AAPM Newsletter November/December 2005 Vol. 30 No. 6

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 30 NO. 6

NOVEMBER/DECEMBER 2005

AAPM President’s Column Howard Amols New York, NY Time flies and this is my last column as AAPM president. It seems like only a year ago I was writing my first presidential column, which sort of makes sense since presidential terms run for about a year. So, first column, last column, should be about a year in between! Be that as it may, both the AAPM and I have survived the year. I look forward to (gleefully) handing over the reigns to incoming President Russ Ritenour on January 1 and

moving on to my new position of chairman of board, in preparation for which I am working hard on my Frank Sinatra impersonation (dooby dooby doo).

Also on January 1 we say goodbye, congratulations, and thank you to outgoing Chairman of the Board Don Frey and Secretary Jerry Allison. It’s been a privilege working with both of them and I’ve appreciated their friendship and camaraderie as well as their tireless efforts on behalf of the AAPM. I’m sure that incoming President-elect Mary Martel and Secretary

Gary Ezzell will fill in the voids left by their departure with vigor and enthusiasm.

It is not uncommon for an outgoing official to wax poetically about the wonderful accomplishments of his/her administration (See Amols - p. 2)

William D. Coolidge Award Dr. Gary T. Barnes is the recipient of this year’s William D. Coolidge Award. One of AAPM’s highest honors, the award recognizes a member who

TABLE OF CONTENTS has exhibited a distinguished career in the field of medical physics and who has exerted a significant impact on the practice of medical physics.

Dr. Barnes was born and grew up in northwestern Pennsylvania.

He received his B.S. in physics (1964) from Case Institute of Technology (now Case-Western Reserve University) in Cleveland, Ohio and his Ph.D. in physics (1970) from Wayne State University in Detroit, Michigan.

Following the completion of his (See Coolidge - p. 5)

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Coolidge Speech Awards Executive Dir’s. Column Education Council Rep. MCC News Development News Leg. & Reg. Affairs Reference Values Clinical Research CAMPEP News Summer Undergrad. Fel. Staff Profile Report Travel Grant Report AAPM/IOMP News New Member List Letter to the Editor

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Amols (from p. 1) and how healthy the society (or country, or state, or company, or whatever) is as they close out the fiscal and/or calendar year. Indeed the AAPM has had a good year and at 48 years old, it is in good health. Our annual meeting and scientific journal are thriving, members are overwhelmingly satisfied with AAPM services and the value they receive for their dues, and there’s money in the bank for a rainy day. The latter is no longer a trite expression or symptom of paranoia as we note the recent hurricanes Ophelia and Rita, and upcoming annual meetings in Orlando (2006) and Houston (2008), and AAPM’s potential liability should disaster strike. Hurricanes not withstand-

ing and despite our current economic well being, the AAPM is heading into calendar/fiscal year 2006 with our largest projected budget deficit ever (more on that later).

However, instead of looking backwards and highlighting AAPM’s recent successes, I’d prefer to focus my last presidential column on what I believe to be AAPM’s major challenges over the next several years. And no, I’m not referring to independent billing or higher salaries (these are important issues but not our highest priorities). I’m talking instead about education and professional competence.

Since our annual meeting in July, there has been an NCI planning workshop on QA in radiation therapy (Eric Klein and I rep-

resented the AAPM), and a discussion group hosted by the University of Chicago on the same topic. The NCI planning workshop will most likely spawn a full fledged workshop sometime in 2006 to be jointly hosted by the AAPM, ASTRO, ACR, and NCI. Also, in January the AAPM, RSNA, and ACR, under the direction of Bill Hendee and Herb Mower, will be holding a Summit on Physics Training (of radiology and radiation oncology residents, and medical physicists). There will also be an IAEA International Symposium next November on ‘Quality Assurance and New Techniques in Radiation Medicine’ that will be cosponsored by the AAPM. In addition, I recently returned (along with Russ Ritenour and Mary

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Martel) from a meeting with the RSNA Board of Directors where we discussed common interests and concerns about physics education, funding of medical physics training, Self Assessment Modules (SAM’s) and Maintenance Of Certification (MOC).

This is all occurring in the wake of last summer’s ACR Intersociety Meeting, which also focused on education and training. And lurking not too far over the horizon are the ABR’s grand plans to implement MOC standards, higher educational standards for sitting for the boards (by 2012), and gradually raising the passing scores for the board exams over the next several years.

Up until last year ASTRO donated $36,000 per year to the AAPM to support two medical physics residencies in radiation therapy. Last year ASTRO decided to make the award themselves rather than through the AAPM, but more importantly, they changed the funding mechanism from directly supporting individuals to supporting new training programs instead. Just last month at our meeting with the RSNA Board of Directors exactly the same issue was raised.

RSNA asked whether they should continue supporting individual physics residencies in imaging physics (RSNA has been contributing $36,000 per year for the support of two positions) or whether their money might be better spent in other ways. The distinction between supporting individuals as opposed to supporting new training programs is

an important one, and it is interesting to note that our medical colleagues are keenly aware of an education crisis in medical physics. This crisis exists not only in the training of medical physicists, but also in the training of medical residents. Certainly there are many contributing factors for why many medical residents finish their training with only minimal knowledge of physics. To put it bluntly, one of the most important reasons is that besides not supporting education of ‘our own,’ some of us aren’t doing a bang up job teaching physics to physicians either. And when a medical resident is forced to take a physics course that is being given by someone who is either unprepared or unenthusiastic, or both, the resident comes away from that course not only ignorant of physics, but also disrespectful and unappreciative of physics. The physicist responsible for that course has created a lifetime menace not only for patients, but also for other physicists!

It is also interesting, not to mention disturbing, that ASTRO and RSNA combined spend more money per year supporting physics residencies than does the AAPM’s Education and Research Fund! Let me say that again—ASTRO and RSNA combined spend more money per year supporting physics residencies than does the AAPM’s Education and Research Fund!

The reason for this is that despite all of our pleas, links on the Web site permitting easy credit card payments, our large display

panel at this year’s annual meeting in Seattle, etc., etc., AAPM members have simply not contributed enough money to the fund to support very many fellowships. This has forced us to pay for much of our education program out of the annual operating budget. Which brings me to one of my favorite soap boxes—why individual AAPM members DO NOT support medical physics education.

At our annual meeting in Seattle Excom and headquarters staff went to great efforts to put up a ‘Focus on Our Future’ poster that showcased the contributors and activities on the AAPM’s Education and Research Fund and the AAPM Fellowship and Residency program (special thanks to Cecilia Balaz and Angela Keyser). The poster was directly opposite the registration desk in the lobby between the two technical exhibit halls. If you were at the annual meeting, unless you were making a deliberate effort not to look, this advertisement would have been pretty hard to miss! And while we didn’t have a Salvation Army Santa Claus ringing a bell with a collection plate in front of him, I think the message was pretty clear!

Most of you should also have recently received in the mail our glossy brochure on the AAPM Education and Research Fund.

We had great expectations that publicizing the activities of the fund would generate donations from all AAPM members who think supporting education and the future of their profession is

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Amols (from p. 3) important. Either our expectations were wrong, or there are only seven AAPM members who take that responsibility seriously, ‘cause that’s how many new contributors we’ve had since the annual meeting. Total donations have been approximately $900, which averages out to about 17 cents per member—yea team!

To put that in perspective, 17 cents will get you about 1.2 ounces of Starbucks coffee, 6.5 ounces of gasoline (enough to drive about one mile in your SUV), or one kilowatt hour of electricity in my neck of the woods. Exceptions noted for the 300 plus members who have previously contributed, and especially to the 30 some odd members who’ve contributed $1,000 or more.

Given our members’ apathy, Jack Benny–like generosity, and the fact that we’ve raised about $1,000 or less every year for at least the last five years, forgive me if I wonder out loud whether we’d really be able to raise the half a million dollars or so annually that would be required for a Political Action Committee to lobby for independent billing for therapy physicists, as many members have suggested would not be very difficult?

If by some chance you’ve not yet picked up on the common theme of this month’s column, it is indeed education, training, and competence. Quite frankly, there ain’t enough of any of them, and headlines earlier this year on serious therapy misadministrations

have put the spotlight on a problem that has been creeping up on us in recent years. The combination of increasing medical needs of an aging US population compounded by an explosion of new technologies (such as IMRT, IGRT, PET, MR, digital radiography, PACs, etc.) confronts us with recruiting, training, and education problems that we have never previously faced. We can whine all we want about being overworked, underpaid, underappreciated, and unrecognized as independent providers, etc., but I predict we will make little headway on any of these issues unless we address the questions of competency and training first.

Yes, there may well be a connection between medical physicists being overworked, underpaid and making major mistakes that appear in national headlines, but our first priority must be putting our own house in order. As Fredric March once said to Claude Akins: ‘He that troubleth his own house shall inherit the wind and the fool shall be servant to the wise of heart’ (homework assignment: name the movie this quote comes from, and its original source).

Finally, I just returned from a meeting of the Budget Subcommittee (chaired by Treasurer Maryellen Giger) where we reviewed the proposed 2006 budget. This budget will undoubtedly be modified somewhat by both the Finance Committee and the board of directors at the upcoming RSNA meeting, but we are projecting a deficit of over $500,000 in 2006. I should note

that AAPM starts almost every fiscal year with a rather large projected deficit for two reasons.

First, we try to be very conservative (i.e., pessimistic) in estimating expenses and revenues, and second, rarely does any AAPM council, committee, or task group ever spend its total requested budget. You might want to think a little about the latter reason because it’s not all good news! So the $500,000 projected deficit will almost surely not be realized, but it gives one reason to stop and ponder.

