Newsletter
AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 30 NO. 5
SEPTEMBER/OCTOBER 2005
Chairman of the Board Report
AAPM President’s Column Howard Amols New York, NY Sorry about the run of the mill mug shot for this month’s column—no time to scrounge up a goofy picture. Like most of you I’ve just returned from the annual meeting in Seattle and am trying to catch up with my day job. By all accounts the meeting was a great success; record high attendance and abstract submissions, exhibitor booth space sold out, high quality scientific programs, more and better refresher courses and symposia, and outstanding weather. Kudos to the Meeting Coordination Committee, Local Arrangements Committee, Program Committee, and headquarters staff for all their hard work. Hopefully most of you also noticed the display opposite the registration desk at the annual meeting highlighting the AAPM’s
G. Donald Frey Charleston, SC The AAPM Board of Directors met on Thursday, July 28, 2005 in Seattle, WA. This is a report of the significant actions taken by the board.
Audit Committee Educational Development Fund. We decided this year to use the annual meeting as a venue for acknowledging the contributions of fund donors and the achievements of fellowship recipients. By advertising the successes and achievements of the fund, it is hoped that more members will take their responsibility to support the future of medical physics seriously by making a significant contribution to the fund. Again, the easiest way to do this is by clicking the ‘Ed Fund’ icon on the AAPM Web site and following the directions for making a donation. On the theory that you can never have too many ad hoc committees, let me update you on the status of a few current such committees either recently appointed or recently completed.
In recent years the board has become more aware of its responsibility for oversight of the financial affairs of the association. In 2004 an ad hoc committee reviewed the recommendations of the audit committee. In 2005 an additional ad hoc committee was appointed to review a charge (See Frey - p. 5)
TABLE OF CONTENTS Executive Dir’s. Column Education Council Rep. CAMPEP News Summer School Leg & Reg. Affairs Staff Profile Report Announcements Chapter News ACR FAQs Letters to the Editor
(See Amols - p. 2)
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Amols (from p. 1) First is the Ad Hoc Committee on Alternative Paths to Medical Physics Residency Training. This committee was created earlier this year to address concerns about meeting the future needs for properly trained clinical medical physicists. The committee made its final report to the board in Seattle where the board voted to accept the recommendations of this committee, which in summary are: 1. Recognition of the fact that a structured clinical training program, such as a CAMPEP accredited medical physics residency, provides a superior mechanism for physicists to acquire extensive and varied clinical experience; 2. The AAPM encourages the establishment of additional CAMPEP accredited clinical training programs, recognizing that at present the number of these is insufficient to meet either current or predicted future manpower needs; and 3. The AAPM urges CAMPEP to develop guidelines and standards which enable the expansion of these CAMPEP accredited programs through the establishment of affiliated clinical training sites incorporating structured mentorships. As a follow-up to these recommendations, I intend to create a new task group to prepare a more comprehensive set of recommendations defining the AAPM’s position on this issue. It is imperative that AAPM take
the lead and work closely with both CAMPEP and the ABR. Special thanks to Larry Reinstein who chaired the ad hoc committee. Next, I have long felt that the importance of the AAPM’s Web site will continue to grow and that if it hasn’t already happened, the Web site will soon become the primary vehicle through which the AAPM communicates with its members, by which members communicate with each other, and through which the AAPM communicates with the ‘outside’ world. To date, the AAPM’s Web site, under the excellent direction of Michael Woodward, has grown tremendously but without enough input from the AAPM membership (or leadership) on what our real goals and expectations are for the Web site. As I personally expect the Web site to become at least as important to the functioning of the AAPM as are our journal and annual meeting, I’ve appointed an ad hoc committee (chaired by Colin Orton) to explore the possible need for an AAPM Web site editor and to make recommendations to the board. Finally, let me return to a potentially divisive issue that I have already addressed in several previous columns, namely independent billing by radiation therapy physicists. Contrary to what some members have suggested, the AAPM has been actively investigating the pros and cons of this issue. The Professional Council, in particular Gerry White and Jim Hevesi, has been actively researching the issue; the AAPM
underwrote a study of the economic and political aspects of this question by an independent legal consultant, Powers, Pyles Sutter, & Verville, PC (no affiliation with Hungadunga, Hungadunga, Hungadunga, Hungadunga, and McCormick; and extra credit for anyone who knows what I’m referring to!) Independent billing (also referred to as ‘provider status’) was the main topic of discussion at a Professional Council Symposium in Seattle (which, I might add, was rather sparsely attended), and the issue was discussed at the meeting of the AAPM Board of Directors. The long and the short of it is as follows: 1. Major changes in federal regulations, including portions of the Social Security Act, will be required in order for third party providers and HCCFA to recognize medical physicists as independent providers. 2. Such changes will be impossible to achieve without the formation of a Political Action Committee (PAC). 3. Creating and maintaining a viable PAC is an expensive undertaking requiring at least onehalf to one million dollars to initiate, plus hundreds of thousands of dollars per year to keep it in operation (and this would be a lengthy undertaking, most likely lasting several years at minimum). 4. Because of its status as a non-taxable, primarily educational corporation, the AAPM cannot directly create a PAC or be directly involved in its funding or operation (i.e., any such PAC
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would have to be created and funded by individual AAPM members). 5. No other profession has successfully achieved provider status in the past 10 years. 6. If provider status for medical physicists were successfully achieved, it is inevitable that virtually all radiation oncology charge codes would need to be re-evaluated, and there is no guarantee that total medical physics income would increase as a result (there is even the possibility that it would decrease). The take home message is that lobbying congress for medical physics provider status is not something that can be achieved by having the AAPM’s fairy godmother wave her magic wand. It is a serious undertaking involving serious costs and serious risks. As also reported in Don Frey’s column, the AAPM board felt that because of the importance of this question, it would be premature for the AAPM to officially take a position on this issue and we will continue to investigate all
aspects of the issue, after which the board will again consider an official AAPM course of action, most likely at the board meeting later this year in Chicago.
