AAPM Newsletter November/December 2004 Vol. 29 No. 6

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 29 NO. 6

NOVEMBER/DECEMBER 2004

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

Final Column This is my last column as the president of the association. It has been a great honor and a pleasure to serve. Being president is quite demanding on one’s time.

As of October 1st, I had received more than 2800 AAPM-related e-mails, and had handled many documents, phone calls and faxes. I was also away 37 days on AAPM business. This would not have been possible without the support of my wife, Pat, my colleagues at the Medical University of South Carolina and a list of AAPM members too lengthy

to enumerate. The association prospers only because the members are willing to participate actively as members of committees and liaisons. I have been lucky that many members have responded warmly to my requests that they serve the association. I thank them all. Finally, if the press of AAPM business sometimes made me seem a little abrupt in my responses, I apologize.

Independent Billing The recent survey of the membership indicated a majority is interested in having medical physicists bill directly for professional services that we provide. I have always felt that when medical

physicists provide such services they should be able to bill for them. I have also felt that the barriers to such billing and the risks are so large that it would not be worth pursuing. Since the membership is in favor of independent billing, I would like to describe some of the hurdles we would (See Frey - p. 2)

President-elect Column Independent Billing for Radiation Oncology Physicists Howard Amols New York, NY I’d like to follow up on some findings from the recent AAPM member survey which I reported on in my column from the last

newsletter. There was strong member support for the AAPM accelerating activities in various professional issues. In particular, 64% of members supported independent billing for radiation oncology physicists. Indeed, if this newsletter is an accurate weather vane, the number of letters on this topic confirms that finding. Don (See Amols - p. 5)

Executive Dir’s. Column Leg. & Reg. Affairs Professional Cncl. Rep. CAMPEP News Education Council Rep. Summer UGrad Fellow.

MedPhys Grad Students Travel Grant Report ABMP Activities AAPM/IOMP Thailand Workshop ACR FAQs New Members

p 7 p 9 p 10 p 11 p 12 p 14 p 15 p 17 p 19 p 21 p 24 p 25 p 26

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Frey

(from p. 1)

have to overcome. The first step could be done by the AAPM through the Professional Council Economics Committee. That would be to design a model practice that would describe income to the practice from technical / professional services. For physicists in oncology this would include activities such as medical physics consultations, patient dose measurement and calculation. The model would then include income from professional services and the costs associated with billing for the services. Such a model could tell us what we need to do, in terms of technical and professional collections, to make professional billing economically feasible.

The next part is the more difficult one. It appears to me that the pool of money available is so limited that it is a zero sum game.

To get money for professional services for medical physicists, some other group has to give up money. These money fights are some of the most vicious. The bar chart shows the largest medically related political action committees.

PACs

If one examines the data, one sees that the two largest PACs are those of the anesthesiologists and the nurse anesthetists. This is not because these two groups have a special interest in politics.

It is because they are in a prolonged and vicious battle over money for anesthesia services. A similar situation exists for the optometrists and the ophthalmologists. If medical physicists want to enter this arena, it is critical that we have a PAC that has a war chest of at least $1M and commitments from medical physicists for that amount each year. If we do not make that commitment we could end up with professional billing but with very small payments. That would be a Pyrrhic victory. The AAPM could possibly change its tax status so we could form a PAC, but this might better be left to a different or new organization. In any case, we could not transfer AAPM funds to the PAC. Finally there is the mistaken notion that independent billing is tied to professional standing and prestige. This is certainly not the case in the mind of the general public. The next bar chart shows

PACs - Financial Resources

Financial Resources

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professions that are highly respected by the public1.

One can see that three of the four most respected professions do not bill independently for their services. I believe that the respect we get from our professional colleagues flows more from our body of specialized knowledge and the way we present that knowledge than it does from how we bill for our services.

The AAPM can work on the model practice and develop some data that would be useful as to how to proceed. There is also a commentary from the Professional Council which will be examining this complex issue. See the letter from Howard Amols on the subject in this newsletter.

Council of Radiation Control Program Directors The AAPM has had a long and successful relationship with the Council of Radiation Program Control Directors (CRCPD).

This relationship becomes more and more important as medical devices become more complex.

This has caused the AAPM to elevate our side of the relationship to the status of a subcommittee under the Government Affairs Committee. We owe the success of this relationship to the many years of hard work by Melissa Martin and Keith Strauss. The CRCPD is honoring Keith Strauss by making him the John C. Villforth lecturer for 2005. The John C. Villforth lecture is the most distinguished lecture at their annual meeting.

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Percent of People Describing a Profession as Having ‘Great Prestige’

AAPM Finances The financial reports so far this year have been excellent and it looks like the AAPM will have a surplus of about $700k in 2004.

Since we already have a full year’s worth of operating funds in reserve, it would not be useful to continue to generate additional surplus in future years. At the recent budget and EXCOM meetings it was decided to recom-

mend to the Finance Committee and to the board to reduce income in 2005 by implementing modest reductions in the registration for the annual meeting and summer school. In addition, a planned increase in the fees for the RDCE program was cancelled. It was recommended that some additional funds be spent to improve the AAPM Web site and to increase public awareness of medical physics. We are also

studying to see if funds can be wisely spent to improve the efficiency of work by councils and committees.

This plan has the advantage of allowing us to decrease the surplus without making long-term commitments for the funds. The AAPM budget depends on dues, vendor support from the annual meeting, advertising income from the journal and the state of the capital markets. As we move to electronic publishing, income from Medical Physics is the most uncertain. The plan for managing the current surplus allows us the flexibility to reduce expenses and increase income as necessary.

Education Endowment In spite of our recent pleas, membership participation in the Education Endowment remains

AAPM Virtual Library Now online...

Selected presentations given at the 2004 AAPM Annual Meeting, Pittsburgh, PA, July 25–29 Also available...

CD roms with various Diagnostic Imaging and Therapy presentations given at the 2004 AAPM Annual Meeting Presentations posted in the Virtual Library include...

•streaming video and/or audio of the speakers •transcription of the audio presentations •slides of the presentations

www.aapm.org 3

(See Frey - p. 4)

AAPM NEWSLETTER AAPM NEWSLETTER

Frey

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(from p. 3)

Education Endowment Fund Performance 2000 - YTD

poor. So far we have had 20 contributions this year. That is 0.4% of the members. Last year the average member contributed $0.38. The chart (at right) shows our performance for the last five years. Please consider a contribution so you can take the deduction this year. If the members don’t support the fund, there is no reason to continue it.

Just for Fun Not too long ago I came out of one of those frustrating meetings that we all have to endure. I was really angry and seeing a large window at the end of the hallway, I had the almost overwhelming desire to throw the soft drink can in my hand through the window.

However, being a physicist , I began to think about the problem. Could I throw the can through the window? I know from resident teaching that a welltrained athlete can give a projectile about 120 Joules. Maybe I could give it 40 Joules. The corridor was (h) feet high and I was (s) feet from the window. Then I had to take into account the formdrag, etc., etc.

By the time I got back to my office I was feeling much better.

A few wasted minutes doing some calculations made me feel even better. This episode reminded me that my basic orientation is to physics. It is something I have always enjoyed. It is a profession that I am proud to call my own2.

1 2

The Harris Poll October 16, 2002 Cartoon courtesy of Ehren Stillman

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Amols

(from p. 1)

Frey has comments on this in his current presidential column, as does Jerry White, our chair of the Professional Council. As a radiation oncology physicist myself, I certainly have no objections to Medicare sending a wad of Ben Franklin’s directly to me every month rather than through radiation oncology. My reservations on this issue have been, and continue to be, of a purely practical nature. What are the details of the proposed billing process (the fine print), how exactly are we to achieve it, and at what cost? I’ve yet to hear a concrete plan that will move this issue beyond passionate supporters writing editorials in the newsletter.

There are numerous complications that, to the best of my knowledge, supporters are not addressing. First, there is the tacit assumption that independent billing will follow naturally from licensing. Yet medical physicists have been licensed in Texas for over 10 years, in Florida for over five years, and in New York for about one year, but to date not a single medical physicist has successfully collected a penny from a third party provider. Alas, licensing is a prerequisite for billing but not an enabler. Other radiation oncology professionals such as nurses and therapy technologists have been licensed much longer than we have but do not bill independently. Whether through lack of trying or for some other reason I do not know, but in any case, I ask supporters of independent billing, “What is the

next step? Have you thought through the possible ramifications?”

