AAPM Newsletter March/April 2006 Vol. 31 No. 2 by AAPM Docs

Newsletter AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 31 NO. 2

MARCH/APRIL 2006

AAPM President’s Column Searching for People, Searching for Ideas E. Russell Ritenour Minneapolis, MN As the deadline for this newsletter approaches, I’m reminded of a quote from Douglas Adams, author of The H i t c h h i k e r ’s Guide to the Galaxy and later gems, such as The Salmon of Doubt. He said “ I love deadlines. I particularly like the great whooshing sounds they make as they go rushing by.” Anyway, I managed to hop on this one and I’d like to use this newsletter column to talk about two searches that are starting and a set of issues that will be discussed at great length throughout 2006. A call has gone out for a Web site editor. All AAPM members received an e-mail and the text of it is also posted on our Web site. This person does not have to have any particular computer science skills, as AAPM staff will continue to provide technical support, but, he/she should be famil-

iar with the issues involved in using and administering Web sites. This person will work with the current Webmistress and will be responsible for content accuracy. Moreover, this person is expected to develop a longrange plan for the Web site— a plan that would encompass strategies for ensuring that material on the site is in keeping with the goals and activities of the AAPM. It is expected that this person will work with the board, EXCOM, and council chairs to make sure that information on the site is timely and has received appropriate reviews. This person will serve on and report to the Electronic Media Coordinating Committee. The recruitment effort for this position is the responsibility of the Ad Hoc Search Committee for Recruitment of Web site Editor chaired by Colin Orton. The applicant for this position should have been a member of the AAPM for at least 10 years and have held leadership positions within the AAPM such as com(See Ritenour - p. 2)

Chairman of the Board Report Howard Amols New York, NY A few brief announcements before I dive into my diatribe of the month; EXCOM has initiated a new orientation session for new board members, the first of which will take place at AAPM headquarters on April 21. The goal is to educate board members about AAPM structure and function, and to discuss the legal responsi(See Amols - p. 3)

TABLE OF CONTENTS President-elect Report Executive Dir’s. Column Science Council Education Council CAMPEP News Online Continuing Ed Professional Council Ed. & Research Fund Leg. & Reg. Affairs Health Policy/Economics Clinical Trials Travel Grant Report Myers Announcement International Conf. News ACR FAQs Letters to the Editor Call for Web site Editor Call for Newsletter Editor

p 6 p 7 p 8 p 9 p 11 p 12 p 13 p 14 p 15 p 17 p 19 p 21 p 26 p 27 p 28 p 28 p 31 p 32

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Ritenour (from p.1) mittee chair, board member, etc. Please contact Colin Ortin no later than April 15 (everyone’s favorite deadline). The search committee will compile a short list of candidates by May 1. Selected candidates will be interviewed and the new Web site editor will be appointed by July 1, 2006. Although the official call has not been issued, another important position will need to be filled in the not too distant future and it’s about time to begin the search. Allan deGuzman’s second three-year term as the newsletter editor ends at the end of 2006. Under Al’s leadership, the newsletter has maintained its place as a forum for dissemination of information to the membership, as well as a forum for the opinions and ideas of the membership. Susan deGuzman, as managing editor, has handled the essential functions of producing the newsletter, including the unenviable job of keeping people like me on task and under deadlines. We’re planning for the production side of the newsletter to be taken over by AAPM staff. They are equally adept at keeping me on task and under deadline. Following is a brief description of the editor’s duties: The editor has overall responsibility for the bimonthly publication of the newsletter. The editor (a) reviews all material submitted for publication for suitability and timeliness, (b) reviews with the editorial board, when necessary, any material that is questionable or inflammatory, (c) solicits articles and news items of interest,

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(d) may edit articles and letters to limit space, (e) monitors the interest of the membership on coverage and format, and, (f) meets with the editorial board at the AAPM annual meeting and at the RSNA meeting. Now, I’d like to switch gears and talk about some ideas that seem to be in the air. I’m delighted to say that there has been

a lot of discussion over the last few months regarding educational pathways for medical physicists. These include strategies for existing graduate programs and residencies, and in addition, they include more aggressive approaches to moving toward the goal of having all those in educational programs obtaining significant clinical experience. As you read the following, let me be very

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clear that none of the good ideas were originally mine. They have arisen from thoughtful discussion at the Education Summit in Atlanta at the end of January, and from the numerous e-mails since then that have easily gone into the triple digits. As task group reports are issued and as white papers are published regarding deliberations at the Education Summit, the names of the many individuals involved will come out. I’m reporting the ideas here to help stimulate further discussion. Many have suggested “structured mentorships” where medical physics trainees are paired up with practicing medical physicists. One solution that may be agreeable to CAMPEP is to have these mentorships performed under the supervision of some CAMPEP approved residency or graduate program—a sort of “regional outreach” program. The success of such a program would depend upon the numbers of practicing medical physicists who are willing to spend time sharing their clinical expertise. One reward for time spent in this manner would be the chance to work with new medical physicists long enough to evaluate them for future employment. Another reason to devote time in this way would be the chance to interact with regional educational centers, to keep current in the newest techniques and share information about new equipment. Another idea that has come up is that of changing the way graduate programs function. Individuals who already have an

MS or PhD in physics may find their training needs met by residency programs and a reduced amount of coursework. For those who do not have graduate degrees, in addition to the current MS and PhD degree programs in medical physics, there is the possibility of obtaining professional degrees. These programs might consist of two years of coursework followed by two years of clinical training. Once again, given the limitations of faculty at existing medical physics programs, the clinical training would almost certainly require the establishment of “clinical sites” to which the students would be sent after a certain amount of coursework was completed. This educational model would have some commonality with that of radiologic technology programs and radiologist residencies. Mike Herman is chairing the Subcommittee on Residency Training and Promotion. If you want to contribute more ideas or comment on the ones I’ve mentioned, please contact Mike or Herb Mower, chair ■ of the Education Council.

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Amols (from p. 1) bilities of board members. According to the AAPM Bylaws and Articles of Incorporation, it is the board (not EXCOM) that is legally accountable for the actions and affairs of the corporation. Basically, if I forge some checks and take the AAPM’s reserve fund with me to Costa Rica, it becomes the board’s problem. In the post-Enron corporate world that’s not an ignorable responsibility (by the way, my new e-mail address is amols@millionarecove.cr). Note also that in this context I referred to the AAPM as a corporation rather than as a scientific or professional society—because in the eyes of the law and the IRS, that’s what we are. The AAPM has grown and the world has changed and we need our board of directors to be more involved in the functioning of our society (oops, I meant corporation). Next I’d like to make a special plea to any members having an interest or expertise in financial affairs, particularly medical physics economics and billing. Specifically we’re looking for people willing to serve on AAPM and/ or ASTRO committees that deal with these affairs. If you are interested, please contact me or President Russ Ritenour. That’s the end of the announcements so on to the monthly diatribe. The Medical Physics List Server has been awash in recent months with letters about MOC and medical physics training. The nature of medical physics educa(See Amols - p. 4)

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Amols (from p. 3) tion, degrees, and training has, for better or worse, now become VERY different than from any other branch of physics or medicine. AAPM members seem to be split on whether this is good or bad. Step one in making this assessment is a clear account of the situation—something I would contend that has not heretofore been done. So here goes—a view of medical physics training according to Garp. First, let’s compare medical physics training to training in other physics specialties, and to training in medicine. How does one become a nuclear physicist or a solid state physicist, or any kind of physicist other than a medical physicist? Step one is go to college and major, preferably, in physics, although just about any kind of ‘hard’ science will do. Key observation here is that you do NOT major in nuclear or solid state physics. In fact, there are no such majors. Step two is you go to graduate school where, again, you major in general, but not specialized, physics. You may be required to do a thesis in some specialty but there is no such thing as a master’s degree in nuclear physics or in solid state physics or any other kind of physics. After approximately two years your diploma will likely read ‘MS in physics.’ If you’re interested in research and/or academia, chances are you’ll continue on for a PhD, where finally you get to study your chosen subspecialty in detail. Following that you’ll quite likely continue for one to two ad-

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ditional years as a post doctoral fellow where you will further focus on your chosen specialty. When it’s all over you’ll be closer to 30 years old than to 20, but finally be able to call yourself a nuclear or solid state physicist, even though your diploma will still say ‘physics’ with no adjective attached (actually, it will probably say ‘philosophy,’ but let’s not split hairs). Becoming a physician is not much different. Step one is go to college and major in just about any kind of science, but making sure to include several key courses commonly considered to be part of a ‘pre-med’ degree program. Just like for physics, a key ingredient here is that there is no such major officially called ‘medicine,’ much less ‘radiology’ or ‘radiation oncology’ (know anyone who has a bachelor’s or master’s degree in one of those things?). Step two is go to medical school for four years where again you do not major in any specialty but rather you study GENERAL medicine. During the first two years you mostly try to stay awake in lecture halls and not lose your last meal while dissecting cadavers. During the last two years you do mostly CLINICAL rotations in each medical specialty where you get to touch real patients, work with real doctors, and spend time in real OR’s, real cath labs, etc. Then, and only then, do you enter a three to eight year residency program (depending on your chosen specialty) where finally, after 21 years of school (counting kindergarten but not preschool), you get 4

to study the specialty you’ve chosen for a career. When it’s all over you’re either pushing or looking back at 30 years old, but finally a radiologist or a radiation oncologist. So, the pathways to traditional physics and to medicine are not much different UNLESS you want to be a MEDICAL PHYSICIST, in which case the educational pathway to eternal happiness is completely different. After going to college and getting your bachelor’s degree, for some reason you now have to get an advanced degree (MS or PhD) in something called medical physics as opposed to physics or even medicine. For this you spend two years or less taking very specialized courses in things like dosimetry, radiation physics, radiation safety, etc. You are exposed to virtually no advanced courses in ‘traditional’ physics, (usually) no research, and no clinical experience, but are at the tender age of 23 or thereabouts and supposedly a bona fide medical physicist. If you don’t believe me about the ‘no clinical experience’ part, I suggest you read the CAMPEP guidelines for accreditation which clearly state that CAMPEP doesn’t vouch for clinical training or expertise (or hire a green CAMPEP graduate to work solo in a clinical department and wait for the lawsuits to come pouring in). For many years AAPM members have been debating whether we are physicists or medical specialists. I would contend that with the above educational model, we are neither. The educational path-

