AAPM Newsletter January/February 2006 Vol. 31 No. 1

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 31 NO. 1

JANUARY/FEBRUARY 2006

AAPM President’s Column E. Russell Ritenour Minneapolis, MN Mark Twain said, “I try not to let schooling interfere with my education.” In my first column as president of the AAPM, I want to focus on some things that are happening in the AAPM in the area of education of medical physicists. The American Board of Radiology has indicated that it plans to require that by 2012, in order to be eligible for the board certification exam in any of the areas of medical physics, an applicant will have to have graduated from a CAMPEP approved residency. It is clear that currently

there are not enough residency programs to fill the demand.

There probably are enough available slots in graduate programs to meet current demands, but

there clearly aren’t enough residencies. Referring back to the quote from Mark Twain, people are getting their schooling, but they’re not getting educated clinically. Moreover, for various reasons, many residencies only take medical physicists with PhDs, thus further reducing the number of residencies available to candidates with master’s degrees. Data on the number of training programs, as well as the number of jobs available, is being gathered by the working task group under the Professional Services Committee (both the task group and the committee are chaired by Rob Rice).

(See Ritenour - p. 2)

TABLE OF CONTENTS

Incoming Chairman of the Board Report Howard Amols New York, NY This month’s issue contains a report from our new president, Russ Ritenour, in which he focuses on one of my favorite topics—our need to improve clinical training for new medical physicists and a follow-up on what the AAPM is currently working on in this area. Outgoing Chairman of the Board Don Frey reports on the recent board meeting of

November 30, all of which leaves me free to comment on a few miscellaneous items.

Recently the board of directors asked the membership to vote on a proposed set of bylaws changes designed to decrease the size of the board by reducing the number of at-large board members and also replacing the 20 chapter representatives with seven regional representatives. A two-thirds approval vote of (See Amols - p. 4)

New Board Members Outgoing Chairman Rep. Executive Dir’s. Column Education Council CAMPEP News Professional Council CIRMS Update Treasurer’s Report 2006 Budget Leg. & Reg. Affairs Health Policy/Economics Chapter News Clinical Trials Seed Funding Initiative International Conf. News Staff Profile U.S. Physics Team Letter to the Editor

p 3 p 6 p 8 p 10 p 11 p 11 p 12 p 15 p 16 p 19 p 22 p 25 p 26 p 27 p 28 p 29 p 30 p 31

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Ritenour (from p.1) One approach to clinical training is to allow newly graduated medical physicists to receive formal “mentoring” by a qualified medical physicist. Over the past year, an Ad Hoc Committee on Alternative Pathways has been examining ways to structure residencies that do not require large academic centers, but instead allow qualified medical physicists to mentor and document training of individuals in a clinical setting.

The ad hoc committee’s report was finalized and sent to the board of directors at the Seattle meeting. Since then, a Task Group on Alternative Pathways, chaired by Mike Herman, was formed under the Medical Physics Residency Program Subcommittee of Ervin Podgorsak’s Training of Medical Physicists Committee. That task group has met and is working on a document that describes how these “affiliated residency” positions can be structured. If you would like to express any opinions on the residency situation, please contact the members who are working on these issues, or contact me.

At the end of January there will be an Education Forum in Atlanta. A few representatives from each of the societies that have a stake in the physics education of medical physicists, diagnostic radiologists and radiation oncologists will meet to discuss current problems and future directions.

The AAPM will be represented

by Richard Massoth, Ervin Podgorsak, Tony Seibert and

me. Other societies participating in the forum include the ABR, ABMP, CAMPEP, ACMP, ACR, RSNA, and ASTRO. In all, more than 16 societies will be sending representatives. Herb Mower, chair of the AAPM’s Education Council, has taken the lead in planning this forum. On the day that we discuss education of medical physicists, a number of issues will be covered. These will include trends in cutoff scores at board exams, scarcity of clinical training of medical physicists in

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academic programs, scarcity of residency training programs, workforce issues, and the employment outlook. A white paper will come out of the meeting.

Rather than suffer the fate of many white papers, this one will be seriously considered by the examining and certifying boards.

At present new medical physicists are finding jobs. However, in the jobs they find, they do not always receive the mentoring and (See Ritenour - p. 4)

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Newly Appointed 2006 AAPM Board Members

Gary Ezzell Secretary

Mary Martel President-elect

Stephen Balter Member at Large

Per Halverson Member at Large

Tim Schultheiss Member at Large

George Sherouse Member at Large

Chapter Representatives

John Boone Science Council Chair

Peter Roberson Great Lakes

Palmer Steward Missouri River Valley

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Daniel Bassano Upstate New York

Zhe Chen Connecticut

Steven Sutlief Northwest

Ken Vanek Southeast

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Ritenour (from p. 3) breadth of training required to sit for board exams. If you ask anyone who examines for the oral boards in radiation oncology physics, you’ll hear tales of candidates who say they don’t know anything about an important subject area because they were “just

Amols (from p. 1) members is required to change the bylaws. The plan to restructure the board received a 60-40 favorable vote by the members but failed to obtain the necessary two-thirds majority by 6.6 percentage points. Like most AAPM elections, less than one third of eligible members voted, meaning that about 65 additional ‘yes’ votes would have changed the outcome. So, is the glass half full or half empty? A 60-40 favorable vote could be interpreted as meaning that a large percentage of AAPM members believe that restructuring the board is a good idea. On the other hand, one could argue that two thirds of our members either don’t know or don’t care. Given the importance of this, Excom has asked the Regional Organization Committee and its chair, Dan Pavord, to study the issue. In particular, during the various discussions preceding the vote (on our Web site, on the medical physics list server, at the annual business meeting, and at last summer’s meetings of the board and Regional Organization Committee) a number of issues were

hired to do brachytherapy” and haven’t gotten to do much else, for example. So, if you are a senior member of the AAPM and you’re still reading this column, then you are probably at least somewhat interested in how we train our future colleagues. You might start thinking about how to increase the amount of informal

or, perhaps in the future, formal mentoring that you do. Remember, as you look at entry level physicists, you are looking at the people who will someday design and carry out treatment plans for you and for me. I’d certainly like them to be well trained.

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raised which, had they been addressed in the proposed bylaws changes, might have changed the outcome. Specific issues included more chapter representation on the board through the Regional Organization Committee, mechanisms for regional representatives to regularly visit and communicate with the chapters in their region, changing the mix between at-large and regional representatives, exploring the possibility of more frequent ‘electronic’ (rather than face-to-face) board meetings, etc. In short, despite the fact that the proposed bylaws changes fell 60 some odd votes short of the required two-thirds majority, it is not a dead issue and we hope to be reporting back to you in future columns on progress towards making the board more effective.

At its recent meeting in Chicago, the board also accepted the recommendations of my Ad Hoc Committee on Web site Editor (chaired by Colin Orton). This is clearly the information age and the AAPM Web site has become our window to the world. As such, I believe that, like our journal and newsletter, the Web site needs an editor. Operation and

maintenance of the Web site is already in the excellent hands of Mike Woodward (AAPM Director of Information Services) and his staff, but I believe the need now exists for an editor to manage the content and future goals of the Web site. To date, AAPM members and committees have used the Web site more or less as a bulletin board. As such, editing Web postings for scientific and/or professional content and appropriateness has been done with little or no direction.

Consequently we will soon begin recruiting for our first Web site editor. Again, taking the journal and newsletter as models, the editor will be an AAPM member working part time and will deal with Web site content, working closely with AAPM Headquarters staff who will continue to function as the ‘publisher.’

Changing topics—Don Frey is already reporting on another recent board action in his column in which the board officially stated that the AAPM will not pursue seeking provider status (i.e., independent billing) at this time. It must be reiterated that this decision by the board was made not

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as a matter of principle, but rather as a matter of practicality. A great deal of effort by our Professional Council (chaired by Jerry White) and Professional Economics Committee (chaired by Jim Hevezi) went into studying this issue, including the expenditure of a significant amount of money for a study by an independent consulting firm. The recommendations by the experts were unanimous; seeking provider status at this time is beyond the resources and expertise of the AAPM, not likely to succeed in the current economic and political climate, and possibly counterproductive economically (i.e., even in the unlikely event that we would succeed in principle, we might well lose economically in terms of total physics income).

