AAPM Newsletter January/February 2005 Vol. 30 No. 1

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 30 NO. 1

JANUARY/FEBRUARY 2005

AAPM President’s Column

William D. Coolidge Award

Howard Amols New York, NY On January 1st I officially became the 46th president of the AAPM, as Marty Weinhous headed back to Cleveland for a well-deserved respite and hopefully more time to fly his plane, and Don Frey moved from the presidency to chairman of the board. To both of them my sincere appreciation for trying to teach me the ropes. Also, thanks to AAPM Secretary Jerry Allison, Treasurer Maryellen Giger, Executive Secretary Angela Keyser and the wonderful staff at headquarters. I look forward to working with all of these people this year as well as with incoming President-elect Russ Ritenour.

2005 is the 100th anniversary of Einstein’s Annus Mirabilis 1905 when he published his four seminal papers on Brownian motion, photoelectric effect, special relativity, and E=mc2. Not to be upstaged by a patent office clerk

who rarely wore socks, I’ve set four mirabilis goals for the AAPM in 2005; 1. continue the efforts of my immediate predecessors to restructure the board of directors and to formalize the legal relationship between national AAPM and local chapters; 2. address the manpower shortage and training issues confronting us by developing guidelines for medical physics training that are rigorous, practical, and financially viable; 3. increase public awareness of medical physics by initiating outreach programs to undergraduate and graduate students, and physics teachers; 4. expand the already great AAPM Web site.

Marty Weinhous and Don Frey have already set into motion a plan, recently approved by the (See Amols - p. 2)

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The William D. Coolidge Award, one of AAPM’s highest honors, was awarded to C. Clifton Ling this past year.

The award is in recognition of a member who has exhibited a distinguished career in medical physics, and who has exerted a significant impact on the practice of medical physics.

Dr. Ling received his Ph.D. in nuclear physics from the University of Washington, Seattle in 1971. He then entered radiation biophysics and medical physics as a Research Fellow at Memorial Sloan-Kettering Cancer Cen(See Coolidge - p. 5)

TABLE OF CONTENTS Newly Elected BOD Coolidge Speech Chairman’s Report President-elect Report Campep News Executive Dir’s Col. Treasurer’s Report Budget Spreadsheet Education Council Rep. Leg. & Reg. Affairs Science Council Rep. Travel Grant Report Taylor Memorial Chapter News Letters to the Editor

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board of directors (BOD), to reduce the size of the board and to insure that all local chapters of the AAPM are legally incorporated and in compliance with IRS regulations. The latter changes are a legal necessity, while the former changes are designed to improve the effectiveness of the BOD. There is a consensus that the BOD, currently consisting of 37 voting members, is too large— much larger than other scientific societies of our nature. ASTRO, for example, has 14 voting board members, and RSNA with over 33,000 members (AAPM has about 5000 members) has only eight board members. Our organizational structure is archaic, inefficient, and must be fixed. You will be hearing much more about the restructuring plan in the coming months as specific details are ironed out by a special ad hoc committee created by the BOD at its meeting last month in Chicago. The ad hoc committee is being chaired by outgoing Chairman of the Board Marty Weinhous and consists of the chair of the Rules Committee, two chapter representatives to the current board, plus two at-large members to the board. The charge of this committee is: 1. formulate a plan for regional election of board members with candidates being nominated by local chapters; 2. design regional boundaries to adhere to a one-member, onevote philosophy; 3. maintain the independence of the 20 currently existing AAPM local chapters and assign each

Newly Elected Newly Elected 2005 Board of Directors 2005 Board of Directors E. Russel Ritenour President-elect

Members at Large

Dianna D. Cody

J. Ed Barnes

Matthew Podgorsak

Willi Kalender

chapter to a region for purposes of nominating and electing regional board representatives.

4. the board of directors shall consist of no more than 12-20 voting members.

AAPM members should be assured that no plan to restructure the BOD will come to pass without the approval of both the current BOD and a referendum vote by the entire AAPM membership. There will also be a

special e-mail address set up to allow all members to express their opinions on the reorganization plan prior to the first meeting of the ad hoc committee, which is being planned to be held sometime in February.

My second goal, to address manpower and training issues, could be called my soapbox crusade, as described in many previous letters and editorials. We have clearly failed to recruit bright young physics students into

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our profession and have no financially viable long-range plan to address this shortage or the concomitant problem of how to provide adequate training. The growth of CAMPEP approved programs, admirable though they may be, seems unlikely to be able to address all of our staffing and training needs in the near future.

I have, therefore, created an ad hoc committee chaired by Larry Reinstein to explore alternate pathways for medical physics training in the hopes that AAPM, in cooperation with CAMPEP and the ABR, can agree on a viable long-range plan. This goes hand in hand with my third and fourth Annus Mirabilis goals— to create outreach programs to physics students and teachers, and to expand the AAPM Web site so that more information about our field is available to other physicists and to the general public.

It seems incongruous that the subfield of physics having the highest average salary, and that also offers the professional satisfaction of applying physics to caring for the sick, should be the discipline that has the most difficulty in recruiting new people. I believe this problem results in large part because few undergraduate or graduate students know anything about medical physics. As an aside, I would contest the allegation of some of our members that students dismiss medical physics as a career option because AAPM has not lobbied hard enough for independent billing by oncology physicists—most students are clueless about this!

The reasons good students do not

choose medical physics as a career lie elsewhere. I am unaware, for example, of any physics textbook routinely used in introductory physics courses at the high school, undergraduate, or graduate school level that has a chapter on medical physics. We need to market ourselves much better, and we need to attract the best physics students into our profession, or at minimum, to make them aware of our profession. We have existing committees in the Education Council that will be studying this problem, and we plan to develop slide shows and a speaker’s bureau for medical physics. We have also contracted with Discoveries and Breakthroughs in Science, which is a company that produces video spots that are used by many local television news programs across the country. We have contracted with them to produce news videos on medical physics for use on television news stations, and these videos will also be available for view on our Web site.

This leads into the fourth item on next year’s list of goals, which is to expand the Web site. The Electronic Media Coordinating Committee, chaired by George Starkshall, and the Public Education Committee, chaired by Ken Hogstrom, along with Mike Woodward and his staff, have been charged with expanding their ongoing efforts to put more information about medical physics on our Web site, and to expand both the public and members-only sections of the Web site. Some of the items we hope to see in the public areas include

informational videos about medical physics, and more information for students about careers in medical physics. In the members-only area there will be more information on the activities of AAPM committees, task groups, and local chapters.

I’ve also charged the History Committee and its new chair, Bob Gould, to accumulate archives of AAPM history, interviews with AAPM founding members and other prominent members that have been recorded over the years by Bob Gorson, and historically important medical physics equipment that has been donated to the AAPM over the years. All of these items will need to be photographed and/or digitized, edited, and organized into what I hope will become a virtual medical physics museum on our Web site.

While Einstein was able to manage his Annus Mirabilis as a solo act, it will be impossible for the AAPM to accomplish any of the above goals, much less all of them, without the coordinated efforts of many people; always a challenge for a society that relies mostly on volunteer labor. I’ve calculated that over the course of his lifetime, Einstein saved a total of over 212 hours by not wearing socks! This is based on an average time of 30 seconds per day to put on and to take off a pair of socks, and does not include the time required to buy or wash socks. This means that if every AAPM member were to forego socks and devote the time saved to AAPM activities, we would have available more than

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(from p. 3)

11,000 hours per year of volunteer effort; the equivalent of five full-time employees (more if we add in the time required to wash the socks as well)! A radical thought you say, trading in your socks for the AAPM, but great things happen because sometimes some people think outside the box! So give it some consideration before you put on your socks tomorrow morning!

In any case, this year’s process of appointments to committees is officially done, with the BOD having approved the appointments made by last year’s president-elect (i.e., me). The appointment process, however, is never really complete, and many openings still exist on various subcommittees and task groups.

These latter appointments are made directly by subcommittee and task group chairs rather than by the president-elect. I have tried to the best of my ability to place everyone who expressed an interest in volunteering to the committee of their choice, or to something reasonably close.

AAPM activities, but in defense of the system, we are all volunteers and it takes a lot of time to identify individuals and to make the right appointments to the right committees. As Forrest Gump said, ‘sh_t happens,’ and people make mistakes. Try to think of landing the right committee assignment as loading a new operating system onto your computer—if it doesn’t work the first time, hit control-alt-delete and reboot.

Finally, the AAPM is critically dependent on income generated by our journal, annual meeting, and investment fund. In these efforts and in our efforts to expand the AAPM Web site and create a speaker’s bureau, the AAPM is always looking for volunteers with special expertise in finance, business, computers, publications, and public speaking. If you have special expertise in any of these areas, please throw out all of your socks and give me a call.

Here’s to Annus Mirabilis 2005!

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Sometimes this was not possible, and inevitably some people fall through the cracks in the system.