For starters, for which currently existing charge codes and/or services do you want to bill? The biggest medical physics money maker is computerized treatment planning, the physics part of which is a technical, not a professional, charge. Even the bonanza money from IMRT is almost entirely in the technical, not professional, fees. The professional component of treatment planning is a physician charge, and they’re not likely to give that away without a fight. Radiotherapy billing is a zero sum game! No one is going to add more money to the pot if and when medical physicists start billing independently. The money we bill will have to be taken away from somebody else.

Radiation oncologists and hospitals have well-funded political action committees with financial resources significantly larger than AAPM could ever muster.

Even if successful, we will most likely either be left with a ‘technical’ charge code, which will have to be changed to a professional charge code (remember, this whole crusade is based on 5

our being ‘medical professionals,’ and professionals don’t bill for technical services), or a fraction of the existing physician professional code (and only after what is likely to be a bloody battle). In most academic institutions there is a dean’s tax on income from professional billing (but not on technical billing), meaning that if we convert the current technical charge into a professional charge, we might well end up with less money than we started with (although there will be a lot of happy deans)!

Next, we have to address the fact that most treatment plans are done by a dosimetrist (who’s salary, with rare exception, we do not pay) and not by a physicist.

It is unlikely that the institutions or individuals currently paying dosimetrists’ salaries are going to be all too pleased about physicists collecting bills for work done by one of their employees, even if under our direct supervision. Will independent billing necessitate physicists hiring their own dosimetrists? And where might that lead? What would the counter-argument be if dosimetrists were to become licensed and wanted to bill independently of medical physicists?

The same logic being used for ‘a physicist is a professional working independently of a physician’ (and therefore billing independently) could be used to support the argument that ‘a dosimetrist is a professional working independently of a medical physicist.’

Think about it! Do you really want to go there? Currently there (See Amols - p. 6)

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Amols

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(from p. 5)

are no charge codes for accelerator calibrations. Do you want to create some? If you currently perform these calibrations with equipment purchased by your hospital, will hospitals now expect us to buy our own equipment?

I caution supporters of independent billing to work out these details before going down this path because, if you want to play in the major leagues, you have to be able to hit curve balls! We are not likely to be supported in this venture by our physician colleagues either as individuals or collectively through organizations such as ASTRO, ACR, or the like. Nor are hospitals and other owners of therapy hardware and employers of dosimetrists likely to support us in converting some of the codes they currently collect as technical fees into professional fees that we will bill directly.

While the absence of physician and hospital support, and perhaps even their hostility, should not necessarily dissuade us from the crusade, we should be aware that politically and financially we will probably be on our own. And from the vantage point of insurance companies, Medicare, and legislators, we are small potatoes compared to physicians and hospitals.

There is an old saying, ‘pick your battles wisely.’ Ask yourselves the following questions before proceeding: 1. Can you win this fight?

2. How much will it cost and who’s going to pay for it?

3. Will you be better off if you win? Has anyone estimated the increase in physics salaries if independent billing becomes a reality?

Finally, my understanding is that at least some advocates of independent billing consider this to be as much about professional status as about money, to which I say ‘Pride goeth before destruc6

tion, and a haughty spirit before a fall’ (Proverbs xvi. 18).

In short, think this through before proceeding. The devil, they say, is in the details.

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Executive Director’s Column Angela Keyser College Park, MD

Systems funds these residencies and has been doing so since 1993.

Fellowships and Residencies Your last monthly mailing included an announcement for a sponsored Fellowship, Imaging Residency, and two Radiation Oncology Clinical Residencies.

Applications for residencies must be received at AAPM Headquarters by February 1, 2005.

Applications for the fellowship must be received at AAPM Headquarters by April 15, 2005.

•The AAPM/RSNA Fellowship is offered to individuals and is a two-year pre-doctoral study in Medical Physics that will begin on July 1, 2005. Graduate study must be undertaken in a medical physics doctoral degree program accredited by CAMPEP. The amount of the award will be $18,000 per year for two years.

This fellowship is funded through the AAPM Education Endowment Fund.

•The AAPM Imaging Residency is offered to institutions to sponsor a clinical residency. This is a two-year grant to support a Clinical Residency in Imaging.

The residency program must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. The amount of the award will be $18,000 per year for two years beginning July 1,

Biomedical Imaging Research Opportunities Workshop

2005. This residency is funded through the AAPM Education Endowment Fund.

•The Varian Medical Systems Clinical Residencies are offered to institutions to sponsor two, two-year Clinical Residencies in Radiation Oncology. The amount of each residency award will be $18,000 per year for two years beginning July 1, 2005. The residency programs must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. Varian Medical

The AAPM is once again partnering with the Academy of Radiology Research (ARR), Biomedical Engineering Society (BMES), and the RSNA to sponsor the 3rd Annual Biomedical Imaging Research Opportunities Workshop (BIROW 3).

Many other leading societies in medical imaging are also participating in this event. BIROW 3 will take place March 11–12, 2005 at the Hyatt Regency in Bethesda, MD. AAPM staff members are managing the online abstract submission process. All other meeting logistics are being managed by the RSNA. BIROW 3 is a workshop to identify and explore new oppor(See Keyser - p. 8)

Important dates to remember for BIROW 3: •January 10, 2005 •February 11, 2005

Deadline for abstract submission Early-bird registration deadline (fee: $250) •After February 11, 2005 Fee increases to onsite registration ($325) •February 22, 2005 Advance registration closes

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Keyser

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(from p. 7)

tunities for basic science research and engineering development in biomedical imaging, as well as related diagnosis and therapy.

The workshop will provide information and ideas for new investigators, support accelerated development of biomedical imaging as a scientific discipline, and facilitate coordinated imaging research. It will include invited speakers on selected topics, focused breakout groups, and discussions with invited government representatives.

After presentations, panel discussions will be conducted in breakout groups on the four topics. White papers will be prepared by the breakout sessions and ultimately be distributed and published. The white papers will summarize and make recommendations related to the four topics with regard to opportunities and challenges.

For further details, go to: http:/ /www.birow.org/.

ACP News The end of August was an unnerving time at the American

Center for Physics. A large number of University of Maryland faculty who held a meeting at the ACP on Tuesday, August 24 became ill. On Thursday, August 26, a number of the staff at the ACP called in sick with similar symptoms. The Maryland Health Department was called in to investigate. The ACP Board made the decision to close the building early on Friday, August 27 and called in a “clean team” to thoroughly clean the building. Approximately 45 cleaning staff spent 12 hours on Saturday and another 40 staff spent eight hours on Sunday cleaning every horizontal and vertical surface in the building with a 10% solution of bleach. As a precautionary measure, the building was closed again on Monday, August 30. The health department later confirmed that the gastrointestinal illness was very likely caused by a norovirus.

The ACP Board acted to deter any further spread of the illness caused by employees who could unknowingly bring contaminants back into the building by requiring all employees who showed symptoms to stay at home for three days after being symptomfree. Employees were not

charged sick or vacation time on these days. Approximately 70 staff from the building, including nine AAPM staff and/or their families, were affected.

Staff News Peggy Compton joined the HQ team on October 4 as our accounting assistant. Peggy worked for 27 years in various positions in the headquarters office of a large local grocery chain where she gained extensive customer service experience.

The AAPM Headquarters office will be closed on Friday, December 24 and on Friday, December 31. Some staff will take vacation days during the holiday season, but sufficient help will be available to service your needs.

This is my last column for the 2004 year—my first year as your executive director. Thank you for the privilege of leading your headquarters team. As we end the year, I want to take this opportunity, speaking for all the staff, to wish you and your loved ones a happy and healthy holiday season.

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¿ HABLA ESPAÑOL ?

AAPM is looking for Spanish speaking volunteers to be interviewed by the AIP Department of Media Relations for Spanish language news reports to be aired on Univision and Telemundo stations. The TV program, Discoveries and Breakthroughs Inside Science, covers themes related to the role of physics in the field of medicine.

If you are able to participate, please contact Mary Fox at: mf@mropa.com.

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Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD

Organization of Agreement States Files Petition for Rulemaking re: Part 35 Training and Experience As I mentioned in the last newsletter, the Organization of Agreement States (OAS) was planning to file a Petition for Rulemaking to the Nuclear Regulatory Commission (NRC). This petition was filed September 3, 2004 and has been accepted by the NRC for review. The OAS stated that the “purpose of this petition is to define and specify the minimum training hours for the Authorized Nuclear Pharmacist and Authorized Users identified in §§ 35.55, 35.190, 35.290 and 35.390.”