I’d like to assure all AAPM members that this is not a decision the board took lightly, nor

was it done without careful study or awareness of how strongly some members feel about this issue. A great deal has been made about last year’s member survey in which it is claimed that two thirds of AAPM members strongly support seeking provider status. However, that claim is, at best, only partially true. In the survey members were asked their opinions on six different professional issues (see table below).

Responses were categorized as strongly or somewhat agree or disagree. On the issue of independent billing, only 39% strongly supported it with another 25% somewhat supporting it.

Lumping ‘somewhat support’ and ‘strongly support’ into a single group and claiming that 64%, or roughly two thirds, strongly support this, is therefore a claim subject to interpretation.

(Please see table)

I’d also like to draw your attention to the fact that of the six professional issues surveyed, support for independent billing came in fifth with far more members voicing support for lobbying on regulatory issues, training programs, and increased physics research funds.

So what we need to do now is put this issue behind us, at least until the politics and economics change, and focus on other, more realizable goals. Given the limited resources of the AAPM, it is imperative that we continue to work closely with organizations such as ASTRO and ACR in holding on to what we’ve already got, and ensuring that fair reimbursement will be forthcoming for new, physics-intensive technologies such as IGRT, PET/CT, etc. At the RSNA last November, I had a very productive meeting with out(See Amols - p. 6)

Table: Members who agree that AAPM should be more active in the following activities

Note: The above represents the percentage of respondents who chose from a 4-point scale where 1 = “Strongly disagree”, 2 = “Somewhat agree”, 3 = “Somewhat agree”, 4 = “Strongly agree”, and an option of “No Opinion.” The number of respondents was 1977.

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Amols (from p. 5) going ASTRO President Prabhakar Tripuraneni where the focus of our discussions was on improving the way the AAPM and ASTRO can work together on economic and professional issues. Among other things, we need more physics representation on key ASTRO committees. If you have an interest and/or expertise in professional or economic affairs, please let me know as both the AAPM and ASTRO are looking for, as the Marines say, ‘a few good men (or women).’

Errata: I’d like to correct an omission from my last column in which I lamented the fact that fund-raising efforts for the AAPM Education and Research Fund have languished at the $1000 or less level every year for at least the last five years. What I failed to mention is that although donations to the main fund have, in fact, been dismal, since 1999 we have raised over $40,000 for named memorial funds, most notably the Jack Krohmer, Hy Glasser, and Doug Jones funds, largely through generous contributions from individual AAPM members. Now all we have to do is figure out how to raise that kind of money every year, even when mortality rates are low!

Just for frustration brain teasers: The great English mathematician G.H. Hardy was visiting his number theory protégé Srinivasa Ramanujan on, unfortunately, the latter’s young death-

bed. Awkwardly trying to make conversation in the midst of a tragic situation, Hardy commented that the taxi cab he had ridden in to the hospital had a very uninteresting number, and he then told Ramanujan what the number was. Ramanujan almost immediately replied, “My dear Hardy, that’s a very interesting number. It’s the smallest number that can be expressed as the sum of two perfect squares in two different ways.” What was the number? (If you don’t know about Ramanujan and are looking for a good read, I’d highly recommend The Man Who Knew Infinity: A Life of the Genius Ramanujan by Robert Kanigel).

Answers to last month’s questions on relativistic corrections: 1. Misalignment of 6 Mev electron beam at 4m ~ 8x10-21m.

Misalignment of a 100 Mev proton at 1.5m ~ 2x10-16m.

2. Energy difference between AP and PA 6Mev electron beams ~ 4x10-9 ev 3. Red light will appear yellow if traveling towards the source at ~ 0.5c Answer to quotation: “He that troubleth his own house shall inherit the wind….” From the movie Inherit the Wind, but originally from the Book of Proverbs, 11:29.

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Outgoing Chairman of the Board Report G. Donald Frey Charleston, SC The AAPM Board of Directors met on November 30, 2005 with a full agenda of topics to discuss and act on. This will be a summary of the board activities.

Financial Status Treasurer Maryellen Giger reports that 2005 looks to have been a very good year financially.

The budget began with a deficit of ~$350k but we look to have finished the year with a surplus of ~$370k. Thus we had a net improvement of ~$720k. This is because we tend to budget conservatively and often do better than our projections.

The board-approved budget for 2006 shows a deficit of ~$480k.

Details about the reasons for the good year in 2005 and the 2006 budget are given in the Treasurer’s Report in this newsletter.

Provider Status Over the last year the AAPM has been deeply involved in ana-

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lyzing the advantages and disadvantages of seeking provider status. This issue has been discussed in our newsletter, at the annual meeting and within the AAPM Board of Directors. At the AAPM board meeting in Seattle, a motion to “not seek provider status” was discussed. This motion was tabled because it did not have sufficient language explaining the AAPM’s position. A new motion was brought to the board at the RSNA meeting. By a vote of 32–3, the AAPM board voted to not seek provider status. This is a statement of practicality by the board. It was not intended to be a statement of principle or ethics. The board felt that it would not be productive to expend AAPM resources on seeking provider status at this time.

The AAPM Virtual Library Benefit from the most cutting edge information in the field! The AAPM Virtual Library is a comprehensive database of knowledge to assist in your research efforts. You will save time and money by viewing presentations online – including audio and/or video, slides, and transcript!

Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs.

Conflict of Interest The AAPM membership recently approved bylaws changes that require those who are participating in AAPM committees, councils, task groups and boards to file a ‘Conflict of Interest’ statement. The board passed a motion that only allows board members who have completed their ‘Conflict of Interest’ statements to vote. This same requirement will be extended to AAPM members who serve the AAPM in other ways.

Now available...presentations given at the •AAPM 47th Annual Meeting Seattle, WA •Joint AAPM/American Brachytherapy Society Summer School Brachytherapy Physics 2005

Seattle, WA •AAPM Training Program: Current Topics in Clinical Radiation Protection - as presented at the CRCPD Annual Meeting

Scope of Practice Document The board approved the ‘Scope of Practice’ document that has been a joint effort of the AAPM and the ACMP. The

Kansas City, MO •Physicists of Note: 2005 Interviews Seattle, WA The AAPM History Committee is pleased to present a selection of interviews with prominent medical physicists

www.aapm.org/meetings/VirtualLibrary/

(See Frey - p. 8)

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Frey (from p. 7) document describes the scope of practice of medical physicists. It can be found at: http:// www.aapm.org/govtaffairs/ ScopeofPracticeBODApproved.pdf

Annual Meeting 2010 The board selected Philadelphia as the site of the 2010 meeting.

Future meetings are as follows: Year 2006 2007 2008 2009 2010

Location Orlando Minneapolis Houston Anaheim Philadelphia

The board acted on a number of issues associated with the organization and management of the association. The board approved bylaws changes associated with the Audit Committee and appointed a new Audit Committee

for 2006. The board approved bylaws changes that simplify and clarify the AAPM membership requirements. The final rules for reorganizing the Science Council and International Educational Activities committees were passed. The final rules to eliminate the Publications Committee and the Professional and Public Relations Committee were passed. Professional and Public Relations has been merged with Public Education in the Education Council. The AAPM is putting increased emphasis on public and professional relations and it was thought that one committee would be better than two.

Task group reports will now be published in electronic form and will be available not only to AAPM members, but to other interested individuals as well.

The board received reports from the Education, Professional and Science councils. The coun-

cil chairs have reports in other sections of this newsletter. Bill Hendee, the editor of our journal, Medical Physics, reported that the number of manuscripts submitted increased by 15% in 2005. The number of manuscripts published remained the same. The journal has the best citation impact factors of any medical physics journal.

This is my last report to you as an AAPM officer. I want to take the opportunity to thank the countless number of individuals who have been so generous with their time when I asked them for assistance. I especially need to thank the members of Excom with whom I served, and the AAPM professional staff. Finally, I want to thank Marty Weinhous who mentored me so patiently when I was presidentelect, and my wife, Pat, for her support and forbearance.

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Executive Director’s Column Angela Keyser College Park, MD

ing education designed to streamline the CAMPEP Accreditation process and track credits online.

