AAPM Newsletter March/April 2005 Vol. 30 No. 2

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 30 NO. 2

MARCH/APRIL 2005

AAPM President’s Column Howard Amols New York, NY The big news this month is progress in our plans to reorganize the AAPM’s Board of Directors and strengthen the relationship between national AAPM and local chapters. Marty Weinhous chairs the Ad Hoc Committee on Regional Reorganization and has been charged with drafting a plan, but let me give you my spin on this. There is a great deal of support for this plan, but there are also many AAPM members who have concerns and questions. In a nutshell, it is proposed that the current board of 20 local chapter reps plus 12 board members-at-large be replaced by seven regional board

reps (plus the five members of EXCOM, which will remain as is), thus reducing the total size of the voting board from 37 members to 12. Candidates for regional board reps will be nominated by the local chapter presidents from each region (there will be a mechanism for write-in candidates). AAPM members vote only for candidates from their region, and every AAPM member must join a local chapter.

Details of the plan will be debated and voted on by the current BOD at a special meeting in March and if approved, will be presented to the entire membership for final vote later this year.

If approved by the membership, new board elections will be held in 2006 and the new board will come to fruition in 2007. Let me summarize the pros and cons of the plan: Pros of the plan: (1) Local chapters range in size from approximately 50-500 members per chapter. About half (See Amols - p. 2)

Clinical Trials Report from the Subcommittee on QA of Clinical Trials Trials Permitting the Use of IMRT Geoffrey S. Ibbott Subcommittee Chair This article continues a series that describes clinical trials conducted by cooperative study groups that involve advanced technologies or are otherwise of particular interest to medical physicists. Previous newsletter articles have described RTOG protocols addressing tumors of (See Ibbott - p. 5)

TABLE OF CONTENTS Executive Dir’s Col. Leg. & Reg. Affairs Education Council Rep. Recruitment Report Radiation Dose Update IEC Activities Resrch. Comm. Survey CAMPEP Questionnaire CAMPEP News Chapter News New Members Mammography FAQs Letters to the Editor

p 6 p 7 p 9 p 11 p 12 p 14 p 15 p 16 p 20 p 20 p 23 p 26 p 28

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Amols

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(from p. 1)

of all AAPM members don’t even belong to a chapter, yet each local chapter has one representative on the current BOD. Thus, the AAPM does not operate as a one-member, one-vote democracy.

(2) The current BOD is too large and ineffective. It is far larger, for example, than the boards of RSNA, ASTRO, and other scientific societies of our ilk. This makes it impractical to meet frequently or to have any kind of meaningful discussion on policy or long-range strategy.

(3) According to our Articles of Incorporation and Bylaws, the BOD is legally responsible for the affairs of the corporation. With such a large board and so many board members relatively uninvolved, this is not exactly reality as the current BOD spends most of its meeting time simply rubber stamping decisions made

by EXCOM and council and committee chairs. This concentrates too much power (and work) into too few hands.

Cons of the plan: (1) Doesn’t the AAPM work just fine? ‘If it ain’t broke don’t fix it.’

(2) Local chapter board reps provide a direct link between the AAPM and its members. Replacing local reps with regional reps will make it difficult for board reps to report directly to members and local chapter meetings.

How does one answer the argument, ‘Doesn’t AAPM work

just fine?’Well, yes, on many levels the AAPM does function well, but many important tasks remain in limbo. There’s still a critical manpower shortage; serious questions on recruiting and training future medical physicists; open questions on how electronic publishing will affect our journal, Web site, and annual meeting; addressing the continuing education needs of our members on new technologies; etc., etc., etc. The truth is that the current BOD just doesn’t seem to be able to get around to these or other important issues. Perhaps more importantly, the heavy workload needs to be spread out amongst more than the current inner circle of 1012 individual volunteers (five members of EXCOM, plus three council chairs, plus several key committee chairs). What would the world be like if Edison had said ‘Hmm, doesn’t this gas lamp work just fine?’

What about the second critique of the reorganization plan that regional reps will find it difficult to report directly to local chapters? First, this needn’t be the case. The new plan will budget money for regional board reps to visit local chapters. Second, most information about AAPM and BOD activities can be found on the AAPM’s ever-expanding and improving Web site. In addition, only a small fraction of AAPM members even attend local chapter meetings. And for the vast majority of you who have never attended a BOD meeting (please trust me on this one) — you’ll not be missing much if nobody reports to you directly about what goes on at these meetings!

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So that’s the big news, but there are lots of other important issues on the table. Let me go through them, not in any particular order other than the temporal sequence of them popping into my head.

Independent billing by therapy physicists: I remember the bad old days when the AAPM literally tore itself in half arguing over whether medical physicists should be certified by the ABR or the ABMP. Let’s NOT make that mistake again! Civil wars are not pretty and no single issue is worth splitting our society in half!

There is widespread support, in principle, for independent billing by therapy physicists (even I support it in principle)! The discussion (argument?) is not over the principle, but rather over whether it’s practical or not. I’ve written numerous letters and columns expressing my views on this and need not repeat them here. Let me assure all supporters of this crusade, however, that despite the personnel misgivings of many senior AAPM members (including myself) who have done backof-the-envelope calculations on the finances of direct billing, the AAPM is making a serious investigation into how to proceed. The Professional Council, Economics Committee, and Government and Regulatory Affairs Committee are all studying the issue, and it will receive prominent discussion during the Professional Symposium at this year’s annual meeting in Seattle. If intelligent discussions demonstrate that there’s really meat in that bun (Where’s the beef?) it will most definitely be pursued. But if it turns out to be

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a box of Tuna Helper, well, Betty Crocker may have gotten rich selling Tuna Helper, but I don’t think medical physicists will!

To the consternation of many members, we have recently taken temporary measures to limit public access to many sections of the AAPM Web site. This was done as a stopgap measure to address certain legal and liability issues.

As we all know, the world changed on 9/11. For example, scientific journals (such as Medical Physics) are now grappling with how to handle recent statements from the US Justice Department making it a federal crime to publish papers submitted by scientists from ‘terrorist nations.’

This could be interpreted, for example, as being illegal to have a link or even reference on the AAPM Web site to meetings being held in such countries. There are other liability issues such as unwittingly posting copyrighted

material on the Web site without permission, which could put the AAPM at risk of a lawsuit. At present, the AAPM does not have an effective mechanism for reviewing or editing information on the Web site (please refer to discussion at the beginning of this article on ‘Doesn’t the AAPM work just fine?). We are currently working on these issues. Until such a policy is established, however, it is not prudent to allow individual members or even committees to post unedited and/or unapproved items on the Web site. We expect to have a solution to this problem very shortly (maybe even by the time this newsletter comes to press) but for now, EXCOM and EMCC felt these actions had to be taken as a defensive measure.

The AAPM Educational Endowment Fund was created by the board of directors in 1989. A high profile fund-raising drive

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launched between 1993-5 raised an initial $712,000 which, via investments, has grown to over $1.1 million in total assets. After many years of what can only be described as frustrating debate (please refer to discussion at the beginning of this article on ‘Doesn’t the AAPM work just fine?’), the AAPM has, effective with calendar year 2003, begun to actually use this fund to support educational activities. Prior to calendar year 2003, the fund remained completely untouched—no fellowships were ever supported from it—but beginning in calendar year 2003 the board of directors authorized the expenditure of $54,000 annually from the fund to support three fellowships: (1) $18,000 for an AAPM/ RSNA Fellowship for graduate study in medical physics;

AAPM Virtual Library Now online...

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

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

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

www.aapm.org 3

(See Amols - p. 4)

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Amols

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(from p. 3)

(2) $18,000 for an AAPM Fellowship for graduate study in medical physics; and (3) $18,000 for an AAPM clinical residency in medical physics.

In December 2002 the board also approved, but for various reasons did not implement (please refer to discussion at the beginning of this article on ‘Doesn’t the AAPM work just fine?’), a one-time expenditure from the fund of $25,000 as seed money for research to be awarded by competitive application from younger AAPM members. That money will be awarded in 2005. In addition, the AAPM supports $15,000 annually from operating revenues for student travel grants, plus over $40,000 per year for Summer Fellowships. A further $27,000 in operating funds is authorized in 2005 if the Development Committee can raise matching funds. Finally, the AAPM awards two clinical residencies ($18,000 per year each) in Diagnostic Medical Physics funded by the RSNA, plus two clinical residencies ($18,000 per year each) in Therapy Medical Physics funded

by Varian Medical Systems. Until this year, the AAPM also awarded two $18,000 annual fellowships in Therapy Medical Physics funded by ASTRO. Beginning in 2005 ASTRO has decided to administer these fellowships themselves.

One of the disappointments of the Educational Endowment Fund is the fact that it has never

been sufficiently supported by the majority of AAPM members.

Most of the $710,000 initially raised came from a few dozen very generous individual AAPM members and an exceptional contribution from the RSNA of $250,000. Since that initial fundraising effort, however, contributions to the fund have withered.

Last year we raised approximately 56 cents per AAPM member and the total dollars raised did not cover the money budgeted for fund-raising efforts.

That is to say we actually lost money on fund-raising, which one could argue is a pretty neat trick!

The pathetic reality is that over the years both RSNA and ASTRO have spent more money on physics education than have AAPM members (please refer to discussion at the beginning of this article on ‘Doesn’t the AAPM work just fine?)! I hear a lot of talk from many medical physicists about how we are medical specialists and should be more like

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MDs. For the record, I think we are physicists and not medical specialists, but whichever you think you are, why not take a lesson from our colleagues in RSNA and ASTRO and make a significant contribution to the AAPM Educational Endowment Fund?

This year a very concerted effort is going to be made to breathe life into this fund, and you will be hearing more about this in future columns. In the meantime you can find more information on the fund at the AAPM Web site. Hit the ‘Education’ icon on the left side of your screen, and then the ‘Contribute to the fund’ icon and follow directions (or send a large check directly to me made out to ‘cash’).

And finally, I would like to report that I will soon be appointing a Presidential Ad Hoc Committee to study what is perhaps the single most important issue facing us, namely ‘Why is there a light in the fridge but not in the ■ freezer?’

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Ibbott

(from p. 1)

the head and neck, the lung, and the prostate, and a Children’s Oncology Group (COG) protocol addressing medulloblastoma tumors. This article discusses very briefly a number of clinical trials, from several study groups, that permit the use of intensitymodulated radiation therapy (IMRT). In addition to the 12 trials listed here from groups other than RTOG, there are three trials from RTOG that permit or require IMRT. Medical physicists might wish to determine if their institutions participate in any of these trials, or plan to, as the requirements for participation will likely involve special planning and data-submission procedures. The National Cancer Institute (NCI) requires that trials permitting or evaluating the use of IMRT meet a number of criteria, including requirements for the use of ICRU terminology in defining volumes, and the evaluation of participating institutions through credentialing procedures.