OAS went on to state that the “training and education requirements of Part 35 have been designated as a Category B by the NRC, for Agreement State compatibility in an attempt to provide nationwide ‘consistency and uniformity.’ The higher the compatibility classification, the more prescriptive, and more specific the rule text must be to ensure that all Agreement States and NRC Regions be uniform and consistent. The lack of clearly defined didactic training hours for these rule sections weakens the current rule’s consistency and uniformity.

The OAS believes that the need for specified didactic training hours is a radiation safety issue rather than a ‘practice of medicine’ issue.”

In the Rationale for Changes section of the Petition, OAS states: “The revised rules are less prescriptive, and rely more on the knowledge and performance of Radiation Safety Officers, Authorized Users, Authorized Medical Physicists and Authorized Nuclear Pharmacists to maintain adequate radiation safety programs. Therefore the safe use of radioactive material in medicine now relies primarily on the various training and experience requirements specified in Part 35.

Since radiation safety is the goal of these regulations, consideration must be given to the methods by which an Authorized User, Radiation Safety Officer or Authorized Nuclear Pharmacist receives radiation safety training.

The majority of basic radiation safety principles are learned in the didactic portion of training, not with ‘work experience.’ In addition, proper didactic training programs will better prepare the in-

dividual for out of the ordinary occurrences that are not likely to be seen during supervised work experience. An appropriate didactic training program should supplement the supervised work experience portion so that the individual understands how radiation safety integrates into the practice of medicine.”

The NRC is currently reviewing the petition.

However, in a parallel action, the NRC distributed for review by the Agreement States and the Advisory Committee on Medical Uses of Isotopes (ACMUI) a pre-decisional draft of the final rule which did include a specific number of didactic hours for §§ 35.55, 35.190, 35.290 and 35.390. Although the predecisional draft is not available for public review, this was discussed in great detail at the recent meetings of the ACMUI. During these discussions, the following hours were proposed (see chart below): Note these are the proposed numbers being discussed. They are not yet final.

During the ACMUI there was extensive discussion on the num(See Fairobent - p. 10)

Section of Rule

Total Training and Experience Hours

Didactic Hours Proposed

35.55

700

200

35.190

60

8

35.290

700

80

35.390

700

200

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Fairobent

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(from p. 9)

ber of hours proposed. It was felt that 200 hours for § 35.390 was too high and that it may be more appropriate and reflective of actual training programs if this was 80–100 hours. The NRC is taking these comments under advisement. In addition, the NRC intended that the specification of didactic hours only be applied to those demonstrating training and experience via the alternate pathway and not board certification plus preceptor. However, several members of the ACMUI indicated that in order to ensure those in training, programs could be listed on a license whether they passed the board examinations or not, and to allow for the time lag

between finishing training and completing the board process, training programs would have to train to the alternate pathway and that distinction was therefore moot. The proposed final rule is due to the commissioners in November with a publication date sometime in 2005. Stay tuned for the next iteration.

Conference of Radiation Control Program Directors (CRCPD) Update The CRCPD announced that Ron Fraass, executive director, has taken a position with the Environmental Protection Agency as director of the EPA laboratory

in Montgomery, Alabama. Ron was instrumental in working with and ensuring coordination between the CRCPD and the AAPM. We wish Ron continued success in his new position.

Congratulations to Keith Strauss on being selected as the presenter of the John C. Villforth Lecture Series at the 2005 CRCPD Annual Meeting. The title of his presentation: Improved Radiation Protection in Medicine: Let’s Build a Stronger Bridge and “Get Over It.” Keith Strauss is the director of Radiology Physics and Engineering, Radiology Department, Children’s Hospital, Boston, ■ Massachusetts.

Professional Council Report The Elephant in the Parlor Gerald A. White Council Chair This edition of the newsletter carries several discussions on the topic of direct billing to patients for medical physics services. The topic comes up from time to time in the newsletter, at chapter meetings, in watering hole discussions (another elephant metaphor?) and once even in a fiery acceptance speech for the Coolidge Award. The concept, on superficial discussion, seems to have merit; those of us who work in oncology are associated with phy-

sicians who, mostly, either bill patients directly or are associated with a practice that does. We hear reasoned arguments in favor of the concept, usually based on economic issues, sometimes on issues of professional status and independence, and not infre10

quently on an appeal that mimics the old ads for boxing lessons involving a well-muscled beach habitué and some sand in the face. Those who favor direct billing have been tenacious in presenting arguments in favor; those who are thoughtfully convinced that direct billing is not in our best interest have been more reticent.

We have not yet had a complete examination of all the relevant issues, pro and con.

Amols and Frey, elsewhere in the newsletter, suggest that AAPM address this issue more carefully and we intend to do that.

The AAPM Professional Economics Committee has developed a presentation on econom-

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ics issues that can be presented by a PE committee member at AAPM chapter meetings on invitation. We anticipate a session at AAPM 2005 in Seattle that will provide what has heretofore been missing from the discussion, a substantive overview of the dark (as in unknown, not necessarily malevolent) underside of the reimbursement mechanisms in the United States healthcare environment. Acronyms such as the RUC, the PEAC, CMS, HCPAC, NPWP, and SGR are enough to send chills through the economic spine of our physician colleagues. We, as a group, need to acquire the same level of understanding and respect for the role of these groups and concepts. We need to look at the mechanisms that provide for quality reimbursement levels for physicians with whom we work, while others who may bill patients directly (clinical psychologists, licensed clinical social workers, physical therapists, dieticians, licensed professional counselors, for example), do not have the same relative level of reimbursement overall and most often do not choose to work in private practice.

As suggested by Frey, an understanding of practice models and how they might fit into a system that provides for direct billing is essential. We need to understand what types of patientspecific services are possibly amenable to direct billing and what part of our work effort is clearly outside of the realm of direct billing. One of us (GAW) is part of a group practice and has

been for over 25 years. All of our incomes come from statements we send out and we have a substantial experience with the economic models that Frey describes. The situation is sufficiently complex in that it is not immediately clear that the practice would be in a better situation (and could very likely be in a much worse situation) were direct billing to come to pass, even ignoring the political and collegial struggles described by Amols and Frey. We need to develop a reference body of information that describes private practice structure outside of the consulting physicist model whether or not direct billing is pursued.

In his writing, Amols outlines some of the issues that would need to be addressed in coming to a consensus on the desirability of direct billing. We will find the appropriate forums to explore these topics in some detail and add others, such as the statutory, regulatory and third party payer changes, that would be necessary to understand in order to make an informed judgment on the subject.

As we move forward in educating ourselves on the issues, let us be sure to keep focused on this as an economic and professional issue, temper our discussions to avoid damaging our relationships with one another and with our colleagues in allied professions and, above all, invest the substantial time and effort that will be necessary to develop an informed opinion on the matter. â–

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News from CAMPEP Brenda Clark CAMPEP President We have recently received one application for graduate program accreditation and one for residency program accreditation. Both of these applications are now under preliminary review by the respective committees.

For some time now we have been working with the AAPM Headquarters staff to develop an electronic submission process and associated database for our continuing education accreditation activities. The rationale is to substantially streamline both the CEC application process for program directors and the issuing of CE certificates to individual attendees. This software is currently in the final stages of development and scheduled for testing by the Continuing Education Credit Review Committee later this month. The target date for implementation is January 2005.

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Education Council Report Herb Mower Council Chair

As you read this your various committees, subcommittees and task groups will be preparing for our midyear meetings at the RSNA. Those that are more therapy oriented usually meet at ASTRO. If you are planning on being in Chicago for the RSNA, feel free to drop in on our various meetings. It is a great way to learn how our association works for you, our members.

This year at the RSNA we are sponsoring an IMRT session. It will be on Monday afternoon, November 29th from 1:30 until 5:45PM. This is an excellent opportunity for those of our members who are more therapy oriented to attain some continuing education credits while at the RSNA. It also allows those who are primarily employed in diagnostic physics to get an introduction to IMRT. We hope that you will support this new endeavor.

The Summer School Subcommittee is always looking for new topics and locations for their ses-

sions. If you have any ideas on these and/or would like to work on an upcoming Summer School, feel free to attend this group’s meeting at 8AM on Sunday, November 29th at the RSNA, or contact Paul Feller. The 2005 Summer School will be July 1822 at Seattle University in Seattle Washington (if Mt. St. Helens is good to us!). The topic is “Brachytherapy Physics.” Our annual meeting, also in Seattle, will immediately follow the school.