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way into medical physics now resembles that of a technologist more than it does a physicist or a physician. A harsh assessment, perhaps, but not too far from the truth. We want to be treated and paid like physicians, held in awe by the public for our scientific brilliance and professional integrity, while at the same time not be required to go to school till we’re past 30 years old, or be a couple of hundred grand in the hole when we’re done, like most MDs who pay their way through four years of med school. And if you read some of the gibberish on the Medical Physics List Server, we don’t want to subject ourselves to MOC or have tougher certification exams like physicians, either. We’ve tried to have it both ways—lot’s of respect but with minimal and virtually free training—and in so doing, we’ve failed on both ends. No wonder so many cost-conscious hospital administrators and private practice physicians are asking why they need medical physicists, especially ones with PhDs. Dosimetrists do treatment plans, techs do most of the daily QA checks on equipment, and the guys from Varian, Siemens, Elekta, GE, etc. fix broken machines. It’s gotten so bad that many hospitals and clinics have resorted to outside consultants to perform acceptance tests and commission new high tech equipment because their in-house physicists are either too busy or don’t have the skills to do it themselves. Some medical physicists now know only slightly more

about what’s inside a Linac or PET scanner than an MD or a technologist. Small wonder they do a less than stellar job of teaching these things to medical residents, or even to other physicists. Something is definitely wrong and fixing it is going to require a good, hard look in the mirror. Are we ready to do that? In the immortal words of Pogo (aka Walt Kelly, 1971), ‘We have met the enemy and they are us.’ Medical physics education is at about the same level as medical education was in 1910, prior to the Flexner Report1. For those of you unfamiliar with this report and also interested in medical physics education, I recommend this report to you (or at least its history) as required reading. The report, commissioned by the Carnegie Foundation, was a scathing condemnation of medical education that resulted in the closure of most MD granting institutions in the US (from 160 in 1904 to only 66 by 1935). Today, virtually all medical school curricula are based on the recommendations of this report. Medical education basically reinvented itself in the 1920-30s. Maybe medical physics needs to do the same? 1

Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, bull. 4. New York: The Carnegie Foundation; 1910, p. xii

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Just for frustration brain teaser: Answer to last issue’s teaser on boring taxi cab numbers: The smallest number that can be expressed as the sum of two perfect squares in two different ways is 65. However, I am indebted to Colin Orton and Matthew Al-Ghazi who pointed out to me that the correct Ramanujan/Hardy anecdote was about the smallest number that can be expressed as the sum of two perfect CUBES in two different ways. The answer to that one will be forthcoming in the next newsletter. Hardy, in fact, went on to prove a theorem guaranteeing that the taxicab number (sum of two numbers raised to the nth power in two different ways) exists for any value of n greater than or equal to 1. Finding those numbers, at least for n>3, however, is not easily done. ■

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President-elect Report Opportunity Knocks Mary K. Martel Chicago, IL There are many high-minded quotations about leadership and service that could be used to persuade you to volunteer for AAPM committee membership. I prefer a slightly sarcastic quote by Thomas Edison that “opportunity is missed by most people because it is dressed in overalls and looks like work.” Active involvement in committee service is indeed “work,” but it provides an outlet to channel your

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views and your knowledge, which could, in turn, impact the scientific, educational or professional direction of the AAPM. As a young medical physicist, I first participated at the local chapter level, then accepted an invitation for a task group, and eventually

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volunteered for national level committees. I discovered that committee service helped me feel connected to the AAPM membership, and, in particular, to the leadership. AAPM service is not just for “committee junkies” (as I have heard it said!) but the opportunity to lend your abilities to the AAPM while receiving some satisfaction that your service counts. The committee, subcommittee and task group structure can be viewed at http://aapm.org/org/ structure/. Please keep in mind that only full members may be appointed to committees. As

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president-elect, I appoint members to committees, but, if you are interested in a particular task group or subcommittee, please contact the chair directly. To figure out if you are interested in a committee before you take the leap, you are encouraged to first attend the committee meeting as

a guest. Committee meetings are usually conducted during the AAPM, ASTRO and RSNA meetings. To volunteer, please go to http://www.aapm.org/org/ peat, indicate your preferences, and include a note about any specific interests you may have. There are some committees that

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are very popular so you may not get your first choice, but I will try to accommodate your requests. Feel free to send me an e-mail at my AAPM address (in the directory) if you have any comments or questions concerning the committee appointment process, and ■ I will be happy to help.

Executive Director’s Column Angela Keyser College Park, MD

•Register by June 7 to receive discounted registration fees. •June 30 is the last date to make housing reservations at the convention rate. •Pre-registration for the meeting closes on July 6.

Application Deadlines Approaching The deadline for applications for the Fellowship for Graduate Study in Medical Physics is April 15. The Fellowship will be active July 1, 2006 through June 30, 2008. Details and application instructions are available online. Applications for the new position of Web site editor are due by April 15. The editor is intended to be the “visionary” for the Web site and the “scientific” and “content” director. The editor will work in close collaboration with the AAPM Information Services staff and Webmistress. A list of duties and necessary qualifications is posted online.

Meeting News Meeting information is continually updated online. Please go to www.aapm.org and click on ‘Meetings’ for the latest information on the summer school and annual meeting.

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 Radiation Therapy.” •Register by May 10 to receive discounted registration. •Housing reservations must be made through the University of Windsor by June 1. The 48th AAPM Annual Meeting will be held July 30– August 3 at the Orange County Convention Center in Orlando, Florida. •Authors will be notified of paper disposition by April 18. •The full annual meeting program will be available online by May 12. 7

The AAPM is working with Florida’s blood centers to host a donation center just outside the exhibit hall during the meeting. If you are interested in donating blood, check the ‘Blood Donor’ box during registration. They report that one pint of blood can save three lives! Don’t miss this opportunity to participate. A new feature of the annual meeting planner will be the addition of the committee schedule. Now members will be able to create a personal schedule for the annual meeting that includes committee meetings and sessions, and be able to import that schedule to his/her vCard compatible calendar or PDA. In past years, the AAPM meeting included four and a half days of sessions, from Sunday morn(See Keyser - p. 8)

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Keyser (from p. 7) ing through midday on Thursday. A full day of sessions will be scheduled for Thursday in Orlando. Make plans to stay a little longer!

FYI •AAPM members in the US can now be mapped using Yahoo Maps on the Member Directory. Link to “map” under an individual’s address information and the 99 closest members to

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this individual are shown on a map. •Committee minutes are now available to all AAPM members online. Visit individual committee Web pages from the AAPM committee tree to view. •There were 226 attendees of the 2005 RSNA meeting who identified themselves as medical physicists, but not as members of the AAPM. RSNA has provided the contact information for these attendees and staff will be contacting them to explain the benefits of AAPM membership.

•April 20-23 will be a busy time at AAPM HQ. The Meeting Coordination Committee, Imaging Physics Committee, new members of the board, Science Council, all council chairs and vice chairs, as well as the Executive Committee, will all meet at the American Center for Physics. •The American Institute of Physics (AIP) has begun a yearlong celebration of its 75th Anniversary. The AAPM is a member society of the AIP. For more information on the activities, please visit www.aip.org. ■

Science Council Report John Boone Council Chair It is a new year, and the leadership of the Science Council has some new faces. Jatinder Palta, after serving for six years as Science Council chair, has stepped down but remains as a consultant to the council. Mike Herman was vice chair of the Science Council, and although he is stepping down from this position, he remains vice chair of the Professional Council. After learning the ropes of Science Council as vice chair for the past six years, I now step into the chair position. The new vice chairs of Science Council are Paul Carson (Imaging) and Ellen Yorke (Therapy), and the three of us face these new roles with enthusiasm, determination, and humility. Under Jatinder Palta’s leadership, the organization of Science Council has been funda-

mentally changed. These changes were enacted to improve consistency between the imaging and therapy sides of the house, and also to realign the focus of Science Council towards a renewed mission of engendering and encouraging scientific excellence in the AAPM. While our mission is broad, it is my hope that we will be able to increase the stature of the AAPM as a scientific organization by engaging in a number of new (or revitalized) scientific activities. As a scientific organization, the AAPM should not engage in activities which would place itself in competition with the research activities of its membership. Nevertheless, in regards to scientific research, the AAPM has capabilities to which no single member has access—over 5,000 scientists, geographically dispersed in all 50 states (and many other countries), with a broad array of 8

expertise. The network of medical physicists which the AAPM represents has access to virtually every brand and model of radiation-producing equipment in therapeutic radiology, diagnostic radiology, and nuclear medicine. This large array of physical resources and pool of talent can and hopefully will be used to conduct research appropriate to the scientific organizational level. A model that those of us in Science Council are looking at is that of The American College of Radiology Imaging Network (ACRIN), which has become the de facto organization for initiating and running imaging-based clinical trials throughout the United States. ACRIN, a daughter organization of the ACR, has been a recipient of tens of millions of dollars of federal grant money. Examples of the trials conducted under ACRIN include the Digital Mammography Im-