Just for frustration problem: This is an oldie but goodie. Torture yourself a little before looking up the answer on the internet. You have 12 coins, one of which is counterfeit and can only be discerned from the others because it is either slightly heavier or slightly lighter than the others. Using only a two-pan balance scale and three weighings, determine which coin is counterfeit, and whether it is heavier or lighter.
Answers to last month’s problem: Determine the height of a skyscraper with a barometer. If you answered ‘measure the difference in air pressure between ground level and the roof,’ you get an ‘F’ for creativity. Solutions given by Neils Bohr include:
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1. Tie a long piece of string to neck of barometer, lower barometer from roof to the ground. The length of the string plus the length of the barometer = height of building. 2. Drop barometer from roof, measure time to reach ground. Height = 0.5g * t2. 3. If sun is shining, measure height of barometer, lengths of barometer shadow and skyscraper’s shadow, and use the law of similar triangles. 4. Tie short piece of string to barometer and swing it like a pendulum, first at ground level and then on the roof of the skyscraper. The height is worked out by the difference in the gravitational restoring force T = 2 π (L/g)1/2. 5. Walk up the staircase and mark off the height of the skyscraper in barometer lengths, then add them up. 6. Offer the buildings janitor a nice new barometer in exchange for information on the height of his skyscraper. ■
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.
WIMP - Winter Institute of Medical Physics Holiday Inn Summit County, Frisco, Colorado February 11–15, 2006 For further details see the WIMP Web site at www.utmem.edu/WIMP
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Frey (from p. 1)
Insurance Services
for a permanent Audit Committee. The members of the committee were Mahadevappa Mahesh (chair), Tony Seibert, Melissa Martin, Herb Mower, Jeff Limmer, Chris Serago, Joanna Harper and Richard Baccante (consultantAIP). The ad hoc committee recommended the following charge and responsibilities and duties for the Audit Committee. Charge: The Audit Committee is charged with monitoring the: • Integrity of the association’s financial reporting process; • Appropriateness of the association’s accounting policies and internal controls; • Independence and performance of the association’s independent auditors. Responsibilities and duties: 1. Recommend to the board of directors the appointment of independent auditors based on periodic reviews; 2. Review the annual financial statements, auditor’s report, and other appropriate reports, and forward them to the board of directors with appropriate comments; 3. Inquire of the independent auditors concerning the strengths and weaknesses of the association’s financial staff, systems, internal controls, and other factors that pertain to the integrity of the published financial reports; 4. Review management letters, including management responses
and plans to address the auditors’ recommendations; 5. Review tax policy changes from the Internal Revenue Service that may affect the association’s tax-exempt status or its definition of tax-exempt activities; 6. Provide an avenue for communication among the independent auditors, management, and the board of directors. The board voted to accept the recommendations of the ad hoc committee and directed the Rules Committee to bring appropriate rules changes at the RSNA meeting this year. In the meantime the existing ad hoc committee will review this year’s audit.
Provider Status The board had an extended discussion about whether or not the AAPM should support seeking provider status for medical physicists. After considerable discussion, the board tabled a motion that recommends that the AAPM not seek provider status. The motion was tabled so additional material can be added. It will be considered at the RSNA meeting. The discussion indicated that the board does not favor seeking provider status at this time.
The AAPM was asked to review the possibility of providing group health care plans for its members. This was reviewed by our insurance coordinator and additional information was provided by the Professional Council. It is not practical for the association to provide group health insurance because the pool of members that would seek such insurance is too small.
Treasurer’s Report The treasurer reported that 2004 was an excellent year. The excess of revenues over expenses was $1.1M. This included $344K from our investment fund. This was an improvement of $1.2M over our original budget. Our fund balance continues to increase. (see ‘Fund Balance’ graph, p. 6) Estimates as of May 21st indicate a deficit of about $144K at the end of 2005. However, those figures do not include the expected profits from the Seattle meeting. Historical experience shows that much of the council and commmitee budgets are not spent. With those facts in mind, the association is likely to end the year in the black. The board approved the most recent report from the AAPM auditors.