The RSNA 2004 will feature the second showing of our new AAPM booth. If you did not get a chance to see this great booth last year, stop by when you are on the floor this year.

Our Virtual Library continues to expand. At the 2004 annual meeting we added 45 more hours. This included 27 hours with full video (video streaming) and 18 hours of audio alone. We have changed our vendor to Blue Sky, which gives us much more control over the material in the library as well as ownership of the material.

The Public Education Committee continues to reach out to high school and college physics faculty at our annual meeting through our Educators’ Day activities. On this day local physics faculty are invited to attend our meeting, receive an overview of our profession, and learn about the opportunities available in our field. We hope that they can then 12

share this information with their students, increasing knowledge of and interest in our profession.

With the current shortage of medical physicists, this provides us with an excellent opportunity for the future.

The Education and Training of Medical Physicists Committee reported that we offered 10 undergraduate summer fellowships in 2004. The committee hopes to award 12 in 2005.

If you have students who would qualify for this program or want more information on the program, contact headquarters or George Sandison.

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Summer Undergraduate Fellowship Program Update George Sandison Subcommittee Chair The 10-week AAPM Summer Undergraduate Fellowship Program’s aim is to expose fellows to medical physics research and clinical practice and so influence them to undertake medical physics graduate study. The recent competition for a fellowship was very strong. Sixty-seven students applied and the 10 winners had an average GPA of 3.86!

Part of the formula for success in attracting this large pool of outstanding students was the program’s advertisement in the newsletter of the Society of Physics Students. Below are some of the summer 2004 highlights for a few selected fellows.

Nyimas Arief – (Mentor Dr. Paul Keall – Virginia Commonwealth University) The goal of this project was to determine the feasibility of a prototype three-dimensional wedge which aims to improve homogeneity of dose treatment in radiation therapy for whole brain radiation therapy. Nyimas’s major task was to analyze the data to see whether the wedge improves dose uniformity during treatment.

She is considering a career in medical research and bioengineering.

Courtney Buckey – (Mentor Dr. F. Chris Deibel – Cleveland Clinic Foundation) Courtney measured beam data for four lin-

ear accelerators for use in the clinic’s new treatment planning computer. She also received experience with conventional external beam planning, IMRT, and both HDR brachytherapy and intra-operative brachytherapy.

She was involved in treatment planning for a Radiation Therapy Oncology Group study, performing monthly and annual quality assurance checks on linear accelerators, and observing and assisting patient treatment at the Gamma Knife Center. Courtney was awarded a travel grant from the Penn-Ohio chapter of the AAPM to attend the annual meeting in Pittsburgh.

Christopher Danford – (Mentor Dr. John Humm – Memorial Sloan-Kettering Cancer Center) Chris worked on a project bridging PET molecular imaging with IMRT. PET was used to examine the degree to which regions of tumor hypoxia remain static over and beyond the course of therapy. Chris developed software tools to analyze successive hypoxia PET images of the same patient.

Leah Ezzell – (Mentor Dr. Ping Xia – University of California, San Francisco) Leah had an opportunity to observe the clinical world of radiation oncology and to appreciate the important roles of medical physicists involved in cancer patient care.

Leah worked on a research project to detect patient treat14

ment positioning changes based on computed tomography (CT) image information.

Michael Fernald – (Mentor Dr. Thomas Bortfeld – Massachusetts General Hospital) Michael worked with Alexei Trofimov, PhD on a project to use IMRT compensation for lung tumor motion. He learned how to minimize the effects of the motion via computer simulation then transferred the results to the linac.

A moving phantom was irradiated and the radiation dose measured with film. He is currently preparing a technical note about his findings for publication in a scientific journal.

Stephanie Letchford – (Mentor Dr. Richard Wendt, III – UT M.D. Anderson Cancer Center) Stephanie experienced clinical medical physics and undertook a challenging research project in computerized image formation.

Stephanie investigated SPECT scatter corrections and modified a research software package to suppress their effect. Her modified software was tested using simulated subjects. She also participated in the inspection of the structural radiation shielding in a new clinical building, acquired data for periodic quality control testing of imaging instruments, observed various clinical procedures and acquired data in the annual testing of a multi-slice CT scanner.

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Sarah Witten – (Mentor Dr. Robert Jeraj – University of Wisconsin) Sarah analyzed PET data acquired at different times during the course of a treatment to assess the effectiveness of radiation therapy. A special PET marker targeting cell proliferation was used and heterogeneity of cell proliferation during the treat-

ment was confirmed. Her analysis indicated the need to adequately target the more proliferating parts of tumors.

The program committee thanks the mentors for their participation and encourages as many members as possible to offer their mentoring services. Each year

mentor selection is primarily based on the needs of the selected fellow and often depends upon his/her home’s geographical location. A large mentor pool distributed across the country is important to serve our fellows well.

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2004 AAPM Meeting for Medical Physics Graduate Students Ali S. Meigooni University of Kentucky Lexington, KY This year, several graduate students from our institution were able to attend the AAPM Annual Meeting and benefit from the various activities of this event.

One of the main reasons they were able to come to this meeting was the relatively short travel distance. This enabled them to drive together and minimize the cost.

Our students were excited to see some of the important members of the field whose books and publications they read and use every day. For example, taking a picture with Dr. Khan, whose books are used in various aspects of radiation therapy science, was a great experience for them.

Reading and practicing the major AAPM recommendations such as TG-21, TG-51, TG-43, TG-45, etc., and then meeting the members of these task groups and finding that they were once also at the same point in their career as the students are now,

Pictured l to r: Christodoulos Constantinou, Ashley Gale, Dr. and Mrs. Khan and Clarissa Wright at the annual meeting in Pittsburgh.

“gives us optimism for our own future accomplishments,” said Jennifer Clark. In a meeting with Dr. Glasgow, the students not only were able to take a picture with him, but benefited from his advice regarding the accessibility and humanity of prominent medical physicists.

In addition to meeting wellknown AAPM members, the students were able to visit the scientific sessions and the exhibition hall, which allowed them to learn about cutting-edge advances in medical physics. “Apart from meeting the pioneers in this field, AAPM also provided us an opportunity to look into the latest technological developments in the 15

field of radiation therapy,” said Rafiq Koona, one of the students.

Another student, Bill Howard, commented, “I was able to meet several AAPM members whose names I have seen in publications.” He also stated, “I was able to explore various products used in radiation therapy that I had never seen.” As well, Howard enjoyed a great social time with other colleagues in the evenings.

A presentation entitled, “Survival Guide for Young Clinical Physicists,” as well as the student meeting and other activities, provided students with information and opportunities geared specifically toward their needs at this (See Meigooni - p. 16)

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(from p. 15)

stage in their careers. Clarissa Wright stated that her experiences, especially attending the ‘Survival Guide,’ afforded her “the chance to meet with other medical physics students from all over the country who are working toward the same goals as I am.”

Several students participated in the scientific aspect of the meeting by presenting the results of their research activities. Mr. Rachabathhula practiced his presentation several times to make sure it would be acceptable to his colleagues. Jennifer Clark, who also presented, said “Although I was a little nervous, I really enjoyed the opportunity to stand in front of the medical physics community and present new information that could be useful for the treatment of cancer.” The students were excited that future students may view their contributions in the same light as they themselves view those of current AAPM contributors.

The AAPM Placement Service provided information about the

E

swer a number of questions I had during the CE classes, learn about new technologies, and was inspired by the experiences of senior members and former graduate students from our program.”

Other activities such as exploring the city of Pittsburgh and attending a Pirates game were very exciting for the students. I hope that travel to future AAPM meetings is affordable, so that other medical physics graduate students can attend and enjoy the meeting as much as our students have. Hopefully, these students will be able to contribute to AAPM Task Group projects, committee meetings, or other AAPM activities once they start their careers in the field.

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Need Continuing Education Credits?

CE

C

availability of medical physics positions around the world. “For the students beginning their job search, the AAPM meeting provided an excellent opportunity for networking with other professionals in the field of medical physics,” said Michael Gnaster, a graduate student. Several students posted their resume and were able to meet with prospective employers to discuss positions.

In conclusion, the AAPM meeting was very beneficial to graduate students in many aspects. “It was a great learning opportunity for me by participating in the AAPM Annual Meeting,” says Shahid Bashir, a Ph.D. student.

Phillip Sawyer, also a student, commented, “I was able to an-

RD

R

D

Pictured l to r: David S. Meigooni, Ali S. Meigooni, Rafiq Koona, Venkata Rachabathhula, Phillip Sawyer, Dr. William Henson, Jennifer Clark, and Clarissa Wright.