In 2006, HQ will be working to redesign the AAPM Placement Service to make it more user friendly for both advertisers and members.

News from the Information Services Team By the time you read this, the new AAPM.ORG design will have made its debut. The site has been updated to use the latest Web technologies and to be compatible with text readers for the vision impaired. While AAPM’s site has always been very membership oriented, the new Web site has been reorganized to give

2006 Summer School greater emphasis to AAPM’s emerging government relations and public information initiatives.

AAPM has also been working hard with CAMPEP to implement a new system for continu8

The 2006 Summer School will be held June 18–22 at the University of Windsor in Ontario.

The topic is “Integrating New Technologies into the Clinic: Monte Carlo and Image Guided

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Radiation Therapy.” The program directors are Bruce Curran, James Balter, and Indrin Chetty. The Local Arrangements Committee is headed by Robin Miller, Jeff Richer and Vrinda Narayana. The full program is available online. Online meeting registration and housing reservation information will be available on March 1. Register by May 10 to receive discounted rates.

on a topic chosen by the Science Council as a field deserving special focus.

Meeting information is continually updated online. Please go to www.aapm.org and click on ‘Meetings’ for the latest information on the annual meeting. The online registration process is scheduled to open on March 15, with discounted fees until June 7.

The full meeting program will be posted by May 12.

2006 Annual Meeting The 48th AAPM Annual Meeting will be held July 30–August 3 at the Orange County Convention Center in Orlando, Florida.

Committee meetings will be held at the headquarters hotel, the Peabody, while sessions and exhibits will be held at the convention center.

The deadline for annual meeting abstract submission is March 2. Program Directors Jeff Siewerdsen and Gikas Mageras, along with Education Program Directors Perry Sprawls and Eric Klein, and Professional Program Directors Jerry White and Mike Herman, report that there will be an expanded education program, combined with an enhanced professional program, offering a significant opportunity to gain practical knowledge on emerging technical and professional issues.

A major focus of the scientific program is the increasing integration of advanced imaging concepts in the routine practice of various therapies, especially in radiotherapy. New this year is a symposium of proffered papers, named to honor John Laughlin,

Biomedical Imaging Research Opportunities Workshop A reminder that the 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 (RSNA) to sponsor the 4th Annual Biomedical Imaging Research Opportunities Workshop (BIROW 4).

BIROW 4 will take place February 24-25, 2006 at the Bethesda North Marriott in North Bethesda, MD. Advance registration closes on February 10.

For further details, go to: http:// www.birow.org/

2006 AAPM Membership Directory The new Membership Directory is scheduled to be mailed the first week of February. Something new for 2006 is the listing of the council and committee tree structure, without the list of partici9

pants. Like much of the information in the directory, the listing of volunteers changes frequently throughout the year and is outdated before you receive the directory. For a full list of participants and the most up-to-date information, please reference the online committee tree and membership directory.

2006 Dues Payments 2006 renewal notices were sent in October with payments due by March 1, 2006. If you have an e-mail address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs.

There is a mechanism provided to print a copy of the invoice if you wish to mail your payment.

Please go to the AAPM Home page, log in and click on “Pay Your 2006 Dues Online.”

The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Peggy Compton at 301-209-3396.

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Education Council Report Herb Mower Council Chair Well, we have just returned from the RSNA meeting. Chicago again came through with a little snow for us and, indeed, it’s fair share of cold weather. However, that didn’t chill our activities as a council or as an association. First, I want to express my thanks to all who have worked in any capacity this year on any of the committees, subcommittees, and task groups or in another capacity for the council. You are many and your efforts are greatly appreciated. Special thanks go to Beth Schueler who is stepping down after six years as the chair of the Medical Physics Education of Allied Health Professionals committee and three years as vice chair of the council, and to Ken Hogstrom who is stepping down as chair of the Public Education committee. Russell Ritenour has appointed Don Peck as the new chair to replace Beth, and Mary Fox as the new chair to replace Ken. We welcome both of them as they assume their new duties.

As noted at the board meeting, the association has taken on a very ambitious budgetary year.

Not to be outdone, the Education Council is at the top of the list, primarily driven by new endeavors and concerns for our association and our profession.

At the urging of Howard Amols, we will be actively contributing to the efforts relative to QA at the upcoming IAEA QA meeting in

Vienna and the NCI QA workshop.

Self-Assessment Modules and Self-Directed Educational Programs are both a part of the new ABR Maintenance of Certification Program. At present there is a lot of confusion concerning these and their applicability to the board-certified medical physicist.

Under the guidance of Michael Yester of the Continuing Professional Development Committee, we will be taking a hard look at these issues during 2006. This endeavor, at the outset, will include the input from various sources including our Medical Physics Education of Physicians Committee, the continuing Professional Development Committee, the ACR Education Liaison, the Education Council Chair, Don Frey, as well as representatives of the ACMP, ACR, ASTRO, and ABR trustees. The goal is to enlighten the membership on these issues and to provide mechanisms and templates to use in fulfilling the requirements.

Under the guidance of Dan Bourland, the Public Education Committee hopes to set up a public Web site. This is a substantial undertaking but one that will be very beneficial to those 10

outside the profession who desire more knowledge about who we are, what we do, and why physicists play a role in medicine.

As a part of the reorganization of some of the international activities, the new International Education Committee will be chaired

by Don Frey and will be situated organizationally in the Education Council. This will give us the capability to better assess the needs of medical physics education at the international level.

Over the years we have been acutely aware of these needs and have provided assistance to those countries where expertise is lacking. We hope to expand these efforts in 2006.

We have also established a new subcommittee under the Education and Training of Medical Physicists Committee to address the importance of informing various minorities of the opportunities available in the medical physics profession. Paul Gueye will chair this subcommittee.

As we approach our 50th anniversary, the History Committee, chaired by Bob Gould, is preparing several programs and activities. We are looking forward to seeing these introduced starting at our 2006 annual meeting.

As always, the various committees, subcommittees, and task groups of the Education Council are always open to new members. If you want to find out more about any of these, talk with the chair, contact me, or just stop in at their meeting in Orlando. ■

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Brenda Clark CAMPEP President

News from CAMPEP

As I write this in early December, we are planning a ‘go-live’ date for the long-awaited Continuing Education database of January 1, 2006. The development and testing is complete and we anticipate a smooth launch (keeping my fingers crossed!).

I am very pleased to announce that Dr. Bruce Gerbi has agreed to chair the Residency Education Program Review Committee. He begins in January as Eric Klein steps down.

I would like to recognize the significant contribution that Eric has made to CAMPEP accreditation of residency programs in the three years he has chaired

this committee. Over this period, the number of programs has nearly doubled from seven to 12, and Eric has introduced several strategic initiatives that have improved the process, such as structured annual reporting. Big shoes to fill, indeed!

Since the last newsletter, one residency training program has been reaccredited. Congratulations to: Radiation Oncology Physics Residency Program Shands Health Care, affiliated with the University of Florida Gainsville, Florida Director: Jatinder R. Palta

In addition, there are several other programs, both residency and graduate, that are in the final stages of accreditation, i.e., the site visit has taken place and the final report is being circulated for approval from either the review committee (first) or the CAMPEP Board. More news of these programs is forthcoming.

Finally, I would like to thank James Chu for his work over the last two years on the CAMPEP board. He is stepping down this month and the ACMP has nominated John Hazle as his replacement. Welcome, John.

Best wishes for a happy 2006!

Professional Council Report Gerald A. White Council Chair

Economics – Desire and Reality Elsewhere in this newsletter is an instructive contribution by Wendy Smith Fuss (AAPM Health Policy Consultant) on updates to the 2006 medical payment structure. Take the time to read through it carefully. It is one of a series of upcoming opportunities to become more familiar with important economic issues that face the medical physics profession. It’s tempting to allow our

eyes to glaze over when confronted with the complexities of the U.S. reimbursement system ′ it’s all and groan “Oικονοµικα, Greek to me!” However, if we are to move forward with ensuring adequate reimbursement for medical physics services for new technologies, retain appropriate reimbursement levels where already in place, and achieve modifications to reimbursements that are set at inappropriately low levels, we’ll need to be familiar with the processes under which we will work.

There has been significant discussion regarding pursuit of provider status, and subsequently di11

rect billing for medical physicists.

