachial plexus, heart, trachea and ipsilateral bronchus, and whole lung.

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

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â–

AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER SEPTEMBER/OCTOBER AAPM NEWSLETTER SEPTEMBER/OCTOBER 2004

2003 AAPM Medical Physics Travel Grant Report Nesrin Dogan, PhD Virginia Commonwealth University, Richmond, VA My grant travel started with a flight to London Gatwick. After a one-day stay in London, I drove to Hull where the Princess Royal Hospital is located. I found driving on the left-hand side of the road very confusing. Hull is a coastal city about three hours north of London. Dr. Andy Beavis, the principle physicist, arranged my visit to his department and also organized my first lecture. He invited several dosimetrists and physicists from nearby hospitals to attend my lecture. I presented my talk on Clinical IMRT Treatment Planning and QA. My lecture was very well received and I had a round-table discussion with some of the physicists. Discussions focused on issues related to H&N IMRT planning and Monte Carlo verification of the IMRT plans. The department is relatively small with three dosimetrists and four physicists. The department is equipped with three Varian accelerators with EPID, DMLC, a CT simulator, and a CMS-XiO system for treatment planning. Dr. Beavis explained to me the UK Health Care and academic system. All of the hospitals in the UK, including the Princess Royal Hospital, are part of a National Health System (NHS) trust. I learned that all of the physicists are employees of the NHS trust and the promotion process for the physicists

is very rigid and physicist training is very uniform throughout the whole country. Dr. Beavis also discussed several interesting research projects going on in the department, including advanced MRI techniques in H&N IMRT planning and follow-up, development of more optimal optimization schemes, and development of 3-D educational tools for IMRT. After Hull, I drove to the next leg of my journey, Manchester, where the NHS trust Christie Hospital is located. The Christie Hospital is one of the largest cancer centers in the UK, as well as in Europe, and treats about 9000 patients a year. Dr. Ranald Mackay, who was my host, is the group leader of the department.

He gave me a tour of the department and told me about their current research projects. I also had the pleasure of meeting with Peter Williams, head of the medical physics department, and discussing their projects. Christie Hospital has active programs in IMRT, EPID, Cone Beam CT, and brachytherapy. During my

visit, I had a chance to talk to several members of the physics group and to become familiar with the details of their research projects. I was especially impressed with the size of the department and the projects involving EPID dosimetry and cone beam CT. At the end of the day, I presented my talk on the use of Monte Carlo in the IMRT optimization and QA process in a very nice and modern auditorium with a well-attended audience of physicists, radiation oncologists, and technologists. My talk was very well received and I had interesting questions from the audience.

My drive back to London was very pleasurable. It was very picturesque. I was amazed at how green the whole country was.

This is not surprising since it rained every day during the whole week I was there. I was told that this is very typical of the UK. I spent a few days sightseeing in London before I left for the next stop on my travel grant agenda.

While I was in London, Dr. Jack Fowler and his wife, Ann, invited me for a formal English tea. It was great to see them again and have my first English tea which I thought was delicious. Dr. Fowler was very interested in hearing about my research efforts and those of others, and is always a very warm, engaging, helpful and interested colleague.

I flew to Amsterdam from London for the next stop in my grant

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(from p. 23)

travel. My long-time friend Dr. Iain Bruinvis prepared a very nice dinner the night I arrived. The next day, Dr. Bruinvis and I drove to Heerlen (two and one half hours south of Amsterdam) where I visited the Radiotherapeutic Institute of Limburg (RTIL). Dr. Bruinvis, who used to be the chief physicist at the RTIL, arranged my visit. This was a small center with three Electa accelerators equipped with EPIDs and a dedicated CT scanner. The department is planning to move to a new department in January 2005, which is being built in the city of Maastrict. Dr. Andre Minken, the chief physicist, was very excited about the new department. During my visit I talked to several physicists, including Dr. Bas Nijsten who talked to me about how they use EPID for routine pretreatment patient dosimetry. He developed a pretreatment verification procedure based on EPID to verify a portal dose at the center of open and wedged fields without using the patient, and he is currently working on implementing a similar procedure for use with IMRT fields.

