AAPM Newsletter May/June 2005 Vol. 30 No. 3

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 30 NO. 3

MAY/JUNE 2005

AAPM President’s Column Howard Amols New York, NY The big news in the previous issue of this newsletter was a report on plans to reorganize the AAPM’s Board of Directors.

The big news in this issue is a report on progress in our plans to reorganize the AAPM’s Board of Directors (with any luck we might have some different big news for the next newsletter). Don Frey has a column in this issue with more details on the plan, and Marty Weinhous will be sending a member-wide e-mail regarding this, so let me only briefly mention it here. On March 19 there was a special meeting in Chicago of the AAPM Board of Directors explicitly devoted to discussion of the report from the Ad Hoc Committee on Reorganization. After what seemed to be several days of debate and discussion, which, in checking my

notes, was actually only six hours (How can that be?), the board voted to approve a plan that would reduce its size from 37 voting members to 17 (for details on the plan, please see the column by Don).

This plan can only be implemented if changes are made to the AAPM’s Bylaws, and by law, the Bylaws (pun intended) can ONLY be changed if approved by a two-thirds vote of the entire AAPM membership. That vote will take place later this year, sometime after the Annual Business Meeting. Because of the im-

(See Amols - p. 2)

TABLE OF CONTENTS

A skyline view of Seattle, the site of the 2005 AAPM Annual Meeting, with the Space Needle in the foreground and Mt. Rainier in the distance. Photo courtesy of Seattle’s Convention and Visitors Bureau.

05_26109_AAPM_MayJune

1

portance of this reorganization proposal, we have scheduled extra time for the Business Meeting this year so as to allow a full discussion and to permit members wishing to ask questions and/or make comments to have time to do so. For the 90% of AAPM members who have never at-

2005 Honors & Awards Chairman’s Report Executive Dir’s Column Education Council Rep. CAMPEP News Professional Cncl. Rep. ABR Update Press Luncheon Annc.

Leg. & Reg. Affairs Staff Profile Report Travel Grant Report ISIORT Report Chapter News Mauderli Memorial Letter to the Editor

4/27/05, 5:20 PM

p 3 p 6 p 7 p 8 p 9 p 10 p 12 p 13 p 14 p 18 p 19 p 20 p 21 p 22 p 23

AAPM NEWSLETTER

Amols

(from p. 1)

tended an Annual Business Meeting, and especially for (I’m estimating) the 50% of you who didn’t even know there was such a thing, this is the year for you to finally attend. The Business Meeting will take place on Wednesday afternoon, July 27 at the AAPM Annual Meeting in Seattle, and I urge you all to attend.

To encourage attendance at this year’s Business Meeting, for the first time ever there will be unlimited free beer, dancing girls (and guys), plus a free ticket to a Yankee-Red Sox playoff game this fall for every member who attends.

As I write this column it is early April and it seems premature to be talking too much about the annual meeting in July, but in fact by the time some of you get the next newsletter, it might be too late to make plans for attending.

So let me mention a few other topics of interest vis-a-vis this year’s annual meeting in Seattle.

Debate continues on the question of independent billing by therapy physicists. Many previous letters, both here and on the medical

the symposium will be a pie throwing contest between enthusiasts and skeptics of independent billing. AAPM Excom and the Professional Council are also considering hiring the services of a consulting firm to advise us on the legal and economic ramifications of independent billing.

While we are on the subject of professional issues, I’d like to call attention, for those of you who haven’t already heard, to two very serious radiation therapy misadministrations recently reported. Interestingly, both occurred in states that have licensing laws for medical physicists; New York and Florida. I will not, tempting though it may be, comment further on this seemingly odd coincidence. Both incidents were apparently due, in part, to errors made by board-certified, state-licensed physicists, and both entailed, in part, computer software errors that were not detected by the physicists involved.

I am not familiar with all of the facts in either incident, but to the best of my knowledge both entailed multiple people (including medical physicists) not following their own policy and procedure

VO

TE

2

05_26109_AAPM_MayJune

2

4/27/05, 5:20 PM

TE TE VO

The 2005 AAPM election will open for online voting on June 15, 2005. Paper ballots will be mailed to members who have no e-mail address or a bad e-mail address and members that have opted out of online voting.

The deadline to submit your vote electronically or by paper ballot will be July 6, 2005.

TE VO

VO TE VO O

physics listserver, have addressed this issue. As important as this issue may be (or may not be, depending on your point of view), I make a special plea to all AAPM members to keep this debate rational and focused on the facts. Let’s not repeat mistakes of the past and permit the AAPM to divide itself into two rival camps over a single issue.

For some of our younger members who perhaps don’t know what I’m referring to, and for some of our older members who perhaps don’t remember what I’m referring to (where was I?????), ask someone who does remember—because collectively we’ve made that mistake more than once!

To whit, at this year’s annual meeting there will be several sessions devoted to professional issues including a Professional Council Symposium on Sunday which will be focused on “Current Economic Issues for Medical Physicists.” Thanks to Economics Committee Chair Jim Hevezi and Professional Council Chair Jerry White for organizing these sessions. I’ve been told that one of the highlights of

AAPM Election

TE

V

MAY/JUNE 2005

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

2005 AAPM Awards & Honors Congratulations to the recipients of the following awards, achievements and honors in 2005:

William D. Coolidge Award is presented to Gary T. Barnes, PhD

Fellows

AAPM Medical Physics Travel Grant is awarded to Warren D. D’Souza, PhD

AAPM-IPEM Medical Physics Travel Grant is awarded to Stanley H. Benedict, PhD

Honorary Membership is awarded to Brian C. Lentle

Jack Fowler Junior Investigator Competition is awarded to Andrei B. Pugachev, PhD

The following are named Fellows in 2005 for their distinguished contributions to the AAPM: Ivan A. Brezovich, PhD Brenda G. Clark, PhD Ian A. Cunningham, PhD Lee W. Goldman, MS Chang-Ming Charlie Ma, PhD Wlad T. Sobol, PhD Jerry A. Thomas, MS

The 2006 Call for Nominations and Applications is available on the AAPM Web site at http://www.aapm.org/org/committees/awards_honors/index.html#nominations.

Please note that the deadline to receive nominations and applications is October 15, 2005.

manuals or conforming to commonly accepted standards of quality assurance, and neither entailed any hardware failures.

There has been extensive discussion of these incidents on the medical physics listserver, and I urge anyone not already familiar with the details of these accidents to go out of their way to find out about them as there are sobering lessons to be learned.

While this column is not the appropriate venue to discuss the

details of these incidents, I do want to comment on what I believe to be important lessons we should all learn from these events.

To whit, every once in a while a hardware or software failure (Xray machine, computer, etc.) that is totally beyond anyone’s control results in serious injury to a patient. But the overwhelming majority of such accidents, including the two occurrences referred to above, require a human accomplice. Rarely does a hard-

ware or computer failure by itself result in patient injury. Such injuries, almost always, also require active collaboration by a human being failing to do his/her job.

Although these two incidents were of a very different nature (one entailed intensity modulated radiation therapy, the other stereotactic radiosurgery), I am intrigued by several aspects common to both. First, as alluded to

3

05_26109_AAPM_MayJune

3

4/27/05, 5:20 PM

(See Amols - p. 4)

AAPM NEWSLETTER

Amols

(from p. 3)

earlier, commonly accepted quality assurance procedures and cross checks were not performed. Both of these accidents could have easily been prevented by the most routine dosimetry cross check (again, for details go to the physics listserver). Second, both accidents resulted, in part, because the physicists involved were either unfamiliar with, or failed to notice, unusual values of certain parameters.