Symposia have been held at both the AAPM and ACMP annual meetings, and the issue has been widely aired in personal discussions and e-mail chains in the last year or so. The AAPM Board of Directors considered the issue at the July 2005 meeting and again at the November 2005 meeting in Chicago. At the latter meeting the board approved a motion that the AAPM should not actively pursue provider status and direct billing procedures for medical physicists at this time. Although there was general agreement that provider status might be a desir(See White - p. 12)

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White (from p. 11) able goal, the decision was based on considerations of practicality, resource allocation and the likelihood of a net positive outcome.

In a short article such as this, it’s not possible to review in detail the many issues that informed the board decision, but I’d like to mention just a few of them.

Provider status would require several federal legislative changes, each of them a liming step, each with a very poor chance of success and each requiring a significant expenditure of time and money. In the unlikely event that the legislative effort was successful, it would then be necessary to achieve regulatory recognition of the provider status by CMS, which would require licensure of medical physicists in all or nearly all states. Were that

to be achieved, we would then need to move forward to create new CPT codes for certain procedures and modify CPT codes that are currently used to describe our work effort. The current atmosphere in the AMA’s CPT panel (the AMA “owns” the CPT© process) would make such changes highly unlikely. In the event some or all of the necessary changes were made, the new and revised CPT codes would need to go before the Relative Value Update Committee (RUC) and the Practice Expense Advisory Committee PEAC) of the AMA to have a value attached. The RUC and PEAC valuations of codes are based on a long, complex process that as often returns a value less than the result that was anticipated. They are not likely to be sympathetic to our effort. At

the end of this long process, even if we were successful at each step, it is not certain that the outcome would be a net increase in reimbursement for medical physicists and could well result in an overall decrease in reimbursement for radiation oncology as a whole due to the reevaluation of most radiation oncology-related codes.

In a recent survey of the membership, five potential areas of emphasis for AAPM were offered for prioritization. Direct billing polled in fifth place of the five options. In the near term we will focus our efforts on important, potentially achievable economic goals that will maintain the position of the QMP as a valued member of the clinical team, with appropriate reimbursement for ■ our professional services.

CIRMS Meeting Udate Larry A. DeWerd AAPM Liaison to CIRMS, & Geoffrey S. Ibbott The Council on Ionizing Radiation Measurements and Standards is organized for educational and scientific purposes to analyze the current and future needs of ionizing radiation measurements and standards. CIRMS has a broad-based membership from industry, state, federal government and academia. The main objectives of CIRMS are the advancement and dissemination of the physical measurements and

standards needed for applications of ionizing radiations. For more information, see: www. cirms.org.

‘Impact of New Technologies on Radiation Measurements and Standards’was the theme of the CIRMS annual meeting held October 24-26, 2005. The plenary sessions included presentations on new measurement technologies, national standards and measurements in extreme environments. Plenary talks included the method of discovery of the transportation of radioactive sources across borders, includ12

ing detectors, and then the verification of the presence of nuclear materials. Talks were also given on radiation protection and emergency response. The current status of PET/CT was reviewed.

There was a session dealing with the detection of neutrons and heavy charged particles. Finally, talks were given on industrial irradiation processing and validations of medical imaging.

Breakout sessions for each of the subcommittees included Medical Applications, Radiation Protection, Homeland Security, and Industrial Applications and Mate-

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rials Effects. The meeting ended with student presentations, two of which were related to medical concerns. These presentations included MCNP simulations to guide phantom fabrication and the calibration of CT chambers.

The Medical Subcommittee breakout section was divided into six sessions. The general theme of the Medical Breakout sessions was ‘Unconventional Measurements and Standards.’ The first session updated the need for standards in biodosimetry and radioimmunotherapy. Session 2 reviewed proton therapy and the need for standardized dosimetry procedures and international calibration standards. Session 3 dealt with dosimetry applications, especially the status of dosimetry with microspheres. Session 4 was on new external beam applications, in particular the dosimetry of tomotherapy. Session 5 explored the new area of electronic brachytherapy as represented by the Xoft X-ray system. Finally, session 6 updated the progress in standard brachytherapy, including both low dose rate and high dose rate sources.

The first session of the Medical Breakout updated the past year’s accomplishments in biodosimetry.

M. Grace discussed gene expression biomarkers of radiation exposure and dose: “Multi-target QRT-PCR assay applications to biological dosimetry.” Progress on her central hypothesis has shown that radiation exposure directly or indirectly produces alterations in the expression of genes. The change in expression can be measured and related to

dose. In the second talk of this session, George Sgouros reviewed radioimmunotherapy. In this area there is a complete lack of good dosimetry and standards, which means that quite a bit of work is needed so that this technique can be applied with confidence. A standard will need development.

Session 2 dealt with proton therapy and dosimetry. Although proton therapy is increasing in use, the dosimetry for the dose delivery is based upon cobalt standard. There have been some measurements with a calorimeter for proton beams, but a correlation between the cobalt calibration and these calorimetry measurements should be done so that dosimetry can have a solid basis.

Jonathan Farr from Indiana gave a good review of the status of proton therapy and dosimetry.

Geoffrey Ibbott then delivered a paper for Wayne Newhauser on commissioning and quality assurance of a proton therapy unit.

Session 3 dealt with extension of dosimetry applications to unconventional treatments. One of these applications is brachytherapy with microspheres, which has proven fruitful to treat liver tumors. William Dezarn reviewed this area. The nuclear medicine program at NIST and its interaction with radiopharmacies was reviewed. There still is no program in place so that the radiotherapy physicist can measure the dose delivered with any confidence. Other methodologies of measurements, such as the Sicel implantable MOSFET dosimeter, were explored.

13

Session 4 on new external beam applications raised a number of questions in determination of the dosimetry involved when doing Tomotherapy. Rock Mackie reviewed Tomotherapy and its present use.

Electronic Brachytherapy was the topic of Session 5. Tom Rusch first gave a description of the Xoft micro X-ray source. The source operates at 40, 45, and 50 kVp, is only about 3 mm in diameter and delivers 10 Gy/min at 1 cm depth in water. Steve Davis described the calibration of the electronic brachytherapy source with a free air chamber, and Mark Rivard described the TG 43 parameters for this source.

In session 6 an update on standard brachytherapy, both low dose rate and high dose rate, was given. The first part of the session was an update on characterization of LDR sources. Mark Rivard reviewed the AAPM working group progress. Mike Mitch of NIST then gave an overview of the NIST WAFAC calibrations. The progress on the standard being developed at PTB for low dose rate sources was discussed and shown to agree to within 1% with the NIST WAFAC. Finally, Larry DeWerd presented an update on the various types of sources and their agreement to within 1% for ■ HDR 192Ir.

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

Treasurer’s Report Maryellen Giger Chicago, IL

2005 Estimates We are pleased to report that 2005 is expected to be another successful financial year for our society, albeit not to the same degree as the previous two years.

It is estimated that we will realize a surplus of approximately $370,000 at year’s end. Our budget for 2005 was approved for a deficit of $348,000. Therefore, in total we will be underspending by $719,225 compared to budget. Highlights of the variances include: •lower than budgeted governance expenditures; •returns on our investment portfolio; •lower than anticipated spending by our councils and committees; and •an extremely successful annual meeting in Seattle, exceeding budget expectations by over $222,000.

2006 Budget The 2006 budget was reviewed extensively by members of the Budget Subcommittee last October. My sincere thanks to Howard Amols, Indra Das, Melissa Martin, Mary Moore, Peter Rosemark and Russ Ritenour for serving on this subcommittee. Also, Angela Keyser, executive director, Cecilia Hunter, director of finance and administration, and

Jean Rice, accounting manager, made substantial contributions to this effort and my thanks to them for a superb job preparing the various spreadsheets. I also thank the various AAPM council and committee chairs who worked with Cecilia Hunter to submit their budgets in the standardized form in time for the subcommittee review.

The 2006 budget was then submitted to the full Finance Committee on November 27, 2005; additions and/or changes were incorporated therein at the request of various committee and council chairs. The resulting modified budget was moved forward and subsequently approved by the board of directors on November 30, 2005.