The department is also in the process of evaluating the Hyperion (developed at the University of Tubingen) Monte Carlo optimization system for IMRT. In the afternoon, I gave a talk on the clinical implementation, treatment planning, and QA of IMRT. The RTIL is also in the process of implementing an IMRT program and they were very excited that I was able to share my experience with them.

The next day I visited the Netherlands Cancer Institute (NKI) which is one of the largest cancer centers in the Netherlands and treats approximately 5000 patients per year. The NKI is an UMPlan treatment planning system user, but they are in the process of commissioning a Philips Pinnacle system. Dr. Iain Bruinvis, the chief physicist, had a full-day program for me. After a tour of the department, I met with several physicists and a physicist-intraining. In the Netherlands, unlike in the US, a medical physics residency must be completed to become a medical physicist. It is a four-year comprehensive program. The department has a separate dosimetry measurement group, which consists of people with the engineering background to do tasks such as commissioning, IMRT QA, etc. The department has 10 permanent dosime trists and therapists in rotation in dosimetry and 26+ academic physics and clinical faculty. I also had a chance to talk to several research physicists. Drs. McDermott and Wendling told me about their use of EPID to study changes in patient dose delivery and measurements of dose profiles. It was very impressive to see how heavily the EPIDs are used for routine patient dosimetry other than just for the patient setup verification. I had a discussion with Dr. Marco Schwartz on IMRT for lung cancer treatment. He showed me the comparisons of Convolution algorithm vs. Monte Carlo (Hyperion) optimization for lung cancer patients. Dr. Jan-Jacob

Sonke talked to me about his research on cone beam CT reconstruction. Their cone beam CT unit (Electa Synergy) is the first in the Netherlands. This system allows contact-less and fast localization of soft-tissue structures.

The department has a project concerning collection and analysis of four-dimensional (lung) images including PET, respiration correlated CT, respiration-correlated megavoltage images and respiration-correlated cone beam CT. At the end of the day of my visit to NKI, I took an hour train ride to Rotterdam, which is the business center of the Netherlands and has the largest port in Europe. In the evening, Drs. Ben Heijmen, Marion Essers, and Marteen Dirkx from Erasmus MC-Daniel den Hoed Cancer center took me to dinner at a seafood restaurant at the Rotterdam Harbor. We had a very nice time talking about a variety of issues, including politics, science, and healthcare. The next morning, Dr. Ben Heijmen, the chief physicist of Erasmus Cancer Center and my host, met me at the department. The Erasmus Cancer Center is the largest cancer center in the Netherlands and is also a part of University Hospital in Rotterdam. The department has 10 linear accelerators (Varian + Electa) equipped with CCD camera-based EPIDs. As in all of the other centers in the Netherlands, the EPIDs were also being used for routine patient dosimetry for both conventional and IMRT treatments. I had discussions with various members of

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the department and an opportunity to learn about their several active research programs, including IMRT, Stereotactic Radiosurgery, Brachytherapy, Hyperthemia, EPID, and Photodynamic therapy. I gave my presentation on the use of MC in IMRT Optimization and QA that was very well attended and received.