ACR-AAPM Survey The ACR is recommending that several additional accreditation programs become mandatory, including CT and MRI. In order to determine if there are enough
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Education Council. Both the Education Council and the International Affairs Committee endorsed the ad hoc committee report favorably.
Frey (from p. 5) Fund Balance
Dollars
Medical Physics
Year
medical physicists to support the effort, the AAPM voted to work jointly with the ACR on a workforce survey to determine the availability of medical physicists to support these additional accreditation efforts. The AAPM did not consider whether or not to support making the additional accreditation programs mandatory.
the AAPM’s role in international affairs. The board voted to accept the recommendations with some minor modifications. The report is available on the Web. The Rules Committee was instructed to draw up rules that would create a new International Education Committee under the
Bill Hendee, the editor of the association’s journal, Medical Physics, reported that there was a smooth transition to the new editor. He also reported that the number of text pages in Medical Physics continues to expand about 10% per year, as shown below. A 10% increase in text pages is predicted for 2006. This expansion is considerably less than the growth in submitted manuscripts, resulting in a growing rejection rate, which for the current year is about 50%. He further reported that Medical Physics continues to improve its citation impact (see below).
Deceased Members The AAPM has not had a uniform policy for honoring deceased members. The board voted to adopt a policy that would standardize the way the association honors recently deceased members. The policy, AP 74-A, can be found on the Web site.
Ad Hoc Committee on International Affairs The board reviewed the report of the Ad Hoc Committee on International Affairs. Perry Sprawls chaired this committee. The report made a number of recommendations to strengthen 6
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Meeting Coordination Committee Bruce Curran reported that the meeting went very well. The scientific attendance was the best ever for a regular meeting. Vendor support for the meeting continues to be excellent. We continue to have large increases in the number of abstracts submitted and in the number of scientific, educational and professional offerings. The committee is considering scheduling sessions in the afternoon on Thursday in Orlando. Thus the meeting would end at 6PM Thursday. Plans for the semicentennial meeting in Houston are already underway. The reports from the council chairs will be provided separately. â–
2005 RDCE
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. Member Registration Fee: $30
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Executive Director’s Column Angela Keyser College Park, MD
your dues via the AAPM Web site to reduce staff processing time. The board of directors voted during their meeting in Seattle to discontinue the dues discount offered to members who elect to only receive the journal online.
Financial Update The 2004 audit report has been reviewed by the Ad Hoc Audit Committee and submitted to the board of directors. Here are a few highlights from the 2004 financial summary: • Excess of revenues over expenses of $1,108,269, including an unrealized gain on investments of $343,824. • An improvement of $1,242,955 over the original 2004 budgeted deficit of $134,687. • AAPM reserves at the end of 2004 were $6,620,068. Conservative projections for the 2005 year indicate a deficit of $144,266 versus a budgeted deficit of $348,379. The major portion of the difference in estimate versus budget is due to the success of the 2005 annual meeting.
2005 Annual Meeting The 2005 AAPM Annual Meeting in Seattle drew a record number of attendees. Over 4,100 people participated in the meeting. Overall registration was up 26% when compared to the registration statistics from the 2004 meeting. Scientific attendance was up 40%, with nearly 2,500 scientific registrants. Exhibitor registrations were up approximately 2%, with the revenue from booth sales up 5%.
Staff News Over 100 hours of selected presentations given by invited speakers were digitally recorded at the 2005 Annual Meeting. These presentations are scheduled to be posted in the AAPM Virtual Library by mid-September. Modified selections of these presentations are also available on CD ROM for purchase. Please view the AAPM Virtual Library site for details: http://www.aapm.org/ meetings/VirtualLibrary/. AAPM is offering CAMPEP credits for the majority of these presentations via the AAPM RDCE program. To view information regarding the AAPM RDCE Program, please link to: http://www.aapm.org/educ/ rdce.asp. Join the hundreds of other AAPM members who are using the AAPM Virtual Library and RDCE Program for their continuing education, research, and information needs.
It is with great pleasure that I announce the promotion of Lisa Rose Sullivan to the position of director of Meetings and Programs, effective immediately. In this position Lisa will oversee the meeting and program activities of the association and join Michael Woodward and Cecilia Hunter on the management team that I established to advise and support the executive director. This reorganization will free me from the day-to-day oversight of the meetings and programs areas. Lisa is very excited about her new role and I know that you will join me in congratulating her and offer your support. ■
Membership Renewal Process for 2006 Dues renewal notices for the 2006 year will be sent out during October. I encourage you to pay 8
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Education Council Report Herb Mower Council Chair Imagine 134 coffee shops, all with the same name, all in the same city. Can’t wait too long for the cup of brew? Just walk about a block or so in any direction and there it is. It’s sort of like looking for a medical physicist in Houston! The 2005 AAPM Annual Meeting is now over and what a great experience it was. Although I did not get a chance to visit with every committee, subcommittee, task group and work group, I did get to visit with many of them during their meetings. What a great group of volunteers we have working hard to provide us with some great programs. My thanks and the thanks of the association to all of you for what you do for us! The meeting started with the well-received review sessions on diagnostic and therapy physics on Saturday and Sunday. We had over 135 in attendance between the two sessions. Eric Klein put together an excellent program for our Education Council Symposium on Sunday. The topic was “Residency Programs.” The Public Education Committee under Ken Hogstrom again hosted an “Educators’ Day” for local high school and college physics faculty. Eight educators joined with us for the day to learn about the field of medical physics, enabling them to later share what we do with their students.