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aging Screening Trial and the National Lung Cancer Screening Trial, two large clinical trials which many AAPM members have and are participating in. In the United Kingdom, the National Radiation Protection Board has engaged in the development of numerous documents which are useful for medical physicists; for example, the computation of radiation dose to certain organs from various X-ray procedures. The United States has a fundamentally different health care system, and there is no one organization which coordinates, performs, and publishes information pertaining to radiation exposure and other issues important to diagnostic, therapeutic, and nuclear medicine physicists. It is my hope that given the resources available to the members of the AAPM, we can, through Science Council, promote and engage in similar activities as an organization. In this arena, our colleagues and fellow members for the Center for Devices in Radiological Health, National Institute for Standards and Technology, and other federal organizations will be involved. Many of the task group reports that have been generated over the years through the auspices of Science Council have touched on the similar topics as reports produced by the National Council for Radiation Protection, the International Congress of Radiation Protection, and the International Congress of Radiological Units and Measurements. It is my hope that the AAPM can develop stronger liaisons to these national

and international organizations in an attempt to identify and conduct information gathering, which may lead to collaborative scientific reports which many of us find very useful. All of these organizations, while independent from the AAPM, nevertheless involve a significant number of AAPM members as their volunteers and employees. It only makes sense, therefore, to engage in stronger collaborations with these scientific bodies for the betterment of the field of medical physics. The recent collaborative document published jointly by the AAPM and the NCRP (147) is an example of this. In addition to scientific bodies, standard organizations such as the National Electrical Manufacturer’s Association and the In-

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ternational Electrotechnical Commission have an impact on what we do, and how we do it, as medical physicists. AAPM members are already engaged with these standards organizations, and this is another example of where Science Council and, indeed, the entire AAPM membership, can affect the future of our field in terms of standards and regulations. Science Council, in addition to maintaining the excellent process of task group inception, deliberation and reporting, will endeavor to expand the AAPM’s scientific footprint in the field of medical physics. I invite comments and suggestions from the AAPM membership pertaining to specific scientific initiatives. ■

Education Council Report Herbert W. Mower Council Chair Although many things are going on in the Education Council, the item I wish to focus on in this edition is the recent ‘Physics Education Summit’ held in Atlanta on January 20–22. The summit was the idea of Dr. William Hendee to help us assess the challenges and needs in physics education in our radiology, radiation oncology and medical physics residency programs. The Education and Training of Medical Physics Committee and the Medical Physics Education of Physicians Committee of the AAPM Education Council, and the American 9

College of Medical Physics jointly sponsored this program. We had 14 organizations and two certifying boards represented with a total participation of 42 individuals. William Hendee, Richard Massoth, Herbert Mower, Ervin Podgorsak, (See Mower - p. 10)

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Mower (from p. 9) Russ Ritenour, Mark Rzeszotarski and Anthony Seibert represented the AAPM. They and the two ACMP representatives served as our facilitators for the various discussion sessions. Other AAPM members in attendance included: Indrin Chetty (representing ASTRO), Brenda Clark (CAMPEP), Geoffrey Clarke (ABMP), Gino Fallone (COMP), Bruce Gerbi (ACMP), John Hazle (ACR), Andrew Karellas (CAMPEP), Eric Klein (ASTRO), Bhudatt Paliwal (ABR), David Pickens (RSNA), Timothy Solberg (ACMP), Perry Sprawls (ICTP), Stephen Thomas (ABR) and Michael Yester (ABMP). In addition, AAPM headquarters provided invaluable support, particularly from Lynne Fairobent (recorder), Karen MacFarland (facilities and meeting coordinator) and Lisa Rose Sullivan (on-site staff facilitator). Their efforts contributed significantly to the overall success of the program. Bill Hendee and I, as well as all the other participants, thank them for their invaluable assistance and support. The summit itself was designed to provide focused discussion on the needs and challenges before us. To accomplish this, we assigned individuals to various discussion groups and shuffled the assignments between sessions. In this manner we kept new ideas flowing and prevented ‘tunneling’

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within the various groups. The result was fantastic with input from all individuals and organizations involved. In retrospect it is fair to say that there are greater challenges in the diagnostic radiology programs and medical physics programs than in the radiation oncology programs. Historically radiation oncology has utilized the ‘team’ approach in its programs and this was evident as we evaluated their current position. As I look back on the weekend, I realize that we have many strengths in our programs and many challenges facing us. As the radiology, radiation oncology and medical physics disciplines become more complex, the challenges are increasing with every day. Our challenge is how to properly address these needs in our various disciplines. The summit did not answer all of these questions. It did give us a great starting point to evaluate the needs and some direction as to possible solutions. It would be inappropriate at this point for me to indicate the solutions and future directions. We will be evaluating the output from the summit and will be reporting back to the various participating groups on this in the near future. ■

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CAMPEP News Brenda Clark CAMPEP President Since the last newsletter, one residency and two graduate programs have been accredited, bringing the total number of programs accredited to 13 in each category. In addition, two graduate programs have been reaccredited. Congratulations to the group in Calgary on achieving accreditation for both their residency and their graduate program in the last two months: University of Calgary/Tom Baker Cancer Centre Medical Physics Graduate Program and Tom Baker Cancer Centre Radiation Oncology Residency Program Calgary, Alberta Director of both programs: Peter Dunscombe Congratulations also to: UCLA Biomedical Physics Interdepartmental Graduate Program UCLA School of Medicine, Los Angeles, CA Director: Michael F. McNitt-Gray University of Oklahoma Health Science Center Graduate Program in Medical Physics Oklahoma City, OK Director: Robert Y. L. Chu Wayne State University Graduate Program in Medical and Radiological Physics Harper Hospital, Gershenson R.O.C. Detroit, MI Director: Jay W. Burmeister From the Continuing Education group: One test program has been successfully processed through the new Web-based application system. Several minor difficulties have been identified which we anticipate should be resolved by the time this newsletter is published. 11

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Online Continuing Education Jacqueline Gallet Chair, Online Continuing Education jacqueline.gallet@kodak.com Don’t recognize our name? We used to be called RDCE (Remotely Directed Continuing Education) and if you were very attentive over the years, we toyed with the acronym CERM (Continuing Education by Remote Means). Our current name reflects our focus and goal: Providing Online Continuing Education services to the membership. Don’t know where we are located? It’s easy. Go to the AAPM Web site. Click on ‘Education,’ then ‘Online Continuing Education.’ There you are. If you are not currently a member, then I urge you to become a member for the following reasons. 1. There are now 12 categories, with a few more planned for the earlier part of the calendar year, from which to select. 2. There are over 170 quizzes available, each quiz giving you 1.0 CEC (continuing education credit). That’s a total of 170 CECs currently available to you, as a member. The CEC is given by CAMPEP ( Commission on Accreditation of Medical Physics Educational Programs). You will receive a certificate from CAMPEP at the end of the calendar year indicating the number of credits achieved successfully

through the Online Continuing Education program. 3. You may take each and any quiz only once in the current year. To successfully pass, you must answer eight of the 10 questions correctly. It is advised to read the article first before attempting the quiz. If you should not succeed the first time, let 24 hours pass before attempting the same quiz again; the system currently won’t allow you to retake the same quiz any sooner. (Read the article during that time.) 4. Some of the Virtual Library presentations are connected to quizzes. What better way to accumulate CECs. You attend the presentation at the annual meeting, then attempt the quiz or quizzes associated with the presentation. You may have just doubled or more than doubled the CECs you accumulated for that one presentation. Think of the possibilities that reside with that scenario. 5. The articles from which the quizzes are derived are linked. Click on the linked article, read the article, take the quiz. It’s that easy! 6. It’s not expensive to join. It costs you about 30c per quiz, and that price is continuously dropping. Currently, the Online Continuing Education has a membership of 1, 457, which is an increase of about 41% from 2004. Since 1999 we have seen steady

growth with a membership increase of more than 170%. From the statistics collected for 2005, it took about two attempts from each member to successfully pass the intended quiz. (PS: Read the article BEFORE attempting the quiz.) The category ‘Radiation Oncology’ had the most activity, followed by ‘Mammography,’ then ‘Radiation Protection’ closely followed by ‘CT.’ There are very interesting quizzes in the other categories; go give them a look. The questions can be answered directly from the linked articles. Remember that this is an inexpensive method to earn CECs, each and every year. Comments, suggestions and constructive criticism are always appreciated. Drop me a note with your wish list for Online Continuing Education. We sincerely thank you for joining and for your continued support. ■

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JANUARY/FEBRUARY MARCH/APRIL 2001 2006

Professional Council Report Jerry White Council Chair Many members of the AAPM are familiar with the AAPM Summer Undergraduate Fellowship Program. The (competitive) program matches mentors with junior or senior physics undergraduate students and funds a summer work effort. By the time you read this, the deadline will have passed for both student and mentor applications. There undoubtedly will be worthy undergraduates without funding or a mentor and mentor applicants without a matched Fellow. I’d like to recommend the experience of our private practice group in funding an un-