I took the train back to Amsterdam at the end of my visit in Rotterdam. The next day I returned back to NKI for a second visit and another full-day program. I met with Dr. Corine van Vilet, one of the clinical physicists, who is planning to establish a breast IMRT program. I shared my experience in forward and inverse planning of breast cancer patients with her. Later in the day I delivered a talk on Breast IMRT in Cancer Treatment. I had a round table discussion with some of the clinical physicists. Our dis-

cussions focused on the use of Monte Carlo for IMRT QA, and how long we need to continue to do QA for IMRT patients. I was told that they only did QA for the first 20 IMRT patients after IMRT implementation and they do not do QA for any of their IMRT patients thereafter. I concluded my visit with a meeting with Dr. Harry Bartelink, the chairman of the department. We discussed the differences in the way the radiation oncology departments are structured, the physicists’ responsibilities and role and the difference between the treatment methodologies used in the US and the Netherlands. In the evening, Dr. Iain Bruinvis took me to a very nice Turkish restaurant in Amsterdam. We had a great time, eating authentic Turkish food, drinking wine, and listening to Turkish music, as well as wonderful conversation. I had one

more day to spend in Amsterdam before my flight back home. I very much enjoyed taking a boat tour, walking along the canals, and watching street performers.

Although I had a very busy, intense trip with many departments to visit, I felt that this trip was an excellent opportunity for me to share my experiences, especially in the field of IMRT. I was able to learn about the clinical and research projects of many diverse colleagues in my field, and to meet so many wonderful people both in the UK and the Netherlands. I would like to thank Drs. Andy Beavis, Ranald Mackay, Andre Minken, Ben Heijmen, and Iain Bruinvis for their time and hospitality. Finally, I would like to express my gratitude to the AAPM for awarding me this travel grant through the generous support of Dr. Charles Lescrenier. â–

AIP State Department Science Fellowship This fellowship represents an opportunity for scientists to make a unique contribution to U.S. foreign policy. At least one fellow annually will be chosen to spend a year working in a bureau of the State Department, providing scientific and technical expertise to the department while becoming directly involved in the foreign policy process. Fellows are required to be U.S. citizens and members of at least one of the 10 AIP Member Societies at the time of application. Qualifications include a PhD in physics or closely related field or, in outstanding cases, equivalent research experience.

Applicants should possess interest or ex-

perience in scientific or technical aspects of foreign policy. Applications should consist of a letter of intent, a two-page resume, and three letters of reference.

Please visit http://www.aip.org/gov/ sdf.html for more details. All application materials must be postmarked by November 1, 2004 and sent to: AIP State Department Science Fellowship American Institute of Physics Attn: Audrey Leath One Physics Ellipse College Park, MD 20740-3843 25

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In Memoriam Robin L. Stern Sacramento, CA and Jeffrey Williamson Richmond, VA The medical physics community has suffered a great loss with the passing of Dr. Hideo (Dale) Kubo on October 3, 2003, following complications of heart transplant surgery. He was a man who thrived on all aspects of his profession, and despite the cardiomyopathy that drained his stamina, he maintained a rigorous pace at work up until the day before his surgery.

Dale was born in 1943 in Yokosuka, a Japanese fishing town at the mouth of Tokyo Bay. He traveled to North America in 1986 to pursue his graduate education, completing his doctorate in atomic and nuclear physics at the University of Rochester in New York in 1973. After returning to Japan for three years to teach at the Kitasato Medical School in Sagamihara, he moved back to the United States permanently and completed his medical physics postdoctoral training at the Memorial SloanKettering Cancer Center in New York.

After training, Dale joined the Department of Radiation Medicine at Massachusetts General Hospital in Boston. While there he published studies demonstrating experimentally that then current exposure standards for I-125 seeds were contaminated by low energy characteristic X rays. This

Dale Kubo 1943-2003

finding, along with theoretical calculations by one of us (JFW), paved the way for the new wideangle free-air chamber (WAFAC) standard implemented at NIST in 1999. Due in large part to Dale’s work, 50,000 prostate patients treated annually with brachytherapy benefit from the elimination of a 10% uncertainty in dose specification. In recognition of his contributions to dosimetry, Dale was selected as a member of two AAPM task groups on dosimetry and chaired the AAPM ad hoc committee that oversaw the clinical transition to the new WAFAC standard of airkerma strength for I-125 brachytherapy.