I learned medical physics in an era before computers ran our lives and everything in them. Perhaps as a result I have a pretty good idea of approximately how many coulombs should be coming out of an ion chamber exposed to 1 Gy of radiation, how many monitor units should be set on a linear accelerator to deliver 1 Gy of X rays, what the TMR is for any given field size, depth, or energy, what the total dwell time should be for a 5 Gy treatment using a 10 Ci HDR source, etc.; and if a computer program or spreadsheet calculation spits out a number that’s way out of my ballpark, I get a little suspicious.

And when I can’t resolve the discrepancy between my experience/intuition and the computer by myself, I call a colleague for help. And if neither my colleague nor I can figure out what the problem is, I then go to my medical colleagues and say something like, ‘we need to delay this patient’s treatment because we have a physics problem.’ If you want to gain the professional respect of your medical colleagues,

MAY/JUNE 2005

one good approach is to tell them ‘I think I might have messed up here’ before, rather than after, you’ve treated the patient.

The bottom line is, to quote Harry Truman, “the buck stops here,” with us. Campaigning for licensing laws or independent billing or whatever, is not how medical physicists become professionals who are respected by our colleagues. Performing like professionals and taking responsibility for our actions (and mistakes) is, in my experience, the best way to gain respect. My final observation on these two incidents is that even the most routine (and dare I say boring) tasks that medical physicists are responsible for are important and contribute in a major may to the care and safety of our patients. And when we start forgetting this, or start acting like it isn’t so, nobody else will take us seriously as professionals either.

End of pontifical address!

Don has had a nice feature in his column which he called Just for Fun. I’ve decided to do something similar, only I’m calling it Just for Frustration. I do not know who invented this little brain twister, but there is a very famous and unorthodox answer given by P.A.M. Dirac. The problem is as follows:

tide has gone out and that he can walk back to shore without waking his partners. Wanting to be fair, he notices that if he throws one fish back into the sea that the remaining number of fish will be exactly divisible by three. So he throws one fish away, takes onethird of the remaining catch, and goes home. An hour later the second fisherman awakens, does not notice that one of his partners has gone home or taken any fish, but does realize that if he, too, throws one fish away, he can take exactly one third and go home. Ditto for the third fisherman an hour later.

What is the smallest number of fish possible in the original pile?

Find first the ‘boring’ answer (fairly easy), and then Diracs answer (not quite so easy). Diracs answer is a wonderful example of thinking outside the box.

Oh, and one last item. I was lying about the unlimited free beer, dancing girls (and guys), and free Yankee-Red Sox ticket giveaway at the Annual Business Meeting.

Also kidding about the pie throwing contest at the Professional Symposium. But please attend both anyways.

■

Three fishermen decide that after a long day of fishing it’s too late to get back to shore so they decide to drop anchor and spend the night on the boat. In the middle of the night the first fisherman awakens, notices that the 4

05_26109_AAPM_MayJune

4

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

5

05_26109_AAPM_MayJune

5

4/28/05, 4:38 PM

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

AAPM NEWSLETTER

MAY/JUNE 2005

Chairman of the Board Report Nonvoting Members •Executive Director •Parliamentarian •Three Council Chairs •Three AIP Representatives

G. Donald Frey Charleston, SC On March 19th the AAPM Board of Directors met in special session to consider the report and proposals of its Ad Hoc Regional Reorganization Committee. As you are aware, the board had previously endorsed the idea of reducing its number of members because of a longstanding concern about its size and composition.

In 2002 Bob Gould appointed an Ad Hoc Committee on Organization and Governance chaired

by Marty Weinhous. That committee had many discussions and kept the board informed. The committee brought two proposals to the board at the 2004 RSNA meeting… (1) that the board endorse a smaller board with regional representatives for a total of 12 to 20 voting members, and (2) that an ad hoc committee of the board, the Ad Hoc Regional Reorganization Committee, be formed (chaired by Marty Weinhous with Chris Marshall, Bob Rice, John Gibbons, Mike Herman and Tony Seibert as members). That new committee met frequently by teleconference and e-mails and evolved a set of proposals for consideration at the special board meeting on March 19th. Those proposals were made available to AAPM members during the process and many of the resulting suggestions were considered and some were incorporated. Because of time constraints and the

desire to have an unhurried, indepth analysis of the proposal, the board voted to meet in special session.

From this session the ad hoc committee proposed a reduction to 12 voting members. There was considerable free and open discussion of the ad hoc committee report. The board considered increasing regionally elected members, adding at-large members and a variety of other possibilities. After considerable thought, the board amended the proposal and then accepted it for action. The amended report leaves the chapters unchanged.

During a lengthy consideration of the possibilities, the board considered: (1) increasing the regional representatives to two per US region, (2) adding six at-large members, and (3) not allowing officers to vote.

Finally, the board voted to add three at-large members to the board. Thus, as amended, the proposed new board would consist of: Voting Members •Five officers •Seven regionally elected members •Three at-large members

This would result in 15 voting and 23 total members (our current board has 37 voting and 45 total members). In addition, the board voted not to require that AAPM members join a chapter.

Bylaws changes necessary to implement the proposals are being finalized and will also soon be circulated. The Bylaws changes will be discussed at the Annual Business Meeting this summer in Seattle (as will the ancillary proposals and their corresponding rules changes).

The AAPM membership will be asked to vote on the Bylaws changes soon after the Business Meeting. No changes can occur without a two-thirds approving vote of the membership.

The ad hoc committees, the Regional Organization Committee and the board developed this proposal after many hours of consideration. Now it is your turn to decide. Please review the report and attend the Business Meeting if you are in Seattle. Shortly after the Seattle meeting you will receive a final set of comments and a ballot so you can vote on the proposal.

■

6

05_26109_AAPM_MayJune

6

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

Executive Director’s Column year and may reach a “sell out” status. Exhibits are open: Sunday 1:00–5:30PM, Monday and Tuesday from 9:30AM–5:30PM and Wednesday from 9:30AM– 1:00PM.

Angela Keyser College Park, MD

2005 Summer School and Annual Meeting Remember to register for the Summer School and the 47th AAPM Annual Meeting before June 8 to qualify for discounted registration fees. Pre-registration for both events closes on July 6.

The 2005 Summer School will take place July 18–22, 2005, 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. The full program and faculty information are available online.

The annual meeting will take place July 24-28, 2005 at the Washington State Convention & Trade Center in Seattle, Washington. Sessions, exhibits, com-

Summer Undergraduate Fellowship Program mittee meetings and the Awards and Honors Ceremony and Reception will all be held at the center.

Indications are that this will be a very successful meeting. Scientific Program Directors James Balter and Jeff Siewerdesen, Education Program Directors Eric Klein and Perry Sprawls, Therapy Track Organizer Gikas Mageras and Professional Track Co-organizers Mike Herman and Jerry White have put together an outstanding program.

Full program information is available online.

Please plan to attend the Technical Exhibits and show your support to our vendors. They are a vital part of the annual meeting’s success and are great supporters of the AAPM and the medical physics profession. We have a record number of booths this

A stunning arch with usable space connects old and new exhibit areas at the Washington State Convention and Trade Center which is set in the heart of downtown Seattle. Photo by Tim Thompson, courtesy of Seattle’s Convention and Visitors Bureau.