David Wacker, Student Colorado Springs, CO “What is a LINAC?” It sounds ridiculous now, but that was one of my first questions for Greg Gibbs as I began an internship with him last summer. I had asked Greg in the spring if he could think of any use for a college student working with him in a clinical medical physics environment, and, much to my delight, he said yes. With my freshman year at the University of Tulsa completed, and a little Physics 3 knowledge to boot, I launched into an amazing summer. After getting a tour of the hospital and completing my HIPPA training, I had to start absorbing

dergraduate intern privately. We hired a very bright, energetic physics undergraduate student on an hourly basis for the summer of 2005. The total cost to the practice was roughly equivalent to the support offered by AAPM in the ‘official’ program. The position was funded entirely by the

the new world of medical physics. With Greg’s patience and knowledge, I quickly learned what a linear accelerator is, and even a bit about how to operate one. In a short time, I graduated from doing data entry and linac parts inventory, to helping with ionization checks for IMRT fields and routine quality assurance procedures. As his confidence in me grew, Greg allowed me to work with him on a project he had going to characterize the dosimetric properties of CR plates. I was now tasked with exposing and reading the CR plates, analyzing the data collected, and designing new experiments to further our understanding of the plates’ response 13

practice, none of the expense was directly passed on to the hospital or other clients. We gained from a great deal of good work, from the energy of a young, enthusiastic physicist in training (with great computer skills) and from what we believe will be an investment in the future of the profession. David’s summary of his summer work follows. We recommend that all those in private practice consider the opportunities from a privately funded summer intern. The AAPM Summer Fellowship Program has shown the way and we can, as individual members, amplify the effect. ■

to radiation. I conducted testing on time decay, field-size dependence, plate-to-plate reproducibility, and saturation point, to name a few. Conversations with Dr. Art Olch, who was also working with the CR plates, led to contact with Kodak about their new radiation oncology beam dosimetry system. We participated in gathering data in the Kodak project , and I began testing the system as per their specifications. With Greg’s supervision, I completed numerous tests on the system, the results of which were sent to Kodak for analysis. My experiences over the summer—from watching a prostate (See Wacker - p. 14)

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MARCH/APRIL 2006

Wacker (from p. 13) HDR procedure, helping to service the treatment couch and writing an Excel macro to analyze IMRT fields, to helping Greg

move his desk and going to dinner meetings with the entire physics group (12 members in diagnostic and therapy medical physics)â&#x20AC;&#x201D;have given me a unique look into medical physics. I plan

on working with Greg again next summer and hope to use what I have learned to become a medical physicist myself. â&#x2013;

AAPM Education and Research Fund AAPM wishes to acknowledge and thank the following individuals for their contributions to the AAPM Education and Research Fund in 2005. Alkhatib, Hassan Allison, Jerry D. Amols, Howard Ira Asprinio, Alfred E. Aubin, William Ayr, Glaister G. Bailey, Colin M. Barish, Robert J. Baus, Wolfgang W. Bennett, J. Douglas Berkovits, Laszlo Borasi, Giovanni Boyd, Robert A. Brill, Bertrand A. Bushe, Sheila S. Chang, Sha Corrigan, Kevin Coutrakon, George Craig, Tim Crilly, Richard J. Cytacki, Edmund P. Dauer, Lawrence T. Davisson, Todd Deschesne, Katharin M. Drost, Dick J. Epps, Michael A. Errabolu, Ravimeher Finney, Charles E.

Freedman, D. Jay Frey, G. Donald Gaffney, Cynthia Anne Geiser, Barbara Geisler, William George, James David Gerbi, Bruce J. Giger, Maryellen L. Glennon, Patrick T. Goff, David Loyd Goodman, Matthew P. Goodwin, Paul N. Gray, Joel Findley, David O. Hamilton, Russell J. Harper, Joanna Hazle, John Heaton, Robert Keith Henzler, Margaret Hess, Donald Hevezi, James Holt, Randall William Howell, Roger W. Hunter, Cecilia Hussain, Abrar Judy, Phillip F. Kampp, Thomas D Kereiakes, James

Keyser, Angela Kirk, Bernadette L. Ladle, Roger O. Lamel, Lena S. Larouche, Renee X. Lehto, Norman E. Lipson, Edna Litzenberg, Dale William Loevinger, Eric H. Love, Joel Thomas Luckstead, Steven C. Mackie, Thomas R. Mageras, Gig S. Mah, Eugene Mahesh, Mahadevappa Mahood, Stephen Maitz, Ann H. Malloy, William Malone, Lesley Ann Messinger, Jeffrey G. Miller, Ira Mohan, Radhe Morin, Carol & Richard Myrianthopoulos, Leon C. Nelson, David M.

Ogburn, Patricia Olch, Arthur Pfeiffer, Douglas E. Philip, Jacob S. Praeder, Robert A. Ratcliffe, Alisa J. Ringor, Michael Randall Ritenour, E. Russell Robertson, Gene E. Rosen, Isaac Rothenberg, Lawrence Rowberg, Alan H. Schreiner, L. John Seuntjens, Jan Peter Siedband, Melvin P. Simpkin, Douglas J. Simpson, Larry Skubic, Stanley E. Stinchcomb, Thomas Stroud, Dennis N. Thomas, Stephen Weinhous, Martin Winsor, Robin W. Wisner, Peter A. Wu, Raymond Yorke, Ellen D. Yu, Cedric X.

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JANUARY/FEBRUARY MARCH/APRIL 2001 2006

Legislative and Regulatory Affairs Column Lynne Fairobent College Park, MD

NRC Commissioner Jaczko visits Johns Hopkins Medical Center February 10, 2006 Commissioner Gregory B. Jaczko was accompanied by his senior assistant for materials, Gregory Hatchett. Dr. Mahadevappa Mahesh, assistant professor of radiology and chief physicist at Johns Hopkins University School of Medicine, and Dr. Nicholas Detorie, clinical manager of medical physics also of Johns Hopkins, hosted them for a tour and discussion of the use of radioactive materials in medicine. Also present were Roland Fletcher, head of the State of Maryland Radiation Health

Left to right: Roland Fletcher, head of the State of Maryland Radiation Health Program; Dr. Mahadevappa Mahesh, assistant professor of radiology and chief physicist, Johns Hopkins University School of Medicine; Alan Jacobson, health physicist supervisor for radioactive materials, State of Maryland, Dr. Richard Wahl, director of nuclear medicine and vice-chair of the Department of Radiology at Johns Hopkins; Dr. Gregory Jaczko, NRC Commissioner; Gregory Hatchett, Commissioner Jaczko’s senior assistant for materials; Angela Keyser, AAPM executive director; Stan Wadsworth, radiation safety officer, Johns Hopkins; Michael Harris, assistant administrator of radiology, Johns Hopkins Hospital.

Program and Alan Jacobson, health physicist supervisor for radioactive materials for the State of Maryland, as well as other

NRC Commissioner Dr. Gegory Jaczko visits Johns Hopkins University School of Medicine and is shown the Gamma Knife by Dr. Nicholas Detorie, clinical manager of medical physics at the school.

Johns Hopkins staff. Commissioner Jaczko was sworn in on January 21, 2005. Immediately prior to assuming that post, Dr. Jaczko served as appropriations director for Sen. Harry Reid (DNV) and had also served as the senator’s science policy advisor. In addition, he has been an adjunct professor at Georgetown University, teaching a science and policy course. Originally from upstate New York, Dr. Jaczko earned a bachelor’s degree from Cornell University and a Ph.D. in particle physics from the University of Wisconsin-Madison. Commissioner Jaczko will be addressing the AAPM during the President’s Symposium at this year’s annual meeting. (See Fairobent - p. 16)

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Fairobent (from p. 15 NRC 10 CFR 170 and 171; Revision of Fee Schedules; Fee Recovery for FY 2006; Proposed Rule In the February 10th Federal Register (71 FR 7350; http:// a257.g.akamaitech.net/7/257/ 2422/01jan20061800/ edocket.access.gpo.gov/2006/ pdf/06-1163.pdf), NRC published the proposed revisions to the FY 2006 Fee Schedule. Although the comment period closes before publication of this article (March 13, 2006 comments due), I felt it was important to call attention to this information. NRC stated that because the Omnibus Budget Reconciliation Act of 1990 (OMBRA-90), as amended, requires that NRC collect its fees by September 30, 2006, NRC would not grant request for extension to the comment due date. The following is extracted from the Federal Register notice of February 10, 2006. OMBRA-90 requires NRC to recover approximately 90% of its budget authority in fiscal year (FY) 2006, less the amounts appropriated from the Nuclear Waste Fund (NWF) and for Waste Incidental to Reprocessing (WIR) activities. The required fee recovery amount for the FY 2006 budget is approximately $624 million, which is increased by approximately $0.9 million to account for billing adjustments,

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resulting in a total of approximately $625 million that must be recovered through fees in FY 2006. The amount of the NRCâ&#x20AC;&#x2122;s required fee collections are set by law and are therefore outside the scope of this rulemaking. In FY 2006, the NRCâ&#x20AC;&#x2122;s total fee recoverable budget increased by $83.4 million from FY 2005 in response to increased workload. As such, most annual fees increased. In summary, the NRC is proposing the following changes to 10 CFR part 170: 1. Establish revised Reactor and Materials Program hourly rates; 2. Revise the licensing fees to be assessed to reflect the Reactor and Materials Program hourly rates;

3. Amend Sec. Sec. 170.11 and 170.31 to provide that part 170 fees will be assessed to Federal agencies where applicable (except for certain Federally owned research reactors); 4. Revise Sec. 170.3 to clarify that full cost part 170 fees will be assessed to track and monitor shipments of classified matter; 5. Modify the import and export fee categories under Sec. 170.31; and 6. Make minor administrative changes for purposes of clarification, consistency, and to eliminate redundancy. Extracted from Schedule of Materials Fees (71 FR 7371) (see chart below):

7. Medical licenses: A. Licenses issued under parts 30, 35, 40, and 70 of this chapter for human use of byproduct material, source material, or special nuclear material in sealed sources contained in teletherapy devices: Application............................