I’ve received a good deal of feedback from many younger members about their frustration with the difficulties of breaking into the organizational hierarchy and in finding their first committee or task group assignment. To those members whose volunteer requests did not materialize, let me implore you to try several more things before giving up. Go to the AAPM Web site and find the ‘committee tree’ icon. This will give you a complete listing of all AAPM activities, plus the names of all committee chairs and members, subcommittees, task groups, etc. Feel free to contact these people, or better yet, attend the meetings of various committees at this year’s annual meeting. If this strategy does not work, and/or I messed up your volunteer request and you didn’t get placed on a committee, please contact me directly. I know it seems a little incongruous to be asking you to go through so much effort to be ‘allowed’ to donate what little free time you have for

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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Coolidge

(from p. 1)

ter. Since then, he has held academic appointments at the Massachusetts General Hospital and Harvard Medical School, George Washington University Medical Center, University of California, San Francisco, and is currently the Enid A. Haupt Professor and Chairman of the Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, and Professor of Radiology (Physics), Weill Medical College of Cornell University.

Dr. Ling has been an active participant in professional activities within the AAPM. He served on the board of directors (198287), chaired the Scientific Program Committee (1983-87) and Science Council (1991-93), and participated in numerous committees and task groups. He also contributed to many other societies, serving as chair of the ASTRO Radiation Physics Committee, as a councilor in physics in the Radiation Research Society, and was on grant review panels of both the U.S. and Canadian National Cancer Institutes.

He has been on the editorial boards of Medical Physics, the International Journal of Radiation Oncology/Biology/Physics, Radiotherapy Oncology, Seminars in Radiation Oncology, Radiation Research, and Radiographics.

Dr. Ling has received numerous honors and awards, including becoming an Honorary Member of the European Society of Therapeutic Radiology Oncology, the Evan and Marion Helfaer Distinguished Lectureship of the

Medical College of Wisconsin Cancer Center, the Ray Bush Visiting Professor of Princess Margaret Hospital and Ontario Cancer Institute, the Suntharalingam Lecturer of Thomas Jefferson University, Speaker of the Royal College of Physicians and Surgeons of Canada, the Ira Spiro Visiting Professor of Harvard Medical School, the Franz Buschke Lecturer of the University of California, San Francisco, and in 2003, the keynote speaker at the UK Radiation Oncology Society and Japan Radiological Society annual meetings.

Dr. Ling’s research interests range from the fundamentals of cancer radiation biology to optimized radiation treatment planning and delivery, and more recently biological and molecular imaging as applied to cancer management. He has contributed to brachytherapy dosimetry, particularly of I-125 seeds. In collaboration with other scientists and clinicians, he has participated in the development of 3D-CRT and IMRT, and ushered in the widespread use of these advance techniques. In biological research Dr. Ling has studied the oxygen effect, dose rate effects and the repair of sublethal damage, hypoxic cell radiosensitization, radiation induced carcinogenesis and apoptosis, and the effects of oncogenes on radiosensitivity. At present, his laboratory is focusing on the biological basis of molecular and functional imaging.

Dr. Ling has authored about 200 peer-reviewed papers and over 30 chapters in books and proceedings. He has been the prin-

cipal investigator on numerous grants from the National Institutes of Health, the Department of Energy, and the American Cancer ■ Society.

Dr. Ling’s Speech I would like to thank Howard Amols and Wendell Lutz for orchestrating my nomination for this award, the Awards and Honors Committee for acceding to their recommendation, although there are rumors that it required a filibuster of several persons, including your president-elect, to get this through. I am very indebted to Ed Epp for making this trip and his kind introduction. This is an extraordinary moment for me, and a difficult one. In thinking about this, I struggled as to whether to be profound, to expound on some aspects about our field, or to be mundane, to just thank everyone. Suspecting that I might do poorly in either, I’ll rely on something I chanced upon recently by Kipling, which sounded pretty profound: “If you can dream – and not make dreams your master; If you can think – and not

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Ling

(from p. 5)

make thoughts your aim; If you meet with Triumph and Disaster And treat those two imposters just the same” I guess that it means we should have ideals but not be enslaved by them and become dreamers, translate our ideas to acts, borne defeats with equanimity and to be circumspect of our successes. I wish that I had learned that earlier.

I think Professor Bodansky, my thesis advisor, would agree. I regret that he cannot be here. He is a true scientist and a genuine person, and tried his best to instill in me the curiosity and rigor of scientific investigation, and I am very much indebted to him.

For my post-doc I had to choose between U. of Wisconsin and Sloan Kettering. I do not remember the actual reason for my decision, perhaps it was the higher stipend by $2k, which was a quarter of my salary then, but I was too naïve to know about cost of living. Regardless of the reason, I went to NY and had the good fortune to have Edward Epp as a mentor, who exposed me to the biological side of science, and, more importantly, how to integrate physics and biology—which is perhaps even more important today than it was then. Herb Weiss, Ann Santamasso and Jane Heslin were my teachers on a day-today basis in growing bacteria phage, culturing mammalian cells, counting colonies, and other tasks that, quotidian they may be,

formed the underpinning of my future radiobiology laboratory research. During 1973-74, the $64K question was whether Ed was going to follow Suit, i.e.

Herman Suit of MGH, to Boston. He did indeed, so that’s how I moved north, and having endured the worst of NY, the commuting and the suboptimal housing, vowed never to go back, little did I know.

It was at MGH that I first encountered clinical medical physics. In fact, I was literally thrown into the clinic, an experience close to the ‘close encounter of the third kind.’ Now, in Ed Epp’s lingo, it was total immersion, but to me, nearly a total disaster. Thank God there was Karen Doppke and Miriam Gitterman to the rescue, who were mostly patient, and infrequently impatient, teachers (perhaps due to the slowness of the student). It was a building phase at MGH then, and Michael Goitein tried to teach me how to commission a Co-60 unit. I suspect it was his first try in commissioning a machine, and probably his last. Peter Biggs and I debated constantly as to who was to teach whom on commissioning the Clinac 35. Arthur Boyer was busily commissioning Clinac 18s. When young Shipley wanted to start the I-125 prostate implant program, Arthur claimed that he was too busy, and since the perception was that I had little to do, I was given the task. As it turned out, that was a tremendous opportunity. Another fellow at MGH at the time was Lynn Verhey, who was mostly hidden in the Cambridge cyclotron doing proton therapy.

My wings and independence were tested when I relocated to George Washington. But it wasn’t much of a test because Jim Deye not only left an efficient and effective operation, but also Michael Schell around to help me get going. But after a bit Michael decided to pursue a Ph.D. at U. of Wisconsin and since then I teasingly tell him to change his name to Phichael Dell. Barry Wessels then joined the faculty with his recently acquired MIT pedigree, a frequent source of benign teasing. Ellen Yorke was the antidote for the goings on, who even as a NIH trainee, was already smarter than all of us combined. Perhaps equally brilliant was Ira Spiro, a Ph.D. biologist who tried his darnest to teach us the newest thing, molecular biology, which has become even bigger than he initially thought.

I was at USCF the next four years. During that time, Vernon Smith was way ahead of us in knowing how important imaging was going to be and got a doctorate in NMR imaging. Weaver had excellent eye-hand coordination as a brachytherapy physicist, which is serving him well in woodworking upon his retirement. Paul Stauffer was dedicated to hyperthermia, and still is.

Schell followed me to San Francisco and became the fireman, putting out trouble wherever and whenever. In the lab, Bill Dewey and Gloria Li were major forces, generating currents and tides that swept me along.

Extremely big shoes awaited me when I joined MSKSS in 1989,

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Ling

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(from p. 7)

a department started by Failla/ Quimby in the 1920-30s, and in which John S. Laughlin was chair since 1952. John had not only big shoes, but fortunately also a cadre of seasoned and motivated scientists, and, in addition, John was active in the department for quite a few more years to advise, support and counsel. With his support and that of senior faculty, it has been an enjoyable and gratifying 15 years. A large group of up-and-coming young faculty has also contributed much to our program at MSKCC. As much as we regret that some of our faculty have relocated, we take solace in the knowledge that most of these changes are in the upward trajectory of their careers, and are gratified that we have contributed in some positive way to their advancement.

A large number of professional staff, radiation physicists, dosimetrists, health physicists, biomedical engineers, computer scientists, some of whom are here, but too many to list, also contribute invaluably to our program. Time does not permit me to discuss how each one has contributed—but it is without a doubt that I would not be standing here were it not for the collective support and effort of the entire MSKCC. Of our senior faculty, Howard Amols succeeded Jerry Kutcher as chief of the Clinical Service, Anderson’s legacy in brachytherapy is being sustained

by Zaider, Burman manages and expands our regional program, Chen Chui inherited Radhe

Mohan’s computer empire, and is now assisted by Kijewski and Mageras in supporting Radiology and Radiation Oncology. Ron Finn is in charge of cyclotron operation and radiochemistry production, and John Humm is head of Nuclear Imaging Physics.

Margie Hunt and Ellen Yorke keep External Beam Treatment Planning running smoother. Jason Koutcher is chief of the Service of Imaging and Spectroscopic Physics. Thomas LoSasso heads up the Dosimetry Calibration Section. Gloria Li is chief of the Laboratory of Hyperthermia and Radiation Biology Laboratory.

Rothenberg is head of the Radiological Physics Section, and St. Germain is the radiation safety officer. In truth, all of their significant contributions to the profession of medical physics are well know to you. Also important to our department is our administrative team, Mr. Wei Lui and Ms. Maureen McDonnell, who are both here. They are perceived to be fair, consistent, efficient, and well respected by our staff.