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 • • • www.aapm.org/educ/rdce.asp

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AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER NOVEMBER/DECEMBER AAPM NEWSLETTER NOVEMBER/DECEMBER 2004

2003 AAPM Medical Physics Travel Grant Report Around the UK in 14 Days Paul Keall Richmond, VA “Thou art as wise as thou art beautiful� (William Shakespeare, A Midsummer Night's Dream).

Thus it was in search of wisdom and beauty that I found myself heading to the United Kingdom for two weeks, supported by the AAPM-IPEM Medical Physics Travel Grant.

London At the end of a cramped, crowded flight I was greeted by coastline and green fields of pasture, hay and crops. Back in England. Lovely. A nice time of year to visit in early summer, when the gardens are in bloom and the temperatures are (mostly) warm. At the time, England was in the throes of the Euro 2004 football (soccer) tournament, which meant that there were English flags on houses, cars, shops and people. My first dose of civilized culture came from the modern art exhibitions at the Tate Modern and Tate Britain museums, joined by a sleek catamaran with magnificent views of London on both sides of the river.

An early morning run along the Thames staved off the jetlag for my first port of call to the wellknown Royal Marsden Hospital, hosted by the equally famous Professor Steve Webb, the director of the Joint Department of Physics. The Joint Department is composed of approximately 150 staff

covering several areas of medical physics and has an impressive array of research projects, grants, students and publications.

Several of the radiotherapy project areas were also actively being studied at VCU, such as Monte Carlo-based treatment planning and portal image prediction, biological motion and the effects of motion during IMRT. It was helpful to discuss the different approaches to solutions for common problems.

Cambridge From the Marsden, I visited the picturesque university town of Cambridge where I caught up with an old mate, Dr. Tony Fitzgerald, who is a scientist involved with terahertz medical imaging applications at Teraview.

Terahertz imaging utilizes a largely unexplored band of the electromagnetic spectrum (0.1-100 THz) where interactions of radiation with matter cause vibrations and excitations of biological molecules which can provide characteristic 'fingerprints' to differentiate biological tissues, for example, cancerous and non-cancerous tissue. Terahertz imaging (and spectroscopy) has applications in skin and breast cancer imaging, as well as non-medical applications in pharmaceuticals and defense. Tony took me on an evening bike tour of the Cambridge sights, with several stops for refreshing drinks along the

way, including the pub at which Watson and Crick discovered the double helix form of DNA.

Manchester A train took me to the home city of the most famous sports club in the world, Manchester United. Manchester is also home to the Christie Hospital NHS Trust, the largest cancer treatment centre of its kind in Europe.

World firsts for the Christie include pioneering the use of Roentgen X rays for cancer therapy (1901) and setting the first international standards for radiation treatment (1932). Dr. Ranald Mackay, the group leader for Radiotherapy Physics, hosted my visit. I was fortunate enough to be present for a cone beam CT acquisition of a patient, which was a first for me. I met with members of the Developing Technology Group who were working on several interesting projects including automated implanted marker segmentation, radiotherapy-induced speech (See Keall - p. 18)

17

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(from p. 17)

defects, characterizing electronic portal imaging panels to account for defective and transient diodes, and point-based automated contour generation using radial basis functions.

Birmingham It was a pleasure to again visit Birmingham, to meet with Professor Alun Beddoe, currently the head of the Medical Physics Department at the University Hospital Birmingham, and my former Ph.D. advisor. Alun had organized a half-day research seminar (which the British rail system fortunately allowed me to attend with minutes to spare). Alun's group has an interesting variety of projects, including radiobiology of high LET radiations linked to the BNCT project, improved chemotherapy dose prescriptions and radiobiology calculations, particularly predicting the effects of waiting times and treatment breaks on tumor control, which is an important issue throughout the UK and many parts of the world. The seminar session was followed with further discussion at an English pub.

Birmingham was also a place for social activities and I watched a cricket encounter between New Zealand and the West Indies with Dr. Stuart Green and spent a very relaxed night with a compatriot and colleague, Dr. Richard Hugtenburg.

Cardiff I knew I was in Wales once the street signs became unreadable.

The train trip to Cardiff was very scenic, with views of quaint villages and ancient ruins. Cardiff is known as 'Europe's Youngest Capital' (1955). A blustery wind blew on the harbor as my hosts Dr. Geraint Lewis and Mary Chin took me to lunch at an old Norwegian church, now a café and arts center, where children's author Roald Dahl was baptized. I must commend Welsh hospitality. After mentioning I had never tasted Welsh beer, I left Geraint's house loaded with cans of 'Brains', a local bitter. Geraint is a physicist at Velindre Hospital, a busy cancer hospital with research strengths in Monte Carlo dose calculation and electronic portal dosimetry, also aligned with research interests at VCU, where we hosted Mary while she performed some experiments in 2003.

The itinerary at the centers I visited was similar, with a seminar and discussions or presentations of the various research projects at the host institutions. In all I gave six talks in five cities, “4D Radiotherapy: Imaging, planning and delivery” (four times), “The Application of Monte Carlo to Intensity Modulated Radiation Therapy” and “EPID-based 4D Radiotherapy with Implanted Markers: Lung and Prostate Applications.”

Brighton After a pleasant drive from Cardiff to Brighton (listening to the Wimbledon tennis tournament on the radio) we arrived for the welcome reception for the 2004 Electronic Portal Imaging (EPI) meeting. The EPI meeting was 18

attended by over 250 people from around the world and is very focused on measuring and reducing geometric errors during radiotherapy, as well as appropriately accounting for residual uncertainties. Unfortunately, very few institutions make the effort to evaluate and systematically correct for geometric errors. Often the data to determine errors is routinely acquired during a patient treatment, but the analysis and use of this information is not optimal. It was recommended that manufacturers develop tools to allow for the easy integration of off-line treatment correction protocols into clinical practice. I look forward to the next EPI meeting located in Melbourne, Australia.

Back to London Preceding my flight home I had another day playing tourist in London. The London Eye, which looks like a combination of Ferris wheel and a 137 meter high giant bicycle wheel, gave views of the city of London and beyond (don't look down!). The Saatchi gallery had a Salvador Dali exhibition highlighting how chained we are to conformist society and time.

One interesting quote which remained with me, almost the antithesis of scientific thought, is, “What is important is to spread confusion, not to eliminate it.”

The paintings and thoughts of Dali were mulled over in 'The Tipperary', the oldest Irish pub in London.

Medical Physics Roles Part of my mission was to learn about the clinical, research and

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administrative infrastructure differences between hospitals in the UK and the US, though it is of course also important to highlight the similarities. Medical physicists in the UK and US have similar responsibilities, though UK physicists do not always have the overall responsibility for treatment planning. Another common thread is that physicists work hard. The research projects, with a few exceptions, are based in the same areas.

However, there are several differences between the US and UK medical physics. The UK tends to have fewer facilities, but each facility is larger, typically with four or more treatment machines.

Due to waiting lists, there is much pressure to treat patients quickly, and thus there are several completed and ongoing hypofractionated randomized treatment protocols to determine if similar overall efficacy can be achieved in fewer treatments.

These important studies will im-

pact radiotherapy practice worldwide.

The training system for UK medical physicists is more formal and uniform than the US. Physicists are required to have a masters degree in medical physics, have completed a Grade A Training Scheme and a Program of Advanced Training and Responsibility before they can be considered for corporate membership of the Institute of Physics and Engineering in Medicine, the UK equivalent of the AAPM. Medical physicists in the UK are employed by the NHS (UK National Health Service) which has over one million staff, one of the largest government employers in the world following China's Red Army in terms of workforce numbers. The NHS is undergoing a 'modernization effort' called Agenda for Change, which involves a radical shakeup of the NHS pay and benefits system applying to all NHS staff (with the exception of doctors, dentists

and senior managers). Medical physicists are busy writing job profiles stating their level of responsibility, which will ultimately determine their level of pay.

Summary The AAPM-IPEM travel award is made possible by a donation from Charles Lescrenier, the UK Institute of Physics and Engineering in Medicine and the AAPM. Grateful thanks to my darling wife, Robyn, for looking after our three young children for two weeks— no easy task! Thanks also to Virginia Commonwealth University for supporting my time away from the department (did they notice I was gone?). The hosts at the various institutions I visited were extremely hospitable and generous with their time. Finally, I urge other physicists to take advantage of the travel award opportunities. The experience will be enlightening, entertaining, educational and exhausting—like all ■ good things in life.