There are some exciting things on our plate for the next couple of years, as well as some topics that concern us. Probably the major concern is the financial burden on the summer school budget in order to have the textbooks published in time for the school. In two of the past three years we have missed the production deadline resulting in overtime costs coming to a total of $35,000 above budget. This was a big hit for the summer school budget, and a subcommittee under Paul Feller is looking into acceptable alternatives. There was also a lot of discussion around the international education activities of the AAPM, the International Affairs Committee chaired by Azam NiroomandRad (an administrative committee) and the funding of the committee’s educational activities (most under the Education Council). Over the years the AAPM has brought several good programs and resources to underdeveloped countries through the efforts of the International Affairs Committee. To help address these issues in a manner more in
keeping with the other activities of the association, the council recommended to the board that the ad hoc committee’s report relative to international affairs be approved with the single change that there be established an International Education Committee (rather than subcommittee) under the Education Council. The council also approved making CD copies of our summer schools available to category ‘B’ and ‘C’ countries of the IOMP and opening our Virtual Library to physicists in these countries. The council also approved Don Frey’s recommendation that we permit access to the Virtual Library for CRCPD members. The Conference of Radiation Control Program Directors is the state regulator’s professional association. Over the years, especially through our physics symposia at their conference, we have developed some strong ties with this group. Their executive director, Thom Kerr, was able to join with us for a couple of days at our summer school and the annual meeting. Bob Rice’s Workforce Subcommittee has been moved from the Education Council to the Professional Council. The AAPM will be celebrating its 50th anniversary in 2008. Our History Committee, under the chair of Bob Gould, will be presenting programs at the 2006 and 2007 annual meetings leading into this historic event. Part of the
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News from CAMPEP
2006 events will be at the Education Council Symposium on the opening Sunday morning. Also at the Education Council Symposium that day will be a presentation on the Discoveries and Breakthrough Inside Science (DBIS) program by Ben Stein of the AIP staff (and husband to our staff member, Karen MacFarland). AAPM is a sponsor of the DBIS, which makes cutting edge physics topics available through local TV outlets. They have found that medically related topics are ‘hot’ and this is an excellent way for us to get information about our profession to the general public. Also in 2006 the AAPM will take a leading role, under William Hendee, to host a symposium directed towards evaluating the current trends in physics preparation by medical physicists, radiology residents and radiation oncology residents as they approach their respective board examinations. The results of the board exams have revealed some real areas of concern over the past couple of years and we hope that, through this multi-society evaluation of the whole process, we can establish some guidelines and programs to reverse the current trends. Well, having pretty much filled this edition of the newsletter, I will bid you farewell for now and promise to update you in the next issue as our programs progress. ■
Brenda Clark CAMPEP President Thanks to Ed Mower and Eric Klein for organizing the Education Council Symposium on Medical Physics Residency Programs at the Seattle meeting. If you missed this event, the session was recorded and should be available from the RDCE section of the AAPM Web site soon. Since the last newsletter, two residency programs have been accredited, one new program and one reaccreditation. Congratulations to: Residency Training Program in Diagnostic Imaging Physics Cross Cancer Institute and University of Alberta Edmonton, Alberta Director: B. Gino Fallone and Medical Physics Residency Program in Radiation Oncology McGill University Health Centre Montreal, Quebec, Canada Director: E. B. Podgorsak Other activity by the residency committee includes two applications under review, two programs being mentored with
applications expected soon, and three other programs which have expressed interest and will be requesting mentors soon. The use of mentors to aid the application process was implemented recently and has proved to be of value to program directors going through this process for the first time. The graduate review committee has one new application under preliminary review and two applications where site visits have been scheduled. Good news finally on the Continuing Education database which was delivered to AAPM Headquarters just prior to the Seattle meeting. Early testing has shown that the system is functional, with a few minor glitches that are quickly being resolved. The ability for program directors to enter an application and pay the application fee online is in place and tested. As I write this column, the review process, attendee upload of credits and the attendee interface to the system is being tested. After the help text is written to guide all users, the CE committee members will be asked to do some final testing before release. Hopefully now the end of this particular saga is in sight! ■
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2005 Summer School Review
How many physicists does it take to have a brachytherapy summer school?