Throughout my medical physics career, I have been very fortunate to have clinicians who are appreciative and supportive of medical physics, starting at MGH with Herman Suit, the consummate clinician/scientist. Charlie Rogers at George Washington always said the physicists are the ones who kept him out of trouble.

It was Ted Phillips who said to me, “I do not want to tell the physicist what to do, but want the physicists to tell me what to do,” with which I was happy to comply. I worked with Leibel in two

institutions; a clinician second to none, and his clinical acumen was significant to our program in 3DCRT and IMRT. Sam Hellman, who was physician-inchief when I was recruited to MSKCC, has always been a teacher, advisor and friend. But without a doubt, the physician/ scientist who I have worked most closely with is Zvi Fuks, who is here today. His tireless energy, keen intellect, total dedication and inimitable personality have been most important in shaping a major portion of my efforts the last 15 years.

My professional life would not have been nearly as gratifying if I did not have the support and love of my family. (My wife, Gloria, is shown here with me at Taj Mahal, one of the most beautiful and meaningful places of the world, and to discover its meaning you have go there yourself.) She has been constant in her support, wise in her counsel and uplifting in her encouragement. And our daughters, Thea and Andrea, have been a source of pride and joy. I thank them for years of forbearance and share with them the honor that is accorded to me today. My only complaint is that my babies grew up too fast, and their absence resonates. To make up for the empty space, recently there have been two additions to the family of a furry nature, they have Chinese names: Ping-ping and An-An, which, when translated into English, are my greetings and best wishes—Peace be with you. Thank you very much.

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Chairman of the Board Report Committee Service G. Gonald Frey Charleston, SC In another section of this newsletter there is a call for volunteers from President-elect Ritenour.

One of the great strengths of the association has always been the active support of the AAPM by a large and enthusiastic volunteer pool. However, there is a significant concern that, with the increased hours medical physicists are working, asking members to provide such a high level of service to the AAPM leads to burnout and delays in completing committee assignments. I would strongly ask you to consider service to the AAPM as an important part of membership. Even small increases in the number of active members would help reduce the amount of work each volunteer has to do. Recruiting new members into active committee service has been a goal of all recent president-elects. Steps taken to that end have included

articles in the newsletter, e-mail contact and a Web-based system for asking for appointments.

Most recent president-elects have placed most of the people who asked for an appointment.

In spite of that, most members do not participate. The AAPM would be strengthened if only a few additional percent of the members would become active in the association.

I will review some statistics for you. Presently about 13% of the full members have an appointment to one or more council, committee, subcommittee or task group. That means that 87% do not have such an appointment.

Five hundred thirty members do play an active role. We are

hoping to add some of your names to the active roll.

The number of appointments ranges from a single one to a staggering 21. The mean for those who have appointments is 2.50.

Thus most members are not active but those that are active have multiple assignments. There is a concern that we ask many of the active members to do too much.

It is not surprising that active members serve in more than one role but many of them serve on many committees and task groups.

Following are examples; one administrative committee and a randomly selected example from each council. These numbers are only committee activities.

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One can see that many committee members have many committee assignments. FINCOM is the worst with an average of 8.3 committee assignments and a range of 1 to 21.

These statistics give us good reason to be concerned. What steps can be taken to reduce the stress on the volunteer members?

• encouraging more members to be active in committee work • transferring administrative activities to the professional staff • providing more staff support to councils and committees.

• reducing the number of duplicative and non-productive activities • using the volunteers for assignments that provide a profes-

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sional challenge and a productive committee environment Since the AAPM is financially sound, we can transfer administrative activities to paid staff but staff cannot do scientific, educational or professional tasks.

Those tasks require the input and judgment of a medical physicist.

I ask you to add your voice to the pool of active participants in our organization. Without you we risk losing the leadership we have always had.

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President-elect Report AAPM Grand Prize Giveaway E. Russel Ritenour Minneapolis, MN There is no greater prize than working with colleagues to make a better profession. As presidentelect, it is my job to make committee appointments for the AAPM during 2005. OK, I’m sorry. Maybe the title of this article was just a little bit misleading. Would you have read this if it was titled “Call for Volunteers”?

Some of you certainly would. We are contacted each year by about 50 members. I’d like to increase that number and make better use of the volunteers we have.

You don’t necessarily have to travel to meetings. Many committees do their real work via e-mail and conference calls. However, if you can travel occasionally, it’s a great way to get to know people in the association.

You don’t have to be the world’s foremost authority on anything. There are always things to be done that any medical physicist can do, such as reviewing documents written by other committee members. Here’s how it works: You join a committee and you’re given something to do.

If you do it, people usually remember that and will give you something else to do. Eventually, you’ll find that you know a lot of people in the association and that they value your work. They might

ask you to chair the next task group or subcommittee. If you don’t like chairing things and just want to do some work, then you’re probably valued even more highly.

You don’t have to see yourself as someone who is into politics.

Most of the people who work with the AAPM, even in leadership positions, do not think of themselves as being at all political. Corny as it sounds, they think they are helping the profession and working on projects that they care about.

Every year, some of the people who volunteer are disappointed in the AAPM’s response. One problem is that the presidentelect and committee chairs need to know exactly where your talents and interests lie. Also, you need to know a little about the organization of the AAPM before you volunteer. For example, people sometimes ask to be put on Science Council. Science Council is made up of chairs of committees and other liaison appointees. So, you can’t start out on a council. You have to start out on a committee. You can

check out the names of the various committees, their subcommittees and their task groups online.

You can also read the charges to the committees, but, often, just the name of the committee says it all.

Here is how to find the names and charges of the committees: Go to the AAPM Web site and click on “Organization,” then click on “Committee Tree” and you can search from there. When you are ready to volunteer, contact me. However, in order to help you get on a committee, I’ll need some information from you: - Please tell me about any special talents you may have. For example, we are looking for individuals with business acumen, whether from their educational background or from running a successful business. There are many other examples. Do you have a degree in education? Are you a lawyer? You don’t have to have any special talents outside of medical physics, but we’d like to know if you do.

- Try to be as specific as possible about your interests. For example, if you’re interested in international affairs, are there certain countries or areas of the world in which you are interested?

- If you call or write, or especially if you see me in person, please give me your e-mail address. Yes, we can get it from the directory, but due to the volume of appointments, avoiding direc-

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tory searches helps speed things up.

Finally, if you really don’t know what you’d like to do, please call me (612-626-0131) or e-mail (riten001@umn.edu). There may be things that you would like to do that aren’t all that obvious from the committee listings but that might come out in a brief conversation. And, who knows?

You may win the grand prize. ■

News from CAMPEP Brenda Clark CAMPEP President We currently have several programs under review, two from residency programs and three from graduate programs, of which one is for reaccreditation and two are new applications.

The new software for CEC applications is still on track for implementation in January 2005. Watch for news from the AAPM. Also, we are in the process of revising the Web site to be more user-friendly and informative. This is one of several responses to the input received from the questionnaire circulated earlier this year.

Executive Director’s Column Angela Keyser College Park, MD

E-mail Alert!

A federal spam law that took effect in January 2004 has significantly affected non-profit associations. Because of the CANSPAM Act (Controlling the Assault of Non-Solicited Pornography and Marketing Act), HQ has made some changes to its mass e-mail practices.

A brief summary of CANSPAM and the changes required: •The good news is that transactional or relationship e-mails (i.e., regarding dues renewals, confirmations of transactions like meeting registration) are exempt from most provisions of CANSPAM so the AAPM will continue to do this type of business as usual.

•According to the Federal Trade Commission, if an e-mail markets something, including meeting registration, it is “commercial” and must meet three requirements: 1. the message must include an opt-out mechanism 2. the message must prominently disclose the fact that the message contains an “advertisement,” and, 3. the message must include the sender’s valid physical postal address.

•The greatest obstacle to overcome is that once a member opts out of receiving commercial e-mail messages from the AAPM, CAN-SPAM prohib-

its the sale, lease, exchange, transfer, or release of that person’s e-mail address to anyone else for any purpose—period. The provision is written broadly and even prohibits the publication of commercial opted-out e-mail addresses in AAPM’s online and/or hardcopy directory.

•From now on, e-mails regarding meetings will have to be written using vague language that directs members to the Web site for more information.

•AAPM corporate affiliates are no longer offered the opportunity to send e-mails to our membership.

By eliminating the third-party commercial e-mails and taking more care with the wording of meeting-related e-mails from HQ, we will not need to include an opt-out mechanism that would trigger the unexpected result of deletion from the member directory. My concern is that members will not react to the vague meeting e-mails and will miss critical deadlines. Please, when you receive an e-mail from HQ inform-

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ing you that new information is available online, do not ignore it!

AAPM Web site News 2005 will be a year of change for the AAPM.ORG Web site.

You may have already noticed a reorganization of the home page with an emphasis on helping nonmembers find information about the society and the field of medical physics. The AAPM is planning a large scale redesign of the Web site, no small task for a site with over 14,000 pages of information, which will include more public education areas, a cleaner interface and a more personalized user experience.

2005 Summer School and Annual Meeting The 47th AAPM Annual Meeting and the 2005 Summer School will both be held in July in Seattle, Washington. The summer school will be held jointly with the American Brachytherapy Society from July 18-22 at Seattle University. The annual meeting will be held July 24-28 at the Washington State Convention and Trade Center.