$ 9 , 4 00

B. Licenses of broad scope issued to medical institutions or two or more physicians under parts 30, 33, 35, 40, and 70 of this chapter authorizing research and development, including human use of byproduct material, except licenses for byproduct material, source material, or special nuclear material in sealed sources contained in teletherapy devices: Application............................. $ 6 , 7 00 C. Other licenses issued under parts 30, 35, 40, and 70 of this chapter for human use of byproduct material, source material, and/or special nuclear material, except licenses for byproduct material, source material, or special nuclear material in sealed sources contained in teletherapy devices: Application............................. $ 2 , 3 00

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DOE Source Recovery Program The U.S. Department of Energy (DOE) sponsors a program to recover excess and unwanted radioactive sealed sources presenting disposal difficulties. The DOE conducts this program with reduced or no costs to the licensees. Traditionally, the program dealt largely with americium-241 and plutonium

sources. Owing to heightened concerns about terrorist threats to steal radioactive material for use in a dirty bomb, the DOE is moving aggressively to include other isotopes of concern. Medical licensees are encouraged to register other sealed sources for potential inclusion in this program. The DOE is currently emphasizing larger excess sources containing cobalt-60 and cesium137, such as medical irradiators.

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The DOE is also considering a campaign to manage large numbers of small obsolete sources, examples of which are cesium137 brachytherapy sources, and various radium-226, americium241, and other sources. To be considered, institutions must register their material with Los Alamos National Laboratory. To learn more and register online, please visit osrp. â&#x2013; lanl.gov

Health Policy/Economic Issues Wendy Smith Fuss Health Policy Consultant

Congress Passes Deficit Reduction Act The United States House of Representatives recently passed the conference report on S1932, the Deficit Reduction Act of 2005 (DRA), by a margin of 216-214. The DRA Conference Report passed the Senate by a 51-50 margin in late December. President Bush signed the legislation into law on February 8. While the DRA combination of budget cuts and new spending will net approximately $39 billion in savings over the next five years, reductions to Medicaid and Medicare are responsible for more than half the savings. For community cancer care, the Medicare provisions of the DRA offer both good and bad news.

Medicare Physician Payment Update On the positive side, the legislation eliminates the 4.4% reduction in physician and freestanding radiation oncology center payments under the Physician Fee Schedule. The DRA includes new spending of $1.5 billion in 2006 to implement a freeze on 2005 Medicare payments to physicians for 2006. The Centers for Medicare and Medicaid Services (CMS) has indicated that the 0% update will be made retroactive to January 1, 2006. CMS will issue instructions to carriers and fiscal intermediaries to begin reprocessing claims that were already paid at the negative 4.4% rate, reprocess all the claims prior to July 1, 2006 and issue payments to providers in one lump sum. Providers will not need to resubmit claims.

The reversal of the 4.4% cut to physician payments is welcome news, but it is only a temporary, one-year solution.

Medicare Imaging Cuts A significant negative result of the DRA includes approximately $2.8 billion in cuts to Medicare in-office imaging services in the years 2007-2010. While imaging services only account for approximately 10% of Medicareâ&#x20AC;&#x2122;s physician reimbursements, these reductions account for over 33% of the funds cut from Medicare in the DRA. One provision of the cuts, a reduction in payments for multiple imaging procedures performed on contiguous body parts on the same day, was included in the Medicare Physician Fee Schedule Final Rule issued in (See Fuss - p. 18)

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Fuss (from p. 17) November. The DRA exempts the reductions to multiple imaging services from the budget neutrality provisions of the Social Security Act, meaning that the savings will be retained by the Medicare program. The other damaging provision regarding physician office imaging had not been included in any previous Proposed or Final Rule, nor had it been included in the DRA as it originally passed either the House or the Senate. Effective January 1, 2007, the DRA imposes new payment caps on imaging and computer-assisted imaging services, limiting reimbursement for the technical component (including the technical

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component of global fees) to the lesser of what would be paid under the hospital outpatient prospective payment system (HOPPS) or Medicare Physician Fee Schedule payment. These caps apply to X rays, ultrasound (including echocardiography), nuclear medicine (including positron emission tomography), magnetic resonance imaging, computed tomography and fluoroscopy. The new caps do not apply to diagnostic or screening mammography. These cuts have the potential to drive patients back into the hospital setting for needed imaging services, degrade quality of care for Medicare beneficiaries with cancer and severely impact cancer care access in 2007 and be-

yond. It may result in higher beneficiary co-pays for hospitalbased services, and Medicare beneficiaries in rural and remote locations may be forced to drive great distances to access vital imaging services. Substantial cuts to Computed Tomography (CT) scanning services could have a devastating effect on radiation therapy treatment planning as the policy outlined in the DRA does not distinguish between CT scans used for diagnostic imaging purposes and CT scans used for radiation therapy treatment planning purposes. Finally, none of these reductions take into account the flaw in the underlying concept of equilibrating physician fee schedule and

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hospital outpatient rates for capital-intensive services. Medicare has historically reimbursed hospitals and physician offices under different reimbursement structures–with good reason. For example: •Hospital rates for imaging services are based on hospital cost and charge data that are unrelated to costs in other settings. •Nonhospital locations such as physician offices and freestanding imaging centers have different cost structures from hospitals, and their payment is resourcebased, reflecting the actual costs of providing the service, and are relatively stable from year to year. Hospital outpatient payment rates are charge-based and can vary substantially each year with relative changes in hospital charging practices bearing little, if any, relation to actual costs. •The HOPPS system for calculating hospital outpatient department payments does not adequately account for capital equipment purchases that are significant in the case of imaging services. Finally, the legislation also ensures that payment rates for ambulatory surgical center (ASC) services do not exceed payment rates for the same services provided in hospital outpatient departments. This provision is effective January 1, 2007 until CMS implements a new ASC ■ payment system.

JANUARY/FEBRUARY MARCH/APRIL 2001 2006

Clinical Trials Update The following is another in a series of articles on issues of interest in digital data exchange and clinical trial quality assurance, brought to you by the AAPM Working Group on Clinical Trials. –Art Olch, chair.

Integrating the Healthcare Environment in Radiation Oncology (IHE-RO) Walter Bosch, St. Louis, MO, Bruce Curran, Ann Arbor, MI

The IHE Initiative Integrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information, both within and across clinical departments.1 The IHE initiative began in 1997 as a joint effort of the Radiological Society of North America (RSNA) and the Health Information Management Systems Society (HIMSS).2 IHE is not a standards body, but seeks to promote the coordinated use of established standards such as DICOM and HL7 to achieve a higher level of interoperability among imaging and information systems. IHE is organized as a set of domains. Most domains focus on a particular clinical application area. Current domains include radiology, cardiology, IT infra19

structure, radiation oncology, ophthalmology, patient care, laboratory, patient devices, and pathology. Domains are typically sponsored by an organization of users within the application area. In addition, geographic-based committees address country-specific issues, and a Strategic Development Committee helps to maintain consistency of IHE efforts by providing assistance as new domains are created. Within each domain there exist Planning and Technical Committees responsible for carrying out the efforts of the domain.3 The IHE process is cyclical, typically requiring 20 months to complete. Each cycle is divided into four phases:2 1. The first step in each IHE cycle is to identify one or more Use Cases, which describe problems that can be addressed by better coordination and communication of IT equipment. This is typically done by the domain Planning Committee, made up predominantly of users (clinicians) within the domain (but also including industry representatives, often from marketing and product development). 2. The Use Cases are then considered by the Technical Committee, a group of technically knowledgeable users and indus(See Bosch/Curran - p. 20)

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Bosch/Curran (from p. 19) try personnel, whose responsibility is to break down the issues in each Use Case and select standards that address each identified integration need to create an Integration Profile. The Technical Committee documents this solution as an IHE Technical Framework (TF). 3. Vendors implement these profiles and test their systems with software tools and at a faceto-face Connectathon, where they test interoperability with other vendorsâ&#x20AC;&#x2122; systems. Vendors publish IHE Integration Statements, which document the integration profiles supported by their products. Users can reference integration profiles in requests for proposals to simplify the systems acquisition process.

IHE in the Radiation Oncology Domain IHE-RO (IHE-Radiation Oncology) is an effort led by ASTRO (with assistance from many related societies) to improve the connectivity of computer systems and applications in the radiation oncology domain. It was initiated in late 2004 by Prabhakar Tripuraneni (as president of ASTRO) with assistance from Jatindar Palta. Over the past year, the IHE-RO Planning Committee, led by Jay Cooper and Keith LaPlain (Varian Medical Systems) and Technical Committee, led by Bruce Curran and Stuart Swerdloff (IMPAC Medical Systems), have developed the

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initial Integration Profile which describes transmission of CT, contour, beam, and dose information from imaging system to dose display device. Technical Framework documents are now being completed. An IHE-RO Connectathon is being planned for September, 2006 and public demonstration of this profile is planned for ASTRO 2006 in Philadelphia. The precise technical details necessary to implement the solution are documented into a Technical Framework, which is published (with appropriate comment periods), thus defining the criteria for testing and accreditation that a specific application meets the requirements for the profile. In response to the TF, vendors interested in participating in the profile provide an Integration Statement (IS) describing their product and what parts of the profile it is meant to implement (for example, a CT-Simulation application might support contouring, simple beam generation, and DRR generation). There are three phases of verification and validation of applications that occur following the Technical Framework publication. Using software developed for the domain (generally known as the MESA Test Tools), vendors test their applications in-house to show compliance with the profile. Vendors that have successfully completed such testing may then participate in the Connectathon, a live demonstration of their application in front of the Technical Project Manager showing compliance with the 20

MESA software, as well as valid interaction with other vendors implementing complementary portions of the profile (e.g. a CTSimulation workstation showing transmission of contours and simple beam data to an RT planning system). Products that pass this test of connectivity are allowed to participate in a public demonstration of the profile (exhibit on the floor of the ASTRO Annual Meeting). The Use Case selected for demonstration in 2006 involves the flow of DICOM images and treatment planning data, from CT scan through dose display, for 3D conformal, external beam radiation therapy. The emphasis for this first Integration Profile is on reducing ambiguity and facilitating basic interoperability in the exchange of DICOM RT objects. While most of the attention of the IHE-RO Technical Committee has been focused on communication in the clinical treatment planning process, the use of DICOM data for clinical trials has been an important consideration. Included as transactions in the 2006 IHE-RO Integration Profile are the export and import of CT images, RT Structure Sets, and RT Dose (3D distributions). The Advanced Technology Consortium (ATC) (see http:// atc.wustl.edu), responsible for digital transmission of case information for clinical trials, is also a participant in the IHE-RO effort. With their inclusion, IHE-RO hopes to improve the efficiency of both clinical practice and clinical trials.