This year 65 undergraduate students competed for 12 summer fellowships. This is a slightly higher number compared to 2004. The selected junior- and senior-ranking undergraduates will each receive a $4,000 stipend from the AAPM. Student fellows are selected based on a combination of the quality of their personal statement, their GPA and their potential future in medical physics. Each student fellow chooses his or her mentor, a Full AAPM Member, based on location and the student’s interest in the mentor’s proposed project.

FYI • A new report from TG #18 of the Imaging Informatics Subcommittee is available online only. The report is Online Report No. 3 entitled “Assessment of Display Performance for Medical Imaging Systems.”

• AAPM has recently updated the Member Profile screens to allow for additional preferences to be captured. Specifically, you have more choices in your preference for e-mail alerts (NIH, (See Keyser - p. 8)

7

05_26109_AAPM_MayJune

7

4/27/05, 5:20 PM

AAPM NEWSLETTER

Keyser

MAY/JUNE 2005

(from p. 7)

RPC, Medphys TOC, etc).

Please keep your profile updated.

• Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM’s Conflict of Interest Policy. This policy states that “Individuals selected for service to the Association are required to complete a Potential Sources of Conflict of Interest form, listing relevant connections and interests that may constitute potential sources of conflict of interest within the meaning of this policy in light of the responsibilities falling to the Association.”

• An enhancement has been added to the committee tree pages. Now you can link from the committee tree to the Bylaws and Rules that govern that particular group.

• The search feature of the AAPM Online Member Directory has been modified to use SOUNDEX fuzzy search logic so “Smithe” now returns “Smith” and “Smyth.”

Staff News Lisa Giove joined the AAPM staff on April 4 as our receptionist. Lisa is a recent graduate of the University of Maryland – College Park with a BA in commu-

nications. Along with providing coverage for the main phone line, Lisa handles general inquiries, coordinates copyright requests and processes requests for organizational materials. Councils and committees should contact Lisa for assistance with setting up conference calls.

I have the privilege to lead the 19 HQ team members who call headquarters their home and I want you, the members that we support, to have a better understanding of who the people are at the other end of that e-mail address. Please take a moment to read the group profiles in this and future newsletter issues.

■

Education Council Report Herb Mower Council Chair The committee chairs of the Education Council held a retreat this March in order to better understand the challenges ahead and to better prepare our members for the future. This was a very exciting day and a half with many new ideas and programs taking shape. Howard Amols, our president, gave an overview of the goals of the association.

We were pleased to see that we are working towards the same results. One of the major changes in the council is that liaisons from the association to other groups and societies will be reporting back to the related committees within our structure. This change should improve our relationships

with other organizations and provide a better mechanism for advancing the interests of both groups. As a council, we will also be looking into ways to better serve our members as we become more aware of the needs and requirements for ‘Maintenance of Certification’ with the ABR. Our goal here is to prepare our profession now so that our members in five to seven

years hence won’t suddenly realize that they have to accumulate a lot of continuing education credits, as well as undertake selfdirected projects. We hope to develop a ‘template’ to facilitate designing the projects to meet the professional needs of the physicist and satisfy the MOC requirements.

Paul Feller noted that the new Program Arrangements Task Group will be coordinating topics for the AAPM Summer Schools in conjunction with proposed programs for the ACMP meetings. This will prove very beneficial with emerging technologies and fast track items.

Questions were raised as to the size of some of the (primarily general therapy) Summer Schools.

At this time there is no indication

8

05_26109_AAPM_MayJune

8

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

of limiting enrollment other than the constraints of the location of the school and the number of attendees they can accommodate.

Michael Yester, chair of the Continuing Professional Development Committee, noted that there is still some confusion related to AAPM sponsorship and endorsement of various programs. Sponsorship usually involves monetary support and should always include AAPM members in the planning and execution of the program. Endorsement relates to those meetings and symposia where we are in agreement with the goals of the meeting but are not supporting it.

Sponsorship request forms and the associated budget process are available on the AAPM Web site.

Melissa Martin, chair of the Virtual Library Subcommittee, noted that Blue Sky would be recording more hours at the annual meeting this year. They will record the Summer School as well as the physics tutorial at the Conference of Radiation Control Program Directors Meeting in April.

Ken Hogstrom noted that the Public Education Committee will be evaluating the effectiveness of our “Educators’ Day” at the annual meeting. The intent of this activity is to get local physics teachers at the secondary school level and at the undergraduate level to visit the AAPM meeting for a day to learn about our profession. Although those who have attended in the past few years have been very impressed and appreciated the opportunity to learn about us, overall the atten-

dance has been very sparse. The Public Education Committee will entertain any suggestions to help improve our penetration into this area. The committee is also starting work on a second booth that will be available for other shows

and meetings, such as ASTRO and AIP. We invite you to attend any of our committee meetings in Seattle to learn more about the various activities and programs of the ■ Education Council.

News from CAMPEP Brenda Clark President One new residency program has recently been granted accreditation. Congratulations to: Radiation Oncology Medical Physics Residency Training Program Cross Cancer Institute University of Alberta Edmonton, Alberta Director: B. Gino Fallone Still on the topic of residency training, the AAPM Annual Meeting’s Education Council Symposium scheduled for Sunday, July 24, 9:30–11:00AM, will be dedicated to Physics Residency Programs and will focus on accreditation.

Both of the program review committees are in the process of reviewing several program applications. For those of you who are anxiously awaiting news of your application this may seem like a slow process.

However, we are dependent on volunteer reviewers who must fit this work into their otherwise busy schedules.

Please contact either of the two committee review chairs if you would be interested in participating in program reviews.

Unfortunately the new software for CEC applications and associated database has encountered some difficulties in the testing stage and implementation has been delayed once again. This software was designed in early 2003 and originally scheduled for testing in September 2003 with implementation eagerly anticipated early in 2004.

That it is now more than a year overdue is frustrating for all of us. We realize that our current process is cumbersome and unwieldy and appreciate your continuing patience while we work with the AAPM staff and a software development contractor to■ wards a solution.

9

05_26109_AAPM_MayJune

9

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

4/27/05, 5:20 PM

AAPM NEWSLETTER

MAY/JUNE 2005

Professional Council Report What We Learned from the 77336 Troubles Gerald A. White Council Chair There is a corollary to the often spoken observation that “Success has a hundred fathers, failure is an orphan.” Endeavors that end poorly give rise to reflection (and sometimes remorse and recrimination) but those that end well frequently lead to a bit of backslapping, toasts to success but not an analysis of characteristics of the efforts that led to success. I’d like to encourage consideration of the 77336 problem and the resolution pathway, lessons learned and pitfalls to be avoided.

Following is a brief restatement of the problem (there may be one or two radiation oncology physicists who were in rural Madagascar for the last year and don’t know the details). In January of 2004, Aetna announced a policy change in their reimbursements for radiation oncology services to patients; they would deny payment for tasks described by CPT code 77336, Continuing Medical Physics Consultation. Their words were: “Aetna considers the continuing medical physics consultation service to be a quality adjunct to a course of radiation therapy. When used during the normal course of radiation therapy, the medical

physics consultation is considered as an integral part of quality management programs and is not separately reimbursed.”

This was clearly an incorrect interpretation on the part of Aetna, inconsistent with both current practice and the description of the work involved in the services leading to the code in the current ASTRO/ACR Guide to Radiation Oncology Coding 2005.

Aetna was alone in their interpretation; other payers recognized 77336 as describing medically necessary work associated with providing care for radiation oncology patients. As most of you know, Aetna reversed the decision and, effective April 1, 2005, has reinstated payment for 77336.