William Parker & Robin Miller Summer School Chairs The 2005 AAPM-ABS Summer School on “Physics of Brachytherapy” was held at Seattle University in Seattle, Washington on June 17–22, just prior to the AAPM Annual Meeting. Program Directors Bruce Thomadsen, Wayne Butler and Mark Rivard put together a comprehensive program covering the quintessential basics as well as newer advances on everything related to brachytherapy. The school attracted over 200 scientific registrants from 12 countries who came to hear 26 faculty members deliver 45 presentations on brachytherapy. The attendees certainly got their money’s worth with the school running from 8AM to 5PM and then reconvening for evening sessions (backed up with local beer and wine) until 9PM (longer for some). The sessions were incredibly well attended, surely a testa-
ment to the excellent speakers, and superb selection of beer provided by Michael Gribble (LAC chair) who was an excellent resource for both local trivia and libation. The traditional Wednesday “Evening-in” event featured a typical salmon bake with entertainment provided by a native American dance troupe from the S’Kallam Tribe. One final word—the school could not, of course, run without the invaluable assistance of the Local Arrangements Committee (LAC); just regular physicists who volunteer (or get chosen) for
the task. Special thanks go to Karen MacFarland from AAPM HQ and Char Summers from SU, without whose help the school would not have run as smoothly. This year’s LAC chair was Michael Gribble from the Swedish Hospital; we would like to say an extra thank you to him as well. So join us next summer in beautiful Windsor, Ontario for the 2006 edition of the AAPM Summer School; this one will be on Organ Motion (IGRT) and the Clinical Implementation of Monte-Carlo in Radiotherapy.
Summer School Local Arrangements Committee (l to r): Karen MacFarland, William Parker, Robin Miller, Michael Gribble, Peggy Blackwood, Jeff Richer, Sherry Connors, Vrinda Narayana
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Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD
AAPM Economics Staff Appointment Wendy Smith Fuss, MPH has been appointed to staff the Professional Economics Committee of the AAPM and to look after medical physics reimbursement concerns. She will work closely with me, your GRAC staff member, and other economic staffers at allied medical specialty groups. Wendy brings a wealth of experience in reimbursement issues having previously served in this capacity at ASTRO, the Coalition for the Advancement of Brachytherapy and the Society of Nuclear Medicine. As an independent consultant, she will work part time for the AAPM organizing responses to government and private policy decisions that affect medical physics reimbursement, chiefly for radiation therapy services. Please welcome Wendy to our association.
Veritus (Pennsylvania) Reverses LCD Decision In the spring of 2005, Veritus, a division of Highmark, Inc. and fiscal intermediary for Medicare/ Medicaid in Pennsylvania, published a proposed Local Coverage Determination for Radiation Oncology procedures for its beneficiaries. In the proposal, two medical physics CPT codes,
77336 and 77370, were singled out to be denied payment in the hospital outpatient setting for 2006. This was a departure from previous coverage decisions for these codes. AAPM, ASTRO and ACR economics staff and volunteers responded by writing letters objecting to the denial of payment proposals. On August 9, 2005, we received word that Veritus made an error in this denial proposal and reversed its decision. John Niemkiewicz, a medical physicist practicing in Pennsylvania, brought this issue to our attention and the cooperative efforts of the above organizations again resulted in a positive outcome for medical physics. If you experience such incursions on your practice by carriers in your area of the country, please inform Wendy Smith Fuss at Wendy@HealthPolicySolu tions.net and me at lynne @aapm.org, AAPM Economics staffers, so that action can be taken on it.
FDA Approves Alternate Standard for System Artifacts On June 16, 2005 the Food and Drug Administration notified the American College of Radiology (ACR) that they have completed their review of the alternative standard requested to CFR 900.12(e)(5)(ix) System Artifacts. Although this request was formally submitted by the ACR, this was a joint effort with the AAPM. It was through
AAPM members that the data supporting the request was collected and subsequently analyzed to form the basis for the alternate standard. The FDA stated: “We have reviewed the supporting data you provided. While we believe that the data did not conclusively prove that following the alternative standard will always detect artifacts that might be discovered by following the current regulation, we do believe that the data does establish a very low probability that significant artifacts will be discovered by strict adherence to the regulation. We also agree that the additional time and expense may not be justified for such a small return. We approve your request subject to the following conditions: • The alternative is granted when testing for the annual physics survey only. • When following the alternative, if any filter-related artifact is discovered during the test then all clinically used target-filter combinations as specified under the current regulation must be tested. • When conducting a mammography equipment evaluation
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(MEE), all clinically used target-filter combinations must be tested. Additionally, we are approving this alternative standard for an unlimited period of time.” If you have any questions regarding this, please contact me at lynne@aapm.org.