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Opportunities for AAPM Members The IHE-RO initiative seeks to coordinate the manner in which standards, such as DICOM, are used in order to improve the interoperability among imaging and information systems in radiation oncology. The ultimate goal of this effort is to improve patient care by making patient information available where it is needed. IHE-RO is an intensive, multidisciplinary effort whose success depends on the combined efforts of physicians, physicists, standards experts, and others representing both clinical users and industry. Manufacturers of radiation therapy treatment planning, delivery, and information man-

agement systems are well represented on the IHE-RO Planning and Technical committees. The involvement of clinicians is needed on the Planning Committee to identify clinical needs for improved interoperability, to guide the selection of appropriate use cases, and to prioritize efforts in developing solutions. Technically knowledgeable users, especially medical physicists, are needed on the Technical Committee to help identify, document, and test solutions to clinical problems. More information about IHE can be found at http:// www.ihe.net. Individuals interested in participating in IHE-RO Planning or Technical committees should contact Alan Gay, the ASTRO staff liaison for IHE-RO

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activities at ASTRO headquarters. Note: As these interoperability standards develop, it is important that we all help to create and maintain the expectation that vendors adopt them in their software in a timely fashion. One way to do this is through the RFP (request for proposal) process conducted when buying your next treatment planning or other radiation therapy-related software package. —Art Olch 1

http://www.ihe.net/About/index.cfm h t t p : / / w w w. i h e . n e t / A b o u t / ihe_faq.cfm 3 http://www.ihe.net/About/Organization/org.cfm ■ 2

Travel Grant Report 2004 AAPM Medical Physics Travel Grant Report Cynthia Chuang, Ph.D. Department of Radiation Oncology, University of California–San Francisco (travel completed June 2005)

Heidelberg My 2004 AAPM medical physics travel grant of two and a half weeks started with the German Cancer Research Center, Deutsches Krebsforschungszentrum (DKFZ) in Heidelberg.

During my first day there, I met with the head of the Department of Medical Physics, Professor Wolfgang Schlegel, who gave me a warm welcome and a schedule for my next week’s visit to this research powerhouse in medical physics. For the next four and a half working days, I visited the various research groups at DKFZ. Among the groups, I was particularly intrigued by research conducted by the heavy ion group and the physics model group. Theoretically, radiotherapy using scanning beams of heavy ions can provide highly conformal dose distribution and is supposed to be 21

biologically more effective than photon or proton radiation. It was fascinating to meet with Dr. Oliver Jaekel and learn about the various research projects, such as Monte-Carlo simulation of the heavy ion beams and the interactions between ions and tissues, and investigation of the uncertainties in heavy ion treatment planning, such as range calculations and positioning errors. I was also quite fascinated by the research Dr. Christian Karger and his group were involved in, such as development of new quality assurance methods for heavy ion therapy radiation, experimental (See Chuang - p. 23)

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Chuang (from p. 21) investigation of the radiation response of normal tissues and tumors in animal models to carbon ions, radiation response using Monte-Carlo methods, and many others. These projects were really interesting to me since I had some experiences in similar areas for both photon and Boron Neutron Capture Therapy. I really appreciated Dr. Simeon Nill, a researcher in the Physics Model group, for his generous time in showing me the different research projects being carried out by this group. One of the interesting projects that I had the privilege to observe was that between DKFZ and Siemens Medical on time-adapted, image-guided radiation therapy based on MV- and/or kV-CT images. At UCSF we have been obtaining MV ConeBeam CT for patient positioning verification and are currently investigating its potential for dose verification, leading to adaptive radiotherapy. At DKFZ, the project under way was to implement a kV ConeBeam CT ability in addition to the MV tool. As well, Dr. Nill was investigating a diaphragm belt which, in conjunction with the kV EPID, can be used to trigger the beam and to verify the tumor position for respiratory gated radiotherapy. In the afternoon of my last day at DKFZ, I had a chance to reciprocate the hospitality shown me by the various researchers here. I was asked to talk about my experience with the Accuray Cyberknife system, specifically

Cynthia Chuang with Dr. Wolfgang Schlegel at DKFZ

the optimization process in treatment planning, quality assurance issues, and real-time image guided radiation, especially respiratory-compensating Synchrony radiation delivery. The talk was well received and I was more than happy to share my experience with them and answered some interesting questions.

Tuebingen On Thursday morning I took the bus to go up to the Universitatsklinik fur Radioonkologie. I was greeted there by Dr. Markus Alber, the head of the Section for Biomedical Physics in the Department of Radio-Oncology at the University Hospital Tuebingen. Unfortunately, one of the physicists whom I would have liked to meet, Dr. Matthias Fippel, the developer for VXMC-Fast Monte-Carlo Dose Calculation for Radiation Treatment Planning, was out on vacation. Fortunately there were more than enough interesting topics for an intellectually stimulating discussion, including development of biological models for IMRT opti23

mization, optimization of gantry angles, kinetic analysis of dynamically acquired F-miso PET scans, quantitative characterization of organ motion and future incorporation of this probability function into IMRT optimization, and finally, implementation of fast Monte Carlo code VMCpro into treatment planning for IMRT. I had an extremely interesting discussion with Dr. Alber on their research into the use of Dynamic 18 F-Fluoromisonidazole PET, and how it could predict radiation treatment outcome in headand-neck cancer. Later in the afternoon I was fortunate enough to attend a lecture on â&#x20AC;&#x153;The Use of Hypoxia Imaging Agent F-18 FAZA in an international, multi-center phase III study of Tirapazamineâ&#x20AC;? presented by Dr. Rod Hicks from Peter MacCallum Cancer Center in Melbourne, Australia. It was quite fascinating. Even though we have not conducted any research into hypoxic imaging using PET at UCSF, given the fact that we have a patient population with high (See Chuang - p. 24)

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Chuang (from p. 23) rates of head-and-neck cancer, and the unique ability of hypoxic PET imaging to monitor the outcome of such cancer, it would definitely be a research direction which we would like to pursue in the future.

Munich On Monday morning I arrived at the Klinikum rechts der Isar. My host at the University Hospital of the Technischen Universitat Munchen was Professor Peter Kneschaurek, the director of medical physics. This was a mostly clinical environment but with extensive experience in stereotactic radiotherapy, one of my main clinical responsibilities and research interests. They have conducted vast research into incorporation of functional imaging in target volume definition, specifically using PET and SPECT, and dose painting based on these images. They also are extending stereotactic techniques to the whole body, but especially to the lung. I was asked to talk about my experience of incorporating MRS into our Gamma Knife stereotactic radiosurgery target definition. In addition, I had a very interesting discussion with the physicists regarding the Cyberknife systemâ&#x20AC;&#x2122;s ability to conduct respiratory compensating radiosurgery to the lung and liver. I had quite a few interesting questions from the audience; they were especially excited that I could share my extra-cranial radiosurgery experience with them. I also toured their clinic, starting

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with the BrainLab treatment planning system, and visited the treatment rooms. I had an opportunity to observe a TBI treatment that was very different from how we do it at UCSF. Instead of having the patient standing at 4m away, due to the size limitation in their room design, the patient was put on a platform that moved at some precalculated speed based on patient contour thickness along a rail tracking on the floor. It was an eye opener for me.

EPID potentially for exit dose measurements and verification. We also talked about our experience of using Kodak XV and extended-range films for absolute film dosimetry measurements for IMRT, the appearance of noise pattern, the effect of developer and the interference caused by backward and forward reflection, and how to quantify those artifacts to get the real data. It was a very stimulating and useful exchange of experience and ideas.