Why is the projected 2006 deficit larger than usual? Mostly because of increased spending by Professional and Education councils, and mostly on services members seem to be demanding, such as more involvement by AAPM in government and regulatory affairs, and more AAPM support for educational symposia, cosponsoring meetings with other national and international professional societies, etc. We are also seeing increased operating costs such as insurance bills, credit card fees (when you pay your dues with a credit card, AAPM gets charged a commission), heating costs, and a host of other things. And on that pleasant note I lead you directly to my: Just for frustration brain teasers: Ever wonder why we almost never make relativistic corrections in radiation therapy treatment planning? I thought not! On the off chance that I’ve now got you worried about this glaring oversight, calculate the following relativistic correction factors:

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1.) Misalignment of light and radiation field (6 MeV electrons) for a total skin electron patient being treated at 4 meter SSD. What about for a 100 MeV lateral proton beam at an SSD of 1.5 meter?

2.) Difference in energy between an anterior and a posterior 6 MeV electron beam at isocenter for a 100cm SAD linac.

And if the above two questions aren’t ridiculous enough, try this one: 3.) A traffic cop stops a medical physicist and starts writing up a ticket for driving through a red light. The physicist, ever resourceful, replies, ‘but officer, the light looked yellow to me.’

The police officer unfortunately knew a little more physics than the average beat pounder and promptly tore up the first ticket but wrote out a second ticket for speeding. Approximately how fast was the physicist driving? ******* •The answer to last column’s problem on 12 coins and three weighings can be easily found on the Web. If you can’t find it, you probably won’t understand the solution anyways, so what’s the point?

•The answer to last month’s extra credit question: Hungadunga, Hungadunga, Hungadunga, Hungadunga, and McCormack was the law firm in the Marx brothers movie ‘Animal Crackers,’ and thanks to Ken Coleman for pointing out my misspelling of the senior partner’s name). ■

Coolidge (from p. 1) Ph.D., he received postdoctoral training in medical physics at the University of Wisconsin, Madison. In 1972 he joined the Department of Radiology and Medical School faculty at the University of Alabama at Birmingham where he was chief of the department’s Physics Section from 1976 to 1987, and director of the Physics and Engineering Division from 1987 to 2002. In 2002 he became professor emeritus. He continues to be involved part-time at UAB chairing the Radioisotope and Radiation Safety Committee and teaching radiology residents. He is also involved with X-ray Imaging Innovations, a technology develop-

ment company he founded in 1998.

Dr. Barnes has been active on committees of the AAPM, Southeastern Chapter of the AAPM, ACR, RSNA, ABR and is past president of the AAPM (1988) and the SEAAPM (1979). He is a Fellow of the AAPM, ACR and AIMBE (American Institute for Medical and Biological Engineering) and is a diplomate of the ABR (radiological physics). Dr. Barnes’ research interests are in diagnostic X-ray imaging and include work on scatter control, screen-film systems, digital radiography, mammography and clinical medical physics. He is the author or co-author of 10 patents and 100+ scientific papers.

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Coolidge Speech by Dr. Barnes Thank you, Michael, for the gracious introduction. (Dr. Barnes was introduced by Michael Yester.)

Ladies and gentlemen, it is an honor to be nominated for the Coolidge Award by your colleagues and an even greater honor to pass muster by the Awards and Honors Committee.

I have had the privilege of knowing and working with many of the past recipients of the Coolidge Award. All of these individuals were supportive and helpful to young medical physicists. Two, John Laughlin and John

Cameron, sadly have passed away recently. These two individuals had a major positive influence on me and on my career.

The first recipient of the Coolidge Award was William Coolidge. I was at the Awards and Honors Ceremony in 1973 when his audiotape was played thanking the AAPM for initiating the award in his name and honoring him as its first recipient. He was in his late nineties at the time he made the recording. We know Dr. Coolidge as the inventor of the hot filament X-ray tube—a

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Barnes (from p. 5) major advance in the field of radiology, both in diagnostic and in therapeutic radiology, in that it allowed for the independent control of X-ray tube potential and tube current—a capability that is still important today in diagnostic radiology, and for those of you who are old enough to have worked on orthovoltage units, important for many years in radiation therapy. Dr. Coolidge worked for GE and for many years was the director of the research lab in Schenectady, New York.

I learned something about Dr. Coolidge’s research in the mid1970s when I was working with Ivan Brezovich, and we observed that during an X-ray exposure the X-ray tube current decreased with time after the start of an exposure and reached an equilibrium value after 300 ms. The equilibrium value was 5–10% less than the value at the start of the exposure.

We looked into the problem and I talked with a tube engineer at GE, Ed Rate, about the details and specifications of the X-ray tube filament. He indicated during a phone conversation that the helical filament wire in GE’s Xray tubes was tungsten-218. I replied “tungsten-218, I never heard of tungsten-218. What is tungsten-218? I have never heard of that isotope.” He replied “It was on Coolidge’s 218th experiment that he succeeded in making tungsten ductile.” That is, on his 218th experiment he learned how to make tungsten wire.

William D. Coolidge, receiving the first Coolidge Award in 1972, appears on the front cover of the September 1973 issue of the AAPM Quarterly Bulletin.

Tungsten wire is the key component of incandescent light bulbs and vaccuum tubes and William Coolidge is better known for his contributions to these fields than he is for his contributions to the medical X-ray field. Two hundred and eighteen tedious experiments, but it finally paid off! An example of persistence that I have never forgotten. Persistence pays off! You have to work to succeed.

Back to the anomalous fall-off of X-ray tube current during an exposure that Dr. Brezovich and I observed. The X-ray tube and generator were manufactured by different companies. The tube manufacturer blamed the problem on the X-ray generator manufacturer and the generator manufacturer blamed the phenomenon on the tube manufacturer. Things have not changed in 30 years and finger pointing is still a problem when you mix vendors.

I have had many experiences where one vendor incorrectly blames the other on a multivendor installation. I have also been told many times that no one else complains about a problem or that the radiologists do not complain.

Blowing smoke is easier than fixing a problem. It is important

for medical physicists to understand how the equipment is supposed to work and also how each subcomponent contributes to the the desired level of system performance.

We eventually realized that it was an electron evaporation problem and were able to predict the anamolous behavior using the X-ray tube’s filament specifications and the basic principles of thermodynamics. We prepared an abstract for the upcoming AAPM Annual Meeting, but our abstract was rejected.

The referees thought we were passing gas, electrons, whatever.

We did publish the paper. Of interest is that every X-ray generator design engineer that I have met in the past 25 years, and I have met several, has read that paper and looks at me with respect when he realizes that I am the coauthor. Dr. Brezovich is the first author. On more than this occasion I have had papers rejected for presentation—papers that were subsequently published and that I am very proud of. Setbacks occur, but persistence pays off.

I would like to share with you the background on my entry into the field of medical physics. I was

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one of the “sputnik generation,” that is, the generation, when in grade school, that routinely practiced hiding under one’s desk in the event of a nuclear attack.

Russia’s launching of the first satellite in 1957 was a major event when I was a teenager and, as a result, science and engineering was stressed as an important career choice to high school students. For these reasons and the fact that I had little talent in english and writing, I went to college and studied physics and engineering.

I have since learned the importance of verbal and written communication and presently do far more writing than I do physics.

After receiving my B.S., I went on to graduate school in physics.

I had an excellent mentor and thesis advisor, Dan Gustafson, who was compassionate to students—high shool, undergraduate, as well as graduate students.

On July 20, 1969 Neil Armstrong from Wapokenta, Ohio walked on the moon. The space program was successful and national priorities changed. In 1970, as I was writing my Ph.D. dissertation, NASA laid off 150,000 scientist and engineers.

Subsequently jobs for young, inexperienced physicists were hard to come by. It was an extremely frustrating time for me. However, in retrospect it was a godsend. It forced me to think about my career and what I really wanted to do. Fortunately, while in graduate school I had become friends and taken a few courses with Lloyd Smith. As a result I was aware of medical physics. After completing my dissertation it was

the primary career path that I focussed my attention on.

After many months and considerable effort I was eventually offered a postdoctoral fellowship at the University of Wisconsin.

While looking for a position I talked on the phone with Robert Shalek at MD Anderson, John Laughlin at Memorial Sloan Kettering, and Chuck Kelsey at Wisconsin. I always thought it was gracious of these busy individuals to take the time to talk with a young physicist they did not know, and furthermore, they gave me straight answers, even though they were not the answers that I wanted to hear at the time.

The same week that I was offered the Wisconsin position, I received two much higher paying offers in physics and in university administration. I am glad that these offers did not come earlier. I took the fellowship at Wisconsin even though it paid less, much less, and have never regretted it.

Interacting with the Wisconsin Department of Medical Physics faculty, John Cameron, Karen Doppke, Chuck Kelsey, Phil Judy, Dick Lane, Don Tolbert and Jim Sorenson, as well as the other fellows and graduate students, was an intellectually, if not financially, rewarding experience.

Upon completing my fellowship in 1972 I joined the Department of Diagnostic Radiology at the University of Alabama at Birmingham. At UAB I had the good fortune of working for two excellent and supportive chairmen, Drs. David Witten and Robert Stanley. I owe a great deal to these gentlemen, as well as my

other physics faculty colleagues at UAB—Michael Yester, Dev Chakraborty, A. V. Lakshminarayanan, Xizeng Wu, Doug Tucker, Wlad Sobol and Kevin Junck—and also to many fine postdoctoral fellows. In 2002 I became professor emeritus. During my career I had the opportunity of collaborating on scientific papers and patents with more than 30 colleagues—radiologists, technologists, engineers, and physicists. These individuals played a major role, if not the major role, in these efforts. Since retiring from UAB I have been working with David Gauntt to improve the image quality of bedside (portable) radiography and general radiography. We plan on reporting on our bedside work at the next AAPM Annual Meeting in Orlando.

Of primary importance since completing graduate school has been the support of my wife, Lolly. We are the proud parents of two young men, Kevin and Robert. I appreciate their taking time off from work to be here this evening. My family has been a stabilizing influence and has put up with my idiosyncrasies.