The AAPM worked with ASTRO and ACR to address this issue. There were a number of letters written, separately and jointly with AAPM, ASTRO, and the ACR, to and from Aetna in which we attempted to clarify the work done in 77336 and argue for the importance of payment.

ASTRO and ACR, with AAPM participation, also had several

conference call meetings with higher level Aetna medical and administrative staff who were in a position to influence the Aetna decision. In the most recent set of conference calls and letters, we provided an alternate description of the work done in 77336 in the style of the text in the CPT reference, but one that more accurately describes what the medical physicist does to invoke the charge.

In addition, we provided some vignettes of clinically realistic events that better characterize the work of the medical physicist in the Continuing Medical Physics Consultation. Last, we had begun a process to move specific instances of nonpayment through a court-appointed referee who, subsequent to a previous and unrelated class action suit against Aetna, was charged with identifying and resolving inappropriate denial of payment issues such as ours.

Lessons learned? First I would say patience. The resolution took well over a year. Persistent, firm, consistent interaction with Aetna made it clear that we were not going away, and that we intended to take our case wherever inside or outside of Aetna would be necessary to reverse the decision.

Next, there were the great benefits to a close working relationship with ASTRO and ACR. The economics staff and physician committee members of both organizations were helpful and committed to the reversal and identified several related non-physics

10

05_26109_AAPM_MayJune

10

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

2005 RDCE

Aetna issues that we brought to the table at the same time.

Last, we must pay close attention to the language of the CPT codes and associated code use guidance and how it relates to current standards of practice and the actual work effort of the medical physicist. The CPT descriptive text for 77336 states “Continuing Medical Physics Consultation, Including Assessment of Treatment Parameters, Quality Assurance of Dose Delivery, and Review of Patient Treatment Documentation in Support of the Radiation Oncologist.” Aetna repeatedly cited this language in support of their position that 77336 was for quality assurance and not patient-specific services. Eventually we offered revised language (not to the CPT folks but rather to Aetna) that characterized the work as: “Continuing medical

physics consultation involves the review and analysis of patient status including changes to the treatment regime, consultation on and participation in patient setup and treatment modifications, and reviews of patient-specific treatment and technical notes.” The treatment vignettes we provided illustrated the continuing involvement of the medical physicist in patent care rather than simply a weekly chart check.

Recently, several changes to Brachytherapy Technical Standards were made by the ACR to more clearly describe the work of the medical physicist. “Clinical Quality Management” has been changed to “Clinical Medical Physics Management,” “Physics Chart Check Protocol” to “Medical Physics Consultation” and the descriptive language now describes the task as: “The

Medical Physicist shall develop and implement a program for review and analysis of patient status including changes to the physics aspects of the treatment regime, consultation on and participation in patient setup and treatment modifications, and reviews of patientspecific treatment and technical notes.” The new language is a much better explanation of what we do in the clinic for brachytherapy patients.

The Continuing Medical Physics Consultation is much more than just a weekly chart check.

It is an ongoing involvement with the radiation oncology care of each patient in our department.

We should all recognize this as the standard of care in cancer therapy and we will be joined by third party payors and other professional organizations to the ben■ efit of our patients.

Need Continuing Education Credits?

Earn your medical physics continuing education credits online through the

AAPM Remotely Directed Continuing Education Program Answering 8 of the 10 questions will provide you with one Medical Physics Continuing Education Credit (MPCEC). The results of your passing scores will be forwarded to the Commission on Accreditation of Medical Physics Education Programs (CAMPEP). You will receive a summary of your MPCECs earned through the RDCE program at the end of the year from CAMPEP. Question set categories: CT MRI Radiation Dosimeters Diagnostic Nuclear Medicine Radiation Protection Digital Radiography PACS, DICOM, and Monitors Radiation Oncology Mammography Quality Assurance Programs Ultrasound Member Registration Fee: $30

www.aapm.org/educ/rdce.asp 11

05_26109_AAPM_MayJune

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

11

4/27/05, 5:20 PM

AAPM NEWSLETTER

MAY/JUNE 2005

ABR Update Radiologic Physics Training and Examination for Residents – Update on the ABR Perspective William Hendee, Bhudatt Paliwal & Stephen Thomas ABR Physics Trustees At the annual meeting of the American Board of Radiology in February 2005, considerable discussion focused on the teaching of physics to radiology residents, and on the physics examination for these individuals. The ABR trustees reconfirmed the importance of physics in the education

of radiologists, and supported the need for more in-depth instruction of radiologic physics and technology infrastructure to residents. They also recognized the constraints on this instruction imposed by the need for residents to learn more each year about an expanding clinical discipline that continues to increase in technical complexity.

In recognition of the need for an extended breadth and depth of physics knowledge in radiology, the trustees voted to encourage a greater mastery of physics by increasing the threshold score required to pass the physics examination gradually over the next several years. The goal is to at-

tain a threshold passing score consistent with a quantitative evaluation of the physics knowledge needed to practice radiology effectively and safely. This increase in the threshold should be reflected in both the quality of physics teaching programs and in the time and effort that residents dedicate to master a basic knowledge of physics principles and their applications to radiology.

The trustees also discussed the desirability of retaining the present permissive approach of allowing residents to take the physics examination at the earliest in the fall after they have completed at least one year of residency. This approach leaves the

New Victoreen® Double Check® Pro Daily Check Device streamlines daily radiation oncology QA workload.

Efficient workload planning, user created protocols • Flexible weekly scheduling State-of-the-art communications • Ethernet, USB, Wireless Limitless data storage flash memory - 31 days rolling • Removable flash memory User-friendly interface, large color touch screen • Windows® CE Thorough data analysis, chart, graphical data presentation • Flatness, symmetry, constancy Complete standalone operation • Integrated CPU, memory, color display, touch screen

Upgrade to true Wireless.

Fluke Biomedical.

Better products. More choices. One company.

Call 440.248.9300 or visit www.flukebiomedical.com/rms. ©2005 Fluke Biomedical.

12

05_26109_AAPM_MayJune

12

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

decision of when to take the physics examination up to the resident’s program director and the resident. It was agreed that this policy should remain in effect at this time, but it will be discussed at the forthcoming Association of University Radiologists/ Society of Chairs of Academic Radiology Departments Meeting this spring.

In addition, the trustees discussed the desirability of additional physics instruction during rotations of residents through various clinical specialties, especially those that are technologically complex or that expose patients to ionizing radiation. Although reluctant to set any specific guidelines, the trustees agreed that such instruction was highly desirable. A committee consisting of the three physics trustees and three radiologists was appointed to explore aspects associated with radiologic phys■ ics instruction.

2005 Annual Meeting to Feature Press Luncheon Ben P. Stein Senior Science Writer, AIP Mary Fox Prof. and Pub. Relations Comm. Chair, AAPM For the past few years, the AAPM has been ramping up its efforts to encourage science reporters to cover the annual meeting for their newspapers and magazines. Since 2002, the newly formed AAPM Professional and Public Relations Committee has been working with AIP science writers (including myself) and the AAPM staff and program chairs to put together an annual meeting press release, plus a set of ‘lay-language’ papers describing a few noteworthy meeting papers in nontechnical terms. In addition to emailing the material to our science reporter contacts at newspapers and magazines around the world, the AAPM Web staff assembled in a “Virtual Press Room” where reporters could access the information even if they couldn’t make it to the meeting. (You can find last year’s material by going to http://

www.aapm.org/meetings/ default.asp#archive and selecting ‘Virtual Pressroom.’)