The deadline for annual meeting abstract submission is February 23. This year’s program promises to be better than ever, with an expanded Imaging track, covering basic research and clinical applications. We are also expanding the Joint ImagingTherapy track, as well as CE course offerings.

The 2005 summer school will focus on Brachytherapy topics, and will include a GYN Panel, a

Prostate Panel, a Head Panel and a Breast Panel.

Meeting information is continually updated online. Please go to www.aapm.org and click on “Meetings” for the latest information on the annual meeting and summer school.

FYI •Access to committee minutes – the link to committee minutes has been moved. Now when you go to a specific committee listing in the tree, you will see a separate section for minutes under the “Members Only” section on the right-hand side.

•Staff members have been assigned to work with each council. Lisa Rose Sullivan will be working with the Education Council, Lynne Fairobent with the Professional Council and Cecilia Balazs with the Science Council.

•AAPM membership has exceeded 5,000, which entitles the organization to an additional seat on the board of the American Institute of Physics (AIP). In the spring of 2005, I will join Chris Marshall and Jim Smathers as the third AAPM representative.

I expect that my participation at this level will increase AAPM’s understanding of the services offered by AIP.

Staff News Sharon Lehman and her husband, Sean, became the proud parents of a baby girl on November 30. Jessica Rhianne will join the ACP Daycare Center at the HQ offices when Sharon returns to the office on February 1.

Research Seed Funding Initiative Paul Keall On behalf of the AAPM Research Committee The AAPM Research Committee is pleased to announce the creation of a Research Seed Funding Initiative to provide start-up funds for a research-orientated medical physicist. A $25,000 one-year award is intended to provide funds to develop an exciting investigator-initiated concept, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources.

To be eligible you need to be within five years of your Ph.D. graduation, a full (or pending full) member of the AAPM, and have not been a principal investigator on a major funded grant (>$50 000).

The application should include a five-page description of research project, CV and letter of support from department chair.

The applications will be reviewed based on scientific merit (50%), potential for further funding (25%), and investigator background (25%). The deadline for applications is February 15. Further details can obtained from the flyer accompanying the newsletter, or by e-mail (pjkeall@ aapm.org).

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AAPMNEWSLETTER NEWSLETTER AAPM

JANUARY/FEBRUARY 2005 JANUARY/FEBRUARY 2005

Treasurer’s Report: 2005 Progam Budget Maryellen Giger Chicago, IL Both the Finance Committee and the board of directors met in Chicago in December and reviewed the association’s current financial position, as well as approving a budget for 2005. The budget by program area appears in Table 1 on the following pages.

We are pleased to report that 2004 was another successful financial year for our association.

It is estimated that we will realize a surplus of about one half million dollars. This is a conservative estimate and does not include any unrealized gains or losses on our investment portfolio.

This surplus is mainly a result of the successes achieved by our annual meeting in Pittsburgh and our summer school held at Carnegie Melon University. Our thanks and congratulations go to the summer school committees, the Meeting Coordination Committee, and the local arrangement committees for making this possible. Figure 1 presents an historical perspective of total income and expense for the past five years, as well as the planned budget for 2005.

The 2005 budget was reviewed extensively by members of the Budget Subcommittee last October. My sincere thanks to Melissa Martin, Indra Das, Mary Moore, and Howard Amols (then president-elect) for the time they devoted last October to reviewing every line item with care.

Past President Don Frey, President-elect Russ Ritenour, Secretary Jerry Allison, Executive Director Angela Keyser, and Finance Director Cecilia Balazs made significant contributions to this effort; my thanks to all for a superb job.

The 2005 budget was then submitted to the full Finance Committee on November 28th, 2004, and additions and/or changes were incorporated therein at the request of various committee and council chairs. The resulting modified budget was moved forward and subsequently approved by the board of directors on December 1st, 2004.

As has been the case in previous years, the AAPM budgets by various program areas that it supports; thus, the 2005 budget on the following pages once again presents both income and expenses for these program areas.

Each program area also includes a proportionate share of operating overhead. Highlights of the 2005 budget follow.

The total number of members in the AAPM exceeded the 5,000 mark at the end of 2003 and grew to 5,207 in 2004. The

budget for dues income reflects anticipated growth to 5,463 in 2005, and includes the annual dues adjustment approved by the board in 2001. Dues income, including income from applications and reinstatements, is expected to increase by about $100,000 in 2005 to $1,094,292.

AAPM derives revenue from three sources in the membership services program area. These include approximately $3,000 from advertising in the Member Directory; $50,000 from advertising in the monthly mailings; and approximately $18,000 annually from ads placed in the newsletter.

The major direct expenses anticipated for membership services in 2005 include: the Membership Directory–$30,000; the monthly mailing–$130,000; and the newsletter– ~ $69,000. Also in 2005, there is funding for one additional brochure in the amount of $3,000.

Governance expenditures include the costs for the volunteer board and officers to manage the business affairs of the association.

They include monies for board meetings, Executive Committee meetings, strategic planning, etc.

The total budget for governance activities in 2005 is $174,149 and includes funding for a long-range planning meeting and a contingency fund representing the board-mandated 1% of gross revenue.

The major source of revenue in the Education Council budget

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results from the Remotely Directed Continuing Education program. The fee for 2005 will remain at the same level as in 2004, $30 resulting in income of approximately $31,000. Other income results from contributions to international activities and summer fellowships, as well as the purchase of training slide sets.

Highlights of the Education Council expense requests for 2005 include expansion of the Virtual Library project, production of three new brochures by the Public Education Committee, participation with the AIP in a television initiative called “Discoveries & Breakthroughs in Science,” continuation of the Summer School Scholarship and Fellowship programs, and International Education programs in India, the Philippines, and South Africa, together with some seed money for the International Conference on Medical Physics being held in Nuremburg, Germany.

The total direct expense budget for Education Council activities is $272,700.

The single revenue source under the Professional Council pro-

gram is the Placement Service.

Revenue is expected to decline in 2004 to about $365,000 from over $500,000 in 2003. Estimates for 2005 have therefore been set at $365,000 to reflect this decline.

Highlights of the expense budget under the Professional Council program area include plans for a mid-year, in-person council meeting; funding for Professional & Clinical Relations (PICR) Committee task groups and liaison activities; support for the professional salary survey and the placement service; funding for the Economics Committee for chapter visits; a significant increase in support for the expanded government affairs effort; and funds for the Public Relations Committee’s activities in promoting the AAPM Annual Meeting.

Total spending under the Professional Council area will total $198,035.

Budget requests from the Science Council include funding for general council expenses, including one mid-year, long-range planning meeting; support for a Biological Effects Subcommittee

Figure 1

workshop; funds for completion of Task Group Report 108, PET Site Plan and Scheduling; and an increase in funding for the subcommittees and task groups of the Radiation Therapy Committee, several of which will require an additional in-person meeting in 2005 to complete their work.

The AAPM will once again provide support for the Research Committee sponsorship of the BIROW workshop; and, finally the AAPM continues to support the Calibration Laboratory Accreditation Program. The total direct expense budget in 2005 for Science Council programs is $147,849.

Our society supports a number of administrative and ad hoc committees including the Awards & Honors Committee, the Meeting Coordination Committee, the Development Committee, International Affairs, Finance Committee, the Regional Organization Committee, and the Rules Committee. Direct expenses are anticipated to be $174,500 in 2005 for these activities.

Support for AAPM Liaisons to other organizations is budgeted at approximately $64,000 next year.

Administrative expenditures are also fairly consistent. The major categories include services AAPM receives at the American Center for Physics; bank fees incurred in the processing of credit cards; staff travel for professional development; and fees for professional services such as legal and auditing fees. We have seen a substantial increase in the costs of liability insurance during the (See Giger - p. 17)

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JANUARY/FEBRUARY 2005 JANUARY/FEBRUARY 2005

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Giger

(from p. 15)

Figure 3

Figure 2

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(See Giger - p. 18)

AAPM NEWSLETTER NEWSLETTER AAPM

Giger

JANUARY/FEBRUARY 2005 JANUARY/FEBRUARY 2005

(from p. 17)

past two years as a result of our policies being segregated from those of the American Institute of Physics. The total direct expenses in 2005 for administration are just under $220,000.

AAPM generates income from providing support services to other related organizations and from several sources outside of its program areas. These include insurance and credit card affinity programs and the sale of mailing lists.

Our expenses for our meetings and exhibiting at RSNA each year remain consistent—between $35,000 and $40,000.

Our annual meeting, scheduled for Seattle in July 2005, is expected to draw 3,152 registrants and generate a net income of $333,596, which includes revenue of $1,572,617 less total

expenses (direct plus indirect) of $1,239,021.

The 2005 summer school budget projects 335 registrants generating income of $317,150 and expenses of $260,917 (including overhead) for a net gain of $56,233.

The publication of our scientific journal, Medical Physics, provides a significant source of financing in support of our other program areas. In 2005, this contribution is estimated at just over $600,000 (including indirect overhead expenses.)

Overhead expenses include staffing expenses, as well as Information Systems support— items that cannot be directly attributed to a single project. Each year staff time allocations and staff costs are estimated and then applied to the various program areas to estimate the total cost of programs and services for budgeting purposes. In 2005, the to-

tal overhead spread among the program areas is $2,025,145.