In closing I would like to tell you of an experience I had earlier this month. Mike (Yester) has informed you that one of my interests is caving. Earlier this month I took a young Romanian caver visiting the U.S. to Mammoth Cave in Kentucky and later to the Sloan’s Valley Cave System, a wild cave with 25+ miles of passage that I have visited many

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Barnes (from p. 7) times. We entered the cave and after two miles of mostly large borehole passage, the walking passage ended in a breakdown maze. Breakdown is a pile of mostly big rocks that have fallen from the ceiling of the passage.

There is a large passage beyond the breakdown and on several previous occasions I had crawled Young Investigators Awards John R. Cameron Young Investigator Award (1st place) Fabio Settecase University Health Network, Toronto Factors Affecting Remote Control Endovascular Catheter Steering for IMRI 2nd Place Young Investigator Lifeng Yu University of Chicago Helical Cone-Beam CT for Radiation Therapy 3rd Place Young Investigator Vanessa Clark Washington University Automated Beam Direction Selection for IMRT Based On Geometrical Concepts of Viewability and Orthogonality

through the breakdown. This time I had difficulty and could not squeeze through a tight space.

However, the young Romanian caver crawled beyond the tight spot and urged me on. After several failed attempts I removed my coveralls and finally squeezed through, bruising my chest in the process. It was difficult, but persistence paid off. This latest experience has led me to the ob-

AWARDS The Sylvia Sorkin Greenfield Award The best paper (other than radiation dosimetry) published in Medical Physics for 2004 is presented to: Anuradha Godavarty Chaoyang Zhang Margaret Eppstein Eva Sevick-Muraca for their paper entitled, “Fluorescence-enhanced optical imaging of large phantoms using single and simultaneous dual point illumination geometries,” Medical Physics 31, 183 (2004).

servation that the cave is getting smaller; nothing in life is constant and certainly not the field of medical physics.

My association with the AAPM has been rewarding. I have met many friends and have learned much from my medical physics colleagues. I thank the AAPM for this honor and you for your time and attention.

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Farrington Daniels Award The best paper on radiation dosimetry published in Medical Physics in 2004 (two were given this year): Kristofer Kainz Kenneth Hogstrom John Antolak Peter Almond Charles Bloch Charles Chiu Mykhailo Fomytskyi Frank Raischel Michael Downer Toshiki Tajima for their paper entitled “Dose properties of a laser accelerated electron beam and prospects for clinical application,” Medical Physics 31, 2053 (2004). and Hugo Bouchard Jan Seuntjens for their paper entitled “Ionization chamber-based reference dosimetry of intensity modulated radiation beams,” Medical Physics 31, 2454 (2004).

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Executive Director’s Column Angela Keyser College Park, MD

Fellowships and Residencies Your last monthly mailing included an announcement for a sponsored Fellowship and two Clinical Residencies in Diagnostic Medical Physics. Applications for the residencies must be received at AAPM Headquarters

by February 1, 2006. Applications for the fellowship must be received at AAPM Headquarters

by April 15, 2006.

•Funds for the Clinical Residencies in Diagnostic Medical Physics are provided by the Radiological Society of North America (RSNA). These twoyear grants are offered to institutions in partial support of a fulltime clinical residency in diagnostic medical physics. The residency programs must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. The RSNA has supported these residencies since 1998.

•The AAPM Fellowship for Graduate Study in Medical Physics is offered to individuals and is a two-year predoctoral study in medical physics that will begin on July 1, 2006. Graduate study must be undertaken in a medical physics doctoral degree program accredited by CAMPEP. The amount of the award will be $18,000 per year

for two years. This fellowship is funded through the AAPM Education and Research Fund.

December 9, 2005: •Deadline for poster abstract submission January 24, 2006: •Deadline for early-bird registration ($250) •Fee increases to onsite registration fee ($325) •Housing block deadline February 10, 2006: •Advance registration closes February 24-25, 2006: •Onsite registration (fee $325) For further details, go to: http:/ /www.birow.org/

Biomedical Imaging Research Opportunities Workshop

Staff News

AAPM is once again partnering with the Academy of Radiology Research (ARR), the American Institute for Medical and Biological Engineering (AIMBE), the Biomedical Engineering Society (BMES), and the Radiological Society of North America to sponsor the 4th Annual Biomedical Imaging Research Opportunities Workshop (BIROW 4).

Many other leading societies in medical imaging are also participating in this event. BIROW 4 will take place February 24–25, 2006 at the Bethesda North Marriott in North Bethesda, MD. AAPM staff members are managing the online abstract submission process. All other meeting logistics are being managed by the RSNA. Important dates to remember for BIROW 4:

Shantelle Corado has been promoted to the position of special projects manager. In her new role, Shantelle manages projects relating to the provision of services to outside organizations.

She also coordinates the activities of the AAPM Education & Research Fund, including the grant and fellowship programs.

Lisa Giove has been promoted to executive assistant. In her new role, she will provide support to the Executive Committee and the board of directors, maintain the policy database, handle elections, and manage the HQ office at meetings.

Noel Crisman-Fillhart joined the AAPM staff in August as the senior accounting assistant. Noel fine-tuned her customer service skills working in the banking industry. She is responsible for

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Keyser (from p. 9) analysis and reconciliations for the Accounting Department.

Seana Miller joined the team in October as our customer service representative. Along with providing coverage for the main phone line, Seana handles general inquiries, coordinates copyright requests and processes requests for organizational materials. Councils and committees should contact Seana for assistance with setting up conference calls.

Part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high-performing professionals. The following AAPM team members have celebrated an AAPM anniversary in the last half of 2005. I want to publicly thank them and acknowledge their efforts.

Lisa Rose Sullivan 12 years of service Penny Slattery 9 years of service Michael Woodward 9 years of service Farhana Khan 7 years of service Hadijah Robertson 4 years of service Jennifer Davis 4 years of service Shantelle Corado 3 years of service Catherine Murashchyk 3 years of service Peggy Compton 1 year of service

The AAPM Headquarters office will be closed on Monday, December 26 and Monday, January 2. Staff will take vacation days during the holiday season, but sufficient help will be available to service your needs.

This is my last column for the 2005 year. Thank you for the

privilege of leading your headquarters team. As we end the year, I want to take this opportunity, speaking for all the staff, to wish you and your loved ones a happy and healthy holiday sea■ son.

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Education Council Report Herb Mower Council Chair As I write this, many of you are preparing to go to ASTRO or thinking about your upcoming commitments at RSNA. Continuing education, continuing professional development, MOC and CEC’s continue to be a major portion of our profession and our individual lives. In the midst of all of this is your Education Council with its many committees, subcommittees, task groups, etc. These people help provide the opportunities for you to maintain your leadership and clinical role in our technologically and rapidly expanding profession.

We, as a society, and you, as an individual, need to extend our thanks to them. If you are at the ASTRO or RSNA meeting, feel free to drop in on any of our meetings, introduce yourself, and see how these groups are working for us.

Plans are progressing well for our upcoming “Physics Summit” to be held in January 2006. There has been considerable interest in this program whose purpose, in the words of Bill Hendee, “is to develop a strategy to improve the physics and engineering education and expertise of specialists in each of the three disciplines represented at the Forum” (diagnostic radiology, radiation oncology and medical physics). Due to the number of individuals and groups interested in this topic, we have had to limit the participation

to two representatives from each of the interested societies. We will keep you updated as to the results of this working group.

Our Virtual Library offerings continue to expand under the leadership of Melissa Martin and with the assistance of our headquarters staff under the direction of Michael Woodward and Lisa Rose Sullivan. This year we added the physics symposium at the Conference of Radiation Control Program Directors and Summer School sessions. Many of the offerings in the Virtual Library include opportunities for continuing education credits.

Have you met the two new kids on our block? Their names are SAM and SDEP. Hopefully you will get to know them in the upcoming years. Let me introduce them to you. SAM is short for “Self-Assessment Module” and SDEP for “Self-Directed Education Program.” For those with time-limited board certifications from the ABR, these will become close friends over the next several years. John Hazle, who serves on the ACR Physics Edu-

cation Committee, is one of the key people working on ways to integrate medical physics concepts into SAMs. The AAPM will be involved with this process through representation from the Education Council, Medical Physics Education of Physicians Committee, the Continuing Professional Development Committee, the ACR Education Liaison and Don Frey, current chairman of the board. During 2006 we will undertake initiatives with the ACMP, ACR, ASTRO and ABR trustees to see how the medical physics community will address the SAM questions. Presently MOC requirements for physics diplomats do not include SAMs. However, they do include SDEPs and we hope to have examples of what constitutes an acceptable SDEP available in the near future.

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Happy Holidays to all the AAPM members and Headquarters staff!

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–The editor and managing editor

AAPM NEWSLETTER

NOVEMBER/DECEMBER 2005

Meeting Coordination Committee News Bruce Curran Committee Chair The AAPM Annual Meeting continues to evolve in order to meet the needs of the membership. As shown in the figure, attendance at the annual meeting has increased by more than 50% over the past 12 years, reflecting the success of the Scientific, Educational, Professional, and Technical programs in attracting scientists to our meeting. As a result of the demands of the programs, the AAPM has decided to extend the Scientific, Educational, and Professional Programs to a full day on Thursday starting in 2006.

Scientific Program Notes The structure of the scientific program continues to reflect the convergence of imaging and therapy in our field. We will have imaging, therapy, and joint tracks, each with a balance of proffered papers and symposia with invited speakers. New in 2006 is a symposium of proffered papers, named to honor John Laughlin, on a topic chosen by Science Council as a field deserving special focus. In 2006, the topic will be “Multimodality image fusion and deformable registration.�

Papers selected for this symposium will be given extra presentation time.