The results were gratifying as the meetings have received coverage in such publications as Wired Online that ordinarily wouldn’t be aware of the annual meeting, as well as trade publications such as Aunt Millie that are always on the lookout for good research stories.

For this year’s annual meeting, we will be carrying out the same efforts and adding one more event. Seattle is one of the top US media markets, with quite a few science and medical reporters (and even an association of science writers). Therefore, on Tuesday, July 26 we will have a press luncheon whereby reporters will have an opportunity to learn about the research being presented at the meeting. We hope that the event yields some good press coverage and raises awareness of the top-notch, important research that comes out of AAPM meetings. Perhaps in a future article I can report the results of the press luncheon.

■

13

05_26109_AAPM_MayJune

13

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

4/27/05, 5:20 PM

AAPM NEWSLETTER

MAY/JUNE 2005

Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD

NRC Issues Final Training and Experience Rule: 10 CFR Part 35, Medical Use of Byproduct Material – Recognition of Specialty Boards; Final Rule (70 FR 16336) Well, the wait is finally over. On March 30, 2005 the Nuclear Regulatory Commission published the last section of the revision to 10 CFR Part 35, Medical Uses of Byproduct Materials, in the Federal Register. This section of the regulation delineates the requirements for training and experience for Authorized Medical Physicists (AMPs), Authorized Users (AUs), Authorized Nuclear Pharmacists (ANPs), and Radiation Safety Officers (RSOs). The rule will be effective April 29, 2005 for nonAgreement States with implementation being October 25, 2005 after 10 CFR Subpart J expires. Agreement States have three years to adopt the new regulations.

Next Steps: The certifying boards must request recognized status for all areas wherein their diplomates practice. The decisions by NRC about which boards will be granted recognized status must be made before

October 24, 2005 (i.e., prior to the expiration of 10 CFR Subpart J).

For each of the categories there are basically two pathways to qualify, referred to as the “Board” pathway and the “alternate” pathway. No matter which pathway one takes, a preceptor letter is necessary. As defined in 10 CFR §35.2, Definitions: Preceptor means an individual who provides, directs, or verifies training and experience required for an individual to become an authorized user, an authorized medical physicist, an authorized nuclear pharmacist, or a Radiation Safety Officer.

For currently practicing medical physicists, you will be grandfathered in those areas that you are currently practicing. For example, if you are a therapy physicist performing gamma knife but not HDR, you will only be grandfathered for gamma knife.

If you do both, then you would be grandfathered for both. Remember, the term AMP only refers to therapy physicists.

One issue for AMPs is that in most states, physicists are not currently listed on a license.

AAPM is working with the Conference of Radiation Control Program Directors so that existing therapy physicists will be added to current licenses over the course of the next three years in order that when the Agreement States adopt comparable regu-

lations, you will be on a license and thus able to be grandfathered.

For diagnostic medical physicists to be recognized as RSOs, NRC added section 35.50(a)(2).

The following delineates the requirements for AMPs and RSOs. The entire regulation can be found at: http://a257.g.akamaitech.net/ 7/257/2422/01jan20051800/ edocket.access.gpo.gov/2005/ pdf/05-6103.pdf.

§ 35.51 Training for an authorized medical physicist Except as provided in § 35.57, the licensee shall require the authorized medical physicist to be an individual who– (a) Is certified by a specialty board whose certification process has been recognized by the Commission or an Agreement State and who meets the requirements in paragraphs (b)(2) and (c) of this section. (The names of board certifications which have been recognized by the Commission or an Agreement State will be posted on the NRC’s Web

14

05_26109_AAPM_MayJune

14

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

page.) To have its certification process recognized, a specialty board shall require all candidates for certification to: (1) Hold a master’s or doctor’s degree in physics, medical physics, other physical science, engineering, or applied mathematics from an accredited college or university; (2) Have two years of full-time practical training and/or supervised experience in medical physics– (i) Under the supervision of a medical physicist who is certified in medical physics by a specialty board recognized by the Commission or an Agreement State; or (ii) In clinical radiation facilities providing high-energy, external beam therapy (photons and electrons with energies greater than or equal to 1 million electron volts) and brachytherapy services under the direction of physicians who meet the requirements for authorized users in Sec. Sec. 35.490 or 35.690, or, before October 24, 2005, authorized users who meet the requirements in Sec. Sec. 35.940 or 35.960; and (3) Pass an examination, administered by diplomates of the specialty board, that assesses knowledge and competence in clinical radiation therapy, radiation safety, calibration, quality assurance, and treatment planning for external beam therapy, brachytherapy, and stereotactic radiosurgery; or (b)(1) Holds a master’s or doctor’s degree in physics, medical physics, other physical science, engineering, or applied

mathematics from an accredited college or university; and has completed one year of full-time training in medical physics and an additional year of full-time work experience under the supervision of an individual who meets the requirements for an authorized medical physicist for the type(s) of use for which the individual is seeking authorization. This training and work experience must be conducted in clinical radiation facilities that provide high-energy, external beam therapy (photons and electrons with energies greater than or equal to one million electron volts) and brachytherapy services and must include: (i) Performing sealed source leak tests and inventories; (ii) Performing decay corrections; (iii) Performing full calibration and periodic spot checks of external beam treatment units, stereotactic radiosurgery units, and remote afterloading units as applicable; and (iv) Conducting radiation surveys around external beam treatment units, stereotactic radiosurgery units, and remote afterloading units as applicable; and (2) Has obtained written attestation that the individual has satisfactorily completed the requirements in paragraphs (c) and (a)(1) and (2), or (b)(1) and (c) of this section, and has achieved a level of competency sufficient to function independently as an authorized medical physicist for each type of therapeutic medical unit for which the individual is requesting authorized medical physicist status. The written at-

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

testation must be signed by a preceptor authorized medical physicist who meets the requirements in Sec. 35.51, or, before October 24, 2005, Sec. 35.961, or equivalent Agreement State requirements for an authorized medical physicist for each type of therapeutic medical unit for which the individual is requesting authorized medical physicist status; and (c) Has training for the type(s) of use for which authorization is sought that includes hands-on device operation, safety procedures, clinical use, and the operation of a treatment planning system. This training requirement may be satisfied by satisfactorily completing either a training program provided by the vendor or by training supervised by an authorized medical physicist authorized for the type(s) of use for which the individual is seeking authorization.

§ 35.50 Training for Radiation Safety Officer Except as provided in § 35.57, the licensee shall require an individual fulfilling the responsibilities of the Radiation Safety Officer as provided in § 35.24 to be an individual who– (a) Is certified by a specialty board whose certification process has been recognized by the Commission or an Agreement State and who meets the requirements in paragraphs (d) and (e) of this section. (The names of board certifications which have (See Fairobent - p. 16)

15

05_26109_AAPM_MayJune

15

4/27/05, 5:20 PM

AAPM NEWSLETTER

Fairobent

(from p. 15)

been recognized by the Commission or an Agreement State will be posted on the NRC’s Web page.) To have its certification process recognized, a specialty board shall require all candidates for certification to: (1)(i) Hold a bachelor’s or graduate degree from an accredited college or university in physical science or engineering or biological science with a minimum of 20 college credits in physical science; (ii) Have five or more years of professional experience in health physics (graduate training may be substituted for no more than two years of the required experience) including at least three years in applied health physics; and (iii) Pass an examination administered by diplomates of the specialty board, which evaluates knowledge and competence in radiation physics and instrumentation, radiation protection, mathematics pertaining to the use and measurement of radioactivity, radiation biology, and radiation dosimetry; or