Figures 2 and 3 show income and expenses, respectively, by program area. The 2005 budget, as approved, projects total income of $5,554,863 and total expenses of $5,903,239. This results in a planned deficit of $348,376.

However, we are pleased to report that AAPM remains in sound financial condition, with reserves totaling $6.2 million.

This level of reserves exceeds our goal of having one year’s operating expenses in reserve.

In closing, I would like to thank our AAPM finance director, Cecilia Balazs, for all her help during this past year, especially in making the budgeting process and the job of treasurer manageable. Please feel free to call or email (m-giger@uchicago.edu) if you have any questions concerning this report.

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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

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Education Council Report Herb Mower Council Chair Well, we have just returned from a very exciting RSNA/AAPM meeting. We sponsored a great IMRT session on Monday afternoon from 1:30 until 5:45. It was standing room only and many left when the wall space gave way to standing out in the corridor. After the first paper we all moved next door to a larger room. Although I don’t have the final number yet, I would put the attendance at close to 275. Congratulations to Perry Sprawls, Jatinder Palta and Rockwell Mackie for coordinating and presenting a great program.

Watch RSNA 2005 for part two of IMRT! As we look forward to 2005, Ervin Podgorsak will take over as chair of the “Education and Training of Medical Physicists.”

With the many advances in our field, the current shortage of physicists, ‘Maintenance of Certification,’ and the impending passage of the C.A.R.E. bill, I am sure that we will keep him busy.

Many thanks to Bhudatt Paliwal who has served in this position through the end of 2004.

Also, as 2004 fades into 2005, the History Committee welcomes a new chair. Robert Gould will be succeeding Jerry Dare in this position. One of the big challenges for this committee is how to preserve the ‘apparatus’ that we so dearly love for the edification of future generations. Perhaps a ‘virtual’ museum?

As the association looks to make better use of its volunteers and reduce duplication of efforts, we are looking into a merger between the Professional and Public Relations Committee of the Professional Council and the Public Education Committee of the Education Council. Mary Fox of the Professional and Public Relations Committee will work with Ken Hogstrom, chair of the Public Education Committee, to bring this merger to fruition in 2005. We wish them luck in this process.

Eric Klein will be coordinating the Education Council Symposium for our 2005 annual meeting. The program will be on residency programs, certification, funding of programs and the role of CAMPEP. We will keep you posted as plans are finalized. As we face the challenges of tomorrow, this symposium should be of interest to all of our members.

Speaking of successful programs, our DOT program, as noted in the last issue, was very successful at the 2004 annual meeting. Plans are underway to repeat this four-hour program at

the 2005 annual meeting. Come early for a good seat. This, too, turned into a ‘standing-roomonly’ program in 2004.

The council forwarded a license agreement to the board for approval that we can use for those providing slides and PowerPoint programs for general use by our members. This will help us to expedite inclusion of such programs on our Web site in the near future. We will keep you posted on the programs available and how to access them.

For 2005 we are expanding the recording of programs to our virtual library by adding not only several hours of annual meeting material, but also our summer school and the one-day physics symposium at the Conference of Radiation Control Program Directors Meeting. For those looking for alternative methods of acquiring continuing education credits, check the virtual library for sessions related to our meetings.

We are expanding these and providing some excellent opportunities for you. The cost for access to Web-based RDCE programs remains at $30 for the coming ■ year.

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AAPM NEWSLETTER NEWSLETTER AAPM

JANUARY/FEBRUARY 2005 JANUARY/FEBRUARY 2005

Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD Food and Drug Administration Seeking Input on the need to modify the conditions set forth on 21 CFR § 361.1, Prescription Drugs For Human Use Generally Recognized as Safe and Effective and Not Misbranded: Drugs Used in Research The Food and Drug Administration (FDA) is seeking input on the use of certain radioactive drugs for research purposes without an investigational new drug application (IND) under the conditions set forth in FDA regulations (typically, use of radioactive drugs to determine drug disposition in the body). Specifically, input on the potential need to modify the conditions under which these radioactive drugs are studied in light of the scientific and technological developments since the regulations were adopted in 1975. The full docket on this issue can be viewed at http:// www.fda.gov/cder/meeting/ clinicalResearch/default.htm including the Federal Register notice, copies of the pertinent regulations, and presentation materials from the November 16, 2004 public meeting.

The following questions are being raised by the FDA: A. Pharmacology Issues Section 361.1(b) (2) requires that the amount of radioactive drug to be administered be

known not to cause any clinically detectable pharmacological effect in humans. According to § 361.1(d) (2), investigators must provide pharmacological dose calculations based on published literature or other human data to demonstrate an absence of a clinically detectable pharmacological effect (thus, no radioactive drug may be studied “first in humans” under current § 361.1). i. For an active ingredient chemically manufactured in the laboratory that is also a body constituent (an endogenous substance), what percentage of estimated daily endogenous production could be considered to have no pharmacological effect? (Because heterogeneous biological products (e.g., monoclonal antibodies and therapeutic proteins such as interferon, interleukin, other cytokines, and enzymes) are foreign proteins and are assumed to have the potential to produce an antigenic response, they should be excluded from consideration unless they have been

shown to have no immunologic response.) ii. For an active ingredient that is not endogenous, what animal data, in vitro and/or in vivo, would be needed to demonstrate that there is no human pharmacological effect? Is there an absolute dose that would ensure no pharmacological effect? If so, what data would be needed to support that dose? iii. How may an investigator confirm that a radioactive drug causes no clinically detectable pharmacological effect in humans in accordance with § 361.1(b) (2)? What parameters should be measured, how frequently, and what criteria should be used to determine if a pharmacologic effect has occurred?

B. Radiation Dose Limits for Adult Subjects The radiation dose limits for adult subjects specified in § 361.1(b)(3)(i) are based on the basic occupational radiation protection criteria established by the Nuclear Regulatory Commission under 10 CFR § 20.101. FDA’s thinking in 1975 was that these criteria would enable a potential research subject to make an informed decision regarding participation in a study under § 361.1 because the subject would, in effect, be deciding whether he or she was willing to assume the same risk as a radiation worker for the duration of the study. Con-

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sidering the advances in scientific knowledge and regulatory changes that have occurred since 1975, including new data on radiation effects (Ref. 1) and new recommendations on radiation dose limits (Refs. 2, 3, and 4), are the current dose limits for adults still appropriate for research conducted under § 361.1? If not, what dose limits are appropriate? Should there be different dose limits for different adult age groups? The current dose limits are: C. Assurance of Safety for Pediatric Subjects Currently, § 361.1 allows for the study of radioactive drugs in subjects less than 18 years of age without an IND if: • The study presents a unique opportunity to gain information not currently available, requires the use of research subjects less than 18 years of age, is without significant risk to subjects, and is supported with review by qualified pediatric consultants to the RDRC; • The radiation dose does not exceed 10 percent of the adult radiation dose specified in § 361.1(b) (3) (i); and • As with adult subjects, the following requirements, among others, are met: (1) The study is approved by an IRB that conforms to 21 CFR part 56, (2) informed consent of the subjects’ legal representative is obtained in accordance with 21 CFR part 50, and (3) the study is approved by the RDRC that assures all other requirements of § 361.1 are met.

RDRC Radiation Dose Limits* Organ or System

Single Dose

Annual and Total Dose

Whole body

0.03 Sv (3 Rem)

0.05 Sv (5 Rem)

Active bloodforming organs

0.03 Sv (3 Rem)

0.05 Sv (5 Rem)

Lens of the eye

0.03 Sv (3Rem)

0.05 Sv (5 Rem)

Gonads

0.03 Sv (3Rem)

0.05 Sv (5 Rem)

Other organs

0.05 Sv (5 Rem)

0.15 Sv (15 Rem)

* 21 CFR § 361.1(b) (3) **For research subjects under 18 years of age at his/her last birthday, the radiation dose does not exceed 10 percent of adult dose. ***Radiation doses from X-ray procedures that are part of the research study shall also be included.

Alternatively, when a study is conducted under an IND in accordance with part 312, the sponsor must submit to the FDA the study protocol, protocol changes and information amendments, pharmacology/toxicology and chemistry information, and information regarding prior human experience with the same or similar drugs (see §§ 312.22, 312.23, 312.30, and 312.31). Additionally, § 312.32 requires that sponsors promptly review all information relevant to the safety of the drug obtained or otherwise received by the sponsor from any source, foreign or domestic. This includes information derived from any clinical or epidemiological investigations, animal investigations, commercial marketing experience, reports in the scientific literature, and unpublished scientific papers, as well as reports from foreign regulatory authorities. Section 312.32 also requires that sponsors submit IND safety reports to the FDA. i. Does § 361.1 provide adequate safeguards for pediatric subjects during the course

of a research project intended to obtain basic information about a radioactive drug, or should these studies only be conducted under an IND? ii. If we assume that § 361.1 provides adequate safeguards for pediatric subjects during such studies, given our present knowledge about radiation and its effects, can we conclude that the current dose limits for pediatric subjects do not pose a significant risk? If not, what dose limits would be appropriate to ensure no significant risk for pediatric subjects? Should there be different dose limits for different pediatric age groups?

D. Quality and Purity What standards for quality and purity should apply to radioactive drugs administered under § 361.1 to ensure the safety of research subjects?