Credentialing might require completion of a benchmark treatment plan available from the Quality Assurance Review Center (QARC) or irradiation of an anthropomorphic phantom available from the Radiological Physics Center (RPC). Some trials discussed previously in these articles require electronic data submission to the Image-Guided Therapy QA Center (ITC); however, none of the trials discussed in this article contain such a requirement.

The first trial (the trials are listed by study group, and then, by date opened) is sponsored by the American College of Surgeons Oncology Group (ACOSOG) and is numbered Z9031. The title is “A Phase III Randomized Study of Preoperative Radiation Plus Surgery Versus Surgery Alone for Patients with Retroperitoneal Sarcomas (RPS).” The study opened at the end of August and as of this writing, has accrued only one of the 370 patients projected. As a phase III study, this trial is open through the Cancer Trials Support Unit (CTSU) and is therefore potentially available to any institution.

Next is study 99811, opened by the Cancer and Leukemia Group B (CALGB) called “Phase II Study of Neo-Adjuvant Paclitaxel, Estramustine and Carboplatin (TEC) Plus Androgen Ablation Prior to Radiation Therapy in Patients with Poor Prognosis Localized Prostate Cancer.” The study opened in 2001 and is halfway to reaching its accrual goal of 50 patients.

The Children’s Oncology Group (COG) has opened nine studies that permit the use of IMRT. They are the following: •9803: Randomized study of Vincristine, Actinomycin-D, and Cyclophosphamide (VAC) verses VAC alternating with Vincristine, Topotecan and Cyclophosphamide for patients with Intermediate-Risk Rhabdomyosarcoma. The study opened in September 1999 and has almost met its accrual goals.

•P9934: Systemic Chemotherapy, Second Look Surgery 5

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and Conformal Radiation Therapy Limited to the Posterior Fossa and Primary Site for Children =>8 months and < 3 years with Non-metastatic Medulloblastoma: A Children’s Oncology Group Phase III Study.

Opened October 2000 and is halfway to meeting its accrual goal of 100 patients. Note that the amendment to allow IMRT on this trial is still in review as of this writing. Institutions considering treating patients on this protocol should verify the status of the amendment before using IMRT. •A3973: A Randomized Study of Purged vs. Unpurged PBSC Transplant Following Dose Intensive Induction Therapy for High Risk Neuroblastoma. Opened in February 2001. It has exceeded its accrual goals but is still active.

•AEWS0031: Trial of Chemotherapy Intensification through Interval Compression in Ewing’s Sarcoma and Related Tumors.

Opened in May 2001 and has accrued 409 of 528 patients.

•ARST0121: Groupwide Randomized Phase II Window Study of Two Different Schedules of Irinotecan and Pilot Assessment of Safety and Efficacy of Tirapazamine Combined with Multiagent Chemotherapy for First Relapse or Progressive Disease in Rhabdomyosarcoma and Related Tumors. Opened in June 2002 and has accrued 62 of 102 patients.

•ACNS0126: Phase II Study of Tenozolomide in the Treatment of Children with High Grade Glioma.

Opened in December 2002 and has accrued 77 of 100 patients.

(See Ibbott - p. 6)

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Ibbott

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(from p. 5)

•ACNS0121: A Phase II Trial of Conformal Radiation Therapy for Pediatric Patients with Localized Ependymoma, Chemotherapy Prior to Second Surgery for Incompletely Resected Ependymoma and Observation for Completely Resected, Differentiated, Supratentorial Ependymoma. Opened in August 2003 and has accrued 62 of 350 patients.

•ACNS0122: A Phase II Study to Assess the Ability of Neoadjuvant Chemotherapy +/Second Look Surgery to Eliminate All Measurable Disease Prior to Radiotherapy for NGGCT. Opened in January

2004 and has accrued six of 98 patients.

•ACNS0331: A Study Evaluating Limited Target Volume Boost Irradiation and Reduced Dose Craniospinal Radiotherapy (18.00 Gy) and Chemotherapy in Children with Newly Diagnosed Standard Risk Medulloblastoma: A Phase III Double Randomized Trial. Opened in April of 2004 and has accrued 10 of 600 patients.

temic & Intrathecal Chemotherapy followed by Conformal Radiation for Infants with Embryonal Intracranial CNS Tumors.” This trial opened in January of 2000 and has accrued 56 of 95 patients.

Further details about these protocols and their credentialing requirements are available at the QARC Web page http://qarc.org, the ATC Web page http:// atc.wustl.edu or the RPC Web page http://rpc.mdanderson.org.

The last trial listed was described in detail in the QA Subcommittee’s previous newsletter article.

Finally, the Pediatric Brain Tumor Consortium has opened PBTC-001, “Pilot Study of Sys-

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Executive Director’s Column Angela Keyser College Park, MD

2005 Summer School and Annual Meeting The 2005 Summer School will take place July 18–22 immediately preceding the annual meeting in Seattle, Washington. The program, “Brachytherapy Physics 2005,” will be held jointly with the American Brachytherapy Society at Seattle University. Will Parker and Michael Gribble are heading the Local Arrangements Committee. Bruce Thomadsen, Mark Rivard and Wayne Butler are the program directors. A full program description is available online with a list of faculty. Make sure to register

online by June 8 to take advantage of discounted registration fees. Housing reservations must be made directly with Seattle University by Monday, June 27.

Registration closes on July 6.

The 47th AAPM Annual Meeting will take place July 24–28, 2005 at the Washington State Convention & Trade Center in Seattle, Washington. Sessions, 6

exhibits, committee meetings and the Awards and Honors Ceremony and Reception will all be held at the center.

The headquarters hotel is the Sheraton Seattle Hotel and Towers. The eight overflow hotels include the Crowne Plaza Hotel, Days Inn–Seattle Downtown, The Paramount Hotel, Sixth Avenue Inn, Summerfield Suites, The Warwick Seattle, The Westin Seattle and the Grand Hyatt Seattle.

A designated Companions Welcome Center will be available to registered companions of the meeting attendees in Room 400 of the center. The hours of operation will be Sunday–Tuesday from 8AM–5PM and Wednes-

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day, 8AM–11AM. Complimentary beverages will be available.

The online registration system opened in mid-March. The deadline for discounted registration is June 8. Advance registration closes on July 6. The deadline to make hotel reservations is also July 6.

Larry Sweeney and the Seattle Local Arrangements Committee have a wonderful ‘Night Out’ planned for Tuesday, July 26 at the Museum of Flight. The Museum of Flight’s Great Gallery is a dramatic 142,816-square foot steel-and-glass complex unlike any other museum building in the world! The museum houses a DC-3, suspended in a sky along with over 20 full-size airplanes, everything from a replica of the Wright Brothers glider to the first supersonic jet fighter. Other fun exhibits include a cockpit of an early United Airlines mail plane, a real flying automobile, and the landing gear on a Blue Angels jet.

In all, more than 40 aircraft from the golden age to the space age are on display.

In the Personal Courage Wing, interactive exhibits include 28 stunning fighter planes. This space is dedicated to stories of heroism, determination and sacrifice of those involved in aviation during World War I and World War II. You’ll have access to the museum’s flight simulators. Participants experience state-of-theart audio-visual excitement and tilting motion as part of the virtual Desert Storm Strike program. You can learn the history, role in flight safety, and computer technology of flight simulators.

Several post-conference tours are available, including an Alaskan Cruise! A full list of tours is available online. For the most upto-date information, please visit aapm.org.

FYI •The 2005 AAPM Membership Directory was mailed to members the end of February. A total of 536 members elected not to receive a printed 2005 Directory vs. 426 last year. This is a 25% increase. We saw a 12% increase from 2003 to 2004.

•The AAPM Member Profile now has a new field, “Conflict of Interest.” This area was created to satisfy the self-reporting of

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conflicts per the new AAPM policy, “The American Association of Physicists in Medicine Policy on Disclosure of Personal Involvements and Other Matters Potentially Affecting Association Service,” and can be updated at any time. To view the policy, go to: http://aapm.org/AAPM Utilities/policies/details.asp?id= 200&type=PP.

Staff News Heather Dixon resigned from the receptionist position in January to take another position. As of February 15, we are using a temporary staff person to assist us while we conduct a search for a replacement.

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Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD

FDA Mammography Guidance on Artifact Testing The FDA posted a new announcement regarding the System Artifacts Test granting an extension of the time limit on strict enforcement through the end of September 2005. This new announcement supersedes the FDA announcement of December 8, 2004. This action is a result of the AAPM requesting that the FDA delay the enforcement of this interpretation in order that the AAPM could work with appropriate groups to develop and sub7

mit an alternate standard. The new posting can be found at: http:/ /www.fda.gov/cdrh/mammography/120804memo.html.

The AAPM has developed a data collection template in order to generate the data necessary to support the development of an alternate standard. The template (See Fairobent - p. 8)

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Fairobent

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(from p. 7)

is available on the AAPM Web site. If you have not submitted your data, please go to the AAPM Web site and follow the instructions for doing so. The data is critical to developing the alternate standard. The AAPM thanks all its members for assisting us in this effort. Progress on this issue will be posted to the AAPM Web site and discussed in future columns.

President Bush Appoints Two New Nuclear Regulatory Commissioners With the appointment of Drs. Gregory B. Jaczko and Peter B. Lyons, the NRC Commission is at full compliment. The three other members serving their second terms are: Dr. Nils J. Diaz, chair (term ends June 2006); Mr. Edward McGaffigan, Jr. (term ends June 2005), and Mr. Jeffrey S. Merrifield (term ends June 2007). Because Drs. Jaczko and Lyons were recess appointments, they will only serve for two years until the end of the 109th Congress. The following biographies are from the NRC Web site.

“The Honorable Gregory B. Jaczko was sworn in as a Commissioner of the U.S. Nuclear Regulatory Commission on Jan. 21, 2005. Immediately prior to assuming that post, Dr. Jaczko served as appropriations director for Sen. Harry Reid (D-NV) and had also served as the senator’s science policy advisor.

In addition, he has been an adjunct professor at Georgetown

University, teaching a science and policy course. Dr. Jaczko’s professional career has been devoted to science and its use and impact in the public policy arena.

Previously, he worked as a congressional science fellow in the office of Rep. Edward Markey (DMass.) and later advised members of the Senate Committee on Environment and Public Works on nuclear policy and other scientific matters. Originally from upstate New York, Dr. Jaczko earned a bachelor’s degree from Cornell University and a Ph.D. in particle physics from the University of Wisconsin-Madison. He is a resident of Washington, D.C.” “The Honorable Peter B. Lyons was sworn in as a commissioner of the U.S. Nuclear Regulatory Commission on January 25, 2005. Dr. Lyons brings to the NRC eight years of experience as a science advisor to Sen. Pete Domenici (R-N.M.), and the Senate Energy and Natural Resources Committee. From 1997 to 2002, he focused on military and civilian uses of nuclear technologies, national science policy and nuclear nonproliferation.