MAY/JUNE 2005

(2)(i) Hold a master’s or doctor’s degree in physics, medical physics, other physical science, engineering, or applied mathematics from an accredited college or university; (ii) Have two years of full-time practical training and/or supervised experience in medical physics: (A) Under the supervision of a medical physicist who is certified in medical physics by a specialty board recognized by the Commission or an Agreement State; or (B) In clinical nuclear medicine facilities providing diagnostic and/ or therapeutic services under the direction of physicians who meet the requirements for authorized users in Sec. Sec. 35.290, 35.390, or, before October 24, 2005, Sec. Sec. 35.920, or 35.930; and (b)(1) Has completed a structured educational program consisting of both: (i) 200 hours of classroom and laboratory training in the following areas-(ii) (A) Radiation physics and instrumentation;(B) Radiation protection;(C) Math-

ematics pertaining to the use and measurement of radioactivity;(D) Radiation biology; and(E) Radiation dosimetry; and (ii) One year of full-time radiation safety experience under the supervision of the individual identified as the Radiation Safety Officer on a Commission or Agreement State license or permit issued by a Commission master material licensee that authorizes similar type(s) of use(s) of byproduct material involving the following– (A) Shipping, receiving, and performing related radiation surveys; (B) Using and performing checks for proper operation of instruments used to determine the activity of dosages, survey meters, and instruments used to measure radionuclides; (C) Securing and controlling byproduct material; (D) Using administrative controls to avoid mistakes in the administration of byproduct material; (E) Using procedures to prevent or minimize radioactive contamination and using proper decontamination procedures;

AAPM Virtual Library Now online...

Selected presentations given at the 2004 AAPM Annual Meeting, Pittsburgh, PA 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 16

05_26109_AAPM_MayJune

16

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

(F) Using emergency procedures to control byproduct material; and (G) Disposing of byproduct material; or (iii) Pass an examination, administered by diplomates of the specialty board, that assesses knowledge and competence in clinical diagnostic radiological or nuclear medicine physics and in radiation safety; or (2) [Reserved] (c)(1) Is a medical physicist who has been certified by a specialty board whose certification process has been recognized by the Commission or an Agreement State under Sec. 35.51(a) and has experience in radiation safety for similar types of use of byproduct material for which the licensee is seeking the approval of the individual as Radiation Safety Officer and who meets the requirements in paragraphs (d) and (e) of this section; or (2) Is an authorized user, authorized medical physicist, or authorized nuclear pharmacist identified on the licensee’s license and has experience with the radiation safety aspects of similar types of use of byproduct material for which the individual has Radiation Safety Officer responsibilities; and, (d) Has obtained written attestation, signed by a preceptor Radiation Safety Officer, that the individual has satisfactorily completed the requirements in paragraph (e) and in paragraphs (a)(1)(i) and (a)(1)(ii) or (a)(2)(i) and (a)(2)(ii) or (b)(1) or (c)(1) of this section, and has achieved a level of radiation safety knowl-

SIMPLIFY YOUR IMRT TREATMENT PROCESS...

FROM START TO FINISH. GAMMEX rmi® offers a variety of accessory products to assist with accurate and consistent treatment planning and patient immobilization for IMRT. ON YOUR MARK WITH...the new Gammex CT SIM and CT SIMG Robotic Laser Tracking Systems for unsurpassed accuracy in patient treatment and tumor location. Now with your choice of RED or GREEN Diode Lasers.

GET SET WITH...highly reliable Gammex IMRT phantoms. The 473 Planar IMRT Phantom and the 469 Spiral IMRT Phantom offer simple and reliable film dosimetry methods of verifying complex IMRT treatment plans.

STAY PUT WITH...patient immobilization products that provide excellent positioning reproducibility throughout the IMRT treatment.

To find out how our IMRT accessories can begin working for you, contact a GAMMEX rmi® representative today.

1-800-GAMMEX 1 (426-6391)

GAMMEX RMI® P.O. BOX 620327 MIDDLETON, WI 53562-0327 USA 1-800-GAMMEX 1 (426-6391) 1-608-828-7000 FAX: 1-608-828-7500 EMAIL: SALES@GAMMEX.COM

GAMMEX–RMI LTD KARLSRUHE HOUSE 18 QUEENS BRIDGE ROAD NOTTINGHAM NG2 1NB ENGLAND (++44) (0) 115-985-0808 FAX: (++44) (0) 115-985-0344 EMAIL: UKSALES@GAMMEX.COM

edge sufficient to function independently as a Radiation Safety Officer for a medical use licensee; and (e) Has training in the radiation safety, regulatory issues, and emergency procedures for the types of use for which a licensee seeks approval. This training requirement may be satisfied by completing training that is supervised by a Radiation Safety Officer, authorized medical physi-

GAMMEX-RMI GMBH ODESHEIMER WEG 17 53902 BAD MÜNSTEREIFEL GERMANY (++49) 2257-823 FAX: (++49) 2257-1692A EMAIL: DESALES@GAMMEX.COM

17

w w w. G A M M E X . c o m

cist, authorized nuclear pharmacist, or authorized user, as appropriate, who is authorized for the type(s) of use for which the lic■ ensee is seeking approval.

17

05_26109_AAPM_MayJune

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

4/28/05, 4:39 PM

AAPM NEWSLETTER

MAY/JUNE 2005

Staff Profile Report AAPM HQ Team…at your service!

Angela Keyser AAPM Executive Director This is the first in a series of reports that highlights AAPM’s Headquarters personnel.

The AAPM Annual Meeting has grown significantly in recent years—in the number of abstracts received, the number of exhibiting companies, the number of registrants and the level of meeting support. All the members of the AAPM HQ team play an important role in preparing for the annual meeting, but the major responsibilities are handled by three of the staff.

Lisa Rose Sullivan joined the staff in November 1993 as projects coordinator. She was one of the original five Maryland staff members hired when the AAPM HQ offices relocated from NY to College Park, Maryland. Lisa was promoted to exhibits and scientific program manager in 1998 in acknowledgement of her increased responsibility in the meetings area. Lisa coordinates the abstract process and the scientific and education program for the annual meeting.

She also manages AAPM’s technical exhibits and the Virtual Library. Since 2004 Lisa has served as staff liaison to the Education Council. Lisa also serves as the staff liaison to CAMPEP for the education program review process.

HQ Team members (l to r) Lisa Rose Sullivan, Nancy Vazquez,and Karen MacFarland.

Nancy Vazquez joined the HQ team in 1996 as the receptionist.

She was promoted to programs manager in 1998 and she took on the responsibility of managing the annual meeting and Summer School registration processes.

Nancy is also the staff liaison to the Awards and Honors Committee. Her other major responsibilities are coordination of the monthly membership mailing process and staff liaison for publication issues.

Karen MacFarland, AAPM meetings manager, is the newest member of the meetings team.

She joined AAPM in 2003 as part of the HQ reorganization in preparation for Angela Keyser’s promotion to executive director.

Karen handles the meeting logistics for the annual meeting, the Summer School and other association meetings that are scheduled throughout the year.

Coming next issue….group profile of the AAPM Information ■ Services team.

IOMP’s 14th International Conference of Medical Physics Nuremberg, Germany September 14–17, 2005 Register now on www.ICMP2005.org!