The 2006 budget, as approved, reflects a deficit of $498, 406, with total income of $5,996,153 and expenses of $6,494,589.

Removing the activities passing through the Education & Research Fund from the total, the operating loss is budgeted at $383,406.

Highlights of the proposed budget are:

Sources of Revenue •An increase in income from membership is based on an increase in membership, coupled with the approved fourth-year dues increase. Membership income is expected to provide $1.2 million, or approximately 20% of anticipated income.

•Our annual meeting, scheduled for Orlando in 2006, is expected to draw 3,740 registrants and generate a net income of $619,935. This includes revenue of $1,902,222 less total expenses (direct plus indirect) of $1,282,287.

•The publication of our scientific journal, Medical Physics, provides a significant source of financing in support of our other program areas. In 2006 this contribution is estimated at just over $695,000 (including indirect overhead expenses).

•Other revenue sources include the Placement Service, interest on operating funds, and services provided to other organizations.

Major Areas of Expense •Requests for project funding from the councils and committees increased significantly for 2006.

–the total Education Council request is for $400,250; –the total Professional Council request is for $357,100; –the total request by Science Council is for $177,744; –our Society supports a number of administrative and ad (See Giger - p. 17)

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AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

2006 Approved Budget

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

2006 Approved Budget

Giger (from p. 15) hoc committees, as well as liaisons to other scientific societies. Direct expenses are anticipated to be $177,475 in 2006 for these activities.

•Anticipated expenses for membership services in 2006 include: the Membership Directory–$32,000; the monthly mailing–$140,000; and the newslet-

ter– ~$61,000. There is also funding for one brochure in the amount of $3,000.

•Organizational and governance expenditures are expected to increase slightly as a result of the appointment of an Audit Committee and are budgeted at $168,000.

•Administrative expenses increase each year with the cost of doing business. These expenses include the services provided by

AIP, our legal and audit firms, insurance, and the fees we pay for credit card transactions. For 2006, our budget estimate is $248,218.

•Overhead expenses include rent, staff expenses, and other costs of maintaining a headquarters office. Staff members keep detailed records of their time and actual time allocations are projected forward in order to esti-

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(See Giger - p. 18)

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

Giger (from p. 17) mate total program expenses for the coming year. In 2006 the total estimated overhead spread among the program areas is $2,155,762. This total includes the newly created position in government affairs during 2004.

The table on pages 16–17 presents the approved 2006 budget.

Figure 1 shows both revenue and expense broken down by source. Figure 2 summarizes actual and estimated revenue and expenses from 2000 through the 2006 budget.

Questions or comments concerning the budget can be addressed to me at m-giger @uchicago.edu.

Revenue & Expense by Source Revenue

Expense

Figure 1

Summary

2006 RDCE

Figure 2

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD Well, another year is over.

Where did the time go? It has been a very busy year in the world of AAPM government relations.

We have added a consultant for health policy, Wendy Smith Fuss, to assist with the reimbursement side of regulations and legislation.

Stay tuned in 2006 as Wendy and I work to bring further understanding of the regulatory and legislative worlds to you, our members.

AAPM Board of Directors Approve ‘Scope of Practice’ for Medical Physics – The Statement of Basic Responsibility states: “The essential responsibility of the Qualified Medical Physicist’s clinical practice is to assure the safe and effective delivery of radiation to achieve a diagnostic or therapeutic result as prescribed in patient care. The medical physicist performs or supervises the pertinent procedures necessary to achieve this objective. The responsibilities of the medical physicist include: protection of the patient and others from potentially harmful or excessive radiation; establishment of adequate protocols to ensure accurate patient dosimetry; the measurement and characterization of radiation; the determination of delivered dose; advancement of procedures necessary to ensure image quality; development and direction of quality as-

surance programs; and assistance to other health care professionals in optimizing the balance between the beneficial and deleterious effects of radiation.”

In addition it defines the professional qualifications, the specifics of practice for diagnostic medical physics, medical nuclear physics, therapeutic radiological physics and medical health physics and states that the qualified medical physicist may serve in the capacity of the institutional radiation safety officer as appropriate.

AAPM intends to provide copies of this ‘Scope of Practice’ to regulatory agencies to help them understand what it means to be a medical physicist. The full document can be found on the AAPM Web site.

CARE Act Update – Last March Rep. Chip Pickering (RMS) reintroduced the Consumer Assurance of Radiologic Excellence (CARE) bill in the House of Representatives. H.R. 1426 had 19 original cosponsors (20 with Rep. Pickering) and has been referred to the Committee on Energy and Commerce. As of the writing of this article, there are 103 cosponsors and the Senate bill is forthcoming. The AAPM continues to work with the Alliance for Quality Medical Imaging & Radiation Therapy on moving the Senate bill forward. You can check to see if your representative has signed on as a cosponsor by clicking the following link: http://thomas.loc.gov/cgi19

bin/bdquery/z?d109: HR01426:@@@P. When the Senate bill is introduced, look for a call to action which will request AAPM members to contact their members of Congress urging that they sign the bills and move to pass the legislation in this Congress.

NRC and the Energy Policy Act of 2005 – On August 8, 2005 President Bush signed the Energy Policy Act of 2005 (the Act).

Section 651(e) of the Act expanded the definition of byproduct material in Section 11(e) of the Atomic Energy Act of 1954 to include certain naturally occurring and acceleratorproduced radioactive materials (NARM). It requires the U.S. Nuclear Regulatory Commission (NRC) to provide a regulatory framework for licensing and regulating the additional byproduct material. The NRC is initiating a rulemaking to incorporate NARM into the Code of Federal Regulations. The Act imposes an aggressive deadline for the NRC to issue final regulations

by February 7, 2007. In order to meet this deadline, the NRC will not be preparing a rulemaking plan.

The Act requires the NRC to do the following: •consider the impact of the proposed regulations on availability of radiopharmaceuticals to doctors and patients who rely on them for medical treatment; (See Fairobent - p. 20)

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

Fairobent (from p. 19) •cooperate with the states and to use existing model state standards to the maximum extent practicable; and •prepare and publish a transition plan describing the condition under which agreement and non-agreement states may exercise authority over the newly defined byproduct material.

On November 9, 2005, the NRC hosted a public meeting with a ‘roundtable’ format to allow stakeholders an opportunity to discuss concerns and interact with other interested parties on the subject of NRC regulation of NARM. Participants were selected to represent the broad spectrum of interests who may be affected by this rulemaking. The AAPM (represented by May Moore and Lynne Fairobent) joined 19 other participants who included representatives from the NRC Advisory Committee on the Medical Use of Isotopes (Ralph Lieto), the Council on Radionuclides and Radiopharmaceuticals, the Nuclear Energy Institute, FDA’s Division of Medical Imaging and Hematology Products and Radiological Drugs Research Committee, EPA, CRCPD, ASTRO, ACR, SNM-ACNP Joint Government Relations Committee, the Health Physics Society, the American Society of Nuclear Cardiologists, Harvard Medical School for research input, and representatives from California and North Carolina.

The roundtable format was used to promote a dialogue among the

representatives at the table on issues of concern and to assist the NRC as they develop the new regulations. Major changes include the following: 1) Byproduct material definition has been expanded to include accelerator-produced radioactive materials used for only medical, research, and commercial purposes. Expanding the definition negates changing 10 CFR Part 20, but some changes will be necessary for 10 CFR Part 35.

2) NRC is not responsible for regulating any accelerators.

3) Discrete Radium-226 sources and any other naturally occurring radioactive materials that could be used as a terrorist weapon are under NRC authority.

While the driving influence for the regulatory changes is security enhancement, implementation of the Act has inherent difficulties.

One of these is determining the point when accelerator-produced material should come under NRC jurisdiction. In addition to confusion, duplication of licensure and/ or registration fees, increased operating costs for licensees appears certain in non-agreement states. Developing a definition for “discrete source” applicable to naturally occurring radioactive materials in addition to Radium226 proved to be more complicated than expected. Discrete does not apply to liquids, gas and powders that have no physical boundaries. The proposed rule is expected to have minimal impact on waste disposal and transportation regulations.