Activities of the ABMP Geoffrey D. Clarke Chairman, ABMP The American Board of Medical Physics (ABMP) continues to maintain board certification programs for physicists in Magnetic Resonance Imaging Physics and Medical Health Physics. In April 2004, the International Society of Magnetic Resonance in Medicine (ISMRM) officially became a sponsor of the ABMP, bringing to four the number of organiza-

tions now sponsoring the ABMP. The others include the AAPM, the American Academy of Health Physics and the American College of Medical Physics. The ABMP also set up a new Web site at www.abmpexam.com.

Certification in Magnetic Resonance Imaging Physics The certification program in Magnetic Resonance Imaging

(MRI) Physics was initiated by the ABMP several years ago.

While the examination structure will remain in the usual three-part format, the curriculum will be somewhat revised. A new Part I examination is being devised that will be more appropriate for MRI physicists that did not come through the traditional medical physics disciplines. Knowledge areas required for the new Part I examination will be based on rel(See ABMP - p. 20)

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evance to magnetic resonance in humans and include, in addition to the detailed understanding of magnetic resonance physics, hardware principles and a rudimentary grasp of human anatomy, physiology & biochemistry as they influence the outcome of MR procedures in the human subject.

The detailed curriculum is being reviewed and modified with an anticipated final format to be announced on the new ABMP Web site (www.abmpexam.com) soon. Applicants from traditional medical physics disciplines who seek certification in MRI Physics can still complete the traditional ABMP Part I examination or request a waiver of the Part I examination if they have successfully completed the ABR’s Part I examination.

The ABMP initiative to establish board certification in Magnetic Resonance Imaging Physics stemmed from its belief that professions themselves are the best suited to determine their own standards of competence. In agreeing to sponsor the ABMP, the board of trustees of the ISMRM was acting on its strongly held opinion that their society must be part of this process since it represents the majority of MRI scientists and clinicians. As the application of MRI procedures expands to ever-increasing levels of pulse sequence sophistication, accompanied by the exploitation of higher magnetic field strengths, faster and stronger gradients, and greater radiofrequency power, a profes-

sional qualification ensuring the highest level of competence in those that influence patient safety and procedural efficacy becomes essential. Certification in Magnetic Resonance Imaging Physics by the ABMP is designed to address the competence of an MRI physicist for work with clinical MRI systems. This certification will be of great value not only to members of the general public, but also to the health care administrators, review board committees, and physicians.

Certification in Medical Health Physics The Medical Health Physics (MHP) examination program will continue to use the traditional Part I examination. In 2004, the MHP exam panel, chaired by David Steidley, announced changes in MHP certification eligibility requirements. As a reminder, this major change was made to accommodate members of the American Academy of Health Physics and the Health Physics Society. The ABMP created a three-year window (January 2004 to December 2006) to allow the entrance of well-experienced medical health physicists with extensive practice into the examination for certification in MHP. Candidates with a B.S. degree in physics, medical physics or another appropriately related field from an accredited university, and 15 years of experience in medical health physics, can now apply. Also, now eligible within this three-year period are those persons certified by the American Board of Health Phys20

ics who also have five years of experience in medical health physics.

We are also pleased to announce that the State Board for Medicine of New York has determined that both the ABMP Part I General Examination and the Part II Speciality Examination are acceptable for licensure in that state in the speciality of MHP.

Renewal of Certifications in Traditional Medical Physics Specialities The ABMP wants to remind its diplomates that the initial ABMP certification was for 10 years with recertification occurring at five five-year intervals thereafter. Several diplomates have asked about how they might claim their 72 hours of Continuing Medical Education (CME) credits for the last three years. In fact, there are numerous ways; CAMPEP credits from scientific and professional meetings, local professional meetings, and books or chapters read or published. Also, in-service presentations or lectures, articles, teaching, and many others achievements can be documented and counted toward satisfactory fulfilment of this requirement. The ABMP does not now currently have a rigid (CAMPEP credits only) policy. Diplomates need to fill out the recertification application that can be found on the ABMP Web site (www. abmpexam.com) and list their 72 hours for 2002, 2003, and 2004 for review. The ABMP will contact diplomates if there is a question. Diplomates that are active

AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM NOVEMBER/DECEMBER 2004 AAPM NEWSLETTER NEWSLETTER NOVEMBER/DECEMBER

and conscientious in keeping up with the profession should not have a problem.

The ABMP is currently working to enhance its recertification program to a level of documentation that is equivalent to the new ABR Maintenance of Certification (MOC) program. Details will not be announced until after the full ABR MOC process has been finalized. Like the ABR, the ABMP will encourage those physicists previously certified to adhere to the new standards for maintenance of their professional skills and knowledge base. However, previously certified physicists will not be required to fulfil the new requirements in order to maintain their ABMP certificate.

Future Examinations The timing and venue of both the written and oral ABMP examinations will be arranged in future years to be convenient to both candidates and examiners.

This means that they will be held at the same location as, and concurrent with, annual meetings of sponsoring organizations such as the AAPM and ISMRM. This practice will start with the Seattle AAPM meeting in July, 2005.

The ABMP continues to strive to serve its diplomates and the greater medical physics community. The ABMP will be sending out information booklets this fall regarding its examination activities in 2005. These booklets will be sent to diplomates that have

kept current regarding recertification and those physicists that have been identified as potentially being interested in sitting for one of the ABMP examinations.

Please contact me, Geoffrey Clarke (clarkeg@uthscsa.edu), to be put on the ABMP information booklet mailing list if you want to ensure that you receive this information later this year.

Also, please remember that additional information and continuous updates can be found on the new ABMP Web site at www.abmpexam.com .

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AAPM/IOMP International Scientific Exchange Program Azam Niroomand-Rad President, IOMP The 13th* AAPM/IOMP oneweek course/workshop on Radiation Therapy Physics was held August 23-27, 2004 in Chengdu, China after a delay of over one year due to SARS concerns. The one-week course entitled “Advances in Radiation Oncology Physics” was organized by the International Scientific Exchange Program Subcommittee of the AAPM International Affairs Committee, and the Chinese Association of Radiation Physicists of the Chinese Society of Medical Physics (CSMP). The workshop attracted over 250 participants from all over China, most

of whom are radiation oncology physicists and radiation oncologists who have been in practice for several years.

AAPM and CSMP were the main sponsors of the workshop, which was also endorsed by IOMP and the Sichuan Society of Radiation Oncology. The Asian Oceanic Affairs Subcommittee was able to get funding to support the travel expenses of 12 faculty members from the U.S. and Canada. The same number of U.S. faculty was supported by the North American Chinese Medical Physicists Association (NACMPA). Parallel to the workshop, the NACMPA put together a commercial exhibit and a series of Instrumentation Ses-

sions to provide hands-on experience for the participants. Altogether, 33 Chinese and international firms participated in this effort.

A total of 24 lecture hours were presented in the five-day course in the Chengdu Convention Center. The lectures were given in English with instantaneous interpretation via a wireless system provided by NACMPA. In addition to the lectures, blocks of time were reserved for small group sessions on various topics of interest. There were 36 such sessions given with an average participation of about 50 people.

Topics covered included basic QA, radiation safety, education, (See IOMP - p. 22)

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certification, recent advances and future research directions in radiation oncology and physics. In two of the afternoons, about 30 relatively younger physicists participated in the Dose Calibration Workshop and the Chamber Inter-comparison Workshop in the Huaxi Hospital of the Sichuan University Medical School. Dr. Faiz Khan and Mr. Thomas Slowey from the U.S., and Dr. Jianrong Dai of the Chinese Academy of Medical Sciences conducted the hands-on workshops.

A PowerPoint presentation of material from all the lectures and topical sessions was printed in very high resolution format to show the figures in great detail.

Each of the participants was given this 215-page book at registration time. Feedback indicated that this effort reduced the language barrier and improved the educational impact of the course.

All the PowerPoint and PDF files were put in a compact disc and sent to each participant after the workshop. In addition, MDS Nordion and TomoTherapy donated and shipped 250 copies of the textbook, The Modern Technology of Radiation Oncology: A Compendium for Medical Physicists and Radiation Oncologists, by Jacob Van Dyk. The first 250 institutions sending at least one participant were given a copy of the book.

The Asian Oceanic Affairs Subcommittee used its Web site quite effectively during the planning and organizing stages. The Web site,

http://www.aapm.org/org/committees/ao, keeps the program of the workshop, the Chinese and English abstracts of all 24 lectures and 36 topical sessions, the list of faculty, the geographic distribution of participants, and other information on display.