E. Exclusion of Pregnant Women Section 361.1(d)(5) requires that each female research subject of childbearing potential state in

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AAPM NEWSLETTER NEWSLETTER AAPM

Fairobent

JANUARY/FEBRUARY 2005 JANUARY/FEBRUARY 2005

(from p. 21)

writing that she is not pregnant or, on the basis of a pregnancy test, be confirmed as not pregnant before she may participate in any research study involving a radioactive drug under § 361.1. Is written attestation adequate assurance that female research subjects are not pregnant? If not, what other assurance should be provided?

F. RDRC Membership Under § 361.1(c)(1), an RDRC must include the following expertise: (i) A physician recognized as a specialist in nuclear medicine, (ii) a person qualified to formulate radioactive drugs, and (iii) a person with special competence in radiation safety and radiation dosimetry. Would a RDRC benefit from any additional expertise, such as a pharmacologist or toxicologist? Should such memberships be required?

Under § 361.1(c) (4), changes in the membership of an RDRC must be submitted to the FDA as soon as, or before, vacancies occur on the committee. However, the regulations do not require approval of new members by the FDA before a new member assumes committee responsibilities. We review the qualifications of new members when we receive them and contact the RDRC when we identify new members we consider to be unqualified, but we do not always receive notifications of changes in membership in a timely manner.

At times, this has resulted in unqualified members serving on

RDRCs for extended periods.

Should the regulations specifically require that the FDA approve RDRC membership changes before new members assume committee responsibilities? For example, would it be appropriate for the regulations to allow the FDA 15 days to review the qualifications of a proposed new member before the member could assume committee responsibilities?

Approximately one hundred people attended the public meeting on November 16, 2004, many of which serve on RDRCs. Key issues raised during the public meeting was the need to revise the dose limits and the concern over the possibility of not allowing research on pediatric subjects.

Comments are due to the FDA January 16, 2005. AAPM is preparing comments on this issue. If you would like to provide any input, please send your comments to Lynne Fairobent, Legislative and Regulatory Affairs Manager at lynne@aapm.org by January 10th.

If you would like to submit comments directly to the FDA, you may do so by identifying Docket No. 2004N-0432, using any of the following methods: • Federal eRulemaking Portal: http:// frwebgate.access.gpo.gov/cgi-bin/ leaving.cgi?from=1eaving FR.html&log=linklog&to=http:// www.regulations.gov. Follow the instructions for submitting comments.

• Agency Web site: http://frwebgate. access.gpo.gov/cgi-bin/ leaving.cgi?from=leavingFR.html& log=linklog&to=http://

www.fda.gov/dockets/ecomments.

Follow the instructions for submitting comments on the agency Web site.

• E-mail: fdadockets@oc.fda.gov. Include Docket No. 2004N-0432 in the subject line of your e-mail message.

• FAX: 301-827-6870.

• Mail/Hand delivery/Courier [For paper, disk, or CD-ROM submissions]: Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.

Instructions: All submissions received must include the agency name and Docket No. All comments received will be posted without change to http:// frwebgate.access.gpo.gov/cgibin/leaving.cgi?from=leaving FR.html&log=linklog&to=http:// www.fda.gov/ohrms/dockets/ default.htm, including any personal information provided.

This marks my six-month anniversary with AAPM. I would like to thank all of you for your support in helping me to transition to my new position at AAPM. Without your input, guidance and support I could not succeed. To the AAPM staff, thank you for making me feel welcome and a part of your “team.”

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The Editors regret an error in authorship of the article, “AAPM/IOMP International Scientific Exchange Program” (Chengdu, China) from p. 21 of the last issue.

Raymond Wu, chairman of the Asian Oceanic Affairs Committee, is the proper author. Our sincere apologies.

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AAPM AAPMNEWSLETTER NEWSLETTER

JANUARY/FEBRUARY 2005 JANUARY/FEBRUARY 2005

Science Council Report Jatinder R. Palta, Science Council Chair John Boone, Imaging Physics Committee Chair Michael Herman, Therapy Physics Committee Chair We are pleased to report that the AAPM Board approved the restructuring of the Science Council (SC) into two broad committees; the Imaging Physics Committee and the Therapy Physics Committee. The new SC structure was sought to invigorate the scientific arm of the AAPM, and to allow our organization to better engage in relevant science in the United States.

The Science Council, at the strategic planning retreat earlier this year, recognized that it made little sense that radiation therapy was a sole committee in the SC, and handled the bulk of issues affecting the majority of AAPM members (radiation oncology physicists). Diagnostic imaging committees, on the other hand, were defined on modality boundaries (Diagnostic X ray, Ultrasound, Nuclear Medicine, and MRI), a structure which served to split up an already smaller contingent of diagnostic imaging physicists. Furthermore, and partly due to the inefficient structure, the role of the Science Council had become mostly perfunctory, simply approving the actions of its constituent committees. The consensus at the retreat was that the SC desperately needed rejuvenation through re-

organization. It was suggested that we create an Imaging Physics Committee, and the four diagnostic modalities (Diagnostic X ray, Ultrasound, Nuclear Medicine, and MRI) which are currently represented as committees on the SC, be subsumed as subcommittees under the Imaging Physics Committee. Several other subcommittees which reflect appropriate topics in diagnostic imaging were also added.

The remaining committees were also realigned.

The AAPM Board approved the following new structure of the Science Council: Science Council Membership: Chair (1), Chair of each committee as members and council vice chairs (2), Members-at-Large (6), and Liaisons to Professional, Educational Councils and Program Subcommittee (3) Therapy Physics Committee Membership: Chair (1), ViceChair (1), Chair of each Subcommittee (8), Ex Officio Members, 4-6 Members-at-Large, and Liaisons Subcommittees: Brachytherapy, Calibration Laboratory Accreditation, Quality Assurance, Radiation Dosimetry and Treatment Planning, Radiation Safety, Treatment Delivery, Therapy Imaging, Therapy Research Imaging Physics Committee Membership: Chair (1), Vice

Chair (1) Chair of each Subcommittee (8), Ex Officio Members, 4-6 Members-at-Large, and Liaisons Subcommittees: Computed Tomography, Diagnostic Imaging and Information Technology, Imaging Research, Magnetic Resonance Imaging, Nuclear Medicine, Radiation Protection, Ultrasound, X-ray Radiography and Fluoroscopy The challenge for the restructured SC is to now come up with new and creative ideas for injecting more real science into AAPM activities, which is their primary mission. Each of the categorical committees of the SC will now have a research subcommittee that will focus on new science and novel scientific projects. We anticipate that the new structure of the SC will help us identify projects that do not compete with the scientific endeavors of our individual members, but rather which capitalize on what the AAPM can uniquely bring to a scientific project. Much of the scientific potential of the AAPM lies in the fact that we are a collection of thousands of scientists, with a wide geographic distribution and with a relatively broad array of expertise and equipment which can be harnessed in appropriate projects. For example, we are uniquely qualified to collect data such as relative values for radiation doses in diagnostic imaging procedures and the benchmark dataset for the vali-

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dation of treatment planning systems in radiation oncology. Just as the American College of Radiology has the ACR Imaging Network (ACRIN), which has been a successful mechanism for executing clinical trials in imaging, the AAPM Science Council will consider developing collaborative efforts which may lead to the AAPM being a recipient of NIH and other federal funding, which would be redistributed to AAPM member institutions for specific scientific exercises through subcontracts. The ACRIN network has been funded in excess of 100

million dollars (DMIST~$28M and NLST~$200M, alone).

Of significance is the fact that much of the task group charging and approval process will now be performed at the two categorical committee levels. Task groups and working groups will be organized under subcommittees of the categorical committees, with the Science Council only involved in the approval to form a task group, working group or subcommittee. This will free up the Science Council to concentrate on the broader issues related to physics and scientific issues. The

subcommittee structure under each categorical committee will provide an opportunity for a larger number of AAPM members to get involved in the scientific endeavors of the AAPM. We are excited about the reorganization of the Science Council, and will strive to both expand the scientific enterprise and increase the visibility of scientific endeavors in our organization.

We welcome comments and suggestions from all interested AAPM members in regards to this important revitalization process. â–

IPEM/AAPM Travel Grant Report Eric Klein St. Louis, MO In 2002, I was the recipient of the IPEM/AAPM travel grant. I was proud to receive the grant with travel plans for 2003. However, plans were postponed due to the Iraq war. Therefore, I ended up taking the trip in 2004 for which I appreciate the AAPM and IPEM’s indulgence in my delay and replanning. When I applied for the award, the main purpose for my trip was to exchange ideas in terms of medical physics training. This initiative was certainly fulfilled, along with much more during this very eventful and educational trip to the United Kingdom.

The first city I visited was London, where I spent time at different facilities doing a variety of things. I was able to visit the Elekta linear accelerator head-

quarters in Crawley, just south of London. As an Elekta user, it was fascinating to see the hands-on approach of how the accelerators are constructed, and that few accelerator parts are outsourced.

During my visit, I was also able to see what is on the horizon for their new Synergy-S platform and gain an appreciation for what the Elekta consortium institutions are doing with the current Synergy system.

I also interacted with Slavik Tabakov from Kings College in London. Slavik oversees the EMERALD Project of medical physics training by remote means.