In 2005 we had a record number of submissions, and as a consequence, gaining acceptance for an oral or poster presentation

became more competitive. Submitted abstracts needed to be well written and well supported to be selected. Even so, the total number of oral and poster presentations is almost overwhelming. In 2006 we will have a full day of presentations on Thursday.

However, adding even more sessions would only exacerbate the cognitive overload. More can be less, and so we will mostly redistribute sessions from earlier in the week, reducing the number of competing choices and creating more opportunities to view posters and visit vendors. We expect the review process to be at least as rigorous and selective as last year. Our overall goal is to increase the scientific communication at the meeting, and that requires both good presentations and good audiences who can listen, reflect, and interact.

Professional Program Notes The Professional Program was very well received again at the 2005 annual meeting and we will continue to have a dedicated

room and program track at the annual meeting in 2006.

Proffered papers will once again be solicited in 2006 with newly defined professional categories, including: 1. Clinical Practice of Medical Physics 2. Legislation and Regulation 3. Legal and Ethics 4. Economics 5. Education 6. Administration and Management Please look for the professional category definitions/selections when you submit abstracts this year and share your valuable experience with your colleagues by presenting in the professional sessions. Since a professional abstract is, by definition, not a scientific submission, the review criteria will be appropriately modified to reflect this.

In addition, the Professional Program will contain symposia, panels and courses on current essential topics in medical physics and some that will be brought

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back by popular demand. The symposia will include: 1) a discussion on intellectual property, to introduce the medical physics community to models for dissemination of information and associated intellectual property issues; 2) an address by an NRC Commissioner on current significant issues in NRC regulations and ongoing development of regulatory policy that impacts our practice; 3) a discussion on significant human resources issues in medical physics including a report from the AAPM workforce task group, application of the 2003 Abt Study and preparation for the next Abt Study; 4) a review of the AAPM Ethics Policy, which is under full revision; and 5) an update on ongoing activities related to ABR MOC, plus a discussion on meeting other necessary continuing education requirements for the practice of medical physics.

We will present professional panel sessions that discuss: 1) litigation: administration and enforcement of licenses and malpractice, including HIPAA; 2) human relations: hiring firing, and procurement, workplace dynamics and what to do if you’re spread too thin, including relevant OSHA issues; and 3) details of

current CRCPD Suggested State Radiation Regulations, as these documents represent the framework that most states use to regulate our QA programs.

Three essential professional courses will be presented: 1) medical errors and medical physics will be further expanded from last year’s program. There is so much to learn and so much for which we really need to be responsible. A multiday course will provide an introduction to medical errors, their significance and implications, error analysis and reduction philosophies. The course continues with specific applications for error reduction through analysis and QA implementation in therapy and imaging disciplines; 2) an economics primer, which will provide a review of the complexities of medical economics from reimbursement and the mechanisms for influencing economic policy to necessary accounting and management tools for the practicing medical physicist; and 3) a detailed discussion of who we are as medical physicists, beginning with the Scope of Practice of Medical Physics and extending to how and where we practice. This will be followed by an overview/ implications of passage of the CARE bill.

Educational Program Notes The annual Continuing Education Needs Assessment Survey is currently in final preparation for release. This survey first solicits topics from AAPM members, committees, and task groups, and then allows the membership to vote for those topics most important for the Educational Program.

This information is used not only for our annual meeting, but also to assist in identifying courses for ASTRO, RSNA, and AAPM Summer School topics. In 2006 we will continue to offer courses not only in the early morning hours, but in selected time slots throughout the day.

The 2006 program promises to be the best yet. Your participation by submitting abstracts and getting involved in the discussions at our meeting will strengthen the program and continue to shape our field. Our annual meeting program directors for 2006 are: Scientific Program, Jeff Siewerdson and Gig Mageras; Educational Program, Eric Klein and Perry Sprawls; and Professional Program, Mike Herman.

We look forward to seeing you in Orlando next year.

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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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Development Committee News Shantelle Corado Special Projects Manager College Park, MD The AAPM has announced the recipients of seven residencies and two fellowships since 2004.

These awards are sponsored by the AAPM, the RSNA Research and Education Fund, ASTRO and Varian. The awards were made on a competitive basis, according to Dr. Bhudatt Paliwal, chairman of the Awards Selection Subcommittee of the AAPM Development Committee.

The 2004 AAPM Fellowship for Graduate Study in Medical Physics was awarded to the UT Health Science Center with Gary Fullerton as the program director and Rachelle Ramer as the fellow. Dr. Ramer holds a Ph.D. in medical physics from State University of New York at Buffalo.

The 2005 AAPM Support for Clinical Residency in Imaging grant was awarded to UC Davis with J. Anthony Seibert as the program director.

The 2004 ASTRO Support for Clinical Residency in Radiation Oncology grants were awarded to two universities. One award was made to the University of Chicago with Mary Martel as the program director and Desiree Jangha as the resident. Dr. Jangha holds a Ph.D. in nuclear and radiological engineering and health physics from the Georgia Institute of Technology. Washington University/Barnes-Jewish Hospital received the second ASTRO

Desiree Jangha

Lisha Zhang Mark Wiesmeyer

residency with Eric Klein as the program director and Mark Wiesmeyer and Lisha Zhang as the residents. Dr. Wiesmeyer holds a Ph.D. in computer science and engineering from the University of Michigan College of Engineering, Ann Arbor. Dr. Zhang holds a Ph.D. in biomedical engineering from the University of Michigan College of Engineering. ASTRO has sponsored 12 previous grants in this program.

The 2004 RSNA Research and Education Fund Clinical Residencies in Diagnostic Medical Physics Grants were awarded to two universities. One award was made to the University of Texas M.D. Anderson Hospital with John Hazle as the program director and Ruijie Rachel Liu as the resident. Dr. Liu holds a Ph.D. in medical physics from State University of New York at Buffalo.

The University of Alberta Cross Cancer Institute in Edmonton, Canada, received the second RSNA Residency with B. Gino

Fallon as the program director and Hans-Sonke Jans as the resident. Mr. Jans is currently a graduate student.

The 2005 AAPM/RSNA PreDoctoral Fellowship for Graduate Study in medical physics was awarded to the University of Wisconsin with James Zagzebski as the program director and Matt Vanderhoek as the fellow. Mr. Vanderhoek holds a BS degree in physics from the University of Maryland at College Park. The RSNA has sponsored seven previous grants in this program, in addition to co-sponsoring eight pre-doctoral fellowships.

The 2005 Varian Support for Clinical Residencies in Radiation Oncology was awarded to two institutes. One award was made to the University of Florida with Jatinder Palta as the program director and Zhong Su as the resident. Dr. Su holds a Ph.D. in nuclear engineering from the University of Florida, Gainsville. The Washington University/BarnesJewish Hospital/ Mallinckrodt

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Matt Vanderhoek

Ruijie Rachel Liu Hans S. Jans

Zhong Su

Institute received the second Varian Residency with Eric Klein as the program director.

For a complete listing of all fellows and residents since 1990, please check the AAPM Web site: http://www.aapm.org/educ/ edfund.asp. Applications for Support for Clinical Residencies in Diagnostic Medical Physics Sponsored by The RSNA Research and Education Fund will be available on November 15, 2005 with a February 1, 2006 deadline. Applications for the Fellowship for Graduate Study in Medical Physics sponsored by AAPM will be available on November 15, 2005 with an April 15, 2006 deadline. â–

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AAPM NEWSLETTER

NOVEMBER/DECEMBER 2005

Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD

NRC Commissioners at Full Strength Edward McGaffigan, Jr. was sworn in for an unprecedented third term as a commissioner of the U.S. Nuclear Regulatory Commission yesterday by Chairman Nils J. Diaz. His reappointment by President Bush and confirmation by the Senate brings the NRC to its full complement of five commissioners. McGaffigan’s first term began Aug. 28, 1996.

He was renominated by President Clinton and confirmed by the Senate in May 2000, and served an additional five years.

His current term will expire in June 2010. McGaffigan holds a bachelor’s degree in physics from Harvard University. He also holds master’s degrees in physics from the California Institute of Technology and in public policy from Harvard’s Kennedy School of Government. McGaffigan has been a friend to the medical community and very supportive of our issues in the past.

Energy Policy Act of 2005 In July, President Bush signed the Energy Policy Act of 2005 into law. Included in this legislation is a provision to expand NRC’s authority to include any discrete source of radium-226 that is produced, extracted, or converted after extraction, before, on, or after the date of en-

actment of this paragraph for use for a commercial, medical, or research activity; or any material that (i) has been made radioactive by use of a particle accelerator; and (ii) is produced, extracted, or converted after extraction, before, on, or after the date of enactment of this paragraph for use for a commercial, medical, or research activity; and any discrete source of naturally occurring radioactive material, other than source material, that the commission, in consultation with the administrator of the Environmental Protection Agency, the secretary of energy, the secretary of Homeland Security, and the head of any other appropriate federal agency, determines would pose a threat similar to the threat posed by a discrete source of radium-226 to the public health and safety or the common defense and security; and (iii) before, on, or after the date of enactment of this paragraph is extracted or converted after extraction for use in a commercial, medical, or research activity.

The act also specifies that the commission shall enter into an arrangement with the National

Academy of Sciences under which the National Academy of Sciences shall conduct a study of industrial, research, and commercial uses for radiation sources.

The study shall include a review of uses of radiation sources in existence on the date on which the study is conducted, including an identification of any industrial or other process that uses a radiation source that could be replaced with an economically and technically equivalent (or improved) process that does not require the use of a radiation source; or may be used with a radiation source that would pose a lower risk to public health and safety in the event of an accident or attack involving the radiation source. The study results should be submitted to Congress no later than July 2007.

The act also specifies the establishment of a task force on radiation source protection and security. The chairperson of the task force shall be the chairperson of the commission (or a designee).