Please visit the China workshop link to view the details. The Web site allows for this kind of close cooperation regardless of the physical distance between the collaborators.

The workshop would not have been possible without the generous support of the many industrial sponsors listed in the workshop home page. Among them are regular supporters of the ISEP program which includes Siemens, Varian, Elekta, NOMOS, CMS, MDS Nordion, and Sun Nuclear. Most of the other sponsors listed in the home page either have supported past ISEP programs or indicated that they will be happy to sponsor future programs.

The participants were asked to enter a score of 1 to 10 on the Course Evaluation Form for each of the lectures and sessions attended. About half of the participants returned the forms. It is interesting to note that the higher scored sessions were either delivered in Chinese or given with good translation. This is consistent with the written comments collected, which indicated repeatedly that the language used and translation quality were very important and/or appreciated.

However, the most popular comments by far were on the overall good quality of the course, the 22

participants’ appreciation of the presentations of all faculty members, and the desire for more frequent future AAPM/IOMP courses.

On the other hand, the two most mentioned negative comments were on the quality of Chinese translation for certain sessions, and on the fact that there were sometimes four parallel sessions taking place in the main hall.

Another disappointment to all participants was the fact that the books by Jake Van Dyk were held by the Chengdu Custom, making it necessary to ship the books to the participants after the workshop. We hope to learn from this experience so that we may better prepare future scientific exchange events in China or elsewhere.

The Asian Oceanic Affairs Subcommittee would like to express special appreciation to the many hard-working individuals for their contributions to the success of the event. Special thanks are due to Prof. Yimin Hu, Prof. and Mrs. Dake Wu, Dr. Jianrong Dai, Mr. Ke Zhang, Dr. Sen Bo, Dr. Shaoyu Du, Mr. Zhiquan Tang, Dr. Jinyi Lang, Dr. Reijie Yang, Dr. Fangfang Yin, Dr. Jeff Ning Yue, and many others. The names of the U.S. and Chinese members of the Organizing Committee are listed in the Web pages if you are interested in contacting them for additional information. *Pakistan (1992), Poland (1993), Iran (1994), Turkey (1995), Morocco (1996), Russia (1997), Egypt (1998), Brazil (1999), Romania (1999), Thailand (2000), Bangladesh (2001), Saudi Arabia (2002) â–

AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER NOVEMBER/DECEMBER 2004 AAPM NEWSLETTER NOVEMBER/DECEMBER

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NOVEMBER/DECEMBER2004 2004 NOVEMBER/DECEMBER

Thailand Workshop Current QA/QC Practice in Radiotherapy and Oncology Cheng B. Saw, Pittsburgh, PA, Anchali Krisanachinda, Bangkok, Thailand, and Sivalee Suriyapee Bangkok, Thailand A three-day Thailand workshop entitled “Current QA/QC Practice in Radiotherapy and Oncology” was held in Bangkok, Thailand from August 30th to September 1st, 2004. The invited faculty members for this workshop who were from the United States were Cheng B. Saw, PhD, Todd Pawlicki, PhD, Jack Yang, PhD, Raymond Wu, PhD, and Zhen Zheng, PhD. This workshop was organized by Cheng B. Saw, Anchali Krisanachinda, PhD, and Sivalee Suriyapee, ME. The AAPM, the North American Chinese Medical Physicist Association, and the IOMP endorsed this workshop. The Thai Medical Physicist Society was the sponsor. Financial support was provided by Siemens Medical Solutions, Mentor Corporation, LACO, Scantronix Welhofer, Sun Nuclear, TomoTherapy Inc, Varian Medical Systems, Elekta, North American Scientific, Business Alignment Co, Ltd, Kamol Sukosol Electric Co, Ltd, Supreme Product, Dispo-Med Co, Ltd, and Roche Thailand, Ltd. The keynote address, “Frontiers in Oncology,” was made by Dr. Kris Chatamara, Department of Surgery, Faculty of Medicine,

Chulalongkorn University, Thailand. His talk stressed the chronological changes in the management of breast cancer from mastectomy to breast conservation as the current standard of practice around the world.

Although the objective of this workshop was quality assurance, additional topics were selected for inclusion at the request of host faculty. These included the commissioning of treatment planning systems, the use of 3D tools, IMRT update, and shielding requirements. Dr. Saw presented quality assurance aspects for linear accelerators, simulators, and CT-Simulators, while Dr. Zheng and Dr. Yang presented brachytherapy and high-dose rate QA, respectively. The procedures in the commissioning of treatment planning systems were explained

by Dr. Yang for the ADAC Pinnacle Treatment Planning System, Dr. Zheng for the Eclipse Treatment Planning System, and Dr. Pawlicki for the Xio Treatment Planning System. Dr. Zheng explained the AAPM TG51 (1999) and IAEA TRS-398 (2000) calibration protocols and their differences. The use of the 3D treatment planning system and treatment tools, such as dose volume histogram, were discussed by Dr. Saw and Dr. Pawlicki. Dr. Yang and Dr. Wu presented an update on the status of IMRT independently. Last, Dr. Wu discussed stereotactic radiosurgery and 24

shielding requirements for radiation producing installations.

There were 57 members of the Thai radiological community who participated in this workshop.

The intent of this workshop was to have interactive sessions between the faculty and the participants. There were a number of questions regarding the commissioning of the treatment planning systems and IMRT. These subject matters are of much interest because Thailand is undergoing a transition from 2D to 3D treatment planning systems with future implementation of IMRT. The distribution of a number of copies of the textbook, Foundation of Radiological Physics, authored by Cheng B. Saw to the Thai radiological community was made possible through a partial financial contribution from Siemens Medical Solutions. After the meeting, the faculty toured Bangkok and its neighborhood graciously accompanied by the host faculty for two days. A few members of the faculty enjoyed the Thai massage experience for relaxation. The overall assessment of the workshop, based on the comments from the participants, faculty, and organizers, was positive. The faculty members had a very good time and look forward to returning to Thailand in the near future.

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AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM NOVEMBER/DECEMBER 2004 AAPM NEWSLETTER NEWSLETTER NOVEMBER/DECEMBER

ACR Stereotactic Breast Biopsy Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler Senior Director, ACR Breast Imaging Accreditation Programs Does your facility need help applying for accreditation? Do you have a question about the Diagnostic Modality Accreditation Program? Check out the ACR’s Web site at www.acr.org; click “Accreditation” under “Quick Links” and then “Diagnostic Modality Accreditation Program.” You can also call the Diagnostic Modality Accreditation Information Line at (800) 770-0145. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. Our facility is in the process of obtaining accreditation for stereotactic breast biopsy. The only mass case we have to submit was performed more than three months ago.

Can we submit this case?

within three months of each other has been extended to six months.

Q. Many of the physicians at my facility have begun using an intact tissue device larger than 11-gauge. Is this acceptable for Stereotactic Breast Biopsy Accreditation?

A. Yes, The 11-gauge restriction on core biopsy devices has been removed and all stereotactic biopsies performed with any FDAapproved core biopsy device can be submitted for Stereotactic Breast Biopsy Accreditation.

Q. I am a medical physicist with a B.S. in a physical science. I meet all MQSA requirements and started performing mammography and stereotactic physics surveys before 1999. Would I be considered qualified to perform surveys on stereotactic units at accredited facilities even though I do not have a master’s degree?

A. The ACR recently changed the requirement for medical physicists performing surveys of stereotactic breast biopsy units to be more consistent with MQSA. Medical physicists must now meet the following requirements:

Requirements for Medical Physicist

A. Yes, The Committee on Stereotactic Breast Biopsy Accreditation recognizes that biopsies for masses are often performed using ultrasound and that it may be difficult for a facility to submit a stereotactic biopsy of a mass performed within the previous three months. For this reason the requirement that the clinical images and phantom images be

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AAPM NEWSLETTER AAPM NEWSLETTER

NOVEMBER/DECEMBER2004 2004 NOVEMBER/DECEMBER

New Members The following is a list of ‘Change of Status’ and ‘New Members’ from April, 2004 – September, 2004.