In 1991, Dale became the first chief of physics at the brand new Department of Radiation Oncology at the University of California, Davis, a position he held until his death. He was a driving force behind the development of the department, and his contributions helped the UC Davis Can-

cer Center win NIH Clinical Cancer Center designation.

While at UCD, Dale established himself as a leader in the emergent technology of breathing synchronized radiotherapy. Although the concept of gating had been developed in Japan for ion-beam radiotherapy in the late 1980s, in 1996 Dale became the first to implement gating for photonbeam radiotherapy and the first ever in the Western world. Ultimately this work led to a commercial gating system which is now used around the world to improve lung cancer radiotherapy.

Dale’s interests went beyond his research to supporting and training young physicists and physicians. He was instrumental in the establishment of UCD’s physician residency program and was working on establishing a matching medical physics residency. He also worked hard to foster ties with the Japanese medical physics community.

In addition to Dale’s research and mentoring work, he was an active and respected clinical physicist. He was deeply involved in both the AAPM and ASTRO. He served on the Radiation Therapy Committee and the board of directors, and was elected a Fellow of the AAPM in 1999 in recognition of his many achievements.

Although Dale spent much of his time and energy on medical physics, he had a variety of other interests as well. Foremost was his (See Kubo - p. 28)

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(from p. 27)

family, to whom he was devoted.

He was also an avid traveler, a nature enthusiast, a patron of music, and an insatiable learner.

He is survived by his mother, Toshi Kubo, his three brothers, Teruo Kubo, Tsugio Kubo, and Mitsuo Kubo, his wife, Paula Kubo, and his daughters, Naomi Peters and Hitomi Kubo. He will be missed by all whose lives he touched.

■

Memoriam Guidelines Members are encouraged to send articles to memorialize fellow physicists who are well known to the medical physics community and the AAPM. Such articles should be no more than 500 words in length and, if possible, be accompanied by a photograph (high resolution photos of 300 dpi are preferred).

-the Editor

Letters to the Editor Emeka S. Izundu, PhD Las Cruces, NM eizundu@mmclc.org Please permit me to thank Dr. Ivan A. Brezovich for his numerous excellent contributions toward the promotion of the medical physics profession, (Letters to the Editor, AAPM Newsletters May/June 2004, p.23; November/December 2003, p. 22; July/ August 2003, March/April 2003, p.22; Dear Dr. Williams, ASTRO News, April-June 2004, p.2; Empty Nest Syndrome, Advance, June 2004, p. 41, to name a few.) May I recommend that every member of the medical physics profession read his articles.

I completely agree with all his views, which explain why medical physicists are often regarded as technicians, an image that does not enhance our profession. Talking about respect, very few medical physicists report to the CEO or COO of the institution of employment. The majority report to departmental directors, managers and even chief therapists! This is certainly another reason for the steady drain of medical physicists to other professions that Dr. Brezovich observed. In fact, if I were younger, I would leave medical physics for medical school, for more money, respect and the ensuing satisfaction.

I strongly concur with Dr. Brezovich that AAPM should “concentrate its efforts where they count,” which is getting

medical physics recognized just like all other medical specialties.

The fact that Medicare denied medical physicists provider status in the 1980s (20 years ago!) is no reason for AAPM to abandon this vital issue. Many changes, in technology and methodology, have taken place in the field of medical physics since the 1980s.

“I strongly concur with Dr. Brezovich that AAPM should ‘concentrate its efforts where they count,’ which is getting medical physics recognized just like all other medical specialties.”

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__________________

Hsinshun Terry Wu, PhD Shreveport, LA twu@wkhs.com I enjoyed all previous annual AAPM meetings, but this one was unique. The newly introduced sessions on professional issues addressed vital topics that have so far been all but ignored.

The paper “New Challenges for the Medical Physics Profession”

by I. Brezovich was a real eyeopener, especially for young medical physicists who have little

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Letters to the Editor or no understanding of the current economic and political system.