18

05_26109_AAPM_MayJune

18

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

Travel Grant Report Paul R. Morrison Boston, MA paul@bwh.harvard.edu As readers are likely aware, the purpose of the AAPM/IPEM Medical Physics Travel Grant is “to promote communications and professional partnerships between US AAPM members and members of the IPEM (Institute of Physics and Engineering in Medicine) in the United Kingdom.” As the 2004 recipient, I would like to provide this first report on my 2004-2005 activities under this grant.

By way of introduction, my work and interests are in the principles and practice of imageguided thermal therapies (socalled “tumor ablation”). I work as a medical physicist in the Department of Radiology at Brigham & Women’s Hospital (BWH) in Boston. The scope of the BWH program is broad: the ablation agents include cryogens, radiofrequency current, laser light and focused ultrasound. The procedures are called: cryotherapy, RFA, LITT, and FUS, respectively. Either MRI or CT are used to target tumors and to image the thermal processes in tissue; thus providing a minimally invasive technique for focal tissue destruction. These procedures are being applied in the liver, kidney, lungs, brain, musculo-skeletal system, and other tissues throughout the abdomen. Ablations are being performed in in-

creasing numbers around the world. While the foci of clinical and research work will change over the coming years, this is a good point to start looking at the role that medical physicists can play in the experimentation and practice of thermal tumor ablation.

In July 2004, I attended the AAPM Annual Meeting and had the pleasure to receive the award of the travel grant from G. Donald Frey, PhD. At the same meeting, I attended the Image-Guided Therapy Symposium. The latter was a Joint Diagnostic Imaging/ Therapy Session that was led by Jeffrey Siewerdsen, PhD. The symposium’s four presentations covered topics that included: imaging techniques for guidance and navigation, robotics, and computer assistance for planning and visualization. It was a broad overview of several aspects of image-guided therapy and was interesting and well attended.

After receiving the award in July, I learned that the IPEM’s own annual meeting was to take place in September 2004. I decided that it would fit well within my plan for the year’s work to attend—I could perhaps better understand the goals and means of the IPEM. That program included two sessions that might be suitable for ablation: Non-Ionizing Radiation and Interventional Radiology. In the spirit of promoting communications, I submitted an abstract for the meet-

ing which was subsequently accepted.

In September I flew to Manchester and took a train over to the historic city of York. The conference took place on the intriguing campus of the University of York. I was fortunate to meet and chat briefly with IPEM’s president, Prof. Peter Williams. I was able to introduce him, and other members, to the nature of my visit. Admittedly, as at the AAPM’s conference, there was little on thermal ablation. Although each was well received, there was only one ablation presentation at each of the sessions noted above—albeit each was well attended. I presented my talk on Image-Guided Thermal Ablation of Tumors in the Non-Ionizing Radiation Session.

That talk reviewed aspects of our clinical and research activities here in Boston. This included case examples of CT-guided RFA and MRI-guided cryotherapy, and our interest in MRIguided RFA as well as the imaging assessment of tumor ablation.

The talk concluded with a literature review to more thoroughly underscore the worldwide interest in ablation and the range of pursuits in the field. In my review of the then-previous 12 months (Sep 2003 – Aug 2004) of the British Journal of Radiology, Physics in Medicine & Biology, Medical Physics, Radiology, Journal of Magnetic Reso(See Morrison - p. 20)

19

05_26109_AAPM_MayJune

19

4/27/05, 5:20 PM

AAPM NEWSLETTER

Morrison

MAY/JUNE 2005

(from p. 19)

nance Imaging, British Journal of Surgery, Journal of Vascular & Interventional Radiology and the American Journal of Roentgenology, (in order of increasing incidence of reports) there were 69 ablation-related peer reviewed scientific articles.

These articles reported results on clinical and experimental studies primarily of RFA in liver, kidney, lung, bone, adrenal gland, and breast. More basic research was reported on thermal modeling, dose simulation, phantom experiments, imaging science and 3D assessment of effects. Studies of ablation-related technologies included the use of lasers in the liver, and of advances in RFA and therapeutic ultrasound probe designs.

I will be traveling later this year (2005) to London on a visit that will include time with the interventional MRI group at St. Mary’s Hospital in London under the direction of Dr. Wladyslaw Gedroyc. Historically, that group has been a sort of sister-site to our own BWH interventional MRI group, and has considerable experience in thermal therapies. I look forward to reporting on this next experience having been able to offer this introduction to the AAPM Newsletter readership.

■

ISIORT Report 4th Meeting of the International Society for Intra-Operative Radiation Therapy

Dr. Lou Harrison from Beth Israel Hospital, NY and president of the ISIORT, addresses the attendees at the recent International ISIORT meeting.

Peter J. Biggs Boston, MA The fourth in a series of biennial international conferences dedicated to intra-operative radiation therapy (IORT) was held in Miami, Florida from March 17th–19th. Previous meetings were held in Pamplona (Spain) in 1998, Boston, Massachusetts in 2000 and Aachen (Germany) in 2002. Over 85 attendees from many countries, including the US, Italy, Germany, France, Spain, The Netherlands, Japan and Austria participated in the proceedings. The proceedings opened with a keynote speech by Umberto Veronesi, head of the European Institute of Oncology in Milan, on the changing role of radiation in the treatment of breast cancer. He described how lumpectomy plus radiation became accepted as the equal of surgery and how, currently, IORT, at the time of lumpectomy, is being compared with conventional electron boost therapy. This

was followed by a panel discussion on the various radiation modalities used for treating breast cancer, including interstitial brachytherapy, Mammosite®, IORT, HDR-IORT, the Zeiss IntraBeam device and external beam radiation. There were many individual sessions with presentations on breast, GU, upper GI, GYN, colorectal, soft tissue sarcoma, head and neck and pediatric cancer.

There were two sessions on physics. The first included talks on electron beam methodology, dosimetry and dose protocols.

M. Fantini discussed the new mobile linear accelerator in the field, the Liac, manufactured by Info & Tech. M. Fantini designed the Liac as well as the Novac 7.

The Liac design is similar to the Novac 7 except that it is smaller and lighter and comes with a higher maximum energy (10 vs 9 MeV). T. Rusch (Xoft corporation) presented data on a new, disposable 50 kVp device for intraoperative work. S. Beddar

20

05_26109_AAPM_MayJune

20

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

presented a report on the AAPM’s TG72 task group (IntraOperative Radiation Therapy using Mobile Electron Linear Accelerators: Report of the AAPM Radiation Therapy Committee Task Group No. 72).

P. Biggs reported on the neutron background in electron beams of various energies. This is an important issue in Europe since there is an energy limit of 10 MeV for a manufacturer to obtain easy approval of a new linear accelerator. Above that energy, ‘heavy bureaucratic procedures’ are necessary, which includes considerations of background radiation, both X-ray and neutron.

A. Petrucci spoke about the Italian dose protocol and S. Onori

and D. Followill reviewed the Italian and RPC’s dosimetry QA programs.

The second session discussed the application of HDR to IORT. W. Jaggernauth and S. Beddar discussed problems with the HDR technique that could lead to underdosing. S-T Chiu-Tsao described how radiochromic film could be used to verify the dose distribution for HDR applicators.

Two papers presented surveys on the use of IORT in the US and Europe that showed some interesting findings. The number of these units installed worldwide has grown since the last meeting.

At that time, there were a total of 65 installed linear accelerators, both conventional and mobile (of

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

which 18 were mobile accelerators), but that total is now 73 (of which 28 are mobile accelerators). There are a total of 36 IORT sites in the US (24 treating with electron beams) vs. 47 in Europe (37 with electron beams).