20

The NRC plans to publish the proposed rule in the Federal Register by April 28, 2006. The proposed 45-day public comment period is scheduled to end June 12, 2006. Roundtable participants recommended extending the comment period. The mandated February deadline restricts options. In order to extend the comment period, the NRC will request authorization to post the proposed rule on the NRC’s RuleForum Web site in March, 2005 while the commission is reviewing the draft prior to publication.

The AAPM is monitoring this very closely and is working with the NRC staff as allowed to minimize the impact. Particular issues of concern will impact licensees in non-agreement states such as stand-alone PET centers that have never had an NRC license.

The AAPM is also working to have data to assist with defining the point at which the accelerator-produced material should come under NRC’s authority.

Video shows clinicians how to treat children exposed to chemicals used in bioterrorist attacks – On Tuesday, December 6, the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) released The Decontamination of Children: Preparedness and Response for Hospital Emergency Departments, a 27-minute video that trains emergency responders and hospital emergency department staff to decontaminate children after being exposed to haz-

AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

ardous chemicals during a bioterrorist attack or other disaster. This video provides a stepby-step demonstration of the decontamination process in real time and trains clinicians about the nuances of treating infants and children, who require special attention during decontamination procedures. Produced for AHRQ’s Bioterrorism Preparedness Research Program, the video outlines key differences between decontaminating children and adults; provides an overview for constructing portable and permanent decontamination showers and designating hot and cold zones; and provides steps to establishing and maintaining pediatric decontamination capacity in a hospital emergency department. A free, single copy of the video (available in DVD or VHS format) may be ordered by calling 1-800-358-9295 or by sending an e-mail to ahrqpubs@ ahrq.gov.

NRC Training and Experience Rule Update – On March 30, 2005 the Nuclear Regulatory Commission (NRC) published in the Federal Register the last section of the revision to 10 CFR Part 35, Medical Uses of Byproduct Materials. This section of the regulation delineates the requirements for training and experience for Authorized Medical Physicists, Authorized Users, Authorized Nuclear Pharmacists, and Radiation Safety Officers.

The rule became effective April 29, 2005 for non-agreement states with implementation being October 25, 2005 after 10 CFR

Subpart J expires. Agreement states have three years to adopt the rule. The boards that have been recognized can be found at: http://www.nrc.gov/materials/ miau/miau-reg-initiatives/specboard-cert.html.

At the time of this article no medical physics board has been recognized. The AAPM continues to work with the American Board of Radiology and the American Board of Medical

Physics as they pursue recognized status. As of this issue, the American Board of Health Physics has been recognized for Training for Radiation Safety Officer (10 CFR §35.50) for certifications issued from January 1, 2006 to the present.

■

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AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

Health Policy/Economic Issues Wendy Smith Fuss, AAPM Health Policy Consultant

All Payments Under Physician Fee Schedule Will Be Reduced by 4.4% in 2006 Unless Congress Intervenes by January 1st (Report of December, 2005) The Centers for Medicare and Medicaid Services (CMS) published the Physician Fee Schedule final rule for 2006 which updates payment rates to physicians and other providers, including freestanding radiation oncology clinics, for more than 7,000 health care services and procedures. All payment rates and policy changes will be implemented on January 1, 2006.

The only major policy to effect radiation oncology and medical physics payments for 2006 is that the annual update factor (conversion factor) is reduced by 4.4% across all physician payments.

The conversion factor is updated on an annual basis according to a formula specified by statute, which is designed to rein in the growth in outlays for physician services. The formula requires CMS to adjust the factor up or down depending on how actual expenditures compare to a target rate, called the sustainable growth rate (SGR). The SGR, in turn, is calculated based on medical inflation, the projected growth in the domestic economy, pro-

jected growth in the number of beneficiaries in fee-for-service Medicare, and changes in law or regulation The 2006 conversion factor is $36.18. The conversion factor will reduce 2006 payments across-the-board by 4.4%.

CMS forecasts payment reductions under the current SGR system for 2006 and later years. The cumulative impact of projected reductions from 2006 to 2012 is approximately 27%. Congressional action will be necessary to alter physician payment reductions in 2006 and beyond. Pending legislation would eliminate the -4.4% reduction for 2006 and replace it with a modest 1.0% increase in all payments.

Consistent with a recommendation to Congress by the Medicare Payment Advisory Commission, CMS will reduce payments for certain diagnostic imaging procedures to reflect their limited additional costs when performed on contiguous body parts in the same session with the patient.

Effective January 1, CMS will implement a multiple procedure payment reduction to technical component (TC) services and the TC portion of the global services whenever two or more diagnostic imaging 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 25%. CMS will phase in the payment reduction over two years with a 25% 22

reduction in 2006 and a 50% reduction in 2007.

CMS does not apply the multiple procedure reduction to the professional component of the service at this time. They state that “physician work is not significantly affected for multiple procedures.� For 2006, when the global service code is billed for these procedures, the TC would be reduced 25% for the second and subsequent procedures, but the professional component would be paid in full. Global billing applies to freestanding imaging centers.

The most significant impact of this policy will occur among radiologists and diagnostic testing facilities that will experience a -1.0% impact in 2006. Most other specialties, including radiation oncology, experience a very small 0.1% payment increase as a result of the budget neutrality adjustment.

A detailed summary of the final rule is available on the AAPM Web site.

Most Hospital-Based Radiation Oncology Services Will Realize Payment Increases in 2006 The Centers for Medicare and Medicaid Services (CMS) recently released the 2006 Hospital Outpatient Prospective Payment System (HOPPS) final rule.

AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

The changes to the payment rates and increased volume of services contribute to an overall increase of 5.2% in projected payments to over 4,000 hospitals for Medicare outpatient services.

Some brachytherapy services will realize payment reductions in 2006. Prostate brachytherapy

(CPT 77778) will decrease significantly in 2006. High Dose Rate brachytherapy (CPT 77781-77784) and port films (CPT 77417) realize a small payment reduction. All other radiation oncology codes will experience higher payments in 2006 (See Table below).

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Stereotactic Radiosurgery CMS will discontinue the use of the stereotactic radiosurgery (SRS) planning codes G0242 (Cobalt-60 SRS planning) and G0338 (LINAC-based SRS planning) in 2006. CMS will instruct hospitals to bill charges for (See Fuss - p. 24)

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

deleted in 2006. This code was replaced with the new CPT code 77421 (Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy) effective January 1, 2006. CPT 77421 has been assigned to New Technology APC 1502 with a payment of $75.00. This is a new code for image guided radiation therapy (IGRT). CPT 77421 should not be reported with the five Gcodes for stereotactic radiosurgery treatment delivery, which are billed under HOPPS in 2006.

Fuss (from p. 23) SRS Planning using all available CPT codes that most accurately reflect the services provided.

AAPM supported the elimination of the “G” codes for SRS treatment planning.

CMS finalized its proposal to maintain SRS treatment delivery HCPCS codes G0173, G0251, G0339 and G0340 in their current APCs. CMS will reassign HCPCS code G0243 to clinical APC 127 for 2006.

Stereoscopic kV X Ray HCPCS code C9722 (Stereoscopic kilovolt X-ray imaging with infrared tracking for localization of target volume) has been

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Proton Beam Therapy For 2006, CMS will maintain the simple proton beam therapy codes (CPT 77520 & 77522) in APC 664 Level I Proton Beam Therapy Codes. The payment increased 68.8% in 2006 to $947.93.

CMS moved the intermediate (CPT 77523) and complex (CPT 77525) proton beam therapy codes from a New Technology APC into clinical APC 667 that

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

increased the 2006 payment by 33.4% to $1,134.08. AAPM supported the CMS proposal to move Proton Beam Codes 77523 and 77525 from New

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All payment rates and policy changes were implemented on

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■

Chapter News Upstate New York Chapter Honors Ervin Podgorsak with its Lifetime Achievement Award Ken Hoffmann Chapter Secretary The Upstate New York Chapter of the AAPM presented its Lifetime Achievement Award to Ervin Podgorsak, PhD, at its fall meeting on November 18, 2005 at Rochester General Hospital in Rochester, New York. Dr. Podgorsak is Professor and Director of Medical Physics at McGill University in Montreal, Canada. He received the award in recognition of his contributions to the field of radiation therapy physics throughout his distinguished career. Dr. Podgorsak was introduced by his son, Matt Podgorsak, PhD, who is the immediate past president of the UNYAAPM and a current board member at large of the AAPM. As part of the award ceremony, he presented “Vignettes from Medical Physics (1970-2005),” covering highlights of his scientific career, as well as discussing issues in North American health care financing and the ‘red tape’

Dr. Ervin Podgorsak (center) receives the UNYAAPM Lifetime Achievement Award from Daniel Kim (right), chapter president, and Matt Podgorsak, immediate past president of the chapter.

encountered in the medical physics profession.