He and his group have produced some very impressive methods of physics training in terms of didactic education. This fits in well with how British physicists are trained and continue to be trained throughout their careers.

My final stop in London was at the Royal Marsden (not Sutton).

I was hosted by principal physicist Margaret Bidmead and was able to understand the training scheme for physicists, along with seeing an outstanding facility. The department, which is fairly modern, is housed within the confines of a beautifully restored 19th century building. They literally have to construct new buildings within the confines of the restored buildings. This Varian-based department is performing many interesting IMRT studies, particularly for head & neck cancers.

My next stop in the U. K. was to the city of Hull, a shipping village near the east shore. Dr. Andrew Beavis was my host. I have had the pleasure of knowing Andy for many years, including being his first host in the United

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States, and his hospitality was more than reciprocated. The Royal Princess Hospital in Hull, where Andy is the principal physicist, is not one of the largest facilities, but I would say it certainly is one of the most inventive in the U.K. I was impressed to see what they are currently doing with their technologies. They are making amazing advances in visualization software employed for usage in radiation therapy.

The potential for such work is unlimited.

I next visited Christie Hospital in Manchester, England, where Ranald McKay and David Mott were excellent hosts. Christie Hospital has an amazing history for brachytherapy and more recently with IMRT, and is quite an active principal participant in the Elekta consortium. I was able to see a Synergy system in clinical use in which kilovoltage cone beam CTs are acquired and used for daily setups and for comparison with online portal images.

This allows assessment of both inter- and intra-treatment variations.

Some of the common radiotherapy themes that I observed throughout the facilities included a few revelations. The perception of a long wait list in this nationalized health care system of England was put to rest. They have worked out not only methods of efficiency, such as use of record and verification systems, but, more importantly, they have configured idealized radiation prescription schemes that allow for

higher daily doses. This cuts down the total course of therapy and allows more patients to be treated. Waits are no longer than two weeks, which isn’t much different for IMRT patients in the U.S. Also, the shielding and room designs allow for treatment rooms without doors. The methodology to reduce the contribution of scatter and direct leakage at the door is accomplished by long mazes and baffles configured within the mazes. Aesthetically, this makes for a much more pleasant environment, not only for the therapist day-to-day, but also for the patients.

IMRT use is accelerating in the U.K., but unlike the U.S., it is being approached with very structured and very careful protocol studies. Clinically, questions are being answered in a very methodical fashion. It is certainly obvious that IMRT in the U.K. is not financially driven the way it is in the U.S., as it has progressed slowly and carefully and certainly is not widespread. The one realization that the English radiotherapy community is dealing with is that the longer IMRT treatments will potentially delay the treatment of some patients due to a reduction in the number of daily treatment slots. There is talk that some clinics are starting to engage in prostate brachytherapy, although they see it as an alternative to prostate IMRT rather than a complementary stand-alone service.

Another common observation is that the British physicist workday is only 40 hours per week, at least on paper. Most physi-

cists do work more than 40 hours, but do not come close to the hours we work in the States, which for most of us is between 50 to 60 hours per week. However, salaries of the English physicists are far below those in the U.S. Another interesting observation is the fact that brachytherapy has diminished in its role over the past decade in England.

The main purpose of my trip was, again, to trade experiences of the education of medical physicists. As I am involved with the CAMPEP Residency Education Program Review Committee, I was able to make some direct comparisons to the U.K. method of training. After graduating from either a masters program or a doctoral program, physicists in the U.K. then begin a two-year training program that is very similar to our residency programs. It involves both didactic education and robust and regimented clinical training. The difference is that in the U.K., this two-year structured training is the only pathway for physicists to enter the field. This is governed by the IPEM, which is also the awarding group. Following the two-year training, physicsts are then eligible to go work as a physicist rather than as a trainee at a facility. After three more years they are eligible to become registered (what we call certified). This entails an oral exam that is typically one hour in length.

A written exam is not required.

The next step of physicist training after registration is that with more years of mentorship and direct training, one can then be-

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come a principal physicist, which is basically a level higher than an entry-level physicist who is registered (which is one level higher than a training physicist).

The training facilities are limited in number and all need to provide the same type of curriculum for the training program and again building up to the registering of physicists. It was very interesting to share and compare ideas of what we have now for residency programs as our method of training and evaluation of physicists does not require completion of a structured program. This may change if the American Board of Radiology mandates that physicists graduate from an accredited residency program before sitting for the boards.

During my visit I also provided formal lectures and discussions at the institutions. I presented lectures on subjects such as “Transitions to Heterogeneity Corrections” and “Prospects for Modulated Electron Radiotherapy.”

However, most of my discussions revolved around IMRT quality assurance, specifically methods, requirements, and, “How much is enough?” with a trade-off of ideas of how physicists are supported in such efforts.

I found the English people overall to be very friendly and helpful, whether it was the large cosmopolitan city of London or the small city of Hull. I want to thank both AAPM and IPEM for supporting my travel to the United Kingdom.

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Lauriston Sale Taylor Robert Gorson On behalf of the AAPM History Committee

1902 to 2004

tection. He was in the right place at the right time when, in 1928, he recognized the need for naThe world of tional and intermedical physics national stanand health physdards of radiaLauriston Taylor is presented the Janeway ics mourns the Lecture tion protection Medal by Edith Quimby at the anpassing of the nual banquet of the American Radium So- and radiation in 1954 at the Homestead Hotel in last of the early ciety measurements.

Hot Springs, Virginia. pioneers in raHe assumed the diation protection. Lauriston Taylead roles in creating both the lor (Laurie as he was affectionICRP and the NCRP and was an ately known by friends and colearly participant in the ICRU. leagues) died peacefully in his Many AAPM members had the sleep on November 26 in a reprivilege of working with Laurie tirement facility in Mitchellville, on various committees of the MD. He was 102.

NCRP, ICRP, ACR, and RSNA. The January 2005 issue of the An expert radiation scientist, suHealth Physics Journal features perb administrator, excellent a fitting four-page obituary for writer and skillful diplomat, he Laurie, former president of the was most effective in getting sciHealth Physics Society. A special entists from many disciplines to tribute on his 100th birthday also freely volunteer their time to proappeared in the June 2002 issue. duce scientific reports in all fields In this column, we will touch only of radiation usage. briefly a few facets of Laurie’s It was Taylor who, in 1929, eslong career that AAPM memtablished the first radiation stanbers, in particular, will find interdards and calibration laboratories esting. at the National Bureau of StanLaurie was the last of the secdards (now NIST) providing an ond generation of radiological essential service to emerging raphysicists, which included such diation therapy facilities. notables as Failla, Quimby, In 1934, Taylor was one of the Parker, Marinelli, Glasser, first to recognize the need to esWeatherwax, Marvin Williams, tablish an X-ray physics certifiHarold Johns, Mayneord, cation program. Under his chairSievert, Wyckoff and others. (The manship, the RSNA Standardfirst generation included Roentization Committee adopted comgen, Curie, Rutherford and petency standards for the “RegDuane). istry of X-ray Physicists.” ThirFor most of us, Laurie’s name teen years later, the certification is synonymous with radiation pro(See Taylor - p. 28) 27

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of physicists was peremptorily taken over by the American Board of Radiology. In the end, it was Taylor’s diplomatic skills that prevented an “open and public revolt” in the radiological community over that issue.

From 1977 to 1979, Laurie recorded 25 videotaped interviews of radiation scientists as part of the BRH Series on “Vignettes of Early Radiation Workers.” Included were a number of nowdeceased AAPM members: Edith Quimby, Carl Braestrup, Robley Evans, Marvin Williams, Lillian Jacobson, Reid Warren, Herb Parker, George Henny and

Harold Johns. The success of these Taylor interviews inspired the AAPM History Committee in 1990 to initiate its own program of videotaping oral histories, which continues to date (some 134 so far). Taylor himself was interviewed by the committee in 1994 and 1995. More recently the HPS and ASTRO followed suit with similar programs.

Partly in jest, Laurie attributed his longevity to radiation exposure. He was an expert witness for the Department of Justice in a number of cases claiming radiation injury from small doses.

He was highly critical of the use of extrapolation based on the linear no-threshold relationship for

calculation of carcinogenic effects of very low doses and dose rates. His testimony was particularly effective when the lawyers for the defense would elicit from Laurie his estimate that he had accumulated without discernible effects a whole-body doseequivalent of over 1000 rem from accidental, occupational and medical exposures.

Laurie lived a very long and most productive life. He left us a legacy we all can cherish; one his profession will never forget. See the Health Physics tribute for ■ more details.

Chapter News Upstate New York Chapter Honors Steve Balter at its Fall Meeting Ken Hoffman Buffalo, NY Stephen Balter, Ph.D. received the Lifetime Achievement Award at the fall meeting of the Upstate New York Chapter of the AAPM on November 12 at Weiskotten Hall at the SUNY Upstate Medical University campus in Syracuse, NY. He was introduced by Steve Rudin, Ph.D., who pointed out that Steve has participated in all phases of medical physics— diagnostic, therapy, clinical, academic, industry, and government.