Docket Office at (202) 6931648 or sent electronically to http://ecomments.osha.gov/. Three copies of written comments and attachments must be submitted to the OSHA Docket Office, Docket H-016, Room N-2625, U.S. Department of Labor, 200 Constitution Ave., Washington, DC, 20210. Further information on submitting comments can be obtained by calling
the Docket Office at (202) 6932350. AAPM is preparing comments and has a meeting scheduled for September 8, 2005 with OSHA to discuss the request for comments. If you have any questions regarding this, please contact me at lynne@aapm.org. ■
OSHA Requests Comments on Radiation Regulations On May 3, 2005 OSHA published a request for information related to the increasing use of ionizing radiation in the workplace and the potential for a worker to be exposed to it. The agency will use the information to determine if and how its ionizing radiation standards should be updated. The document can be found at: http://a257.g.akamaitech.net/7/ 257/2422/01jan20051800/ edocket.access.gpo.gov/2005/ pdf/05-8805.pdf. On August 1, 2005 the Federal Register announced that it is extending the public comment period until November 28, 2005. In part, the agency is extending the comment period to give stakeholders adequate time to comment on the National Academy of Science’s Biological Effects of Ionizing Radiation (BEIR) VII report on health risks for exposure to low levels of ionizing radiation, which was not issued until June 29, 2005. Written comments must be submitted by Nov. 28, 2005. Written comments (10 pages or fewer) can be faxed to OSHA’s 13
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Staff Profile Report
Announcements
AAPM HQ Team…at your service!
HQ Accounting Team Members Jean Rice (l) and Peggy Compton
Angela Keyser AAPM Executive Director The AAPM Accounting Team is hard at work supporting the activities of the association. Like the Information Services (IS) Team, profiled in the last issue, the valuable work of the Accounting Team is also often accomplished behind the scenes. Jean Rice, our accounting manager, joined the staff as a temporary accountant back in January 1994 to assist with the preparation of the 1993 audit, the first audit performed following the move of the AAPM Headquarters to Maryland. This was a daunting task following a complete turnover of staff resulting from the relocation. However, Jean rose to the challenge and has continued to be the backbone of the accounting function! While the actual “bookkeeping” had been managed by AIP, the decision was made to bring all of the accounting functions in-house in June of 1994 and Jean was named accounting manager.
Since that time Jean has been instrumental in the development of the accounting department services we now provide, both to staff and to our members. Jean also supervises the dues billing and collection function for the American Association of Medical Dosimetrists. She works closely with IS and the membership department in the development and testing of new software enhancements to our database. Peggy Compton joined the accounting team in October 2004 as the accounting assistant. Peggy processes dues renewals and other cash receipts, prepares checks and does the invoicing. Prior to joining AAPM, Peggy worked for Giant Foods for more than 20 years, most recently serving as the order desk specialist responsible for the orders of more than 190 stores. Peggy is also the friendly voice you hear on the phone when calling for information from the accounting department. ■
William R. Hendee, PhD has received the American Roentgen Ray Society’s 2005 Gold Medal for distinguished service to radiology. He is one of only three recipients of the award this year, presented at the Society’s annual meeting in New Orleans on May 18. Dr. Hendee is currently president of the Medical College of Wisconsin Research Foundation, dean of the College’s Graduate School of Biomedical Sciences, and professor in the Medical College’s Health Policy Institute (bioethics) and in the departments of radiation oncology, biophysics and radiology. “The Gold Medal is reserved for the select few who have the absolute highest commitment to radiology research and education,” says T. Michael Bolger, JD, Medical College president & CEO. “It serves as a fitting tribute to Dr. Hendee and what he has accomplished during his career.”
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Announcements Dr. Hendee has served as chairman of radiology at the University of Colorado, was the first non-physician president of the ABR (2002-04), is a representative to the ABMS, and was recently selected editor of AAPM’s Medical Physics journal. ■
Benchmark Beam Data: Improved Accuracy in Radiotherapy Bill Simon, Sun Nuclear Corporation; Chihray Liu, Jatinder Palta & James Dempsey, U. of Florida; Geoff Ibbott, Ramesh Tailor & David Followill, RPC; John Bayouth, U. of Iowa; & Dan Pavord, Western Pennsylvania Hospital The National Cancer Institute has recently awarded Sun Nuclear Corporation a Small Business Innovation Research (SBIR) contract. This is a collaborative effort involving Sun Nuclear; the University of Florida; the RPC at M.D. Anderson Cancer Center; the University of Iowa; and the Western Pennsylvania Hospital. Several members of the former AAPM task group 67 (TG67 – “Benchmark Datasets for Photon Beams”) are represented in this
effort. The RPC will provide oversight to the effort, which will ensure the quality of collected benchmark data. The aim of this project is to make available measured benchmark megavoltage (MV) photon-beam data to the radiation oncology physics community for use in clinical quality assurance (QA). The hypothesis is that high quality benchmark data can be acquired by comprehensively characterizing single linacs of each make. This will be achieved by accurately collecting comprehensive MV photon-beam data sets for linacs representing all three major manufacturers used in North America. The benchmark data will thoroughly describe the characteristics of these linacs’ photon beams so that radiotherapy treatment planning (RTP) companies and clinics throughout the United States can use it to examine the accuracy of dosecalculation algorithms, thereby improving the treatment of cancer. The standard phantom to measure these data will be made commercially available for use in linac commissioning and periodic QA. Currently AAPM task group report 53 makes recommendations for RTP QA, which is even more significant with the advent of complex intensity modulated radiation therapy (IMRT) in community clinics. Software to streamline routine RTP QA, using the benchmark data, will be made commercially available, enabling recommendations from
this task group. The structured benchmark datasets will enable RTP companies to improve beam modeling and achieve better dose calculation accuracy. The first phase of the contract will develop requirements for the benchmark datasets that will fully characterize the modern day delivery systems in commercially available 3D treatment planning systems. Data will include test patterns that will be able to point out the weakness of dose calculation algorithms. Dose distribution in heterogeneous media will also be measured using heterogeneity phantom components. These dataset requirements are very important to the planning of the data collection and to the success of the project. Anyone with comments on these requirements or the project itself should contact either Geoff Ibbott, Ph.D.; Director, Radiological Physics Center; UT M.D. Anderson Cancer Center, gibbott@md anderson.org; or Bill Simon, Principal Investigator, Sun Nuclear Corp, billsimon@sun nuclear.com. This project has been funded in whole or in part with Federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract No, HHSN261200522014C.