More recently, he was involved with issues on national and international nuclear policy, energy research and development, and hydrogen technology. From 1969 to 1996, Dr. Lyons worked in progressively more responsible positions at the Los Alamos National Laboratory. During that time he served as director for industrial partnerships, deputy associate director for energy and environment, and deputy associate director-defense research and applications. While at Los 8

Alamos, he spent over a decade supporting nuclear test diagnostics. Dr. Lyons has published more than 100 technical papers, holds three patents related to fiber optics and plasma diagnostics, and served as chairman of the NATO Nuclear Effects Task Group for five years. A native of Nevada, Dr. Lyons received his doctorate in nuclear astrophysics from the California Institute of Technology in 1969 and earned a bachelor’s degree in physics/ math from the University of Arizona in 1964. In addition, Dr. Lyons was elected to 16 years on the Los Alamos School Board and spent six years on the University of Mexico-Los Alamos Branch Advisory Board. He is a resident of Virginia.”

Conference of Radiation Control Program Directors Update The CRCPD announces a new executive director – Thomas A. Kerr replaces Ron Fraass who resigned in November 2004 to take a position at the Environmental Protection Agency. Mr. Kerr comes to the CRCPD with a BS in Corporate Training (areas of expertise are Radioactive Waste Management, Public Policy and Health Physics).

The CRCPD designates a new liaison to the AAPM – Ms. Debbie Gilley, environmental manager, Department of Health Bureau of Radiation Control for the state of Florida. Ms. Gilley also served on the CRCPD Board of Directors and is cur-

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rently the Healing Arts Council chair.

AAPM wishes to thank Dr. Jill Lipoti, assistant director for Radiation Protection Programs & Release Prevention for the state of New Jersey, for the many years she served as the CRCPD liaison to the AAPM. Jill’s insight and understanding of the technical as well as the political and regulatory issues have been recognized by many organizations and appreciated by the AAPM. We wish Dr. Lipoti well as she moves on to other endeavors.

Food and Drug Administration Update FDA 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.

In my last article I discussed that the 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). 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 comment period was due to close January 16, 2005. However, due to com-

ments received, the comment period has been extended awaiting publication of draft guidance related to Exploratory Investigational New Drugs (INDs). A new closing date has not been announced.

In this discussion there were four references mentioned that I forgot to list. They are: 1. Preston, D.L., Y. Shimizu, D.A. Pierce, A. Suyama, and K. Mabuchi, “Studies of mortality of atomic bomb survivors, Report 13: Solid cancer and noncancer disease mortality: 19501997,” Vol. 160, No. 4, pp. 381-407, Radiation Research, 2003.

2. International Commission on Radiological Protection, “1990 Recommendations of the International Commission on Radiological Protection,”’ Annals of the International Commission on Radiological Protection (ICRP), ICRP Publication 60, vol. 21, No. 1-3, pp. 1-201, 1991.

3. National Council on Radiation Protection Measurements (NCRP), “Limitation of Exposure to Ionizing Radiation,” NCRP Report no. 116, Bethesda, MD, 1993.

4. National Council on Radiation Protection and Measurements, “Principles and Application of Collective Dose in Radiation Protection,” NCRP Report No. 121, Bethesda, MD, 1995.

Also, to clarify from my article in the last issue, RDRC stands for the Radioactive Drug Research Committee. The details of the RDRC program are described in the Code of Federal Regulations, ■ Title 21, Part 361.

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Education Council Report

Herb Mower Council Chair Each year the president-elect issues a ‘call to serve’ notice. Have you ever wondered what happens to the responses? The president-elect often makes a direct appointment. Other names are forwarded to the appropriate chairs for action. I am sure that I will miss some but, as a result of this, we welcome in various capacities in the Education Council tree the following members who have indicated an interest to serve: Matthew West, Muthana Al-Ghazi, Jian Want, Eugene Lief and Brian Methe.

Summer School Proceedings The Summer School Subcommittee is again reviewing the best method of providing the proceedings to attendees and making the completed volume available after the school. Over the years we have done softcover editions, hardcover editions, photocopied material at the school and CDs. (See Mower - p. 11)

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Mower

(from p. 9)

The question before the committee is how best to address the needs of the attendees and the membership in a financially responsible means. If you have any thoughts on this, please communicate them to Paul Feller or to me.

Summer School 2007 The committee is still looking for possible topics for this school. In keeping with the natural progression of topics, this is probably a year for a good “general diagnostic” topic. Forward any suggestions to Paul Feller.

Medical Physics at the RSNA As we go to press we have the following scheduled for RSNA 2005, in addition to the regular refresher tracks and tutorials: •Physics for Residents topic: Multi-detector / Cardiac CT

•Equipment selection topic: Digital Radiography •Basic Physics Lecture for Technologists: PET/CT and SPECT/ CT Believe it or not, we project topics for the RSNA meeting three years in advance. Thus, during 2005 we will be deciding upon the topics for 2008. If you have any suggestions, contact Perry Sprawls.

History Committee Under the direction of its new chair, Bob Gould, the committee is making plans for the celebration of the association’s 50th birthday. The magic year? 2008!

In preparation for this they will have short presentations on the historic perspective of medical physicists in emerging clinical disciplines at the 2005 (Seattle), 2006 (Orlando) and 2007 (Minneapolis) AAPM meetings.

Please let the committee know if you have some items of histori-

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cal interest so that they can be included in one of the presentations.

Education Council ‘Special’ Programs at 2005 Annual Meeting In addition to the many other offerings at the annual meeting in Seattle, the Education Council will be involved with the following ‘special’ programs: •Education Council Symposium on Sunday morning, topic: Physics Residency chaired by Eric Klein •Shipping of Radioactive Materials symposium–repeat of the very successful session by Roy Parker at our 2004 meeting.

•Symposium on Wednesday afternoon entitled “Teaching Diagnostic Physics to Radiology Residents.”

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Report on the Recruitment of Young Physicists Rene J. Smith Subcommittee Chair One of the priorities of the last few AAPM presidents, as well as our new president, Howard Amols, and the new chairman of the board, Don Frey, is the recruitment of young physics majors into Medical Physics. As chair of the Subcommittee for the Recruitment of Young Physicists into Medical Physics, I would like to encourage all of you to get as

active as possible in your community. The AAPM Public Education Committee has a set of slides on PowerPoint that I have used very effectively. It is an excellent introduction to our field and you can use it as is, or you can use part of it. I gave a presentation at a local university and was asked to come back and give a lecture on different imaging modalities. Some of the students want to visit the hospital where I work and this is an ex-

cellent way to attract young physics majors into our field. I also had a chance to spend a day during the holidays with a very enthusiastic young man who wants to enter our field. From personal experience, I can assure you that an informal lunch with the chair of the Physics Department of your local college or university can also work wonders. As an added "side effect," you will have a lot of fun talking with these enthusiastic young men and women.

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2005 MARCH/APRILMARCH/APRIL 2005

Update on Radiation Dose in CT Richard Nawfel Terry Yoshizumi Radiation Protection Committee The purpose of this article, prepared by the AAPM Radiation Protection Committee, is to raise awareness of the patient dose issue in today’s MDCT scanners.

Data in this article should not be used to compare dose performance between different manufacturers. Multi-detector CT (MDCT) scanners were introduced in 1998. Today, we are witnessing continuous leaps in CT technologies. For example, the state-of-the-art CT scanners provide faster tube-rotation times (less than 0.4 seconds for a full rotation), greater anode heat capacity (greater than 8 MHU for current MDCT scanners when compared with 2-3 MHU of single-slice helical CT scanners in the late 1980s).

There are many factors that influence patient dose in modern MDCT scanners: (a) choice of tube potential, (b) tube current, (c) tube rotation time, (d) slice thickness, (e) pitch factor, (f) beam filter, (g) geometric efficiency, (h) shorter focal spot to center-of-rotation distance, and (i) patient thickness.

In addition, the scope of clinical CT applications has expanded from traditional diagnostic radiology procedures to applications for cardiac CT angiography, radiation oncology cancer staging and treatment planning, and PETCT. As a result, accurate dose

information seems to be lagging behind the technology advancement in the medical physics community.

Concern has been raised in recent years regarding the radiation dose from CT examinations, especially with the use of MDCT and the recent increase in the number of multiple acquisition studies performed. Furthermore, scanning is sometimes performed in anatomical regions where the dose to critical organs may be significant. These doses can vary considerably from scanner to scanner within a medical institution, and also from one institution to another. Thus, qualified medi-

cal physicists should play a role in dose assessment and development of new scan protocols.

Routine CT Studies The following are examples of effective doses (ED) from CT studies at a single institution.

They consist of a spiral acquisition through the anatomical region of interest (chest, or abdomen and pelvis). They are all performed at the same tube potential, 120 kVp, however, the effective mAs, beam collimation, and pitch can vary considerably.

These variations can lead to different doses between CT scanners for the same CT study.

Table 1. Comparison of Effective Dose (mSv) 4-slice

16-slice

64-slice

Chest

8.09

6.91

7.69

Abdomen/pelvis*

8.21

8.47

10.8

Source: Richard D. Nawfel, Brigham and Women’s Hospital (Boston, MA), 2004 data.

Notes: All scanners are Siemens; All ED calculated from measured CTDI; All exams performed at 120 kVp. *See Reference (1)

Specialized CT Studies Furthermore, the organ dose from some examinations can be quite high in both adult and pediatric patients. One example is the breast dose received from coronary CT angiography (CTA) or pulmonary embolism (PE). This high dose in CTA is due to the very low pitch used.

12

In pediatric CTA, breast dose has been reported as 35, 84, and 126 mGy for low, medium and high scan protocols.(2) ED comparison for pediatric CTA is shown in Table 2. For adult CTA the breast dose can be as high as 40–90 mGy with a pitch 0.375.

This is at least 11-26 times higher than 3.5 mGy received by the breast for a two-view mammo-

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gram, or 2700-6000 times higher than 0.015 mGy breast dose for a PA chest exposure. ED comparison for adult CTA is shown in Table 3.

For PE, the breast dose can range from 43 – 66 mGy.(3) Once again, in comparison, this is 12-19 times higher than 3.5 mGy received by the breast for a twoview mammogram, or 28704400 times higher than 0.015 mGy breast dose for a PA chest exposure. Table 4 shows ED for PE. In clinical practice, given that CT doses can vary significantly between scanners or among institutions, it is important for medical physicists to get involved in dose assessment from the outset and not rely completely on values provided by the manufacturer or obtained from another institution. Then, physicists can establish a basis for comparing their doses with national standards, and provide accurate radiation risk estimates at their own institution.

Physicists willing to participate in a follow-up study may contact: Terry Yoshizumi, Duke University, yoshi003@mc.duke.edu, or Richard Nawfel, Brigham and Women’s Hospital and Harvard Medical School, nawfel@bwh. harvard.edu.