On average, about 500 patients are treated annually in the US vs. about 1100 in Europe. Interestingly, about 63% of the treatments in Europe are for breast cancer followed by rectum (15%). Randomized trials are already underway in Europe in the areas of breast (30% of centers), rectum (22%) and sarcoma (11%).

The next meeting of the ISIORT will be held in the 2006-2007 ■ time frame in Madrid.

Chapter News Southern California Chapter Workshop on CT in Radiation Therapy Steve Goetsch SCC Educational Chair Chris Cagnon SCC President The Southern California Chapter (SCC) hosted a one-day workshop at the beautiful Sheraton Universal Hotel in Los Angeles in February. Monsoon rains subsided long enough to allow speakers from three other states plus Canada to join a distinguished group of local chapter faculty members. About 60 SCC

SCC President Chris Cagnon at the chapter’s Midwinter Symposium

AAPM members attended, along with another 20 dosimetrists, physicians, and UCLA graduate students, as well as 25 exhibitors from 19 corpo-

rate sponsors. Chapter President Chris Cagnon put together a panel of experts on “CT in Medicine: A (Still) Evolving Modality.” Professor David Brenner from Columbia University spoke on “Radiation Risk with CT.” David Jaffray from Princess Margaret Hospital in Toronto, Dianna Cody of M.D. Anderson, Christoph Panknin of Siemens Medical Systems and Thomas Ruckdeschel of Alliance Medical Physics also flew in to give talks.

Local speakers included Steve Lee (chair of Radiation Oncology at UCLA Medical Center), Michael McNitt-Gray (director of UCLA Biomedical Physics

21

05_26109_AAPM_MayJune

21

4/27/05, 5:20 PM

(See Goetsch - p. 22)

AAPM NEWSLETTER

Goetsch

(from p. 21)

Graduate Program), Tim Schultheiss from City of Hope,

MAY/JUNE 2005

John DeMarco from St. Jude’s Medical Center, Melissa Martin of Therapy Physics, Inc. and Nicole Wink (UCLA graduate

student). The program and some of the talks are available on the SCC Web page at www.

■ aapmscc.org.

Walter Mauderli, DSc 1924-2005 Lawrence Fitzgerald Summerfield, FL Dr. Walter Mauderli passed away on March 27, 2005 at the age of 81 following a lengthy illness. He grew up in Aarburg, Switzerland during WWII and served in the Swiss military as a second lieutenant. His education was interrupted by military service but, following that, he was able to attend the Swiss Federal Institute of Technology where he earned his doctorate under such professors as Nobel Laureate physicist Wolfgang Pauli. Walter worked as a graduate assistant at the University of Zurich in the newly created Division of Isotopes and the Betatron Laboratory. Here he gained knowledge of the clinical use of radioactive isotopes and dosimetry of x and electron radiations. He was responsible for the calibration of radiations from Grenz ray energies to 31 MeV. In 1954, Walter took a position as a medical physicist at the University of Arkansas Medical Center, Department of Radiology, planning to stay in the US for only one year. However, in 1958, Walter joined the Department of Radiology in the University of Florida Medical Center as their first medical physicist, where

he was responsible for dosimetry and maintenance of a 2 MV Van de Graaff generator.

Active in developing the use of computers in radiology, Dr. Mauderli performed fundamental research in electronic instrumentation in the fields of therapeutic radiology and nuclear medicine. He excelled in the miniaturization of ionization chambers and electrometers, always applying new electronic technology as soon as it became available. He developed the forerunner of the modern radionuclide dose calibrator as well as instrumentation for in vivo measurements during radium implants.

In the 1960s Walter was one of the founders of the medical physics graduate program at UF and radiological technology programs at two regional community colleges. He was also academically affiliated with the depart-

ments of Nuclear Engineering Sciences and Environmental Engineering Sciences. Over his academic career he supervised many graduate students in their master’s and doctoral research efforts. He retired as professor emeritus in 1988.

Walter was a charter member of the AAPM and served on the initial board of directors. In 2003, the Florida Chapter of the AAPM honored Walter by an award bearing his name, to recognize lifetime achievement in the field of medical physics in the state of Florida. The Walter Mauderli Award is given periodically to a Florida medical physicist who is distinguished by significant scientific or clinical research, outstanding service as an educator in medical physics or outstanding clinical service in medical physics.

Walter was a man who loved to work in his lab. He hated vacations, preferring to tinker in his lab. He had a great sense of humor and loved life in general. He was loved by his students and will be missed by many friends and colleagues. Walter is survived by his beloved wife of 55 years, Lotti; four daughters: Claudine, Patrizia, Priska, Pamela; a son, Walter, Jr.; and three grandchil■ dren.

22

05_26109_AAPM_MayJune

22

4/27/05, 5:20 PM

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2005

Letter to the Editor It’s the Economy, Physicist!

Ivan A. Brezovich, PhD Birmingham, AL ibrezovich@uabmc.edu Some medical physicists are surprised that RSNA and ASTRO have spent more money on medical physics education than have AAPM members (see, e.g., Amols, March/April 2005 AAPM Newsletter, p. 4). To me, the lack of enthusiasm for training programs shows that medical physicists know the laws of economics. When the supply goes up, prices go down.

Members of RSNA and ASTRO often have financial interests in diagnostic and therapeutic radiation facilities. Any reduction in physics costs achieved by increasing the supply of physicists raises profits. Also, there is the perception that training more physicists will lead to higher quality. Hence, an increased output of physicists is a win-win situation for these two organizations, a big return on a small investment.

For AAPM members, an expansion in training programs pro-

duces winners and losers. The winners are the few physicists who get the newly created teaching positions, trading the stressful clinic for the more desirable classroom. The losers are the many clinical physicists who get their paychecks cut, workload increased, or even get fired as the new graduates start competing for the same jobs.

As long as board certified physicists are leaving the profession to go to medical school or become sales representatives, there is no real shortage of physicists. If there is a shortage, it is one of positions that pay market prices. Nobody would argue that there is a severe food shortage since one can no longer buy a steak for a dollar.

It is also noteworthy that only a few years ago ASTRO strongly encouraged reducing the size of or even abolishing existing residencies for radiation oncologists.

If there had been an excess of radiation oncologists, and a shortage of medical physicists, wouldn’t market forces have pushed radiation oncologists into medical physics? Yet even then, the opposite was happening.

The volatility of the job market and the uncertainty of the entire medical physics profession best explain why 80% of AAPM members expressed concern in the AAPM poll about the supply and training of medical physicists.

Do we really want to pay our clueless youngsters money (stipends) to get them into a profes-

sion that others are leaving? And what about quality?

I, therefore, believe that instead of concentrating on recruiting new physicists, we ought to concentrate on keeping the physicists that are already practicing. We can do that by securing government recognition of the medical physics profession. The vision of a bright future will draw back many of the physicists who had left the profession, and enable new students to take out bank loans to pay for their own education. The supply issue will thereby resolve itself. If there are still problems, AAPM and its members will have the resources and motivation to solve them. ■

$$$

The downtown Seattle Art Museum, designed by architect Robert Venturi, opened to rave reviews in 1991.

Photo courtesy of Seattle’s Convention and Visitors Bureau.

23

05_26109_AAPM_MayJune

23

4/27/05, 5:21 PM

AAPM NEWSLETTER

MAY/JUNE 2005

AAPM NEWSLETTER Editor Allan F. deGuzman Managing Editor Susan deGuzman

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

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

Next Issue: July/August 2005 Postmark Date: July 15 Submission Deadline: June 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

24

05_26109_AAPM_MayJune

24

4/27/05, 5:21 PM