The membership of the task force shall consist of the following: the secretary of Homeland Security (or a designee), the secretary of defense (or a designee), the secretary of energy (or a designee), the secretary of transportation (or a designee), the attorney general (or a designee), the secretary of state (or a designee), the director of national intelligence (or a designee), the director of the Central Intelligence Agency (or a designee), the director of the Fed-

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eral Emergency Management Agency (or a designee), the director of the Federal Bureau of Investigation (or a designee), and the administrator of the Environmental Protection Agency (or a designee). The task force, in consultation with federal, state, and local agencies, the Conference of Radiation Control Program Directors, and the Organization of Agreement States, and after public notice and an opportunity for comment, shall evaluate, and provide recommendations relating to, the security of radiation sources in the United States from potential terrorist threats, including acts of sabotage, theft, or use of a radiation source in a radiological dispersal device.

NRC is holding a public meeting to discuss the requirements on

the commission imposed by the passage of this act in November.

Under the act the NRC has 18 months to promulgate regulations. In promulgating regulations under this act, Congress directed that the commission consider the impact on the availability of radiopharmaceuticals to physicians, and patients whose medical treatment relies on radiopharmaceuticals.

The AAPM will be participating in the November 9th meeting and will provide more information on this as it becomes available. Please contact Lynne Fairobent, AAPM’s manager of Legislative and Regulatory Affairs at lynne@aapm.org if you have questions.

Congratulations to AAPM Members A note of congratulations is in order for Dr. Charles Coffey as he was named the Distinguished Alumni for 2005 by Purdue University’s School of Health Sciences. In addition, Dr. George Sandison, head of the school, has announced the formation of an advisory board for the school.

Named to the board are Brent Murphy, president and CEO of ARC, Richard Vetter, Ph.D., radiation safety officer of the Mayo Clinic in Rochester, MN, and yours truly. Not bad to have two AAPM members and staff invited to serve as we currently make up half of the advisory board.

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CMS Publishes 2006 HOPPS Proposed Rule Wendy Smith Fuss College Park, MD On July 25th the Centers for Medicare and Medicaid Services (CMS) published the 2006 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. All radiation oncology procedure codes will realize increases in hospital payments in 2006, with the exception of brachytherapy. All of the brachytherapy APCs (312, 313 and 651) have proposed reductions slated for 2006. Most significant is the CMS proposal to decrease payment for CPT code 77778 by 42.3% from the

current payment of $1,248.93 to $720.71 in 2006. CPT code 77778 is billed most often for low dose rate prostate brachytherapy.

CMS is also proposing a multiple diagnostic imaging procedure reduction for 2006. Currently under HOPPS, hospitals receive the full payment for each diagnostic imaging procedure for each service on a claim, regardless of how many procedures are performed using a single modality and whether or not contiguous areas of the body are reviewed. Consistent with MedPAC’s recommendations in its March 2005 report to Con-

gress advising that the technical component payment for multiple imaging services should be reduced when they are performed on contiguous areas of the body, CMS has identified 11 families of imaging procedures to adopt this policy. CMS proposes that whenever two or more procedures in the same family are performed in the same session, the first procedure will be paid at the full reimbursement level and the second at a discount of 50%.

AAPM submitted written comments to CMS regarding the 2006 HOPPS proposal that included the following recommendations: (See Fuss - p. 18)

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Fuss (from p. 17) •AAPM recommends that CMS use only “correctly coded” claims for brachytherapy APCs 312, 313, and 651 to determine the final 2006 HOPPS payment rates where each brachytherapy procedure claim must contain an appropriate brachytherapy source device “C” code(s). Further, CMS should provide more education to hospitals regarding the importance of accurate cod-

ing, including brachytherapy sources and related devices.

•AAPM supports the American College of Radiology’s comments and the APC Advisory Panel’s recommendation that CMS delay implementation of the multiple diagnostic imaging procedure reduction for one year to allow additional time to study this proposal.

•AAPM supports the CMS proposal to move Proton Beam Codes 77523 and 77525 from

New Technology APC 1510 to clinical APC 667 Level II Proton Beam Radiation Therapy.

•AAPM supports the elimination of the “G” codes for stereotactic radiosurgery treatment planning.

The final rule will be published

by November 1, with an effective date of January 1, 2006. ■

Reference Values for Diagnostic Radiology Joel E. Gray AAPM Radiation Safety Committee Task Group Chair Recently the Radiation Safety Subcommittee’s Task Group published a report on Reference Values in the grey journal, Radiology, entitled “Reference Values for Diagnostic Radiology: Application and Impact.” (Gray JE, Archer BR, Butler PF, Hobbs BB, Mettler FA, Pizzutiello RJ, Schueler BA, Strauss KJ, Suleiman OH, Yaffe MJ. Radiology 2005; 235:354-358) RVs are used to compare radiation doses from individual pieces of radiographic equipment with doses from similar equipment assessed in national surveys. The RVs are usually set at approximately the 80th percentile of the survey distribution. This means that 80% of the facilities use less radiation than the RV. Those facilities exceeding (or approaching) the RV should review their equipment and techniques to determine why their doses are

higher than 80% of the other facilities in the US. (It should be stressed that image quality is of primary importance and that any dose optimization should take place with image quality in mind.)

The International Commission on Radiological Protection encourages the use of RVs as a means of benchmarking radiation doses and as a tool for dose reduction through optimization of the medical imaging equipment and system. The use of RVs in the UK has been very effective in lowering doses. National sur-

veys have shown reductions in patient radiation doses approaching 50% over 10 years after first publishing RVs. The AAPM Task Group has published RVs for four radiographic projections, head and body CT, fluoroscopy, and two dental projections (see table).

These reference values were developed from US national survey data over the past 10 to 15 years. Consequently, the first four radiographic projections are based on data from screen-film radiography.

AAPM Reference Values for Adult Diagnostic Radiographic Projections or Examinations

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These RVs should not be used for regulatory purposes nor should they be considered limits of good practice. These should serve the purpose of benchmarking, allowing medical physicists to compare doses from a specific facility to those being used throughout the country.

It is important to remember that these RVs are based on state-ofthe-practice as opposed to state-

of-the-art facilities. All facilities were statistically sampled to obtain this data so the doses used by the small office radiology practices are weighted the same as the doses from major teaching hospitals. Consequently, the prudent medical physicist may wish to set an optimization goal lower than these RVs. Reference Values are being used in Europe and many other

places throughout the world for benchmarking purposes. The use of RVs is encouraged by both the International Commission on Radiological Protection and the International Atomic Energy Agency, as well as the AAPM. With the publication of RVs based on US data, AAPM members have a new tool for benchmarking patient doses and optimizing radiographic imaging systems. â–

Getting Involved in Clinical Research James M. Galvin RTOG Liaison, AAPM Clinical Trials Working Group Radiation Oncology is a complex medical specialty. There are a large number of radiation delivery modalities, and the radiobiological response of tissues to radiation is not yet clearly understood. Additionally, combining radiation with other forms of therapy, like surgery and drugs, can be advantageous in many treatment situations. This means that there are many possible combinations of radiation delivery methods, dose fractionation schemes, surgical techniques and chemotherapeutic drugs. Few institutions around the world have a patient population that is large enough to effectively test competing treatment strategies. Multiinstitutional cooperative group studies allow institutions to pool their resources and patient populations to more quickly reach a statistically valid conclusion concerning the advantage of one treatment regimen over another.

Although this is the only reason-

able way to find the most effective treatment method for a particular disease process, it is hard to control an experiment that extends across a number of different treatment facilities. Physicists play an important role in guaranteeing that data collected in clinical trials involving radiation are indeed useful. This physics contribution goes well beyond the efforts that are made locally to guarantee that a certain protocol is properly implemented. Before a radiation protocol is opened for accrual of patients, one or more physicists have worked on various aspects of its development.

This involvement might take the form of helping to write the protocol so that the description of the technical details is easily understood and followed, or the physicists might help to introduce quality control measures that verify an institution’s ability to adhere to the protocol requirements.

Only a small group of physicists has chosen to get involved in the process of protocol development, and it is interesting to note

that, in comparison, a relatively large number of our physician colleagues see this as an important and stimulating activity. As physicists, we are often called upon to interpret and help implement certain protocols. However, most physicists are not familiar with the steps involved in getting a protocol approved and ready for patient accrual. It takes a considerable amount of effort, but it is also a nice opportunity to work with both physicist and physician colleagues to help advance our medical specialty. Also, it is an opportunity to get involved in clinical research. Many physicists do not work in a setting that allows them to do basic laboratory research. Clinical research does not require the resources that are usually only available to physicists employed by a university or major clinic. Thus, physicists who are not inclined or able to do basic research should consider participating in the work of organizations like the Radiation Therapy Oncology Group

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(See Galvin - p. 21)

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Galvin (from p.19) (RTOG). Please refer to the recently published AAPM report #86, “Quality Assurance for Clinical Trials: A Primer for Physicists,” for more information about clinical trials and the physicist’s role.

As a result of a number of reports that have appeared in this newsletter over the last few years, it should be clear that there is a small group of very dedicated physicists working to guarantee the quality of clinical trials that use radiation for therapy. These physicists are members of the Advanced Technology Consortium (ATC). The ATC is funded by the NCI and consists of the Image-Guided Therapy Center (ITC), the Quality Assurance Review Center (QARC), the RTOG, the Resource Center for Emerging Technologies (RCET), and the Radiological Physics Center (RPC). This group has had a major impact on the introduction of 3DCRT, IMRT and image guided technologies into RTOG and other cooperative group protocols. However, at least within the RTOG, many aspects of protocol development are not handled directly by the ATC. Instead, this work is done within the structure of the particular protocol group. Taking the RTOG as an example, developing the technical aspects of any new protocol might be assigned to one or more members of the Medical Physics Committee. The problem is that the Medical Physics Committee of the RTOG has too few members. The po-

tential pool of members consists of all physicists working for institutions having RTOG affiliation.