Steve has served the medical physics community not only in

Steve Balter (center) is presented with the Lifetime Achievement Award

by Matt Podgorsak (r) and Steve Rudin.

terms of significant contributions in investigative research, but also by his membership and guidance on numerous committees. Steve gave the keynote address of the meeting, “Physics and Technology in the 1960s,” in which he took us on a captivating, historic tour of his early days at Memorial Sloan-Kettering Cancer Center. What they achieved with little or no computer support opens

the eyes of those of us who grew up where computers and 3D technology are a given.

The scientific session featured a variety of presentations. Balu Rajagopalan, Ph.D., presented an invited lecture on “Application of Information Obtained by Functional Imaging to Radiation Therapy Planning.” Other presentations included “MRI/PET Nonrigid Breast-Image Registra-

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tion Using Skin Fiducial Markers” by A. Krol, “Studies of a Novel Prototype MicroAngiographic Fluoroscope” byY. Wu, “Adult and Pediatric Doses in Chest CT” by A. Vance, “Evaluation of Dose Delivery in Ultrasound-Guided Pelvic Radiation Therapy” by Z. Wang, “Self-Calibration of a MicroCone-Beam CT” by R. Chityala, “Generalized Detector Performance Evaluation Parameters for a Microangiographic System” by G. Yadava, “A Geometrical Method for Lesion Placement in Radiosurgery of Functional Brain Disorders” by G. Cernica, and “Web Services for Radiation Oncology Workflow” by D. Kim. Daniel Kim is taking over the presidency of the chapter as Matt Podgorsak retires to past president and becomes at-large board member of the AAPM. Harish Malhotra is our president-elect.

The next meeting of the chapter will be in May 2005 at SUNY Upstate.

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IAEA Seeks Medical Physicist(s) to Help with New Cancer Initiative Cancer kills more people worldwide than AIDS, tuberculosis and malaria put together. The number of cancer patients in the developing world is set to double to nearly 10 million per year by 2020. And, there is already a desperate shortage of equipment and staff!

The IAEA has a long track record of providing equipment and training staff to safely treat cancer patients. The IAEA has set up PACT–“Programme of Action for Cancer Therapy”–to take radiotherapy to where it is most needed. The World Health Organization has welcomed the initiative.

The IAEA needs the assistance of experienced medical physicists on a temporary basis: minimum– three months and maximum–one year. The tasks would include working with developing countries to assess their treatment needs and capabilities and to provide assistance in formulating and implementing projects to address any gaps. If you are interested, please visit the Web site (www.iaea.org/NewsCenter/ News/2004/pact.html) or contact Ken Shortt (k.shortt@iaea.org).

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Letters to the Editor Why Should I Belong to the ACMP? Ed Nickoloff, DSc ACMP Chairman eln1@columbia.edu I have been asked over the years by various medical physicists, “Why should I join the ACMP, or Why should I continue to be an ACMP member?” I recently tried to provide an answer to that question which I would like to share with you.

I have been told by some medical physicists that the AAPM appears to be doing everything that is needed; thus, there is no need to join another professional organization. First of all, the AAPM is a very large organization and an individual can become lost in the crowd. I happen to like the smaller more personal interactions provided by the ACMP. There is more opportunity to interact with other medical physicists and to make significant contributions to various activities of the organization. Furthermore, I hope that physicists realize that the AAPM was involved with the initial formation of the ACMP; the ACMP’s initial goal was supposed to be the development of professional activities while the AAPM was going to concentrate upon scientific and educational activities. At the time of the formation of the ACMP, one pressing issue was that the ABR did not want to have physics trustees. In response to this situation,

the ACMP created and was the sponsor of the ABMP for the certification of medical physicists.

Subsequently, the ABR has: accepted medical physics trustees, one physicist (Dr. William Hendee) has been elected president of the ABR, and the ABMP & ABR have merged most of the certification endeavors in medical physics. In fact, Dr. Hendee and Dr. Paliwal (one of the ABR physics trustees) are currently ACMP members.

Times have changed!! The AAPM is now involved in many professional activities, and the ACMP is involved with many continuing education courses. I believe that the AAPM organization and membership have an obligation to support the ACMP because they were involved with the formation of the ACMP. Currently, there are ongoing efforts to discuss issues of improved cooperation and coordination between the AAPM & ACMP, like the meeting of the two EXCOMs during the 2004 RSNA. In my opinion, there is no adversarial relationship between the two organizations. In fact, almost all ACMP members also belong to the AAPM. Many former AAPM presidents are members and/or fellows of the ACMP like: H. Amols, G.D. Frey, R. Gorson, W. Hendee, K. Hogstrom, F. Khan, J. Laughlin, E. McCullough, C. Orton, B. Paliwal, J. Purdy, L. Reinstein, A. Smith, E. Sternick, N. Suntharakingam, M. Weinstein and A. Wright.

I feel that most medical physicists earn a salary far above the median salary of most people in the USA. This salary is, in part, enhanced by the existence of various professional organizations.

Moreover, physicists have an obligation to be involved in promoting and improving their profession. The ACMP has many committees and commissions which look forward to and encourage participation of its members. If no efforts are made by the committee members, the committees are less effective, and the members’ personal experience of involvement with a professional organization is diminished.

The ACMP is involved with: professional symposia, annual meeting with continuing education courses, interactions with ACR/ AAPM/AAMD and other organizations, publication of the ACMP Newsletter and a Web site with report summaries of activities important to medical physicists. The ACMP sponsors the JACMP, which currently is the primary journal for medical physicists to publish and read practical clinical manuscripts. The ACMP was the initial sponsor of the ABMP and is currently still a sponsor of the ABMP, which is the only board for MRI, hyperthermia, and medical health physics certification. In fact, the ABMP may expand to include other medical physics certifications (which the ABR is not interested in doing) like computer

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scientists, PACS and specialties in radiation therapy like IMRT. The ACMP has been involved with the CARE bill and other efforts to promote state licensure of medical physicists in order to improve their standing in the medical community. The ACMP Annual Meeting provides a good platform to meet and interact on a personal basis with experienced clinical medical physicists from across the country. The presentations at the meeting are primarily practical clinical topics rather than esoteric research that has little impact for most clinical physicists.

The AAPM was founded in the 1950s; it has slowly increased in membership (an average of three - five percent per year) and matured over 50 years. The improved services provided by the AAPM is in no small measure attributable to increased membership. The ACMP was only founded in 1989 and is only about 15 years old. It takes time to build membership which provides both the money and man(woman) power to provide greater member services. Rather than to fail to join or drop a membership in the ACMP and limit resources to only one professional organization.......I would recommend maintaining membership in both the AAPM and ACMP. All medical physicists should try to recruit more colleagues to join the ACMP in order to provide it with more resources for medical physicists to better help themselves.

Both the AAPM and ACMP have roles to play to promote our

profession. It is an obligation to our profession to contribute back by belonging to professional organizations (more than one)! As John Kennedy said (slightly para-phrased), ‘Ask not what the ACMP can do for you, but ask what you can do for your profession by having membership in the ACMP.’ The financial cost of membership is insignificant in comparison to most medical ■ physicists’ salaries.

Medical Physics Services Emeka S. Izundu, PhD Las Cruces, NM eizundu@prhc.net Dr. William A. Dezarn recently reported that AETNA had informed his center that CPT code 77336 would no longer be reimbursed (Med. Phys. Digest, October 16-18, 2004)! This reminds me of the biblical adage, ‘To he who has, more will be given, and to he who has not, even the little he has will be taken from him.’

While reimbursement of other medical professionals is going up, the little that medical physicists have keeps shrinking. The AAPM and ACMP need to address provider status for medical physicists now, just so we can keep what little we have.

There are no doubts within the medical community whether certified medical physicists are medical professionals. Anyone who questions this should call the

American Board of Medical Specialties (ABMS). Why then do medical physicists not bill directly for their medical services?

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Not having Independent billing – Fair for medical physicists?

Di Chen, PhD McAllen, TX dchen@uast.net Independent billing for medical physicists is a must if clinical medical physicists are to maintain good quality for patient care, professional status, as well as adequate compensation for their work. It is a survival issue for the entire medical physics profession given the prospect of socioeconomic pressure of Medicare reform.

If medical physicists are not lobbying for the very essence of their work, no one else will care. We, and only we, the providers of medical physics services to patients, are most knowledgeable about what we do and its impact on patient care. Just because there is no current law for direct billing by medical physicists, one can not come to the conclusion that direct billing is not achievable, or not pursuable.

Yes, there will be costs associated with lobbying for the passage of legislature for direct billing. And there will be annual costs just for maintaining direct billing even if it is passed. But is it worthwhile to raise the membership

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dues to a level to support the ongoing lobby so that we can one day truly tell graduate students that they will be viewed as medical professionals in the eyes of administrators and MDs?

I do believe that we need to be cautious in minimizing conflict with our physician colleagues. And I believe that there are ways to do that. The point is to convince our physician colleagues that there will be no reduction or threat to their current billing scheme, and

that quality of patient care is to be directly benefited if this bill is to pass.

I hope that AAPM will weigh this issue thoughtfully and act in favor of the interest of the majority of its members. â–

AAPM NEWSLETTER Editorial Board

Editor Allan F. deGuzman

Arthur Boyer Nicholas Detorie Kenneth Ekstrand Geoffrey Ibbott C. Clifton Ling

Managing Editor Susan deGuzman

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: March/April 2005 Postmark Date: March 15 Submission Deadline: February 15, 2004

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE

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

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