There were five other scientific presentations at the meeting.

Anant Gopal, PhD from the Toshiba Stroke Research Center in Buffalo, presented methods for three-dimensional lumen reconstruction from two angiographic views. Steve Rudin, PhD, also from Toshiba, discussed low-dose, microchannelplate light amplifier-based detectors for cone-beam computed tomographic mammography.

Moonseong Oh, MS, from the Department of Radiation Medicine at Roswell Park Cancer Institute, also in Buffalo, presented the group’s experience in the clinical implementation of enhanced dynamic wedges.

25

George Cernica, MS, also from Roswell Park, discussed the accuracy of the Leksell GammaPlan dose calculation algorithm. Robert Lavallee, BA, from the Department of Radiology at SUNY Upstate Medical Center in Syracuse, described the use of tissue air ratios to obtain organ doses in CT. Finally, Roger Szafranski, the northeast regional sales manager for Accuray, gave a presentation describing the CyberKnife robotic radiosurgery system.

The meeting concluded with a business session. The next chapter meeting will be held in the spring of 2006. Information will be available on the chapter Web site http://www.unyaapm.org/.■

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

Clinical Trials Tips for Physicists dealing with patients on clinical trials Arthur Olch Chair, AAPM Working Group on Clinical Trials

tocol, or it is the first patient your department has treated on this protocol.

The following is another in a series of articles by the AAPM Working Group on Clinical Trials discussing QA and other issues of interest to physicists whose departments treat patients in clinical trials. We hope that these articles are helpful to you in becoming a more effective member of the clinical trial team in your department. Questions or comments about this or other articles, as well as suggestions about future articles, can be addressed to me at (aolch@ chla.usc.edu).

Tip: Download the protocol from the cooperative group Web site and read it. The clinical physicist should be aware of and responsible for ensuring that the treatment plan that is developed for this patient is in accordance with the protocol guidelines. Also, you might find it helpful to form a ‘protocol team’ consisting of at least the clinician, a physicist, and a dosimetrist. Review the requirements of the protocol, have the dosimetrist do an example treatment plan for the protocol, and have the team review the results. (These dry runs are often required by the QA center associated with the protocol.)

1) Problem: You are either in the middle of treating a patient or have finished treatment and you are notified that protocol data needs to be submitted. You did not even know this patient was on protocol!!

Tip: Set up a system in your department whereby you are notified at the time of patient registration into a protocol that will involve radiation therapy. You should request an e-mail or phone notification upon registration from the clinical research associate handling the registrations.

2) Problem: You are notified that a patient is on protocol but you are not familiar with the pro-

3) Problem: You have finished treating the protocol patient and need to submit certain data to the quality review center. The data required includes some structures that were not drawn. In addition, the dose specification point differs from your department’s routine.

Tip: Read the protocol and fully understand the dose specification and reporting requirements before starting to plan the patient’s treatment. They often will be different from that routinely used in your clinic. The dose specifica26

tion could be at a point or an isodose surface. The dose prescription requirement could be different from the dose specification requirement.

4) Problem: You anticipate the treatment of your first patient on a protocol for which you need to submit data to the QA center electronically. What do you need to do?

Tip: For RTOG protocols, you will need to demonstrate the capability of sending the digital data.

You will have to work through a dry-run case. First, you will need to be sure you have the necessary software in your treatment planning system to upload the DICOM RT data elements, CT images, structures, plan, and dose. Practice using this software in advance. If you don’t have this software, explain to your hospital administration that it is a requirement of your department’s continued participation in treatment of patients on these protocols. You can get more information about the specific upload procedures by visiting the Web site of the QA center (RTOG, ITC, QARC, RPC for example).

Instructions will be posted there if not in the protocol. In addition, request that your treatment planning vendor supply high quality, easy-to-use software for DICOM RT data exhange.

AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

5) Problem: You are going to treat a protocol patient with IMRT. What do you have to know about this situation?

Tip: The first thing you need to do is verify that the protocol allows IMRT. Read the RT protocol guidelines to find an explicit statement allowing IMRT. If there is no statement one way or the other regarding IMRT, you should assume the protocol does not allow it. Contact the responsible QA center for clarification.

The protocol will define target, organs-at-risk, and hot spot doses in terms of dose and volume limits. Review the protocol requirements with the physician and dosimetrist prior to treatment planning. Be sure you include the patient’s body contour (other unspecified tissue) in the DVH output as this is a requirement.

You will also have to have passed an IMRT benchmark case that may include irradiating an anthropomorphic phantom supplied by the RPC. Be sure you get this benchmark done successfully in advance of your anticipated patient accrual.

6) Problem: Your department tells you they want to start treating protocol patients. What do you need to do to get ready?

the anticipated additional physics resources that need to be allocated. Plan to request these resources from administration.

Become familiar with the cooperative group that is conducting the studies, for example, RTOG, COG, etc. Visit their Web site to

download benchmarks, reporting forms, and the protocols themselves. Become a member of the cooperative group yourself so you may login to these sites. Do not underestimate the time and resource commitment for this new endeavor!

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

To be eligible you need to be within five years of your PhD graduation, a member of

Tip: Start by reading AAPM report #86, “Quality Assurance for Clinical Trials: A Primer for Physicists.” It gives an overview of clinical trials in general and discusses each of the elements of a clinical trials program in radiation oncology. It includes a section on 27

the AAPM and have not been a principal investigator on a major funded grant (>$50 000).

The application should include a five-page description of the research project, as well as a curriculum vitae and a letter of support from a department chair. The applications will be reviewed based on scientific merit (50%), potential for further funding (25%) and investigator background (25%). The deadline for applications is February 15. Further details can obtained from the flyer accompanying the newsletter, or by contacting Shantelle Corado (shantelle@ aapm.org).

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

International Conference News The First AAPM/EFOMP Scientific Symposium at the International Conference of Medical Physics – Nuremberg, Germany Willi Kalender, Conference President Azam Niroomand-Rad, IOMP President and Chair, AAPM International Affairs Committee The first AAPM/European Federation of Organizations in Medical Physics (EFOMP) Scientific Symposium on “Advances in Imaging and Radiation Therapy” was held September 12–13, 2005 in Nuremberg, Germany, just prior to IOMP’s 14th International Conference on Medical Physics (ICMP-2005). This conference was jointly organized with the EFOMP (9th EFOMP Congress) and the German Society of Medical Physics (36th Annual Meetingof DGMP). It also included the annual meeting of the German Association of Biomedical Engineering .

The AAPM / EFOMP symposium was efficiently planned and hosted by Willi Kalender, Wolfgang Schlegel, Rock Mackie and Jatinder Palta. The two-day program offered a comprehensive overview on the latest developments in 12 extended lectures, a manufacturer’s session and a pro-con debate on “IMRT vs. Proton therapy.” Nine of the 18 lecturers were from North America representing the AAPM. The response from more than 150 participants was very positive and encouraged holding

another such joint American/European effort.

The IOMP’s 14th International Conference on Medical Physics was also very successful. By joining the meetings of five societies, it was possible to provide a comprehensive and diverse program that offered in-depth insight into the broad spectrum of medical physics, biomedical engineering and healthcare, in general. Many excellent invited lectures and refresher courses contributed to a well-rounded, high-class conference. Recent developments in imaging (CT, Ultrasound, MRI, and others) were presented along with achievements in therapy, radiation protection, education, and oncology.

Over 1300 participants from 52 countries attended the IOMP conference from September 14– 17. The 968 accepted presentations were divided into twelve tracks; 532 of them were accepted as oral presentations and 405 as posters. The most popular tracks, as measured by number of accepted abstracts, were ‘Radiation Oncology Physics’ (149 abstracts), ‘Diagnostic Imaging’ (151 abstracts), ‘Diagnostic and Therapeutic Instrumentation’ (109 abstracts) and ‘Image and Biosignal Processing, Modelling & Simulation’ (147 abstracts). The IOMP was involved in arranging the scientific program, particularly in relation to the 28

Education and Training/Continuing Professional Development track and the IOMP/ICRP special session.