Change of Status Corresponding Young K. Lee Kent, UNITED KINGDOM

Full Kristy Brock Toronto, ON CANADA Jonathan N. Howe Fairfax, VA Chulhaeng Huh Tampa, FL Thierry B. Sarrazin Sion, SWITZERLAND

Junior Randi F. Aaronson Richardson, TX Svetlana Denissova Saint John, NB, CANADA David G. Englehart Saint Louis, MO Kara K. Ferachi Baton Rouge, LA Stephen M. Gajdos Cleveland, OH Yi Le Richmond, VA Patricia E. Lindsay St. Louis, MO Frank D. Pazik Summerville, SC Juilien H. Svoboda New Orleans, LA

New Members Associate Glenn T. Jenning New York, NY Douglas A. Kieper Newport News, VA Joseph Lauritano Holbrook, NY Keith R. Nelson Waunakee, WI David R. Smith Cleveland, OH

Corresponding Juliette Angles Bordeaux Cedex, FRANCE

Vicky L. Howard Greensboro, NC Thiruloga C. Jagannathan Sugarland, TX Peter A. Jenkins Kaysville, UT Sigrid C. Joite-Barfuss Forchheim, GERMANY Thomas A. Karzoumi Dublin, OH John T. Keane Garden City, NY Cynthia E. Keppel Norfolk, VA Kohno Ryosuke Chiba, JAPAN Bijoy K. Kundu Charlottesville, VA Jian Liang Royal Oak, MI Matt Lucas Baltimore, MD Kim-Chiu Luk La Canada, CA Bruce A. Lulu Gulfport, MS Donia MacDonald St John’s, NL, CANADA William Thompson Main Sunnyvale, CA Helvecio C. Mota Greenville, NC Patrice Munger Montreal, QC, CANADA Dmitri F. Nichiporov Bloomington, IN Lech S. Papiez Mooresville, IN Mi-Ae Park Newton, MA Indu F. Saxena Torrance, CA Matthew G. Skinner Palm City, FL James B. Stubbs Alpharetta, GA Sean Thomas Toner New York, NY Oleg N. Vassiliev Houston, TX Sastry S. Vedam Richmond, VA Jagannath Venkatesan Arlington Heights, IL Patrick G. Virador Concord, CA Keith T. Welsh Stony Brook, NY

Amineh Hamad Khatib Jerusalem , ISRAEL Brendan N. Hill Act, AUSTRALIA Valeria Landoni Roma, ITALY Barbara Lazzari Florence, ITALY Minoru Hosoba Kyoto, JAPAN Andrea Nitrosi Reggio Emilia, ITALY

Full Gamal Akabani Durham, NC Peter P. Antich Dallas, TX Alonso R. Arellano Los Angeles, CA Manuel M. Arreola Gainesville, FL Julian Badragan Calgary, AB, CANADA Clyon Wayne Bell Jamaica, NY David M. Beylin Rockville, MD Karen L. Brown Danville, PA Edward Bump Kirkland, QC, CANADA David W. Burkett Lebanon, TN Radim Cernej Royal Oak, MI Melvin G. Chaney Gilbert, AZ Huaiyu Heather Chen-Mayer Gaithersburg, MD Young-bin Cho Toronto, ON, CANADA Stephanie Corde Grenoble, FRANCE Vadivel Devaraju Lansdowne, PA Wilson Fong Palo Alto, CA Kenneth L. Freeman Cleveland, OH Mohamoud Ali Gaildon Marietta, GA David Goodyear St John’s, NL, CANADA Keli C. Henn Beaver Falls, PA Ping Hou Houston, TX

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Nathan E. Yanasak Augusta, GA Collins Yeboah Toronto, ON, CANADA Zirao Zheng Concord, CA David C. Zhu Chicago, IL

Junior Amar K. Basavatia Madison, WI Joseph D. Bauer New York, NY Kevin P. Beaudette Boston, MA Chris Beltran Rochester, MN Josephine Chen Oakland, CA Glenn R. Deacon Chula Vista, CA Neal S. Holter State College, PA Yibing Hu Forty Fort, PA Ravi Kulasekere Copley, OH Albert J. Lagroue Tickfaw, LA Jun Li Charleston, SC Wei Lu St. Louis, MO Ivaylo B. Mihaylov Richmond, VA Silvia Pella Boca Raton, FL Charles R. Schmidtlein New York, NY Jussi K. Sillanpaa New York, NY Jun S. Song Somerville, MA Erato Stylianou Nicosia, CYPRUS Takele D. Tsegaye Rochester, MN Roy C. Wood St. Louis, MO Gin-Weigh Wu Long Branch, NJ M. Ming Xu Maywood, IL Yongjian Yu Charlottesville, VA Lifei Zhang Houston, TX

AAPM NEWSLETTER JANUARY/FEBRUARY2004 2001 AAPM NEWSLETTER NOVEMBER/DECEMBER 2004 AAPM NEWSLETTER NOVEMBER/DECEMBER Guowei Zhang Baltimore, MD Mutian Zhang Bronx, NY

Student Maxwell Amurao San Antonio, TX Steven Babic London, ON, CANADA Leonard M. Borrelli Clinton, OH Jing Cai Charlottesville, VA Blake A. Cannon Houston, TX Heeteak Chung Gainesville, FL Julio R. da Graca Piscataway, NJ Ivan C. Danchev Columbia, SC Colin H. Delaney Grayslake, IL Delal Dink West Lafayette, IN Andreea C. Dohatcu Buffalo, NY Abhishek P. Dwivedi Stony Brook, NY Kamal Eljabaly Cary, NC Wenzheng Feng Detroit, MI Jonas D. Fontenot Houston, TX Ashley A. Gale Lexington, KY Rohini George Richmond, VA Sean Graham Toronto, ON, CANADA Daya P. Gulabani Charlestown, MA Fanqing Guo Albany, CA Maritza A. Hobson Madison, WI Giang T. Hong San Francisco, CA Yu Ning Hsu Columbia, MO Yu-Huei J. Huang San Antonio, TX Jared F. Hund Rolla, MO Ines-Ana Jurkovic Baton Rouge, LA Laurie A. Kelly Baton Rouge, LA Jingli L. Kiger Cambridge, MA Kwang Pyo Kim Gainesville, FL

Charles Kirkby Edmonton, AB, CANADA Abdul-Azeez K. Koletowo New York, NY Tamara N. Kouskoulas Grosse Pointe Woods, MI Bart D. Lynch Gainesville, FL Mindy Q. Mai Waukegan, IL Christina Medina Fullerton, CA John P. Miller St. Paul, MN Rebecca Milman Houston, TX Farid G. Mitri Rochester, MN Daniel W. Mundy West Lafayette, IN Keith Nakonechny Edmonton, AB, CANADA Bhavinkumar H. Patadiya Columbia, MO Tania Perkins San Antonio, TX Andrew R. Prideaux Rolla, MO Susanne P. Quarfoth Minneapolis, MN Premavathy Rassiah San Antonio, TX Mohamed Reda Pocatello, ID David R. Roesener Cincinnati, OH Babak Sasanian Nanuet, NY Sujith P. Sasidharan Greenville, NC Evelyn L. Sebastian Royal Oak, MI Theodore R. Steger Houston, TX Timothy Allen Stiles Madison, WI Teresa E. Tutt College Station, TX Kevin W. Waddell Louisville, KY Kawana S. White Greenville, NC Carly D. Williams Gainesville, FL Mark P. Winslow Troy, NY Genevieve N. Wu Los Angeles, CA Girijesh K. Yadava Buffalo, NY Huixiong- John Zhang ■ Cleveland, OH

AAPM One Physics Ellipse College Park, MD 20740-3846 To The American Association of Physicists in Medicine Members: All of us in the Kubo family would like to thank you for the beautiful memorial service that you provided for Hideo “Dale” Kubo. It was bittersweet to be attending the annual sessions. It was wonderful to be there and meet colleagues of my father’s whom I had only heard of, yet difficult to swallow that my father wasn’t with us. Knowing that he wouldn’t be attending the sessions anymore was very heart breaking. Physics in Medicine meant so much to my father. I hope that his legacy will continue to be a part of your association. His integrity, drive and ability to foresee the future is what made him great in physics I hope. Please do not forget.

Thank you for inviting us to the sessions and allowing us to experience what helped to make my father’s short life complete. He was truly grateful and humbled by the amazing minds that he interacted with at the sessions. Thank you again.

Sincerely, Naomi Kubo Peters Paula Kubo Hitomi Kubo

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AAPM NEWSLETTER

NOVEMBER/DECEMBER 2004 NOVEMBER/DECEMBER 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)713-6565 Fax 2340 Westover Drive, Winston-Salem, NC 27103 The AAPM Newsletter is printed bi-monthly.

Next Issue: January/February 2005 Postmark Date: January 15 Submission Deadline: December 13, 2004

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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