Berlin I arrived in Berlin at around 6AM Tuesday. I walked to the Campus Mitte of the Charite, the university hospital of the Berlin Humboldt University, which is the oldest medical treatment facility in Germany. While there I met my host, Dr. Ines Eichwurzel, who is in charge of IMRT implementation and quality assurance, another of my main research interests. I was given a tour of the department; the clinic has three Linac equipped with EPID, and one Cobalt teletherapy machine, which is really a rare sight nowadays. I also observed an HDR treatment planning and delivery. After lunch Dr. Eichwurzel and I sat down and had a long, detailed and informative exchange of experience and ideas on the implementation of IMRT and, more specifically, on quality assurance of the treatment delivery. We discussed research ideas of using EPID for patient positioning, MLC leaf position, and intensity pattern verification, and exchanged ideas on how to use 24

Hamburg I arrived at Hamburg Thursday morning and went to visit my next and last destination, the University Medical Center HamburgEppendorf of the University of Hamburg. I met with Professor Rainer Schmidt, my host and the head of radiological physics in the Department of Radiotherapy. For the next day and a half I visited different parts of the clinic; there was one brand new technology for patient portal verification that I observed which is truly interesting. With special LAP lasers installed on the simulator, and the software LeafSim produced by a small German company, the MLC shape from Lantis (the Siemens Record and Verify System) could be displayed on the patient using the LAP lasers. In addition, I talked to Dr. Cremers, the physicist who was in charge of quality assurance, and saw the QA phantom they designed that could house all kinds of dosimeters. I also visited the physicist who wrote the Matlab program this department used for

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Gafchromic film analysis for dose verification of IMRT and stereotactic radiosurgery. During the afternoon of my second day in Hamburg, I had the opportunity to meet the junior physicists and graduate students in the group. I learned about their research projects, most of which were more clinically oriented, but equally interesting. The projects included using Monte Carlo for biological modeling, investigating the micro-MOSFET for brachy dose verification, testing a new micro-MLC for stereotactic radiotherapy, designing an electron MLC for electron treatments, studying a matrix ion chamber for IMRT dose verification, and using GafChromic EBT film for IMRT and stereotactic radiotherapy QA. These projects were of great interest to me since I have experience in some of these areas. It was a very enthusiastic discussion and intellectually interesting meeting, and I had quite a few questions from the students regarding my experience in these areas. I was then asked to talk about the research projects currently underway at UCSF, and specifically my own research interests in IMRT QA and Cyberknife radiosurgery QA. This concluded my two and a half week visit to five different institutions in Germany. Even though I had a very busy, intensely packed schedule with the many departments that I visited, I felt that this trip was indeed a tremendously useful and educational journey. It gave me an excellent opportunity to meet so

many wonderful colleagues in Germany, to learn a lot about the clinical practices and research projects being conducted by these colleagues, and to share my experiences with them, particularly in IMRT QA, whether it be radiographic film, MOSFET, EPID or Gafchromic film. I was also happy that I could answer the many inquiries about the Cyberknife systemâ&#x20AC;&#x2122;s ability for extra-cranial radiosurgery. I would like to thank Professors Wolfgang Schlegel, Peter Kneschaurek, and Rainer

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Schmidt, and Drs. Markus Alber and Ines Eichwurzel for their time and warm hospitality. Finally, I would like to express my sincere gratitude to the AAPM for awarding me this travel grant, and I am especially appreciative of Dr. Charles Lescrenier for his generous support of this grant, which enabled me this excellent opportunity to visit many of the German colleagues in the field, and the opportunity of an extraordinary educational experience. â&#x2013;

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William G Myers Collection Opening and Exhibits The Medical Heritage Center at the Prior Health Sciences Library at The Ohio State University Medical Center is pleased to announce the opening of the William G. Myers, MD, PhD Collection in May. Dr. Myers was a pioneer in the field of nuclear medicine. His contributions to the profession include the development of radioactive gold seeds for interstitial therapy and the introduction of more radioisotopes (11) into nuclear medicine than any other individual. He was also known as the “godfather of the cyclotron.”

Highlights of the Myers collection include: •Photographs of and correspondence between Myers and other founders of nuclear medicine, such as Paul Aebersold, John Lawrence, Hal Anger, Irene Curie, and noble prize winners Rosalyn S. Yalow and Glen T. Seaborg. •Correspondence from Myers to his newly-wed wife describing his experience as a radiation monitor during ‘Operation Crossroads.’ •Unique photographs of early and experimental nuclear equipment, including early scintillation cameras and cyclotrons.

The collection opening will be accompanied by an exhibit and other public programs that will enhance awareness of its availability for research. The MHC’s Web site will feature a Myers virtual exhibit and a new MHC digital library with the Myers Collection serving as the pilot collection. For future access to these digital resources, please visit http:// mhc.med.ohio-state.edu/. For more information on the collection, please contact archivist Mary Manning MA, MLIS, at man ning.84@osu.edu .

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International Conference News AAPM/IOMP International Scientific Exchange Programs Regional Course & Workshops â&#x20AC;&#x201C; Yaounde, Cameroon Azam Niroomand-Rad, IOMP President; Adel Mustafa, ISEP-Diagnostic Co-chair; & Mr. Appolinaire Ngnah, CAPM President The 15th AAPM / IOMP International Scientific Exchange Program (ISEP) Course/Workshop in radiation therapy physics, combined with the 4th ISEP Course/Workshop in diagnostic and nuclear medicine physics, was held successfully in Yaounde, Cameroon, November 7â&#x20AC;&#x201C;11, 2005. This program was conducted under the distinguished patronage of the Minister of Higher Education, The Minister of Public Health, and the Minister of Scientific Research and Innovation, in collaboration with the General Hospital of Yaounde, the General Hospital of Douala, and the Faculty of Medicine and Biomedical Sciences at the University of Yaounde, and the National Committee for the Fight Against Cancer (NCFAC) in Cameroon. The objectives of the courses and workshops were to update the knowledge of medical physics, to present current practices in radiation therapy physics, diagnostic/nuclear medicine imaging to clinical physicists, radiologists and radiation oncology physicians, and to graduate students interested in medical physics. The radiation therapy workshop of this program, which was con-

ducted by Profs. Faiz Khan and Azam Niroomand-Rad, included the calibration of the Co-60 photon beams using International Atomic Energy Agency (IAEA) Technical Report Series (TRS)398 protocol. The agreement between the measured and stated output was better than 0.5%. The diagnostic and nuclear medicine workshops were conducted by Prof. Robert Gould and Drs. Adel Mustafa and James Halama, and included procedures for establishing quality assurance programs in diagnostic radiology and nuclear medicine in imaging facilities with limited access to quality control tools. A total of 53 participants were registered including one from the Republic of Chad and one from Congo. Mr. Appolinaire Ngnah, president of the newly established Cameroon Association of Physicists in Medicine (CAPM), along with Prof. Joseph Gonsu, MD, the host program director, helped organize and plan this program. The opening ceremony began with welcoming addresses by Prof. Gonsu, Prof. Doh Anderson, Permanent Secretary of NCFAC, Prof. NiroomandRad, and Mr. General Inspector of Ministry of Higher Education representing His Excellency, the Minister of Higher Education. The program ended with a presentation of certificates of participation 27

and certificates of appreciation to the participants and faculty. The local expenses of the faculty were supported by the host institution and their travel expenses were financed by funds provided by the AAPM, North American Chinese Medical Physics Association, and Brachytherapy Research and Education Foundation. This program was not possible without the support of IOMP and these organizations. We would like to express special thanks for their generous contributions. We also wish to acknowledge the commitment and effort of Mr. Charles Ntungwe, executive director of AFRI-MED USA at the Department of Radiation Medicine, Georgetown University Hospital, Dr. Charles Di Mintyene, cultural attache at the Embassy of the Republic of Cameroon in Washington D.C., and Prof. Fru F. Angwafo III, MD, secretary general of the Ministry of Public Health of Cameroon, and all other staff of the Local Organizing Committee who worked very hard in the past few years to organize and implement this program. Their hospitality and friendship are valued by the faculty and the participants, as well. We would also like to thank the AAPM faculty, including Dr. Paul Mobit, for volunteer(See IOMP - p. 28)

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IOMP (from p. 27) ing their time and efforts in this endeavor. We also express our thanks to the director general of HGY who hosted the ISEP/AAPM course. During the course we met with the Ministries of Public Health

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and Higher Education to stress the training and official recognition of medical physicists; now an MSc training program is to be started in Cameroon with the help and collaboration of IOMP and IAEA. ■

Frequently Asked Questions for Medical Physicists Does your facility need help applying for ACR accreditation? Do you have a question about the ACR Diagnostic Modality Accreditation Program? Check out the ACR’s Web site at www.acr.org; click “Accreditation,” then scroll down to the modality program. You can also call the Diagnostic Modality Accreditation Information Line at (800) 770-0145. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. The Toshiba Aquilion-16 can only perform an AXIAL scan in the 4-detector mode (N=4). How do I measure CDTI for a 16-detector clinical scan mode (N=16)? Is measuring CTDI with the 4-detector mode (N=4) acceptable? A. If a site is using a 16 x 1 mm helical protocol (N=16, T=1), then for CTDI measurements they could perform an AXIAL scan in the 4 x 4 mm detector configuration (N=4, T=4) and get the same radiation beam width as for the 16 x 1 mm configuration. The measured CTDI values for the N = 4, T = 4 mode will apply to both the 4 x 4 mm and 16 x 1

Direct Billing Still Alive Ivan A. Brezovich, PhD Birmingham, AL ibrezovich@uabmc.edu

ACR CT Accreditation

Priscilla F. Butler Senior Director, ACR Breast Imaging Accreditation Programs

Letters to the Editor

mm modes (the product of N and T equals 16 in both cases). Similarly, if a site is using a 16 x 2 mm helical protocol (N=16, T=2), then for CTDI measurements they could perform an AXIAL scan in the 4 x 8 mm detector configuration (N=4, T=8) and get the same radiation beam width as for the 16 x 2 mm configuration. The measured CTDI values for the N = 4, T = 8 mode will apply to both the 4 x 8 mm and 16 x 2 mm modes (the product of N and T equals 32 in both cases). If the above solutions are not adequate for the particular detector configuration used clinically, the site can make the CTDI measurements using the service mode (there all radiation beam widths are selectable for an AXIAL scan). ■ 28

According to the latest newsletter, AAPM will not pursue provider status “at this time.” This comes as no surprise to anyone who has been following the discussions in the newsletter and other venues. Achieving direct billing was never mentioned by our leaders as an option, only when and how to suspend the effort were subjects worthy of serious consideration. As soon as one “unsurmountable” obstacle proved surmountable or nonexisting, another one was put in its place. For example, when the 2004 poll showed that lack of enthusiasm was not a problem (a nearly 2/3 majority of the general membership, and probably a much larger percentage of therapeutic physicists, were in favor of direct billing), the need for universal licensure became the new barrier, and a law firm was consulted. When the law firm found explicit provisions in Medicare legislation on how to deal with absence of licensure, experienced members of various economic committees were asked for an evaluation, including potential resistance by radiation oncologists. When these dedicated AAPM mem-