To give our patients the best possible care, we need to attract young talent into the profession, and make sure they have the physical and human resources to do their work safely. We cannot secure these vital constituents until medical physicists are recognized as professionals. A well-informed medical physics community is essential for achieving the vital professional status. I therefore encourage AAPM to make professional sessions a regular part of future meetings. Other professional societies have such sessions, so why shouldn’t we?

“I ... encourage AAPM to make professional sessions a regular part of future meetings. Other professional societies have such sessions, so why shouldn’t we?”

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_________________

Ivan L. Cordrey, PhD Cookeville, TN icordrey@crmchealth.org I really enjoyed the professional sessions during this year’s

AAPM meeting. I believe the topics addressed in the professional sessions have been ignored for too long. It is true that we are a scientific society, but we are also direct patient care professionals whose concerns must extend outside the purely scientific realm. In order for patients to benefit from any scientific progress, medical physicists need appropriate equipment, manpower and authority to implement the suggested procedures.

In the current environment, recognition of medical physics continues to erode. At some hospitals, medical physicists have to report to the chief therapist or nurse, have to work long hours that can be unhealthful, and have to use outdated equipment for their quality assurance and calibration procedures. For them, improvements in quality assurance, IMRT and imaging are only of academic interest. Their work schedule is determined by others who have generally less education and direct responsibility for the patient.

As was pointed out in one of the presentations, certified medical physicists are listed by the American Board of Medical Specialties (ABMS) just as radiation oncologists and radiologists are listed. Yet medical physicists are not entitled to direct billing for their services. The ability to bill directly is the feature that distinguishes “medical professionals” from “medical technicians” in the eyes of many hospital administra-

tors. Thus medical physicists are often viewed more like the radiation therapists and X-ray technicians than the medical doctors.

If other ABMS listed professionals are entitled to direct billing, why are medical physicists excluded? Furthermore, audiologists, social workers, clinical psychologists and many others who are not ABMS listed have direct billing privileges. Medical physicists also pass the litmus test of patient contact. They have substantially more patient contact than pathologists who enjoy direct billing yet rarely see a patient. We medical physicists are personally liable for our decisions, and should have professional liability insurance, but have neither full control of the situations we monitor, nor can we bill directly for our services.

“If other ABMS listed professionals are entitled to direct billing, why are medical physicists excluded?”

These issues may not seem as glamorous as the latest advances in IMRT optimization or image guided therapy, but they are no less important to the long-term health of our profession. I hope AAPM will take these issues se-

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Letters to the Editor Cordrey

(from p. 29)

riously and work to secure direct billing privileges for medical physicists. Such billing privileges will help emphasize the critical role we play in patient care, and may help administrators recognize that medical physicists are not just technicians.

■ _________________

The Coolidge Award The Awards and Honors Committee is charged with the difficult task of selecting individuals for the awards the AAPM bestows each year. While we recognize the enormous effort that this requires, we would like to express our concern about the selection process for the Coolidge Award. The criteria listed by the Awards and Honor Committee to use when considering individuals for the Coolidge Award are: 1) Significant impact upon the scientific practice of medical physics, 2) Significant influence on the professional development of the careers of other medical physicists, and 3) Demonstrated leadership in national and/or international organizations, with specific emphasis on AAPM activities.

We have no problem with these criteria if they are applied in a

balanced manner, since they recognize scientific contributions, career development and general service to the medical physics community. However, in recent years the Awards and Honors Committee has placed what we believe is undue emphasis on the last phrase of the third component of the qualifications: direct service to the AAPM. We have been told by the Awards and Honors Committee leadership that direct service to the AAPM at a high level is a prerequisite for succeeding as a Coolidge nominee regardless of the scientific, professional development or general service accomplishments.