This is a rapidly increasing number of US and Canadian institutions, with the current number at 250 facilities. Although this number is large, the number of physicists attending either of the two yearly RTOG meetings remains small. My comments here are aimed at recruiting physicists to join the RTOG Medical Physics Committee. Dr. Michael T. Gillin is the chair of this committee, and you should contact him (mgillin@mdanderson.org) if you are interested in helping with the important responsibilities of this committee.

In addition, the Children’s Oncology Group, the nation’s cooperative group for clinical trials for children, has a physics committee. The committee is a subcommittee of the Radiation Therapy Committee. The COG meets twice a year, spring and fall. During the meeting there are sessions devoted to radiation therapy and the physics committee also meets.

The chair of the COG Physics

Committee is Art Olch (aolch@chla.usc.edu) who is also looking for more physics members.

Both the RTOG and COG physics committees offer a great opportunity for service and to get directly involved with the physics issues pertaining to clinical trials.

The next RTOG meeting will be in Miami Beach at the Fontainebleau Hotel starting on Friday, January 20 and ending on Sunday morning, January 22.

You are encouraged to go to the RTOG Web site (www.rtog.org) to view the program for this gathering. In addition to the educational and scientific program organized by the RTOG for each meeting, physicists will be interested in the Medical Physics Committee and the Image Guided Radiation Therapy Committee meetings. Of course, physicists might also want to attend committee meetings having to do with particular disease sites.

We need your help for this important effort. See you in Miami!

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The new AAPM Booth at the 47th Annual Meeting of ASTRO, October 16–20, 2005 in Denver, Colorado

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News from CAMPEP Brenda Clark CAMPEP President Several graduate committee members have participated in three site visits since the last newsletter—a burst of activity after a quiet few months. Site visits rarely happen during the summer months as we require participation from almost all progam contributors and supporters. Finding a time when everyone is available during peak holiday and conference time is almost impossible. Hopefully these programs are now well on their way to achieving accreditation; the tasks remaining are submission of the final report and approval of the board.

available on the CAMPEP Web site. On the topic of the database and electronic submission of CE program applications, I’m told that although the testing hit some ciritical errors (again), these have now been fixed and release is scheduled for the end of November.

In addition to all this activity, members of the CAMPEP Board and committees are also working to develop a set of policies and procedures. This effort is considerable but justified with the rationale to increase transparency of our activities while expediting continuity and consistency.

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The residency committee is similarly busy with one application seeking board approval, one site visit already scheduled, another application under preliminary review, and three applications in the mentorship phase. In addition, both committees have revised the format used for reporting to provide some uniformity and clarity.

From the continuing education group, CAMPEP now offers CE credits for writing examination questions or serving as an oral examiner. At present, this offer is limited to the ABR examinations but could be expanded to other examination boards in the future. Details of the criteria for credits will be

Summer Undergraduate Fellowship Program Update George Sandison Subcommittee Chair Last summer was the fifth time the AAPM Summer Undergraduate Fellowship Program was run.

The 10-week program’s aim is to expose the fellows to medical physics research and clinical practice and so influence them to undertake graduate study leading to a career in medical physics. Competition for a fellowship was very strong with a total of 89 applicants and the 12 winners having an average GPA of 3.8.

Part of the formula for success in attracting this large pool of out-

standing students was advertisement of the program through the Society of Physics Students. Special thanks are due to those members who volunteered to serve as mentors for the fellows this past summer. We encourage those mentors not selected to volunteer again next year as mentor selection is strongly influenced by the fellow applicants’ requests to study in geographic areas nearby their residences. A large base of potential mentors across the country helps the subcommittee to best meet the individual fellows’ requests. Below are some

of the highlights for a few selected fellows’ summer 2005 work.

Amy Bornholdt – (Mentor Dr. Steven Avery –University of Pennsylvania) The recent clinical introduction of intensitymodulated radiation therapy (IMRT) which provides high doses to targets and spares normal tissue has revolutionized treatment of head and neck cancer. IMRT is especially attractive in this tumor site due to the close proximity of the targets to many critical normal tissues, as well as minimal target motion when the

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head and neck is well immobilized. Clinical problems lie in the adequate definition and delineation of the targets and the associated increased risk of marginal tumor recurrences, the reduction of high dose points (hot spots) in the low neck region, which can cause damage to blood vessels, and reducing dose to the normal upper lung.

Amy is studying head and neck patients with similar tumor geometries to determine whether splitting targets into separate sections will reduce hot spots and lower the dose to the lungs. She is also trying to establish a standard IMRT treatment for tumors under similar geometry. Amy also participated in clinical duties including monthly calibrations of the linear accelerators and the CTsimulator and all special radiation procedures offered by the clinic.

Tim Burns – (Mentor Dr. Bruce Thomadsen – University of Wisconsin) Tim worked on a project to assess the strength of radioactive sources used in implants for prostate cancer treatment. These radioactive sources are sealed in sterile packages that can’t be opened before the operation, making their required calibration a challenge. Tim and his co-investigator, Corey Watts, solved the problem using images formed on X-ray film by the radiation sources themselves to assay the strength of each source.

This approach required a complicated mathematical unfolding procedure because the darkening on the film near any one source also had a contribution from all other sources.

Kathryn Dikeman – (Mentor Dr. John Ashburn – University of Kentucky) Kathryn worked on a project characterizing EDR2 film for measuring radiation dose inside patients receiving electron beam therapy. Film has advantages compared to other radiation detectors due to its higher spatial resolution, two dimensional record of radiation dose distribution and the fact that it can be cut to custom dimensions for specific tasks. Kathryn found that EDR2 film is relatively insensitive (<7%) to the energy of electron beam radiation and the angles it makes with the radiation beam (up to 60 degrees).

She tried a complex test case on the scalp of a phantom patient and found that the EDR2 film measurements agreed closely with other dose measuring devices but that the computerized estimates provided by a treatment planning system needed significant correction. Kathryn concluded that the film can be used for accurate custom measurements of patient dose for complex treatments.

Justin Horacek – (Mentor Dr. Nicholas Detorie – Johns

Hopkins University) Justin focused on a project related to total body irradiation (TBI) of pediatric patients. TBI is used for patients undergoing bone marrow transplantation and requires the use of large radiation fields and radiation dose calculations at multiple points in the body. Working with Dr. Detorie, Justin’s specific project entailed megavoltage photon (6 MV) data acquisition under TBI treatment conditions and incorporation of this data into a mathematical model that could be used in conjunction with the patient CT images. With the assistance of Dr. Todd McNutt, a computerized treatment planning system was used to model the TBI data and display the 3D dose distribution inside the patient’s entire body. The information is useful for designing treatment aids for reducing the radiation toxicity experienced by some patients undergoing the TBI procedure.

Azaree Lintereur – (Mentors Drs. David Loshek, Sugata Tripathi and Mehran Zain – Marshfield Clinic) The timing of Azaree’s fellowship permitted her to take part in the commissioning

Fellow Azaree Lintereur with Mentor David Loshek at the Marshfield Clinic

(See Undergraduate - p. 24)

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Undergraduate (from p. 23) of a new $2.1 million medical linear accelerator at Marshfield. In addition to her assistance with the beam measurements, she was engaged in understanding the physics underlying the monthly tests that are performed to ensure that the penetrating power of the radiation beams has not changed.

Based on this work experience, Ms. Lintereur is preparing a scientific article “Attenuator based measurements of the stability of electron beam energy” for submission to the Journal of Applied Clinical Medical Physics.

2005 RDCE

Saud ur Rahman – (Mentor Dr. James Halama – Loyola University Medical Center) Saud worked on a project to validate techniques used in nuclear medicine to measure the amount of the beta-emitting isotope Yittrium-90 administered to patients to treat liver cancer. The Yittrium-90 is attached to small microsphere particles and administered directly into liver tumors via the hepatic artery. It is critical to know the amount of radioisotope, and hence the radiation dose, that will

be delivered to the tumors and other nearby organs such as the lungs. Successful treatment of these patients requires that a very high radiation dose to liver tumors is delivered while minimizing the amount given to nearby organs. Nuclear medicine is a discipline in radiology that uses gamma cameras to externally image the location and amount of a radioisotope given to patients for diagnosis and to treat diseases.

Adam Shulman – (Mentor Dr. George Ding – Vanderbilt University) Monte Carlo simulation of radiation transport is one of the most accurate methods for calculating dose distributions in radiation therapy. At Vanderbilt Medical Center, a new accurate dose calculation algorithm based on Monte Carlo technique is being implemented for electron beam treatment planning. Adam tested and validated the accuracy of the algorithm by comparing the radiation doses predicted by the Monte Carlo-based electron beam treatment planning system to measured doses. The comparison was performed for vari-

ous treatment parameters including different beam energies. This validation was vital to the evaluation of the algorithm prior to its release for local clinical use.

Adam also participated in the routine radiotherapy treatment unit quality assurance procedures that form part of the clinical role of medical physicists.

Stacy-Ann Stephenson – (Mentor Dr. Katja Langen – M.D. Anderson–Orlando) During her stay at M.D. Anderson– Orlando, Stacy-Ann helped to evaluate a new radiation dose measurement device (i.e. a dosimeter) based on film. This new dosimeter is Gafchromic film, called EBT (ISP, Wayne, NJ), that self-develops and is tissue equivalent. Stacy-Ann calibrated the device and film and assisted in clinical measurements of radiation dose for a patient undergoing treatment on a special machine, TomoTherapy Hi*ART unit (TomoTherapy, Inc., Madison, WI). The nature of the dosimeter allowed its immersion in water, which is a close radiation mimic of the human body, for ■ measurements.

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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leadership in their interactions with Congress, federal agencies & other policy makers. Lynne has been instrumental in establishing and maintaining relations with similar professional societies and others in the medical, basic science and science policy communities. Lynne is also the staff liaison for the Professional Council.