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

Table 2. Comparison of Effective Dose in Pediatric CTA (in mSv)

Pediatric CTA*

Low 120 mA

Medium 220 mA

High 330 mA

7.4 +/- 0.6

17.2 +/- 0.3

25.7 +/- 0.3

*Note: For details, see reference (2); GE 16-slice CT scanner. Measured with a CIRS five-yr old pediatric phantom and MOSFET detectors. GE snap shot burst plus, 120 kVp, 16 x 0.625 mm, 0.5 sec tube rotation, pitch 0.275.

Table 3. Comparison of Effective Dose in Adult CTA Scanner

ED (mSv)

Adult CTA*

GE 16-row

20.6 +/- 0.4

Adult CTA**

Siemens 16-row

18.8

*Source: Terry Yoshizumi, Duke University Medical Center (Durham, NC), 2004 data.

Notes: Data taken with MOSFET dosimeters in CIRS Phantom with a GE 16row CT scanner. Scan protocol: 120 kVp, 320 mA, pitch 0.375, 0.5 sec tube rotation. Reference (3). ** Source: Richard D. Nawfel, Brigham and Women’s Hospital (Boston, MA), 2004 data.

Scan protocol: 16-row Siemens scanner, 120 kVp, 550 mAs (effective mAs), pitch 0.28, 0.42 sec tube rotation.

Table 4. Effective Dose in PE (in mSv)

PE*

Scanner

ED (mSv)

GE 16-row

14.4 +/- 2.1

*Note: Reference (3) GE 16-slice CT scanner. Measured with a CIRS adult female phantom and MOSFET detectors. Duke PE scan protocol used: 140 kVp, 380 mA, 0.8 sec tube rotation, pitch 1.375.

REFERENCES: (1) Nawfel RD, Judy PF, Schleipman RA, Silverman SG. Patient Radiation Dose at CT Urography and Conventional Urography. Radiology 2004; 232:126-132.

(2) Hollingsworth C, Chan FP, Yoshizumi T, Frush DP, Nguyen G, Lowry C, Toncheva G, Hurwitz L. Pediatric Gated Cardiac CT Angiography: What is the radiation dose? Presented at the 90th RSNA Scientific Meeting, Nov. 28 - Dec. 3, 2004, McCormick Place, Chicago, IL. (3) Courtesy of Lynne Hurwitz, M.D., Duke University (unpublished data 2004).

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AAPMNEWSLETTER NEWSLETTER AAPM

2005 MARCH/APRILMARCH/APRIL 2005

IEC Activities and the Diagnostic Medical Physicist Cynthia H. McCollough AAPM Liaison to IEC Subcommittee 62B: Diagnostic Imaging Equipment In 1904, leaders in science and industry from around the world gathered in St. Louis, Missouri to discuss the need for cooperation and standardization of electrical equipment and machinery. This meeting led to the establishment of the International Electrotechnical Commission (IEC) in 1906. In 1907, interested groups within the U.S. formed the U.S. National Committee of the IEC (USNC) to oversee our country’s participation in IEC activities. The work of the USNC is administered through the American National Standards Institute (ANSI). Specific comments on draft international standards and the U.S. vote on such standards are forwarded to the IEC via ANSI and the USNC Technical Advisory Group (TAG).

So what does this hierarchy of acronyms have to do with the practice of diagnostic medical physics within the U.S.? Why should the U.S. medical physicists care about the content of an IEC document, which sets forth numerous detailed specifications for equipment, safety, performance and testing? The reason is simply this: in today’s global marketplace, manufacturers of medical imaging devices must comply with IEC standards to sell their equipment in countries through-

out the world. While the U.S. is not necessarily one of these countries (IEC standards do not have the direct force of law in the U.S.), many IEC standards are formulated into law in numerous other countries. Since the manufacturers desire to streamline testing and compliance issues, the steps that they take to meet an IEC standard in a particular product in Asia and European countries are integrated into the product that we will use here in the United States.

In CT, for example, the display of CTDI dose values was mandated by an IEC safety standard and adopted as law in the European community. Thus, the U.S. market was equipped with this capability in order to satisfy the European requirement. A more dramatic example can be found in the definition of pitch. In the early days of multi-slice CT, two distinct definitions of pitch evolved which caused considerable confusion within the CT community. Because the IEC addressed the issue, requiring that pitch be defined in terms of the total nominal radiation beam (and not just the width of the individual detector element or data channel), the definition of pitch was standardized once again. Although no state or federal laws in the U.S. require the use of IEC pitch, the requirements of a global marketplace facilitated the implementation of a single pitch definition abroad and in the U.S. 14

Thus, the contents of IEC standards have substantial and longrange effects within the U.S. radiology and medical physics communities. Unfortunately, the AAPM has had very little direct input into the standard-making process of the IEC because so few of its members are involved in the activities of the Diagnostic Imaging Subcommittee and its various working groups and maintenance teams (working groups are formed to develop new standards; maintenance teams review, revise and update existing standards).

As the diagnostic imaging liaison from the AAPM to the IEC, I hope to facilitate increased participation in the IEC process by AAPM members. Steve Balter and Ehsan Samei are active with the IEC, as are AAPM members working with the FDA (though their role is to speak for the FDA and not necessarily the AAPM).

I’d like to create a more complete list of AAPM members who are active in the diagnostic imaging activities of the IEC, or who would like to be. Please drop me an e-mail at mccollough.cynthia @mayo.edu with your name, contact information, area of expertise, and CV if you’d like to serve the AAPM in this capacity.

This will enable me, together with the Diagnostic Imaging Committee of the AAPM, to select reviewers for draft standards as they are sent to me for review.

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AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

Results of the 2004 AAPM Research Committee Survey How much research do AAPM members actually do?

Paul Keall On behalf of the AAPM Research Committee To date, there has been a significant dearth of knowledge of the status of the research funding support from AAPM members and the research productivity of AAPM members. To remedy this situation, the AAPM Research Committee wanted to provide to the AAPM members and executives quantitative statistics regarding the current status of medical physics research productivity and funding by its members. The information is useful (1) as general information for members, (2) for lobbying grant-funding bodies for increased consideration of medical physics applications and (3) for strategic planning purposes of the AAPM Executive Committee.

To this end, in May 2004, all North American resident AAPM members were requested to participate in a general survey. Sixtyone percent of you (2099 members) completed this survey (congratulations and thank you for the high turnout!). Survey respondents who had been a Principal Investigator (PI) on a grant (243 members) or had published a research article in a peer-reviewed journal (751 members) within the past three years received additional research-related questions.

Efforts were made in the survey design to minimize duplication of information by respondents.

The overall aim of the survey was to quantify: • The total amount of research effort by AAPM members • The total amount of research effort allocated to AAPM members by their employers • The total amount of financial research support for AAPM members • The productivity of AAPM members in terms of research output • The distribution of research effort and support by subspecialty (e.g. therapy, diagnostic) • The distribution of research effort and support by institution type (academic, hospital, free standing) • The distribution of research effort and support by funding source (institutional seed grants, commercial, federal) • The distribution of research effort and support by investigator degree and years of experience The survey results are can be found at http://www.aapm.org/ pubs/#survey (click on “2004 Research”) on the AAPM Web 15

site. However, to whet your appetite, a brief summary of this information is given below.

Almost all (97%) of the PIs held a PhD degree, though PhDs were only 51% of the respondents of the general survey. More than two-thirds of the PIs held two or more grants. Over one-third of the respondents had published an article in the last few years, which indicates a broad research commitment within the AAPM membership. Eighty-one percent of the journal article authors held PhDs. For those authors and PIs, 18 and 26 hours on average per week, respectively, were dedicated to research. However, in most cases (~70%) our employers are not allocating time for these activities. Of the 326 grants described in the survey, most were awarded for two–four years. Seventy percent of these awards were for over $100,000, with 32% for over $500,000.

In summary, over one-third of the membership has published articles over the past three years and these authors spend around 20 hours per week dedicated to research. Congratulations—as a profession this is very positive.

Also, most of us are nobly spending our own time on research-related activities, as our employers do not generally allocate us time– even for those who are PIs of research grants. We also donate (See Keall - p. 16)

AAPM NEWSLETTER NEWSLETTER AAPM

Keall

2005 MARCH/APRILMARCH/APRIL 2005

(from p. 15)

much time mentoring students and post-doctoral fellows. For those funded, the largest share comes from the National Institutes of Health, though industry and other sources contribute a significant amount. We are somewhat savvy about intellectual property protection.

Based on the survey, some recommendations for the researchoriented medical physicist include: • Negotiate protected research time with employers • Continue to conduct and report on high quality research • Protect valuable intellectual property • Continue to mentor post-doctoral fellows and students • Seek funding to continue the good work The Research Committee acknowledges the contributions of Raymond Chu and Megan Henly from the Statistical Research Center of the American Institute of Physics for conducting the survey and analyzing the results. We also acknowledge the input of Brett Poffenbarger, the chair of the AAPM Professional Survey Subcommittee. Feedback on the survey and ideas for additional information to be included in future surveys are welcome (contact pjkeall@vcu.edu).

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Results of the 2004 CAMPEP Questionnaire Brenda Clark On behalf of the CAMPEP Board In March 2004, CAMPEP circulated a questionnaire eliciting input from the general medical physics community on CAMPEP accreditation processes for graduate and residency programs. The accreditation of continuing education programs was not addressed in this questionnaire.

By June 10, 2004, we had received 160 responses from individuals working at approximately 125 different institutions; 60 and 49 from individuals in institutions offering graduate and residency programs, respectively. Of the responses from individuals working in institutions with established programs, approximately 35% were accredited by CAMPEP. This level of response and the overwhelmingly positive input indicates a strong level of support for CAMPEP activities, which is encouraging.

The appendix gives the numerical response to the eight questions asked in the survey, from which it can be seen that, in general, the perception among the respondents is that CAMPEP accreditation is seen as a positive and worthwhile endeavour.

Many of the respondents took the trouble to add comments and a summary is given here.

The comments can be grouped into several issues, and in many 16

cases similar ideas were expressed by several respondents.

The main issues raised were: the perceived relevance of accreditation, the flexibility of CAMPEP accreditation and CAMPEP’s application process.

Perceived Relevance This group of comments contained responses indicating that many members of the community are unaware of the relevance and value of accreditation. It was also stated that as accreditation is not yet recognized by board certification bodies or licensing agencies, it is difficult and sometimes impossible to obtain institutional support for accreditation activities.

Accreditation should be seen as a public recognition that an educational program has met national standards and also as a tool to ensure that education programs enable their students to be competent practitioners. To date, accreditation has been widely embraced in the medical field and most of us work in facilities that are accredited by the appropri-

AAPM NEWSLETTER AAPM NEWSLETTER

ate body. However, accreditation is not yet seen as relevant in some other educational areas, illustrated by the fact that few universities or university programs are accredited.