As expected, most participants were from Germany (738) while 201 participants were from 31 other European countries. There were 104 participants from outside Europe; 48 from the U.S. and 10 participants each from Canada and Australia. Diversity and a high standard were prominent features of the industry exhibition with 40 exhibitors from the health care and medical physics sector attending. Some exhibitors also offered dedicated lunch sessions.

The social program included an icebreaker party and many participants had the opportunity to explore the historic city centre.

The highlight of the social events was the official state reception offered by the State of Bavaria on Friday night at the historic Nuremberg Castle.

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AAPM NEWSLETTER JANUARY/FEBRUARY JANUARY/FEBRUARY2006 2001 AAPM NEWSLETTER

Staff Profile Angela Keyser AAPM Executive Director

AAPM HQ Team…at your service!

This month I would like to profile the staff who are the front line customer service team members.

Hadijah Robertson came to the AAPM as a long-term temporary employee during a staff absence. She officially joined the staff in March, 2001 as programs assistant. Hadijah assists with meeting activities including registration, exhibits and abstract submission. She provides support for the Placement Bulletin, the Online Education process (formerly the RDCE program) and CAMPEP. Jennifer Davis joined the AAPM HQ team in April, 2001 as the receptionist. At the end of 2003 Jennifer was promoted to administrative assistant in acknowledgement of her increased responsibilities. Since May, 2004 Jennifer has served as membership services coordinator. She coordinates the membership application process, handles membership matters and is also the contact for corporate affiliate questions.

Lisa Giove was hired in April, 2005 as the receptionist. She worked part time for AAPM until she finished her studies at the University of Maryland in May. In August, 2005 Lisa was promoted to the new position of executive assistant. She provides

L to R, front row: Hadijah Robertson and Lisa Giove; back row: Jennifer Davis, Seana Miller and Noel Crisman-Fillhart

support to the executive director, the Executive Committee and the board of directors and is the headquarters liaison to the AAPM chapters. Lisa also maintains the council and committee listings and the AAPM Online Policy Manual, handles elections, and manages the headquarters office at various AAPM association meetings.

Noel Crisman-Fillhart is the newest member of the accounting department. She came aboard in August, 2005 as the senior accounting assistant. Noel is responsible for reconciliations and analysis for the Accounting Department.

Seana Miller is the newest member of the AAPM HQ team.

She was hired as the customer service representative in Octo29

ber, 2005. Seana answers the main phone line, handles general inquiries, and processes requests for organizational materials. She also assists with the Medical Physics journal. Contact Seana for assistance with setting up conference calls.

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Correction In the November/December 2005 issue of the AAPM Newsletter, an error of omission was made in the article, “Reference Values for Diagnostic Radiology” (p.

18). Authorship is also due to Benjamin R. Archer, who served as co-chair with Joel Gray on the AAPM Radiation Safety Committee Task Group.

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

The U.S. Physics Team and the International Physics Olympiad Ben Stein and Martha Heil American Institute of Physics How does the physics community encourage some of its best high school physics talent? Here in the U.S. the American Association of Physics Teachers (AAPT) and the American Institute of Physics (AIP), with support from the AAPM and other physics societies, sponsor a competition each year for high school students to represent the U.S. at the International Physics Olympiad Competition.

The U.S. Physics Team program promotes high school interest in science, encourages future scientists, engineers and their teachers, rewards students, teachers and high schools for excellent performance, and prepares a U.S. team for the International Physics Olympiad.

Begun in 1965 among eastern European countries, the International Physics Olympiad Competition gradually grew to include many western countries during the 1970s. In 1986, the AAPT organized the United States Physics Team for the first time.

The 1986 team was made up of 20 talented high school physics students who had been nominated by their teachers. This team brought home three bronze medals—more medals than any team had ever won in their first competition. Since that time, the United States has consistently

ranked in the top 10 of all nations.

The AAPT recruits, selects and trains U.S. physics teams each year to compete in the International Physics Olympiad. The recruiting and selection process begins in early January when high school teachers nominate their best physics students. About 1300 high school students take the preliminary exam each year.

Approximately 200 top scorers from this first test advance to the semifinal round of competition.

A second test, student transcripts and letters of recommendation, are used as the basis for selection of the 24 members of the U.S. Physics Team. These students, from schools all over the United States, travel to the University of Maryland–College Park at the end of May for the annual U.S. Physics Team Training Camp. There they engage in nine days of intense studying, testing and problem solving. At the end of that training camp, five students are selected for the ‘Traveling Team.’

The AIP and AAPT held a tribute to the 2005 Physics Olympiad Team on Capitol Hill on May 18, 2005. This event was co-hosted by Reps. Vern Ehlers (R-MI) and Rush Holt (D-NJ), the two members of Congress who are trained PhD physicists.

All members of Congress received a physics toy from AIP and AAPT to highlight the need to 30

support science and math education funding. The AIP media team generated news coverage for the team members which resulted in coverage in numerous media outlets throughout the country. Appropriately so, all 10 AIP member societies provided support to the U.S. Physics Team.

In 2005 at the International Competition in Salamanca, Spain, each student on the U.S. team, as in almost all of the past 20 years that the U.S. has had a physics team, brought home a medal. The International Physics Olympiad Competition now attracts teams from all over the globe. The 2006 competition, which will involve physics students from at least 70 countries, will be held at Nanyang Technological University in Singapore.

The U.S. Physics Team welcomes involvement as well as support. For more information, please visit www.aapt.org/olympiad2006/. The AAPT Web site description of the program (www.aapt.org/Contests/ olympiad.cfm) includes example questions from previous exams.

(Ben and Martha would like to thank the AAPT for their help in pre■ paring this article.)

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Letter to the Editor AAPM Members are not Stingy or Apathetic Ivan A. Brezovich Birmingham, AL You can fool all people some of the time, and you can fool some people all the time, but you can’t fool all people all the time.

These proven words of wisdom explain why AAPM members contributed this time only $900 to the Education and Research Fund, whereas a similar fundraiser netted substantial cash only a few years ago. Contributors to the first fund drive mistakenly assumed that AAPM was expanding its mission to include the socioeconomic needs of medical physicists and gladly opened their wallets. By now, AAPM members have gotten wiser.

Before we embark on an expansion of training programs, we have to take into account that output of medical physicists, licensure, direct billing, attracting highly qualified and motivated physicists into the profession, raising the bar on ABR exams, etc. are complex, intertwined issues that have to be addressed together as a group. Increasing the output of physicists without addressing the remaining issues inevitably lowers the financial security and professional standing for all medical physicists. That’s simple, basic economics. The “a

dime a dozen” days for physicists who had helped put man on the moon, the very best and brightest scientists at that time, are vivid examples of the harm that an uncoordinated expansion of physics training programs can do. I am NOT advocating the abolishment or even the reduction of existing training programs, but now is not the time for massive expansion.

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We first need to find a mechanism for preventing the bidding wars for lower wages and longer working hours that will become inevitable when the planned newly minted physicists enter the job market. Direct billing is the one such mechanism that works for all other medical specialties, See Brezovich - p. 32)

AAPM NEWSLETTER

JANUARY/FEBRUARY 2006

Brezovich (from p. 31) including radiology and radiation oncology, and would most certainly also work for medical physics. I predict that contributions to

the Education and Research Fund will skyrocket as soon as the other vital socioeconomic issues are addressed. Medical physicists are not apathetic or stingy, but they are becoming economi-

cally savvy. They love their profession to the point that they don’t want to harm it by their misplaced generosity.

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AAPM NEWSLETTER

Editorial Board Arthur Boyer Nicholas Detorie Kenneth Ekstrand Geoffrey Ibbott C. Clifton Ling Editor Allan F. deGuzman

Managing Editor Susan deGuzman

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

The AAPM Newsletter is printed bi-monthly.

Next Issue: March/April 2006 Postmark Date: March 15 Submission Deadline: February 15, 2006

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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