Staff Profile Report HQ staff members (l to r)Penny Slattery, Shantelle Corado, Lynne Fairobent and Cecilia Hunter (standing)

■

Angela Keyser AAPM Executive Director This month we would like to profile several of our staff who manage programs and projects that do not necessarily fit into a “Department” category but which nonetheless play a significant role in serving the AAPM membership.

Cecilia Hunter joined the AAPM HQ team in June 2003 as director of finance and administration. She has put her extensive background of nonprofit association management to work guiding AAPM’s financial and administrative functions, ensuring that the leadership is kept fully informed of the financial position of the organization. Cecilia oversees the accounting, human resource, legislative and regulatory affairs, and scientific journal activities. She also serves as the AAPM’s contact with outside professional service providers, including auditors, legal counsel, and bank affiliations. Cecilia also serves as the staff liaison to the Science Council.

Penny Slattery was hired in 1996 as journal manager when AAPM began to transition the administrative support of the Medical Physics journal to the HQ offices. She coordinates the processing of manuscripts for the journal and serves as liaison to the publisher, the American Institute of Physics. Penny was instrumental in moving the manuscript submission process online and to the overall success of the journal.

Shantelle Corado came aboard in 2002 as a programs assistant in the Meetings Department. She has recently been promoted to special projects manager. In her new role, Shantelle manages projects relating to the provision of services to outside organizations. She also coordinates the activities of the AAPM Education & Research Fund, including the grant and fellowship programs.

Lynne Fairobent joined the AAPM staff in June 2004 as legislative and regulatory affairs manager. She assists the AAPM

APS CONGRESSIONAL SCIENCE FELLOWSHIP 2006-2007 The American Physical Society is currently accepting applications for the Congressional Science Fellowship Program. Fellows serve one year on the staff of a senator, representative or congressional committee. They are afforded an opportunity to learn the legislative process and explore science policy issues from the lawmakers’ perspective. In turn, Fellows have the opportunity to lend scientific and technical expertise to public policy issues.

Qualifications include a PhD or equivalent in physics or a closely related field, a strong interest in science and technology policy and, ideally, some experience in applying scientific knowledge toward the solution of societal problems. Fellows are required to be U.S. citizens and members of the APS. Term of Appointment is one year, beginning in September of 2006 with participation in a two-week orientation sponsored by AAAS. Fellows have considerable choice in congressional assignments.

A Stipend of $50,000 is offered in addition to allowances for relocation, in-service travel, and health insurance premiums.

Application: Please see the APS Web site (http://www.aps.org/ public_affairs/fellows.html) for detailed information on materials required for applying and other information on the program.

All application materials must be postmarked by January 15, 2006 and should be sent to the folllowing address: APS Congressional Science Fellowship Program c/o Jackie Beamon-Kiene APS Executive Office One Physics Ellipse College Park, MD 20740-3843

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AAPM/IPEM Travel Grant Report – Part II Paul R. Morrison Boston, MA paul@bwh.harvard.edu This is the second installment of a two-part report on my travels under the 2004-2005 AAPM/ IPEM Medical Physics Travel Grant. Please recall that the purpose of the grant is “to promote communications and professional partnerships between U.S. AAPM members and members of the (IPEM) Institute of Physics and Engineering in Medicine in the United Kingdom.” The first part of the travel report, previously published in the AAPM Newsletter (May/June 2005), reviewed my September 2004 trip to York where I presented the talk “Image-Guided Thermal Ablation of Tumors” in the session on Non-Ionizing Radiation of the IPEM’s annual meeting.

That talk provided an overview of the principles and practice of image-guided thermal therapies (ablation). These techniques are practiced by both interventional radiologists in US, CT and MRI suites, and by surgeons in the operating room. These therapies can be used to target tumors throughout the body, including those arising in the liver, kidney, lung, and bone. My intent was to provide the IPEM members in the session with an understanding of the level of interest among both clinicians and researchers in the field.

The second part of my travel under the grant took place this

past June. I visited Wladyslaw Gedroyc, MD, director of the interventional MRI group in the Radiology Department at St. Mary’s Hospital in London. For the purposes of the grant I was interested in his practice of MRIguided thermal ablation.

Dr. Gedroyc had begun St. Mary’s clinical interventional MRI program at nearly the same time our Old entrance of group started at Brigham Saint Mary’s Hospital in London. and Women’s Hospital. was spent in good conversation Thermal ablation has been a with Dr. Gedroyc, his two fellows common ground for the two inand other staff members. Later stitutions. Separately, we have a in the afternoon I presented the longstanding interest in using MRI thermal ablation talk that I had to monitor RFA to heat/coagugiven at the IPEM annual meetlate tumors. St. Mary’s has also ing to the fellows. From the contaken on MRI-guided FUS of fiversations with Dr. Gedroyc, it broids, an area of active investiwas interesting to learn that radigation in the BWH FUS Laboologists solely use their MRI suite ratory under the direction of at present, and no surgical proKullervo Hynynen, PhD. At cedures take place there. In conBWH, we also do interstitial latrast, at BWH there is a rather ser treatments for certain brain equal divide among neurosurgery, pulse sequences that provide radiation oncology and noninvasive feedback on teminterventional radiology for time perature changes in tissue and the in the interventional magnet. Dr. ways in which they are displayed Gedroyc noted that he has been to the user. doing the laser liver and fibroid In June of this year, after arrivcases on a regular weekly basis. ing at Heathrow Airport, I had He also presented his enthusiasm taken a notably quick express for FUS that is performed in a train ride to Paddington Station, separate facility with a closed 1.5 which was right next to the hosTesla scanner; those cases are pital. The high technology of the done also on a regular basis. interventional MRI suite is juxtaSubsequently, I returned for a posed to the centuries-old archimorning ablation. The laser liver tecture of the buildings. After a tour of the facility, the afternoon (See Morrison - p. 28) 26

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Morrison (from p. 26) and laser fibroid procedures are done in a 0.5 Tesla vertically open MRI scanner. This magnet is one of the original systems designed for intervention & surgery, and part of a program championed by GE Medical Systems to exercise and understand MRI-guided procedures. The system is identical to the original one installed at BWH. For the laser procedures they use near infrared light from an Nd:YAG laser system with a custom beam-splitter that allows them to utilize multiple optical fibers (needed for coagulating large volumes of tumor). The fibers are placed through the skin (percutaneously) under imageguidance into the tumor.

That morning’s case was a laser ablation of a fibroid. (As it happened, the patient had scars on her abdomen from a previous surgery; the scars presented a problem for the acoustic window needed for FUS, Dr. Gedroyc’s preferred method for treating fibroids. Separately, fibroids sometimes present with calcification on their periphery—also a contra-indication for FUS, and thus those are also referred for percutaneous laser ablation.) Dr. Gedroyc placed MRI-compatible needles through the skin and into the tumor under MRI guidance. This is similar to what we do with cryoneedles under MRI and RFA electrodes under CT at our institution. The laser treatment fibers were passed through the needles and extended out into the tumor. With the laser activated, a T1-weighted FSPGR imaging

Longdon, England with Big Ben in the background.

sequence was used to monitor the temperature. Over several minutes there was a decrease in image signal intensity indicative of an increase in temperature. As the tissue was heated, a digital image subtraction provided a single-slice display of the thermal map as an overlay on the grayscale image of the anatomy. The thermal map utilized a calibration system of their own that related signal intensity change to temperature elevations. The displayed intensity change seemed to cover the targeted volume. The fibers and needles were removed and a small bandage applied to bring a close to the apparently successful procedure.

I was soon back on the train to the airport and homeward bound.

It was a pleasure to have a chance to meet with the interventional MRI group there, learn more of their activities and to observe the procedure.

The most striking lesson of the trip was the complementary nature of the FUS and laser interventions at their facility for fibroid therapy. The group at St. Mary’s has a clear vision of how FUS ablation (a non-invasive, trancutaneous procedure) can be a benefit to patients. However,

when presented with a contraindication, they provide the option of a minimally invasive percutaneous procedure. The second lesson for me was that the lasers worked well for them in ablating several cubic centimeters of tissue. At BWH we have used cryotherapy and RFA for larger volumes of tissue ablation in the abdomen. But, the laser is very compatible to the MRI environment. When we use the laser at BWH, it is generally for small tumors in the brain. Notably, we use a more quantitative, multislice thermal mapping of the heat based on measuring the proton resonance frequency shift method (as done for FUS).

Thermal ablations are being performed in increasing numbers around the world. Now is a good time in the development of the field to look for the contributions that medical physicists can provide in both the research and clinical applications.

Thanks to Ferenc Jolesz, MD and Stuart Silverman, MD at BWH for supporting my participation in the program. Thanks also to the AAPM and IPEM and Dr. Lescrenier for the availability of the travel grant. Overall, it proved an invaluable experience.

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AAPM/IOMP International Scientific Exchange Program Saiyid M. Shah Course Director The 14th AAPM / IOMP International Scientific Exchange Program course and workshop in radiation therapy physics was held successfully in Manila, Philippines, August 1-5, 2005. This program was cosponsored by the Philippines Organization of Medical Physicists (POMP) as the host organization.

The objectives of this course/ workshop were to update the knowledge of medical physics, to present advanced radiation therapy physics to clinical physicists, to intercompare calibration of photon beams using IAEA and AAPM TG-51 protocols, and to exchange information concerning the medical physics profession in the Philippines and nearby countries. Even though this course/ workshop was intended for medical physicists, some radiation oncologists, dosimetrists and radiation therapists also attended.

A total of 73 participants were registered, including one dosimetrist from Singapore and one medical physicist from Korea. Almost all the medical physicists in the Philippines were able to attend this program.