These comments have clearly identified the need to raise awareness within the community, and the members of the CAMPEP Board have agreed on several courses of action. Among these, the Web site will be revised to be more informative, program graduates will be sought to write articles for publication describing personal experiences with accredited programs, data on relative performance of graduates in certification examinations will be sought, and a symposium on accreditation is planned for next year’s annual meeting(s).

Flexibility of CAMPEP Accreditation This group of comments highlighted the perception that achieving accreditation relies on conforming to a predetermined set of criteria with little flexibility.

There were also several questions concerning the requirement that graduate programs have a minimum of eight students.

The board’s response to this issue is threefold. First, the accreditation application guidelines posted on the Web site describe a typical program and do not represent a rigid requirement. The program review committee members are flexible on various aspects of program structure and content. The two program review committees have been asked to review the wording of the guidelines to emphasise this flexibility.

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

Second, CAMPEP’s Graduate Education Program Review Committee (GEPRC) was asked to review the requirement relating to program size. The response from the GEPRC is that although the guidelines recommend that a minimum of eight students are enrolled in the program, in practice, accreditation has not been denied on the basis of low student numbers alone. There is no such limitation in the requirement for residency training programs.

Third, it should be pointed out that CAMPEP has accredited programs having a focus and greater strength in either imaging or therapy. While it is recognized that medical physicists require a basic knowledge in both areas, it is not always feasible for a center to offer students comparable depth in both topics.

(See Clark - p. 18)

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AAPMNEWSLETTER NEWSLETTER AAPM

Clark

2005 MARCH/APRILMARCH/APRIL 2005

(from p. 17)

The Application Process Feedback on this topic reflected the concern around the documentation, resources and administrative support required for accreditation application. CAMPEP has recently moved to a templatebased application which should serve to standardize the application format (but not the programs!). Not only will this assist the program directors making the application, but it will also greatly streamline the review process.

Efforts will also be made to emphasize the value of the self-study required by the application and

to recommend that this document be kept up-to-date. This practice will facilitate regular program review and greatly reduce the effort required to apply for reaccreditation.

Summary Since itâ&#x20AC;&#x2122;s formation in 1995, CAMPEP has grown and developed with the needs of the community to the level where now we estimate that more than half of all medical physics graduate students attend an accredited program. Accreditation of residency training is also on an upward trend. The strength and value of CAMPEP accreditation is best evaluated by the response of our

clientsâ&#x20AC;&#x201D;the students. This response has, in recent years, been clearly in support of accreditation, with those programs achieving and maintaining accreditation being clearly favored by the student applicants. The input from this questionnaire will be used by the CAMPEP Board and committee members to maximize relevance of our activities and to ensure continuing credibility of our processes. Above all, the objective is to accredit programs in which the student can expect to have a comprehensive quality educational experience in medical physics, with the emphasis on quality.

Appendix Key: Strongly Disagree=1

Strongly Agree=5

(1) If I had an opening for a staff physicist, all other things being equal, I would hire a physicist who had completed a CAMPEP accredited residency program.

(2) If I had an opening for a resident in radiation oncology physics, all other things being equal, I would hire a physics graduate from a CAMPEP accredited program.

60 50

Count

(3) CAMPEP accreditation provides a meaningful confirmation that the educational program functions at an acceptable standard.

40 30 20 10 0

0

18

1

2

3

Response

4

5

6

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JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

(4) The CAMPEP requirements for accreditation are reasonable.

(5) The CAMPEP requirements and guidelines for accreditation are clear.

(6) The teaching resources required to run a CAMPEP accredited program are reasonable.

(7) The effort required to apply for CAMPEP accreditation is justified.

30 25

Count

(8) CAMPEP offers support and encouragement to institutions considering applying for accreditation.

20 15 10 5 0

0

1

2

3

Response

4

5

6

â&#x2013;

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AAPM NEWSLETTER NEWSLETTER AAPM

2005 MARCH/APRILMARCH/APRIL 2005

News from CAMPEP Brenda Clark CAMPEP President The Residency Program Review Committee has recently been busy completing initial reviews for two programs for which site visits have been scheduled. Two new applications have been received and are under initial review. If all these program applications are successful, the total number of accredited residency programs will rise to 14.

The Graduate Program Review Committee is in the process of reviewing three program applications.

I am happy to report that the new software for CEC applications is now in the final testing phase with a release date in sight. Thanks to Lisa Rose Sullivan and Bruce Thomadsen, among others, for all the hard work.

On the Web site, we have placed a general introduction to accreditation activities (in general), and CAMPEP (in particular) on the initial page.

We shall shortly be adding introductions to the three different committee pages with the aim of adding clarity to our accreditation processes.

Chapter News News from the Great Lakes Chapter Jean M. Moran Chapter Past President On November 6, 2004, the Great Lakes Chapter of the AAPM held a Young Investigators and Image-Guided Therapy Symposium at the London Regional Cancer Centre (LRCC).

The meeting was a great success with 140 attendees from Canada and the United States. Qualified medical physicists were eligible for CAMPEP credits for attending the program.

the winner of the Young Investigators Competition. The chapter would like to thank Dr. Randy Ten Haken for taking the enclosed photographs from our November 6 meeting.

The Image-Guided portion of the program began with presentations by two developers of image-guided technology. Overviews were presented by Dr. Rock Mackie of the University of Wisconsin-Madison and Tomotherapy, Inc. on Tomotherapy, and by Dr. David Jaffray of Princess Margaret Hospital in Toronto on Conebeam CT. Dr. Tomas Kron of

Pictured are 15 of the 16 students from institutions in Michigan and Ontario, Canada who gave presentations at the symposium.

Sixteen students from institutions in Michigan and Ontario, Canada gave excellent presentations on topics such as imageguidance, optimization, Monte Carlo modeling, and dosimetry.

Student presentations were evaluated based on their scientific content, quality of presentation, and knowledge of the subject. Dylan Hunt from Sunnybrook Health Sciences Centre and the University of Toronto was 20

the LRCC led several groups on tours of their Tomotherapy unit.

He also gave a presentation on Tomotherapy research topics at the LRCC. The program continued with a presentation by Dr. Fang-Fang Yin, formerly of Henry Ford (currently at Duke University), on clinical applications of kV imaging at the Henry Ford Health System. The grand finale of the day was a panel discussion between Drs. Jaffray,

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Dr. Tomas Kron with his umbrella so attendees could find him while touring the LRCC Tomotherapy Unit.

Mackie and Yin and moderated

by Dr. Colin Orton with questions from the audience to discuss challenges facing implementation of image-guidance in clinical practice.

Jake Van Dyk at the LRCC was co-organizer of the program with the GLC-AAPM. He also served as the local arrangements coordinator for the meeting. This

meeting was made possible with sponsorship from the following companies: CMS, Elekta, Implant Sciences, Modus Medical, Nucletron, Oncura, Philips, RadioMed Corporation, Siemens, Standard Imaging, Tomotherapy, and Varian.

The chapter recently set up three committees to aid in the transition between officers. We are happy to announce the service of Praveen Dalmia - chair of the Finance Committee, Colin Orton – chair of the Fellowship Nomination Committee, and Marty Johnson – chair of the Ski Weekend Meeting Committee. In addition, the newly elected officers for the chapter are Bruce Curran - presidentelect, Misbah Gulam – secretary, and Rabih Hammoud – treasurer. Iris Ouyang is the current chapter president. Vrinda

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

Narayana continues as the board representative.

Finally, the GLC-AAPM held its 17th annual ski meeting at Shanty Creek in northern Michigan on January 14-16, 2005. The weekend began with a reception cohosted by Iris Ouyang and Marty Johnson. After a day of skiing or snow tubing with their families, members enjoyed a presentation by Dr. Randy Ten Haken from the University of Michigan appropriately titled, “How Steep’s that Slope? Muddling, Meddling and Modeling Normal Tissue Complication Probability.” Afterwards, families joined the chapter members for a delicious buffet. The chapter would like to thank Elekta, LACO, Landauer, North American Scientific, Philips, and Siemens for their generous support of this meeting.

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RAMPS Activities in 2004 Doracy P. Fontenla Chapter Secretary, on behalf of the RAMPS Board of Directors The New York Chapter (RAMPS) meets about eight times a year. Meetings are usually held on the third Tuesday of the month with an invited speaker each time. All meetings start with a half-hour social gathering, and are followed by a dinner. The board of directors meets before the invited speaker seminar at each meeting, which is open to the membership. An announcement of each meeting is sent in

advance to the members via email, and all members are strongly urged to participate.

The first meeting of the year is held in conjunction with the Greater New York Health Physics Society and is dedicated to the Failla Award. This year’s awardee was William Hendee, PhD of the Medical College of Wisconsin, who spoke on: “Are the standards for practice of medical physics too low to ensure healthcare quality and patient safety.”

The second meeting is dedicated to the “Sal Vacirca Young Investigators Symposium.” The 21

ten speakers where: Jussi Sillanpaa, Ross Schmidtlein, Andrei Pugachev, Alex Pevsner, Fan Liu, Xiang Li, Sung Jang, Visruta Dumane, Bulent Aydogan, Onuora Awunor.

The board of directors judges the presentations. For the first prize, the AAPM annual meeting expenses are covered by RAMPS. All participants are invited to the RAPHEX-RAMPS dinner, which usually occurs in June. All the presentations were at an excellent level.

The winner for the first place was Dr. Ross Schmidtlein who (See Ramps - p. 22)

AAPM NEWSLETTER NEWSLETTER AAPM

Ramps

2005 MARCH/APRILMARCH/APRIL 2005

(from p. 21)

spoke on ‘Validation of GATE for Characterizing PET Imaging Artifacts.’

Jong H Kung, PhD, of Mass.

General Hosp/Harvard Med School spoke at the April meeting on “Dose Verification to Static and Moving Organs (Lung Tumors) in IMRT.” The Spring Symposium on “Advancing Radiation Oncology Planning through an Understanding of Biology” took place in May. The objective was to address incorporation of real world biology into radiotherapy. The speakers included Richard Stock, M.D., professor and chair of Radiation Oncology, Mount Sinai Medical Center; Jamie Cesaretti, M.D., assistant professor of radiation oncology, Mount Sinai Medical Center; Ellen Yorke, PhD, associate attending physicist, Department of Medical Physics and Memorial Sloan-Kettering Cancer Center ; David Brenner, PhD, DSc., professor of radiation oncology and public health, Columbia University; John Humm, PhD, attending physicist of medical physics, Memorial SloanKettering Cancer Center; and Gikas Mageras, PhD, attending physicist of medical physics, Memorial Sloan-Kettering Cancer Center.

The business meeting was held in September and hosted, as usual, by the AAPM presidentelect for the incoming year.

Howard Amols, PhD presented “Next Year at AAPM: L’Etat C’est Moi.” Stephen Balter, PhD spoke in October on “Radiation Imaging

Hazards in Interventional Fluoroscopy and kV Radiation Therapy Imaging.”

The December meeting is generally dedicated to a Mammography Mini-Symposium in order to facilitate to RAMPS members the mammography credits needed. Unfortunately this was not possible to happen this year.