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Letters to the Editor bers recommended to proceed (obviously with caution and prudence), lack of resources and membership apathy became the new stumbling block. Never mind that the membership was never given a chance to voluntarily pay for lobbying, or even voice their opinion on that. It is also very peculiar that the vehemence of resistance went up exponentially with increasing distance from the issue. The fiercest opposition came from diagnostic physicists who would not have been affected, since only direct billing for therapeutic procedures was under consideration. Strong opposition came also from owners of medical physics companies, and physicists in academic institutions who are primarily involved in teaching and research. I am not aware of any opposition from nose-to-the grinding wheel, hospital-employed therapeutic physicists whose positions would have been profoundly impacted. Despite the current setback, there is hope. The voices of the majority cannot be ignored indefinitely by any society that wishes to remain relevant. There are now sufficient numbers of physicists outside academia and business to determine the outcome of any AAPM election. But the silent majority needs to participate in the democratic process by running for office, or at least by looking carefully at who they are voting for. With the proper approach, we can also secure help from

ASTRO, whose physician members would greatly benefit from a strong medical physics profession capable of safely implementing even their most ambitious treatment plans. ■

One Fine Day in Middle America Chuck Smith, MS Port Huron, MI RadPhysChuck@comcast.net (Narrator’s Note: The following story is completely true. Quotes are not verbatim. Some minor modifications are made to clarify the story. Beyond that, only the names have been changed to protect the innocent and guilty alike.)

Once upon a time there was a mild-mannered physicist. We can say this person was male, and call him Tom. These things are not relevant in the end. Tom worked in a small community hospital in a rural area. Most of his work was in therapy, but at small sites people wear many hats; one of his was that of RSO. In his career, Tom was not an attention seeker, and had often dealt with anonymity. Sometimes this was a good thing!! But it also meant that administrators, who were usually business people and nurses, frequently forgot to include him in projects that he would ultimately have some responsibility for. He often found out about new X-ray

units and such by sheer chance. When he would ask those in charge of the project if regulatory requirements and standards of practice had been taken care of, the usual response was a blank stare, followed by a round of apologies, and a frenzy of activity to prevent delays. Tom had reluctantly grown used to this sort of thing. (Not that he did not try to remind administration of the need to be involved.) One fine day while conducting a record audit at a hospital clinic, he noticed some carpet samples. “Are you remodeling?” Tom inquired of Sally the secretary. “No, those are for the new building”, Sally replied. “Oh. When is that going to be built?” “It is already up. They are working on the inside now. We hope to move in four months.” “Will they be moving the X-ray unit to this building?” “Yes. Local X-ray Sales, Inc. has already taken care of everything.” Tom was a bit disturbed, and contacted the director responsible for the clinics. She put him in contact with Local X-ray Sales, Inc. “Hi, Tom. I am Susie the saleswoman. I hear you have some questions?” “Yes, Susie, I do.” As they talked some small talk and discussed some issues at another clinic, it came out that Susie (See Letters - p. 30)

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Letters to the Editor Letters (from p. 29) was a former RT who moved into the sales world at some point. Then Tom turned to the new construction. “So, Susie, who did the shielding design?” “Well, Tom, I did.” “Oh. Are you aware that a medical physicist should do that?” “Well, no. Is that some sort of hospital policy? I’m sorry. We try to please the customer and do a good job.” “I believe you try. This is not a hospital policy. It is the recommendation in NCRP Report 147.” “What does NCRP mean?” “The National Council on Radiation Protection and Measurements. It is the guidance document on shielding design for diagnostic medical X-ray facilities.” “So, this is a new law? I didn’t know the law had changed.” “No, it is not a regulatory document, but it is the accepted standard of my profession, and is used by most federal and state agencies as the basis for regulation.” The rest of the conversation is not important. Suffice it to say that Tom was to get all the relevant documentation and review the design, and would be involved from this point on. Luckily, perhaps, the design had already been accepted by the state, and the state was known for its conservatism. Thus, any errors would

likely be in over-shielding. But Tom was going to look for himself. That night, as Tom lay in his snuggly warm bed, kitties purring by his feet, he was troubled. Tom was not one to engage in testosterone-laden turf battles, but he felt that he should have at least been involved in oversight of the process. He also liked to be assured proper methods and protocols were used when required, especially in areas or tasks he would be expected to supervise. After all, isn’t that what he was hired for? How to get his administration to recognize this? He wondered why this occurred over and over again. Was this an issue of his reticence? He thought not. He had spoken many times to VPs about these issues. The fact was, administrative staff just understood very little about his job, and it was often a case of, “out of sight, out of mind,” especially when it came to diagnostic radiology or construction issues. He wondered, was there something that the AAPM could do? Not for him, specifically, but a general outreach to the medical community, and VPs in particular, that would heighten awareness of his profession. As he fell asleep, he wondered what the answer was. (Narrator’s End Note: Aside from the potentially scary situation regarding shielding design by – a very nice and sincere – amateur, one wonders what the membership thinks of Tom’s musings as he drifted off to

dreamland. Certainly such situations are not rare. Is an outreach something that is worthwhile? Is it asking too much of the AAPM, or is it asking for exactly the kind of thing the AAPM should be doing?) ■

WIMP Meeting Allan F. deGuzman Winston-Salem, NC

It’s 7AM, about seven degrees (Fahrenheit) outside and suddenly I hear the sound of a train whistle. No, I haven’t been kidnaped by Snidely Whiplash and tied to a train track, it’s just Ray Tanner calling together this year’s annual WIMP (Winter Institute of Medical Physics) Meeting. I’m sitting in the airport on my way home from this year’s meeting and I’m already looking forward to returning next year. For those of you who don’t know about WIMP, it’s one of the most unique meetings I’ve ever attended. The 30–40 attendees are all required to give a 15 minute talk. There is an eight hour break between the two daily sessions where attendees are encouraged to go enjoy some of the most beautiful scenery and the best skiing in the U.S. The evening sessions (5-7PM) have both attendees and speakers alike dressed in ski bibs showing signs of having worn a hat all day long.

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The size of the meeting allows the participants to interact and really get to know one another in a family-friendly, informal atmo-

sphere, and the talks are usually of high caliber and quite informative. I hope I’m not ruining a good thing by telling everyone about

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this great ‘secret’ . . . if so, I hope Ray will save me a spot on the agenda for next year. ■

Call for Applications for AAPM Web site Editor The AAPM invites applications for the new post of Web site editor. The editor is intended to be the ‘visionary’ for the Web site and the ‘scientific’ and ‘content’ director. The editor will work in close collaboration with the AAPM Information Services staff and Webmistress. Specific duties will include: • establishing and promoting directions for the Web site • proposing enhancements and improvements • developing improved marketing strategies • working with staff to improve appearance, etc. • advising staff on “content” decisions • dealing with copyright and plagiarism issues • working with staff and the Webmistress to develop guidelines for the Web site • reviewing links to assure appropriateness of the material and status of linkages • reviewing Web site statistics to analyze trends, to check for ‘abuse,’ etc. • dealing with financial issues • working with staff to define and justify the most effective software and hardware to support the Web site • serving on and reporting to

AAPM’s Electronic Media Coordinating Committee • working with AAPM’s committees, etc. to enhance their use of the Web site. It is anticipated that this will be an approximately 25% FTE appointment. Significant support for the editor will be available from AAPM Headquarters staff and the AAPM will provide a “modest” honorarium and an expense budget. These financial aspects will be addressed in detail after an initial screening of potential candidates. It is envisioned that successive appointments of Web site editors will be for three-year terms. The first appointment will be for a one-year test period after which the honorarium and expenses will be adjusted to match the actual workload required. Candidates for Web site editor should: • have been an AAPM member for at least 10 years • have held leadership positions within the AAPM such as committee chair, board membership, etc. • have a working knowledge of IT processes and operations (Web site maintenance will re-

main the responsibility of HQ staff) • possess a vision of how to improve the Web site • have strong organizational and administrative skills • be prepared to serve as Web site editor for at least the next four years • be a resident of North America. Individuals interested in being considered for appointment as Web site editor should submit a letter of application addressing the seven items above, plus any other information that might support the application. A CV should also be submitted. These should be sent as e-mail attachments to: Colin G Orton, Chairman, AAPM Web site Editor Search Committee (ortonc@com cast.net). Deadline for submissions of applications is April 15, 2006. The Search Committee will compile a short list of candidates by May 1. Selected candidates will be interviewed and the new Web site editor will be appointed by ■ July 1, 2006.

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Wanted: Newsletter Editor The AAPM is looking for a new editor for the AAPM Newsletter. I will be stepping down as editor at the end of 2006. This is the sixth year that I have been editing the newsletter with the invaluable help of my wife, Susan, the managing editor. I have thor-

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oughly enjoyed my time as editor but look forward to some additional free time and to reading the issues only once. The search committee is headed by Bob Rice, chair of the Professional Services Committee. Please contact him at Rrice@ harthosp.org if you are interested, or me at deguzman@wfubmc. edu if you would like to discuss

the responsibilities and rewards of being the editor (like having your picture in (almost) every issue!) The next editor need not be married to the managing editor (as both Bob Dixon and I have been) or have access to a local printer since AAPM Headquarters is prepared to assist with those responsibilities. â&#x20AC;&#x201C;the editor

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: May/June 2006 Postmark Date: May 15 Submission Deadline: April 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