Mr. Gil Palcone, president of POMP, was the host director and co-director of this program. Ms. Agnette Peralta, director of the Philippines Bureau of Health Devices and Technology, and Mr. Raffy Solis from St. Luke Medical Center, also helped organize

and plan this program. The AAPM faculty were: Drs. Faiz M. Khan, Azam NiroomandRad, Ceferino H. Obcemea, Bhudatt R. Paliwal, Saiyid M. Shah, and Raymond K. Wu. The program began with a welcoming address by Celia Anatalio, MD, assistant director of the Elicano Cancer Clinic. Dr. Anatalio is known as the “Mother of Medical Physics” in the Philippines. The program ended with a presentation of Certificates of Participation and of Appreciation to the participants and faculty.

Evaluation forms were distributed to the participants and were collected upon completion of the program. General comments were noted by some of the respondents at the end of the evaluation form, many of which complimented the faculty on a great job and that this program provided a unique opportunity for the participants to interact with the faculty and benefit from their experiences.

The local expenses of the faculty were supported by the host institution, and their travel expenses were financed by funds provided by the AAPM and the following vendors: Advance Radiation Measurements, Assurance Controls Technologies Co., Brain Lab, Best Industries, Computerized Radiation Scanners, Elekta, Global Medical Solutions, Integrated Energy Systems and Resources, MDS Nordion, PTW, Scanditronix/Wellhofer, Siemens, Sun Nuclear and

Varian. We are grateful to these companies for their generous contributions. The local expenses of this program were supported by POMP, the Philippines Bureau of Health Devices and Technology, IOMP, North American Chinese Medical Physicists Association and local vendors. This program would not have been possible without the support of these organizations and vendors. We would like to express special thanks for their generous contributions.

We also wish to acknowledge the commitment and effort of Ms. Agnette Peralta, Mr. Gil Palcone, Ms. Josephyn Limbo, POMP treasurer, and all other staff of the Local Organizing Committee who worked very hard in the past few years to organize and implement this program. They did a great job and the local arrangements (including the companion program) were superb. Their hospitality was extraordinary. We would also like to thank the AAPM faculty for volunteering their time and efforts in this endeavor.

Last, it is worth noting that there are several state-of-the art radiation treatment centers in the Philippines and that every radiation treatment center is required by law to hire at least one medical physicist. This achievement is largely due to the active efforts and leadership of Ms. Agnette ■ Peralta.

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New Members The following is a list of AAPM ‘Change of Status’ and ‘New’ members from June–September 2005.

Change of Status

New Members

Corresponding

Associate

J Bosman Dordrecht NETHERLANDS

Richard S Benson Highland, OR Mariya Benusovich Winnetka, CA Marcum D Martz Milwaukee, WI

Full Rami R. Abu-Aita Wausau, WI N Robert Bennett Stanford, CA Hong Chen San Fransico, CA Ferney Diaz-Molina Flushing, NY Wenzheng Feng Livonia, MI Daniel J Januseski Marlton, NJ Don-Soo Kim Boston, MA Brent C Parker Galveston, TX Ke Sheng Charlottesville, VA Anthony M Stell Liverpool, NY Mauro Tambasco Calgary, AB CANADA Xueding Wang Ann Arbor, MI

Junior Jamone B Williams Fort Wayne, IN

Yang C Cai Oak Park, IL Yue Cao Ann Arbor, MI Marcelo C Cassese Concord, CA Quan Chen Madison, WI Talal A Chohan Jacksonville, FL Dennis P Clum Dublin, OH Michel Destine Namur BELGIUM Cameron B Ditty Schertz, TX Stella Flampouri Boston, MA Eric M Friets Hanover, NH Bernard W Gardner, Jr Durham, NC Paul L Gueye Hampton, VA Joseph L Hall Dublin, GA Joshua L Hayes Lubbock, TX David Hunter Albuquerque, NM Kadri N Jabri Waukesha, WI Jeomsoon Kim Ann Arbor, MI Ryszard Kudynski Hanover, PA Willem J Lenglet Leeuwarden NETHERLANDS Sung-Yen Lin Beaumont, TX Venkata N Lingampally Claremont, CA

Corresponding Janez Burger Ljubljana SLOVENIA Rita Elaine F Corte Campinas BRAZIL Gustavo A Coscia Pergamino ARGENTINA Alistair Mackenzie London UNITED KINGDOM Thaveethu N Palani Selvam Ottawa, ON CANADA Sollin Selvan Singapore SINGAPORE

Full Joshua Kudi Audu Vancouver, BC CANADA Steve Axelrod Fremont, CA Deidre L Batchelar London, ON CANADA James Beck Winnipeg, MB CANADA Tonya A Bernhardt Oak Ridge, TN Patrick J Byrne Indianapolis, IN

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Fan Liu New York, NY Dershan Luo Houston, TX John P McCaffrey Ottawa, ON CANADA Matthew P Mischke Duluth, MN Vitali Moiseenko Surrey, BC CANADA Douglas J Moseley Toronto, ON CANADA Vadim P Moskvin Indianapolis, IN Rajendran Munusamy Elk Grove Village, IL Dinesh Kumar Mynampati Secunderabad INDIA Bau H Nguyen Plano, TX Gregory Niyazov Fresh Meadows, NY Malika Ouzidane Cleveland, OH Julian R Perks Sacramento, CA Jerimy C Polf Houston, TX Mahnaz Qamar Houston, TX Uday H Rao Evanston, IL Brigitte Reniers Montreal, QC CANADA John L Russell, Jr Norcross, GA Sartaj Sahni Gainesville, FL Jennifer B Sessions Indianapolis, IN

AAPM NEWSLETTER NOVEMBER/DECEMBER JANUARY/FEBRUARY 2001 AAPM NEWSLETTER 2005

Wendy L Smith Calgary, AB CANADA Milan Sonka Iowa City, IA

Raj Shekhar Baltimore, MD Gina L Shelton Round Rock, TX

Paul Robert Sullivan Abington, PA Arivazhagan Vasudevan Elk Grove Village, IL

Luciant D Wolfsberger Newton, MA Beibei Zhang Toronto, ON CANADA ■

Letter to the Editor Only a Physicist Can Operate a Geiger Counter?

Ron Droege Cincinnati, OH rondroege@hotmail.com Why is physics presence required during HDR treatments but not during Co-60 treatments?

Consider the similarities. Both utilize a remotely controlled high activity source in a room having a radiation monitor, intercom, and patient viewing system with access through an interlocked door.

Both have a hand crank used in an emergency to restore a stuck source to a shielded position.

Emergency procedures are similar. For Co-60, the operator lowers the couch, assists in removing the patient from the room, then closes the door and secures the room. For HDR, if the hand crank fails, the physician removes the applicator from the patient, and the operator similarly assists in removing the patient, closing the door and securing the room.

No physics skill or supervision is required during treatment or emergency action.

The hazards of a stuck source are also comparable. A Co-60 source delivers a dose rate of

50-100 cGy/min to a large tissue volume (several liters) near the isocenter. A stuck HDR source delivers dose rates ranging from 50 to 115 cGy/min to the much smaller 80 cc target volume adjacent to a 4 cm diameter MammoSite balloon (assuming an average source activity of 6 Curies). Selected other HDR treatments (e.g., bronchial), result in higher tissue dose rates, but to much smaller volumes.

From the 1950s to the present, physicists have never been required to be present during Co60 treatments. So why does the NRC require this for HDR? One aspect of HDR treatments is unique; a patient survey is required after each treatment. Is this the reason a physicist is required? Does the NRC believe that only a physicist can operate a Geiger counter?

HDR’s early history provides some insight. In November 1992, a patient died five days subsequent to her HDR treatment. The Ir-192 source had become detached from its cable and was left for days inside an implanted patient catheter. If the treatment staff had paid heed to the flashing radiation alarm, or if they had performed a post treatment survey, serious patient injury could eas-

ily have been avoided. Even though compliance with existing regulatory requirements would have prevented this incident, the NRC issued a bulletin in 1993 imposing additional restrictions on all HDR users, including the “requirement” that a physicist (or the RSO) be present during each HDR treatment.

For 10 years it was relatively easy to comply. Some facilities had multiple physicists, while others were permitted substitutions for the physicist. Now it’s not so easy. The new 10 CFR Part 35 permits no substitutions. The emergence of MammoSite treatments, requiring physics presence twice a day at intervals of at least six hours, ties a physicist to a “part-time” clinical site for most of the 40-hour workweek. Vacation coverage is especially problematic. Previously, an absent physicist required relatively little backup; most physics matters could wait for the vacationing physicist to return. But now the backup physicist must be present each day of an HDR treatment, and nearly full time during the week of a MammoSite treatment.

Physics presence is not required to ensure the safety or

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Droege (from p. 31) effectiveness of an HDR treatment. It is a waste of physics manpower at a time when physicists are in short supply. With rising health care costs, who’s going to pay the added cost of the backup physicist during the week of a MammoSite treatment?

The NRC has yet to describe any task or responsibility of the physicist, either during treatment or in the event of an emergency.

If physics presence were a true clinical necessity, it would be worth the time, effort, and money to comply. But it is so clearly unnecessary that the regulation should be changed to require only

the physician and a well-trained operator to be present. It is my hope that the AAPM could make these points to the NRC and effect this change. If you agree, contact me and I’ll forward a summary of the responses to the AAPM. ■

AAPM NEWSLETTER Editor Allan F. deGuzman

Managing Editor Susan deGuzman Editorial Board

Arthur Boyer, Nicholas Detorie, Kenneth Ekstrand, Geoffrey Ibbott, C. Clifton Ling Please send submissions (with pictures when possible) to the editors at: e-mail: deguzman@wfubmc.edu or sdeguzman@triad.rr.com (336)773-0537 Phone (336)713-6565 Fax 2340 Westover Drive, Winston-Salem, NC 27103

The AAPM Newsletter is printed bi-monthly.

Next Issue: January/February 2006 Postmark Date: January 15 Submission Deadline: December 13, 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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