The Ramps Board of Directors is composed of Robert Barish (treasurer), Doracy Fontenla

22

(secretary), John Humm (past president) Eugene P. Lief (board member-at-large), Yeh Chi-Lo president-elect), Yakov Pipman (AAPM chapter representative), Sharon Thompson, (board member-at-large) and J.Keith DeWingaerth (president).

The new officers for 2005 are: John Humm (AAPM chapter representative) and Eugene P. ■ Lief (president-elect).

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

New Members The following is a list of ‘Change of Status’ and ‘New Members’ from October 2004 – January 2005.

Change of Status Corresponding Shada Wadi Ramahi Jubehiha, JORDAN

Full Randi F. Aaronson Richardson, TX Chris E. Allgower Bloomington, IN Ande Bao San Antonio, TX Joseph D. Bauer New York, NY Chris Beltran Rochester, MN Nasir U. Bhuiyan Houston, TX David M. Bower Lafayette, LA Edward D. Brandner Greensburg, PA Maria Bunta Cedar Rapids, IA Laura E. Butler Nashville, TN Jonathan B. Caldwell Elk Grove, CA Marco C. Carlone Edmonton, AB CANADA David K. Chamberlain Reno, NV Nicolas Charest Burlington, VT Josephine Chen Oakland, CA Zuoqun (Jay) Chen Philadelphia, PA Christopher Patrick Cherry Austin, TX Nathan L. Childress Houston, TX Jeremy F. Cole Boynton Beach, FL Bryan C. Coopey Portland, ME John W. Cure Lynchburg, VA Lawrence T. Dauer New York, NY Svetlana I. Denissova Saint John, NB CANADA Darrin C. Edwards Chicago, IL Martin P. Egan Phoenix, AZ

Idris A. Elbakri Denver, CO Kevin Fallon Chalfont, PA Mathew J. Fitzpatrick Houston, TX Louis B. French Galveston, TX Thorsten Frenzel Hamburg, GERMANY Ronald J. Froehlich Lima, OH Steven Anthony Gasiecki Mansfield, OH Chad W. Gerber Belleville, IL Stephen A. Gilliland Buford, GA Maureen C. Grigereit Chesterfield, MO Iuliana Grigoras Middletown, NY Bruce Y. Gu St. Peters, MO Shuntong Guo New York, NY Chris R. Hagness Waterloo, IA Homayoun Hamidian Houston, TX Paul A. Hanny Wright-Patterson AFB, OH Joseph D. Hodges Bossier City, LA Wadih Homsi New York, NY Kai Huang Los Angeles, CA Geoffrey D. Hugo Royal Oak, MI Gerard B. Huppe La Mesa, CA Stephen P. Iorio Freehold, NJ Nina Kalach New York, NY Bassel Kassas Houston, TX Kevin D. Kelly Savannah, GA Lisa Kaye Kennemur San Diego, CA Harjinder Singh Khaira Cincinnati, OH Delsin Khan-Boney Suffolk, VA Amanda L. Krintz Springfield, MO

Alexander LC. Kwan Sacramento, CA Renee X. Larouche Salina, KS Yi Le Richmond, VA Sung-Woo Lee Dalton, MA Kaile Li Belair, MD Jun Li Charleston, SC Jun Lian Chapel Hill, NC Patricia E. Lindsay St. Louis, MO Ruijie Rachel Liu Houston, TX Wei Lu St. Louis, MO Kyle E. Malkoske Winnipeg, MB CANADA Merrill L. Mann Denver, CO Peter Manser Burgdorf, SWITZERLAND Ivaylo B. Mihaylov Richmond, VA Silvana C. Oliveira Allentown, PA John A. Olmsted Charlotte, NC Robin H. Overton Blythewood, SC Kamen A. Paskalev Philadelphia, PA George Pavlonnis Collinsville, CT Silvia Pella Boca Raton, FL Stanley V. Phillips Cuyahoga Falls, OH Kerry L. Rhyasen San Jose, CA Jeff J. Richer Windsor, ON CANADA Emily Y. Robinson Honolulu, HI Iris A. Rusu Maywood, IL Colm A. Saidléar Dublin 1, IRELAND Molly Scheffe Carlisle, MA Charles R. Schmidtlein New York, NY Jussi K. Sillanpaa New York, NY

23

Julie A. Skipper Dayton, OH Lawrence J. Slate Green Acres, WA Brett D. Smith Orland Park, IL Jun S. Song Somerville, MA Theodore R. Steger Waukesha, WI Roger D. Stevenson II New York, NY Deborah L. Stratman Waukesha, WI Michael T. Sullivan Baton Rouge, LA Juilien H. Svoboda New Orleans, LA Jeffrey Tays Roswell, GA Alida Tei Chelmsford, MA Sugata Tripathi Marshfield, WI Takele D. Tsegaye Rochester, MN William P. Wojciechowski Bayville, NJ Gin-Weigh Wu Long Branch, NJ Junqing Wu Baltimore, MD M. Ming Xu Naperville, IL Sua Yoo Detroit, MI Yongjian Yu Charlottesville, VA Yunkai Zhang Chicago, IL Guowei Zhang Baltimore, MD

Junior Erin R. Barnett Surrey, BC CANADA Michael L. Beach Franklin, TN Jeremy P. Blauser St. Joseph, MI Chantal Boudreau Montreal, QC CANADA Chen Chen Wyoming, MI Jongmin Cho Fargo, ND

(See New Members - p. 24)

AAPM NEWSLETTER NEWSLETTER AAPM

New Members

2005 MARCH/APRILMARCH/APRIL 2005 David H. Gultekin Pasadena, CA Leonardo J. Gutierrez New Haven, CT Oscar R. Hernandez San Antonio, TX Yoshiharu Higashida Fukuoka, JAPAN Mary E. Houston Dublin, IRELAND Jiang Hsieh Brookfield, WI Gang Huang Indianapolis, IN Susanta K. Hui Minneapolis, MN Yasumasa Kakinohana Okinawa, JAPAN Yong Ke Willowbrook, IL William Steadman Kiger Boston, MA Sridharan S. Krishnamoorthy McHenry, IL Patrick J. La Riviere Chicago, IL Sergio Lemaitre Milwaukee, WI Xiang Li New York, NY Praimakorn Liengsawangwong Houston, TX Allan Lightman Boynton Beach, FL Edgar G. Loeffler Berlin, GERMANY Parinaz Massoumzadeh St. Louis, MO Yang Meng Houston, TX Feroze B. Mohamed Philadelphia, PA Issei Mori Miyagi, JAPAN Glen E. Naekel Howell, NJ Ramasamy M. Nehru Omaha, NE Andrew Nisbet Oxford, UNITED KINGDOM Edward J. Oâ&#x20AC;&#x2122;Connell Stony Brook, NY Matthew R. Palmer Boston, MA Phillip W. Patton Las Vegas, NV Candace R. Perry Florence, SC Alexander Pevsner New York, NY

(from p. 23)

Gary D. Fisher Dallas, TX Stephen M. Gajdos Cleveland, OH Razvan Gaza Houston, TX Zhong (John) Huang Las Vegas, NV Ravi Kulasekere Copley, OH Shuang Luan Alburquerque, NM Lama K. Muhieddine Cleveland, OH Manish M. Naidu Kent, WA Lindsey M. Patton San Antonio, TX Christina R. Plies Sioux Falls, SD Abhinit Priyadershi Toledo, OH James B. Proffitt Nashville, TN Abhirup Sarkar Newark, DE Kelly J. Slattery Brookfield, CT Sarah M. Way Robbinsdale, MN Lauren Weinstein Berkeley, CA Lisa M. Wilson Las Vegas, NV

Student Laura A. Drever Edmonton, AB CANADA Leonard H. Kim Royal Oak, MI Manuel R. Rodriguez Madison, WI

New Members Associate Mohammed A. Alasmary Makkah, SAUDI ARABIA Craig A. Burch Peabody, MA James E. Dolan New York, NY Matthew R. Dworsak Philadelphia, PA Elizabeth H. Garver Philadelphia, PA Mary Z. Hare Syracuse, NY

Scott A. Kalick Neptune, NJ David L. Leong Seabrook, NH Robert Eugene Peterson Columbus, OH Michael T. Ryan Kiawah Island, SC Richard A. Serrell Port Charlotte, FL Jianning Song Beijing, CHINA

Corresponding Tsi-Chian Chao Tao-Yuan, TAIWAN Peter H. Cossmann Aarau, SWITZERLAND Bunna J. Damink-Koster Roosendaal, NETHERLANDS Jacob Geleijns Leiden, NETHERLANDS Sainz I. Jerez Malaga, SPAIN Chung-Chi Lee Tao-Yuan, TAIWAN Alberto Perez-Rozos Madrid, SPAIN

Full Shamsuddin AdakkaiKadavathu Fisherville, VA Gamal Akabani Durham, NC Auroba L. Al-Samaraee Herndon, VA Finn O. Augensen Morris Plains, NJ Guang-Hong Chen Madison, WI Dongjun Chen Falls Church, VA Robert John Cook Los Angeles, CA Philip M. Cunningham Hamburg, NY Charles A. Curle Raleigh, NC Slobodan Devic Montreal, QC CANADA Vishruta A. Dumane New York, NY Arundhuti Ganguly Palo Alto, CA Mark G. Garcia Albuquerque, NM Beata Gontova Alamogordo, NM

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Thomas G. Purdie Toronto, ON CANADA Dennis M. Quinn Hopewell Junction, NY Jamie R. Quinones Guaynabo, PR Farzad Rahnema Atlanta, GA Gene E. Robertson Mercer Island, WA Hilbrand E. Romeijn Gainesville, FL Zhenyu Shou Pittsburgh, PA Paul Sourivong Omaha, NE James B. Stubbs Alpharetta, GA Akhil Syed San Antonio, TX Michael Tassotto Thunder Bay, ON CANADA H. Julian Tran Longview, WA Shu-Ju Tu Houston, TX Matthew J. Walker Willoughby, OH Congjun Wang Houston, TX Steven Wang Chicago, IL Krishni Wijesooriya Glen Allen, VA Zhitong Yang Oklahoma City, OK Gultekin Yegin Manisa, TURKEY Jing Zhang Shawnee Mission, KS Geoffrey G. Zhang Dallas, TX

Junior Mustafa C. Altunbas Houston, TX Ali V. Aritkan Niia, CYPRUS Bradley A. Beck Salem, OR Tina M. Briere Houston, TX Thomas E. Byrne Knoxville, TN Elizabeth S. Caspari Saint Louis, MO George Ciangaru Houston, TX Jeremy D. Donaghue Erie, PA Mirek Fatyga Richmond, VA