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■
AAPM NEWSLETTER
SEPTEMBER/OCTOBER 2005
Chapter News Rocky Mountain Chapter Doug Pfeiffer Chapter President On April 30, 2005 the Rocky Mountain Chapter held its first annual meeting outside of Denver in over 20 years. We met in Albuquerque, New Mexico and were hosted at the Petroleum Club, giving a marvelous 360 degree view of the city. Generous support was provided by Varian. Another unique aspect of this meeting was the inclusion of dosimetrists in the registrants. We thank them for helping to make this meeting a success.
Talks included a view of the future of radiation therapy given by Peter Munro with Varian, some applications of computed radiography in radiation therapy given by Larry Wendling and Chuck Spleet with Fuji, and an informative and entertaining talk by Phil Berry on the imaging of “objects” at Los Alamos National Laboratory. We also had talks by Phil Heintz on the impact of PACS on radiation oncology, and a talk by Shuang Luan on IMRT optimization achieved by collimator rotation. As part of the business meeting, discussion turned to the board reorganization proposal. A talk was given outlining the current version of the proposal, giv-
ing both its advantages and its impact on our chapter. In the end, it was the consensus of the attendees, reflective of the chapter, that the reorganization proposal is a positive move for the AAPM, and should be approved by the national membership. Also announced at this meeting was the desire of the Arizona members to form their own chapter. It was felt that it would be best to pursue this prior to the reorganization, rather than after, so that chapter boundaries can be reflected appropriately. We wish to thank Phil Heintz and Donna Siergiej for their efforts in arranging this successful meeting. ■
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AAPM NEWSLETTER AAPM NEWSLETTER
JANUARY/FEBRUARY 2001 SEPTEMBER/OCTOBER 2005
ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler 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 tests must the medical physicist perform after a facility installs a new full-field digital mammography (FFDM) unit? What documentation must the medical physicist provide the facility to send in for ACR accreditation? A. FDA regulations require a medical physicist to perform a “mammography equipment evaluation” whenever a new FFDM unit is installed. This evaluation must determine if the FFDM unit meets the applicable equipment requirements listed in 900.12(b) of the regulations and the quality assurance requirements listed in 900.12(e). Section (b) of the FDA regulations are fairly specific and the ACR has developed a simple checklist entitled “MQSA Requirements for Mammography”
to help medical physicists document this section of the evaluation. Section (e) of the FDA regulations requires the medical physicist to follow a quality assurance program that is “substantially the same as the quality assurance program recommended by the image receptor manufacturer.” This complicates the testing since the tests, frequencies and pass/fail criteria vary across manufacturers, models and QC manual versions. The ACR has tried to simplify the final pass/fail documentation for these tests by developing a simple form entitled “Medical Physicist’s Mammography QC Test Summary” for each image receptor manufacturer of FFDM equipment. All of these forms are routinely updated as the manufacturers update their QC manuals and are available on the ACR Web site at www.acr.org. The FDA requires the ACR to collect and review this information as part of accreditation. To summarize – the medical physicist must perform the FDA-re-
quired evaluation and tests, and submit the following completed forms to the facility: • MQSA Requirements for Mammography Equipment • Medical Physicist’s Mammography QC Test Summary – FFDM Unit ManufacturerSpecific The facility must submit these forms to the ACR with documentation showing that all failures have been corrected before they may use the new FFDM unit to perform exams on patients. Q. What quality control tests must the medical physicist and quality control technologist follow for a laser printer? A. The FDA regulations require the facility to follow a quality assurance program that is “substantially the same as the quality assurance program recommended by the image receptor manufacturer.” At this time, most FFDM manufacturers specify that their customers follow their laser printer manufacturer’s QC. However, if the FFDM manufacturer’s QC manual provides instructions on laser printer QC, the facility is required to follow these instructions. The table on page 18 provides current guidance on whose test to follow. Q. Will the ACR accept electronic or digital signatures for accreditation applications, medical (See ACR FAQs - p. 18)
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ACR FAQs (from p. 17)
FDA-required Laser Printer QC (updated August 2005)
physicist’s reports and/or verification of mammography personnel qualifications? A. In general, no. At this time, the ACR does not accept digitized or electronic signatures on any accreditation documents. With today’s computer technology, an individual’s signature may be easily scanned, saved as a picture file and inserted into any document without the knowledge of the original signer, thereby jeopardizing the integrity of the required accreditation information. Consequently, these types of digitized signatures are not accepted. All signatures must be originals (or faxed copies of the originals). The only exception to this policy is for “authenticated” digital signatures. This requires the “signer” to have special software that certifies the authenticity of the signature. Authenticated signatures will be accepted on a case-bycase basis after review by ACR legal staff. ■