This approach effectively overrides the three published criteria for the Coolidge Award by interpreting the word “specific” to mean “exclusive.” We note that this is not a unilateral decision of the Awards and Honors Committee, but is apparently based on guidance they have received from the AAPM leadership sometime in the past. However, there is no written documentation concerning this “guidance” that we are aware of and there has also been no formal action taken by the AAPM Board of Directors in support of this narrow interpretation.

We believe that the current selection process for the Coolidge Award as administered by the Awards and Honors Committee needs to be revised so that the “specific emphasis” phrase does not enjoy the status it currently

has. It is clear that given the current emphasis on direct service to the AAPM, Coolidge himself would not qualify for the Coolidge Award. Certainly, participation and contributions to the AAPM ought to be important considerations, but should not be the dominant element trumping all other accomplishments. If any component should receive more attention, we believe it should be the significance of the scientific accomplishments. Inspection of past Coolidge winners reveals, with few exceptions, world-class contributions to the science of medical physics. In numerous cases in the more distant past, these scientific contributions clearly overshadowed the service-related activities of the awardee. However, recognizing the tremendous achievements of these individuals has brought great renown to the AAPM and has elevated its stature within the scientific and healthcare communities.

“It is clear that given the current emphasis on direct service to the AAPM, Coolidge himself would not qualify for the Coolidge Award.”

This point of view is actually supported in the manner that the AAPM describes the Coolidge Award: “The AAPM’s highest

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Letters to the Editor honor is presented to a member who has exhibited a distinguished career in medical physics, and who has exerted a significant impact on the practice of medical physics.�

We note that specific service to the AAPM is not mentioned in the statement. We therefore ask, why should direct service to the AAPM be a limiting prerequisite to achieving the Coolidge Award?

In addition to our concern about the overemphasis on direct service to the AAPM with respect to the other selection criteria, we also want to comment on the restrictive nature of this requirement. Service to the AAPM at the officer level requires a time commitment that can only be realistically served by those living in North America. We believe that outstanding individuals from Africa, Europe, Asia, Australia

and South America who have made meritorious scientific, academic contributions while being active in their own medical physics community, should be eligible for the Coolidge Award. The current selection process as administered by the Awards and Honors Committee puts these individuals at a distinct disadvantage and effectively eliminates them from consideration.

We end this letter by noting that while the selection of individuals for the Coolidge Award is the responsibility of the Awards and Honors Committee, the criteria for the selection is really determined by the AAPM membership through the board of directors. In addition, the board of directors actually votes and grants the award on behalf of the membership. If you agree with us that direct service to the AAPM should not be an absolute pre-

requisite for receiving the Coolidge Award, please let your board representative know.

Gary T. Barnes, PhD, FAAPM AAPM President-1988 John R. Cameron, PhD, FAAPM AAPM President-1968; Coolidge Award 1980 Paul L. Carson , PhD, FAAPM AAPM President-1987 Paul M. DeLuca Jr., PhD, FAAPM Robert L. Dixon, PhD, FAAPM AAPM President-1992 Gary D. Fullerton, PhD, FAAPM AAPM President-1991 Mitchell M. Goodsitt, PhD, FAAPM Cynthia H. McCollough, PhD Mark T. Madsen, PhD, FAAPM Richard L. Morin, PhD, FAAPM AAPM President-1993 Bhudatt R. Paliwal, PhD, FAAPM AAPM President-1996; Coolidge Award 2002 Guy H. Simmons Jr., PhD, FAAPM AAPM President-1995 Douglas J. Simpkin, PhD, FAAPM Raymond L. Tanner, PhD, FAAPM AAPM President-1974 Charles A. Mistretta, PhD, FAAPM

The AAPM would like to thank all of the exhibitors for their support of the annual meeting in Pittsburgh.

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AAPM NEWSLETTER

SEPTEMBER/OCTOBER 2004 SEPTEMBER/OCTOBER 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: November/December 2004 Postmark Date: November 15 Submission Deadline: October 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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