AAPM NEWSLETTER AAPM NEWSLETTER Sandra C. Fontenla New York, NY Ryan D. Foster Omaha, NE Joni L. Funseth-Smotzer Shelbyville, KY Jimm Grimm Huntingdon Valley, PA Chunhui Han Duarte, CA R. Craig Herndon Odessa, TX Yi H. Huang Taichung, TAIWAN Carmen R. KmetyStevenson Rochester, MN Giovanni Lasio Richmond, VA Guang Li Rockville, MD Weidong Li Richmond, VA Lan Luo Paramus, NJ Feng Ma Houston, TX Matthew A. Meineke South Bend, IN Eric W. Nelson Louisville, KY Michael W. Olex Allentown, PA Donald E. Parry Lansing, MI Ramiro Pino Houston, TX Xiangrong S. Qi Milwaukee, WI Manisha K. Ranade Gainesville, FL Isaac B. Rutel Birmingham, AL Christopher J. Stepaniak Wauwatosa, WI Thomas P. Walsh Longview, TX Zhongmin Wang Pittsburgh, PA Da Guang Xu West Windsor, NJ Tiezhi Zhang Madison, WI

Student Fatima O. Ahmed Dearborn, MI Andrew W. Alexander Montreal, QC CANADA Sangeetha Alladi Dayton, OH Nicholas TG. Bakken Greenville, NC

Lesley N. Baldwin Edmonton, AB CANADA Angela C. Band Nashville, TN Christina M. Barrow Euclid, OH Wayne Benjamin Sunrise, FL Vincent A. Bourke Orange City, FL Jacob R. Bugno Toledo, OH Jorge A. Camacho Baton Rouge, LA Ting-Tung Chang San Antonio, TX Tserenpagma Chaoui Las Vegas, NV Xudong Chen Acton, MA Jennifer Cho Los Angeles, CA Jennifer R. Clark Lexington, KY Michael N. Clemenshaw Fort Meade, MD Jessica B. Clements Gainesville, FL Elizabeth A. Cummings Provo, UT Matthew A. Deeley Nashville, TN Pushkar T. Desai Detroit, MI Dustin M. Diez Nashville, TN Nayha V. Dixit Lexington, KY Patrick Downes Galway, IRELAND Rachid Elkhenifer Lowell, MA Karla A. Esmark Lexington, KY Adam L. Evearitt Toledo, OH Ryan F. Fisher Gainesville, FL Luis E. Fong de los Santos Nashville, TN Claire B. Foottit Ottawa, ON CANADA Jason M. Frazier Nashville, TN Jun-Fang Gao Rolla, MO Zhanrong Gao Ottawa, ON CANADA Siju C. George Gainesville, FL Godfree Gert West Lafayette, IN

Timothy D. Hall Charlotte, NC Thomas Hartwick Los Angeles, CA Deanna Hasenauer Gainesville, FL Justin J. Hayes Lexington, KY Mike Heard Gainesville, FL Elena S. Heckathorne Los Angeles, CA Ryan K. Hecox Houston, TX Edward T. Hornsmith White Stone, VA Shu-Hui Hsu Ann Arbor, MI Jorge L. Hurtado Miami, FL Abrar M. Hussain Albany, NY Desler J. Javier Hanover Park, IL Andrew R. Jensen Madison, WI Jeffrey W. Jones Greenville, NC David W. Jordan Ann Arbor, MI Zhuang Kang Lowell, MA Yusung Kim Madison, WI Sin Wod Kim Buffalo, NY I-Lin Kuo Ann Arbor, MI Daniel J. La Russa Ottawa, ON CANADA Ernest M. Lay Oklahoma City, OK Kenneth G. Lewis Nashville, TN Lan Lin San Antonio, TX Lifeng Lin Livonia, MI Erica M. Ludlum Berkeley, CA Min Luo Madison, WI Guozhen Luo Nashville, TN Clarisse I. Mark Montreal, QC CANADA Eibsee C. Marquez Madison, WI John T. McDonald Los Angeles, CA Randolph L. McKinley Durham, NC

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005 Rachel D. McKinsey Madison, WI Steven L. McLawhorn Greenville, NC Robert A. McLawhorn Greenville, NC Christopher S. Melhus Boston, MA Todd A. Meyers Madison, WI Mani Mirzasadeghi Shreveport, LA Nagaraju Mogili Detroit, MI Cynthia M. Munoz San Antonio, TX Christopher C. Muraski Nashville, TN Yildirim D. Mutaf Naperville, IL Francis C. Ndi Bethlehem, PA Christine A. Noelke Lexington, KY Francisco D. Nunez Fitchburg, WI Irene A. Nwosuh Newark, NJ Jonathon A. Nye Madison, WI Mustafa Ozer Minneapolis, MN Kyle R. Padgett Gainesville, FL Adit Panchal North Chicago, IL Angelica Perez-Andujar Madison, WI Stephen A. Pridmore Charlotte, NC Muqeem A. Qayyum Woodridge, IL Marlyn B. Raderic Nashville, TN Karl H. Rasmussen Madison, WI Jennifer M. Rassuchine Reno, NV John D. Richert Baton Rouge, LA Chun Ruan San Antonio, TX Amitpal S. Saini Brandon, FL Vikren Sarkar San Antonio, TX Eduard Schreibmann Stanford, CA Raina N. Schuhwerk Lexington, KY Zdenko Sego Ottawa, ON CANADA

(See New Members - p. 26)

25

AAPM NEWSLETTER NEWSLETTER AAPM

New Members

2005 MARCH/APRILMARCH/APRIL 2005 Sandra Vidakovic Edmonton, AB CANADA Chao Wang Notre Dame, IN David S. Winter San Antonio, TX Rachel A. Wolff Charlotte, NC Jerry T. Wong Irvine, CA Neil M. Worlikar Whittier, CA Dan Xu Detroit, MI Jan Xu San Antonio, TX Sherman K. Yin Toronto, ON CANADA

(from p. 25)

Amish P. Shah Gainesville, FL Chengyu Shi Little Rock, AR Mark B. Shinn Nashville, TN Jason M. Shoales Houston, TX Jennifer J. Slivka Stow, OH Ryan J. Smith Shelby Twp., MI Teodor M. Stanescu Edmonton, AB CANADA Robert J. Staton Gainesville, FL

Fan-Chi F. Su San Antonio, TX Scott D. Symington Almont, MI Wei Tang London, ON CANADA Nathan S. Thompson Nicholasville, KY Elena Tonkopi Ottawa, ON CANADA Susan L. Tulpa Howell, MI James J. VanDamme Madison, WI Jennifer L. Velez Chesapeake, VA

Gang Yu Ft. Thomas, KY Xin Zhang Atlanta, GA Li Zhao West Lafayette, IN Hua M. Zhao New York, NY Yi Zheng Allen, TX

■

ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler, M.S. Sen. Dir., ACR Breast Imaging Accreditation Programs Does your facility need help applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? Check out the ACR’s Web site at www.acr.org; click “Accreditation,” then “Mammography Accreditation Program,” and then scroll down to “Frequently Asked Questions.” You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. What accreditation testing is required when a facility purchases a new (or previously owned) unit? [This policy has recently been changed to allow facilities more flexibility in accrediting new units.]

A. If the facility has over 13 months left on its current accreditation when the new unit is installed, the facility may choose one of two options. 1) A facility with other fully accredited units will most likely choose to complete a New Unit Addendum and submit the medical physicist’s Equipment Evaluation results along with a reduced fee. Within 45 days of the initial application, the facility must submit a phantom image (with dosimeter), images of a fatty and a dense breast, QC data, and a full medical physicist’s Annual Survey report. Once accreditation is approved for that unit, its expiration date will be less than three years and the same as the expiration dates for the other units at the facility. 2) A facility with only one unit will most likely choose to give up its

26

current MQSA certificate and reinstate the facility with the new unit. The facility must submit a New Unit Reinstatement Application for all units at the facility at the full fee and will receive a sixmonth provisional MQSA certificate. Once approved, the facility will receive a full three-year accreditation from the date of approval.

If the facility has less than 13 months left on its accreditation when the new unit is installed, the ACR will instruct the facility to begin early renewal on all units at the usual renewal fee. Facilities should contact the ACR for the appropriate instructions and applications prior to installation of any new units. Once accreditation is approved, all units at the facility will have an expiration date that is three years from the old expiration date.

AAPM NEWSLETTER AAPM NEWSLETTER

Q. The ACR sent our facility a request for additional information stating that our medical physicist did not evaluate the technologist QC of our new mammography unit. When the medical physicist tested the unit, we had just installed it and were not performing the QC as yet. Must the medical physicist still conduct this evaluation?

unit was installed. In addition, the medical physicist need not evaluate the technologist’s QC program in person. Review of the facility’s QC program may also be done remotely by mail or fax.

A. Yes, the FDA requires that the medical physicist evaluate the facility’s QC for all mammography units. Because an Equipment Evaluation is performed before a mammography unit is used clinically, the medical physicist is not required to complete the “Evaluation of Site’s Technologist QC Program” section of the form at this time.

However, your medical physicist does need to evaluate your facility’s QC program and complete the appropriate section of the QC Test Summary as part of the new unit’s Annual Survey report submitted to the ACR with the full application and/ or testing materials. (This will be about 45 days after the unit is installed.)

The medical physicist should check that all required QC tests are done by the QC technologist initially and then at the FDA-mandated frequencies. The ACR does not require the medical physicist to evaluate a certain number of days of QC. The ACR recognizes that, for this first survey, the medical physicist can only evaluate the number of tests that have been performed since the

A. No. Although your medical physicist must perform an Equipment Evaluation and all items must pass before a new processor is used to develop patient films (see below), a facility does not need to notify the ACR or submit this information for a new or replacement film processor.

Q. We are installing a new film processor at our facility.

Do we have to report this to the ACR before using it for mammography?

Q. Does a facility with a fullfield digital mammography unit need to submit quality control data for their laser film printer even if the physicians interpret only from the soft copy?

A. Yes. The ACR reviews a copy of the laser camera QC as part of accreditation. FDA requires that each facility be able to print diagnostic-quality hard copy for purposes of transferring images. We require facilities to submit hard copy images for evaluation primarily for this reason.

These are the instructions on the accreditation forms: “You must submit at least one calendar month of laser film printer QC data for each printer 27

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

used for digital mammography even if the laser film printing is performed by a third party. We recommend you use the QC chart provided in the laser film printer’s QC manual. Your printer’s QC program must be substantially the same as the quality assurance program recommended by the manufacturer.

IMPORTANT: The clinical and phantom images must be taken within the same 30-day time frame and must be within the time period shown on the laser film printer QC chart.”