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JANUARY/FEBRUARY 2001 SEPTEMBER/OCTOBER 2005
Letters to the Editor Must Get Radiation Oncologists on Our Side Di Chen, PhD McAllen, TX dchen@uast.net Fear of alienating our physician colleagues by seeking provider status for medical physicists is paralyzing some of us. I believe, however, that this fear is totally unjustified. AAPM is highly respected by ACR, thanks to the hard work of many renowned medical physicists. Most ACR members regard physicists as medical professionals, and would have no problem standing behind AAPM during its efforts to obtain provider status. By sponsoring the ABR, which certifies physicists at par with radiologists and radiation oncologists, ACR as an organization has obviously recognized medical physicists as professionals. There may be a few individual members of ACR and ASTRO who are concerned that provider status for physicists would reduce their earning potential. How do we get them on our side? AAPM must convince them that medical physicists’ provider status will only strengthen their practice and not cut into their income. Can teeth stand without gums? With radiology and radiation oncology becoming more and more technology oriented, lack of adequate physics coverage is a sure pill for erroneous delivery of radiation to
patients. If our profession goes down, radiation oncologists will see even more lawsuits resulting from inadequate medical physics services. The only way to assure a continuous influx of young talent into medical physics is to establish provider status, once and for all. NOW, instead of debating endlessly whether provider status is achievable, AAPM needs to make an honest, good-faith effort to implement the wishes of the majority of its members. We have to seek allies in the medical and political community, and start collecting money for lobbying. If we do not have enough resources at the moment, let’s start saving for lobbying at a later date. Inaction is the worst form of action, as it will only accelerate the downhill slide of our profession. ■
Professionalism and Licensure Improve Safety Ivan A. Brezovich, PhD Birmingham, AL ibrezovich@uabmc.edu Recent reports of misadmini– strations in Florida and New York have triggered numerous comments by medical physicists on the list server and other venues. Unfortunately, these addressed only errors committed by physicists, while ignoring any potential contributing factors. Even the value of licensure was questioned by some. The national media also
got involved, quoting one comment out of context and with the typical sensationalist spin. Over all, one was left with the impression that some careless physicists need to get fired, and the remaining ones provided with closer supervision to prevent omission of simple, basic quality assurance tests. Fortunately, a more proactive approach was taken by professional airline pilots in response to a rash of crashes by commuter airliners. Pilots requested that any accident investigation include root cause analyses. Abolishing licensure was never suggested. Senior pilots did not propose that the younger ones escape unsafe conditions that existed at some airlines by seeking employment elsewhere. Leaving the problem with those least equipped to deal with it, and accept loss of passenger lives, was not considered the professional thing to do. The ensuing investigations identified lack of sleep due to long duty hours (most of them waiting on the ground), pressure from management to complete flights even when risky, insufficient training, and faulty equipment as major contributing factors. When these hazards were eliminated, the accident rate dropped to nearly zero. Root cause analyses of misad– ministrations in radiotherapy would be well in line with JCAHO standards. These should include the effect of excessive workloads, outdated, inadequate and unreli-
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(See Brezovich - p. 20)
AAPM NEWSLETTER
SEPTEMBER/OCTOBER 2005
Brezovich (from p. 19) able equipment, software flaws, lack of training on new equipment, pressure by administrators to take shortcuts to increase patient output, absence of universal licensure with high standards, etc. In view of the recent incidents, the positive effect of licensure is difficult to ignore. The statistical probability for two series of errors occurring in two of the three states with licensure, with no misadministrations occurring
elsewhere, is very small (<1%). Most likely, the mind-set in states with licensure, one of heightened concern for safety and quality, led to the disclosures which may not have reached the media in states without licensure (the Florida errors were reported voluntarily to the press). “Promotion of licensure of medical physicists as a means of assuring the quality of services” is part of the AAPM Strategic Plan (2005 Membership Directory, p. 56). In addition to rais-
ing performance standards, demanding licensure requirements would enhance the professional standing and authority of medical physicists. Legitimate safety concerns could no longer be brushed aside as unfounded complaints by lazy technicians looking for less work, new toys, and a pay raise. Patients, like airline passengers, will be the ultimate winners if medical physicists adopt the high professionalism and standards proven so valuable ■ in other industries.
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: November/December 2005 Postmark Date: November 15 Submission Deadline: October 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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