Furthermore, the forms go on to explain: “It is important to note that for purposes of transferring films, the FDA requires that the facility be able to provide the medical institution, physician, health provider, patient or patient’s representative, with hard copy films of primary interpretation quality.” ■

AAPMNEWSLETTER NEWSLETTER AAPM

2005 MARCH/APRILMARCH/APRIL 2005

Letters to the Editor Direct Billing for Physicists

Ivan Brezovich, PhD Birmingham, AL ibrezovich@uabmc.edu Direct Billing (DB), favored by a nearly two-thirds majority of our membership, has finally reached the discussion stage within AAPM (articles by [then] President Frey, then President-elect Amols, and Professional Council Chair White, Nov/Dec AAPM Newsletter). Understandably, the AAPM leaders are concerned about the risks versus benefits of DB, and its feasibility. With all due respect, however, I believe that many of the fears and negative attitudes are based on outdated and often incorrect perceptions.

In the following, I will take the liberty to address some of the major concerns.

Dr. Frey suggests that federal expenditures are a “zero sum game,” that “to get money for professional services for medical physicists, some other group has to give up money.” Dr. Amols makes similar comments. The

truth is, the zero sum conditions existed under the Balanced Budget Act, when legislators had to show where money for any extra expenditures would have to come from. Such requirements were loosened by the “Refined Balanced Budget Act,” and were completely abandoned in recent years when 400+ billion dollar budget deficits became acceptable. Consequently, the bloody turf battles between radiation oncologists and urologists about reimbursement for prostate seed implants, expected from the assumption of a zero sum game, never took place. After some lobbying, each of the professionals gets paid, facilitating a continued friendly and collegial relationship.

A similar concept could prevent disagreements within the radiation oncology community.

Dr. Frey’s bar chart shows professions that do not have direct billing privileges, yet are held in high esteem by the general public. Unfortunately, hospital administrators acting in their official capacity are not the general public, and often assign us modified broom closets for offices. Extrapolating from the $450 hourly fees charged for some repairs of medical equipment, members of the general public tend to believe that we have seven-figure incomes. Such a perception brings great prestige. However, according John Barsotti, MD, a radiologist turned businessmen and consultant, lacking direct billing, medical physicists are not con28

sidered as professionals and not necessarily thought of as part of the treatment team (his presentation is on the ACMP Web site, 2002 annual meeting). So the people who count, with whom we work on a daily basis, don’t have such a high opinion.

The fear of unaffordable lobbying is exaggerated, considering that the cost is in proportion to the financial impact on the US health care budget, and goes down substantially when the requests are reasonable. For example, an extra $1 in reimbursement for each of the nation’s 33,000 optometrists translates into an extra $33,000 spent on health care. A similar increase for the 2,000 clinical physicists would raise health care costs by only $2,000. Furthermore, medical physicists are the only ABMSlisted medical specialists who do not have direct billing privileges.

So the request for DB is reasonable. Also, we are not competing against any other professionals for the same money, like nurse anesthetists do. Medical physics services are distinct services that can be rendered only by a QMP. Hence, we do not need a war chest as large as the optometrists’ or nurse anesthetists.’ Interestingly, a few weeks ago a recruiting firm called me and offered to contribute $2,000 to a PAC for direct billing for each medical physicist placed by the company.

I wish we had a PAC so that I could have told the company where to send the checks.

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

Letters to the Editor Dr. Amols’ complaint about “[him] yet to hear a concrete plan that will move the issue beyond passionate supporters writing editorials in the newsletter” overlooks the successful efforts of many of our members who spent substantial amounts of their time and money to address specific issues. The feasibility of lobbying was shown by a group of medical physicists who used their own financial and political resources to get the ear of Congress. In response to their lobbying, three of the most influential members in Congress asked HCFA to inves-

tigate the pay mechanism of medical physicists. Some followup by any of the medical physics organizations may have solved our difficult situation for good.

Using my personal connections, I obtained a statement from ACRO that the organization would not oppose direct billing by medical physicists provided that the money does not come from the pockets of radiation oncologists. Sounds fair to me. I then used my contacts with the staff of an Alabama US senator to move the issue forward. At the request of a staffer, I tried to ob-

tain an official letter from AAPM, stating that the organization would not be opposed to direct billing. I did not ask for any money or other support from AAPM. A number of medical physicists offered to provide that.

I am still waiting for an AAPM response to my letter. With some arm-twisting, I got a letter of support from the Alabama Society of Radiation Oncology, and another letter from one of the founding fathers of radiation oncology as a profession. While not directly proposing DB for physi(See Brezovich - p. 30)

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AAPMNEWSLETTER NEWSLETTER AAPM

2005 MARCH/APRILMARCH/APRIL 2005

Letters to the Editor Brezovich

(from p. 29)

cists, these letters are wide open for such interpretation (copies of both letters are on the Web). I am also aware of many other medical physicists who have much closer ties to Congress and other influential leaders, and who have carefully considered the complex issues involved with DB. These selfless pioneers are eagerly waiting for a framework within the AAPM to continue their work.

Dr. Amols’ assertion that “licensing is a prerequisite for billing but not an enabler” contradicts a statement by HCFA. According to an article by Dr. Hendee in the newsletter, HCFA denied any correlation between direct billing and licensure. The misconception is probably the result of HCFA’s denial of paying unlicensed providers in states where a license is required, i.e., to pay for illegally rendered medical care. In New York, nurse practitioners are not licensed, yet can directly bill Medicare.

Dr. Frey’s fear of a “Pyrrhic victory” is unlikely to materialize, considering how strongly DB is supported by other health care providers. I am not aware of any entity lobbying against their current privilege of direct billing. But I do have a friend whose nurse anesthetist wife’s part-time work pays as much as his full-time employment as a medical physicist.

In conclusion, I believe inaction is the most risky form of action.

It is synonymous to accepting the

course set by others. When supply approaches demand, we can expect layoffs and plummeting incomes as physicists are forced to compete against one another for the available jobs. To prevent that and the ensuing deterioration of our profession, we have to participate in the political process.

Dr. White’s recommendation to temper our discussions, and invest the substantial time and effort necessary to develop an informed opinion, is well taken. I trust the wisdom and capability of my medical physics colleagues to heed his advice. Above all, we must never forget that the welfare of critically ill patients depends on a viable medical physics profession.

■

What do we want out of the AAPM Board Restructuring?

Rick Behrman, PhD Boston, MA rbehrman@tufts-nemc.org The following comments were sent to the AAPM’s Ad Hoc Restructuring Committee. They reflect my own personal opinion only.

As the AAPM Board rep from the New England Chapter (serving my first term which started in Jan. 2004), I did not find the arguments presented at the July and December meetings for reducing the board’s size very convincing.

30

The assumption that a smaller board necessarily leads to a more “active” and “efficient” one (it could meet more often and its members participate in more of the “detailed” decision making) was not backed with evidence, despite its “common sense” ring.

Furthermore, no specific examples of alleged board inefficiencies were given—outside of the generic “its a rubber stamp” for Executive Committee actions, etc. Only the results of a survey showing that the AAPM board was larger than average for other nonprofits of our size was presented.

The current proposals for reducing the board size and changing to exclusively regional representation address more than structural issues, but philosophical ones as well. It’s true that a smaller board could meet more frequently than the present two times per year, have less material to cover at each meeting (although there would always be last minute material as is currently the case), and allow more time for discussion of individual issues.

But how many members could afford the time and expense to go to more meetings? Would this lead to a different self-selection of individuals interested in (or able) to run for the board? Is this desirable? Furthermore, does a smaller and (possibly) more efficient board necessarily lead to better governance?

Two virtues of a large board are that with more individuals “rotat-

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MARCH/APRIL 2005

Letters to the Editor ing” through, a forum of wider diversity of opinion is created (albeit sometimes painfully redundant), and that more “grass roots” members get a chance to serve at the national level and return to their chapters with a better knowledge of AAPM structure and governance. Exclusive regional board representation (as currently proposed) would tend to limit this. In regional elections (particularly where there are one or two large chapters and only a few small ones) the “big names” (people already known on the national level or within the large chapters) are more likely to win than those whose activity is primarily local. Are these the only type of board members we want?

The present mechanism of chapter and at-large representatives ensures that both types of AAPM members are represented.

It seems to me, that without more convincing evidence that there is a true need for restructuring, and without a proposal that more persuasively demonstrates that a restructured board would be more “active” and “participatory” with regard to decision making in ways that lead to improved governance over the present one, I find little enthusiasm for the proposal. One can tinker with structure, but more detailed arguments need to be made as to how this will actually improve things (it could, potentially, make things worse).

One area of ambiguity, for ex-

ample, is what the role of the board should be vis-a-vis the Executive Committee. Do we want a board that more or less oversees and approves (or disapproves) overall policies and procedures as it appears to function presently, or, if we want a board that gets more involved in detailed executive-type decision making, how far into the details should it get it—and does its size matter in this regard? The issues that lead up to the current restructuring proposal need to be spelled out in detail, as does how the proposed restructuring will solve them. Unless these are addressed more fully, my gut feeling tells me that the entire proposal will most probably go down to defeat when voted on by the entire membership, regardless of how good a job the Ad Hoc Restructuring Committee does in squaring the circle. ■

John Laughlin Memory Book Lowell L. Anderson, PhD Memorial Sloan-Kettering Cancer Center, New York, NY anderso2@MSKCC.ORG As you perhaps already know, John Laughlin, former chairman of the Department of Medical Physics at Memorial SloanKettering Cancer Center, passed away on December 11th of last year. In the interest of preserving 31

our recollections of John and his influence on our lives, some of us in the department would like to assemble a book of reminiscences submitted by people who knew and interacted with him during his long career. If you wish to be a part of this project, please send or e-mail your thoughts, 1000 words or less, to Melissa Potuzak (PotuzakM@mskcc.org or Department of Medical Physics, Magnetic Imaging and Spectroscopy, A1125, Memorial SloanKettering Cancer Center, 1275 York Avenue, New York, NY 10021). It would be helpful if your submission were to identify the time period of your interaction with John, in the event our Editorial Committee elects a chronological presentation. Distribution of the finished product will include those who made submissions. Other members of the Editorial Committee are C. Clifton Ling (department chair), Lawrence N. Rothenberg and Jean M. St. Germain.

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AAPM NEWSLETTER

2005 MARCH/APRILMARCH/APRIL 2005

Above: Colin Orton (left) is awarded a plaque by former AAPM President Don Frey for his many years of service as editor of Medical Physics (1997-2004). Dr. Orton was instrumental in transforming the publication into an all-electronic submission process.

Right: Dr. Orton prepares to cut his specially designed cake during the celebration last November at the RSNA in Chicago.

AAPM NEWSLETTER Managing Editor Susan deGuzman

Editor Allan F. deGuzman

Editorial Board Arthur Boyer, Nicholas Detorie, Kenneth Ekstrand, Geoffrey Ibbott, and C. Clifton Ling

Please send submissions (with pictures when possible) to the editors at: e-mail: deguzman@wfubmc.edu or sdeguzman@triad.rr.com (336)773-0537 Phone (336)713-6565 Fax 2340 Westover Drive, Winston-Salem, NC 27103 The AAPM Newsletter is printed bi-monthly.

Next Issue: May/June 2005 Postmark Date: May 15 Submission Deadline: April 15, 2005

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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